national incident management system (nims) national response framework (nrf) hospital incident...
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National Incident Management System (NIMS)
National Response Framework (NRF)
Hospital Incident Command System (HICS)
IS 100.HC, 200.a, 700.a, 800.b
The University of South AlabamaCenter for Strategic Health Innovation
© University of South Alabama Center For Strategic Health Innovation. All Rights Reserved.These slides are a part of the ARRTC program and cannot be reproduced for commercial purposes.
NIMS National Incident Management System
• A standardized, all-hazard incident and resource management concept.
• A comprehensive, national approach to incident management that is applicable to all jurisdictional levels and across functional disciplines.
(700-2-4)
• The intent is to be applicable across a full spectrum of potential incidents and hazard scenarios, regardless of size or complexity. (700-2-3)
• Designed to improve coordination and cooperation between public and private entities in domestic management activities.
• Response actions will be based on the ICS system.
• All First Responders comply with NIMS training requirements.
NIMS National Incident Management System
Established to create uniformity:
– Organization Structure (ICS)– Plans– Training/Exercises Organization– Resources– Communications/Technology
NIMS Implementation Activities for Hospitals
• Similar to expectations placed on government agencies
• Consists of 14 objectives for FY 2009• We will cover all requirements in detail in the
next section: “Update on NIMS Requirements”.
NIMS Compliance
• HSPD-5 issued in 2004• For disaster response agencies and departments,
NIMS made a condition for Federal assistance• Confusion over initial NIMS compliance for
hospitals and healthcare facilities• Initial compliance date Oct 1, 2006 pushed back
to Oct 1, 2007.• Annual FY requirements and 5-year plan
(700-2-7)
National Response FrameworkNational Response Framework
Went into effect in March 2008.
Updated and revised the National Response Plan.
The NRF establishes . . .• Federal coordination structures/mechanisms• Direction for incorporation of existing plans• Consistent approach to managing incidents
Coordination
(700-3-5)
NIMS Aligns command, control,
organization structure, terminology, communication protocols, & resources/resource-typing
Used for all events
Knowledge
Abilities
Resources
StateResponse or Support
FederalResponse or Support
Incident
NRF Integrates & applies Federal
resources, knowledge, & abilities before, during, & after an incident
Implemented for incidents requiring Federal coordination
LocalResponse
Relationship: NIMS vs. NRF
(700-3-5)
NRF Applicability
The NRF applies to all Federal departments and agencies that have primary jurisdiction for or participate in operations requiring a Federal response, including:
Major disasters, emergencies, and terrorist incidents including threats
Other events of lesser severity requiring a coordinated Federal response
Incidents of National Significance
The NRF distinguishes between:
– Incidents that require the Secretary of Homeland Security to manage the Federal response, termed Incidents of National Significance, and,
– The majority of incidents occurring each year that are handled by responsible jurisdictions or agencies
DHS Secretary must declare an event as an Incident of National Significance
DHS Secretary must declare an event as an Incident of National Significance
NRF Structure
Support AnnexesSupport Annexes
Incident AnnexesIncident Annexes
AppendixesAppendixes
Base FrameworkBase Framework Describes the domestic incident management structures and processes
Include acronyms, definitions, authorities, and a compendium of national interagency plans
Describe the structures and responsibilities for coordinating incident resource support
Provide guidance for the functional processes and administrative requirements
Address contingency or hazard situations requiring specialized application of the NRF
Emergency Support Function Annexes - 15
Emergency Support Function Annexes - 15
Scope of Emergency Support Functions
ESF #1 – Transportation
Department of Transportation
ESF #1 – Transportation
Department of Transportation
•Aviation/airspace management and control •Transportation safety •Restoration/recovery of transportation infrastructure •Movement restrictions •Damage and impact assessment
•Aviation/airspace management and control •Transportation safety •Restoration/recovery of transportation infrastructure •Movement restrictions •Damage and impact assessment
ESF #2 – Communications
Homeland Security/NCS
ESF #2 – Communications
Homeland Security/NCS
ESF #3 – Public Works and Engineering
Department of DefenseUS Army Corps of Engineers
ESF #3 – Public Works and Engineering
Department of DefenseUS Army Corps of Engineers
ESF #4 – Firefighting
Department of Agriculture
ESF #4 – Firefighting
Department of Agriculture
•Coordination with telecommunications and information technology industries •Restoration and repair of telecommunications infrastructure •Protection, restoration, and sustainment of national cyber and information technology resources •Oversight of communications within the Federal incident management and response structures
•Coordination with telecommunications and information technology industries •Restoration and repair of telecommunications infrastructure •Protection, restoration, and sustainment of national cyber and information technology resources •Oversight of communications within the Federal incident management and response structures
•Coordination of Federal firefighting activities •Support to wildland, rural, and urban firefighting operations
•Coordination of Federal firefighting activities •Support to wildland, rural, and urban firefighting operations
•Infrastructure protection and emergency repair •Infrastructure restoration •Engineering services and construction management •Emergency contracting support for life-saving and life-sustaining services
•Infrastructure protection and emergency repair •Infrastructure restoration •Engineering services and construction management •Emergency contracting support for life-saving and life-sustaining services
ESF #5 – Emergency Management
Homeland Security/FEMA
ESF #5 – Emergency Management
Homeland Security/FEMA
ESF #6 – Mass Care, Emergency Assistance, Housing, and Human Services
Homeland Security/FEMA
ESF #6 – Mass Care, Emergency Assistance, Housing, and Human Services
Homeland Security/FEMA
ESF #7 – Logistics Management and Resource Support
Homeland Security/FEMA
ESF #7 – Logistics Management and Resource Support
Homeland Security/FEMA
ESF #8 – Public Health and Medical Services
Dept Health & Human Srvcs.
ESF #8 – Public Health and Medical Services
Dept Health & Human Srvcs.
•Coordination of incident management and response efforts •Issuance of mission assignments •Resource and human capital •Incident action planning •Financial management
•Coordination of incident management and response efforts •Issuance of mission assignments •Resource and human capital •Incident action planning •Financial management
•Mass care•Emergency assistance •Disaster housing •Human services
•Mass care•Emergency assistance •Disaster housing •Human services
•Comprehensive, national incident logistics planning, management, and sustainment capability •Resource support (facility space, office equipment and supplies, contracting services, etc.)
•Comprehensive, national incident logistics planning, management, and sustainment capability •Resource support (facility space, office equipment and supplies, contracting services, etc.)
•Public health •Medical •Mental health services •Mass fatality management
•Public health •Medical •Mental health services •Mass fatality management
Scope of Emergency Support Functions
ESF #9 – Search and Rescue
Homeland Security/FEMA
ESF #9 – Search and Rescue
Homeland Security/FEMA
•Life-saving assistance •Search and rescue operations •Life-saving assistance •Search and rescue operations
ESF #10 – Oil and Hazardous Materials Response
EPA
ESF #10 – Oil and Hazardous Materials Response
EPA
ESF #11 – Agriculture and Natural Resources
Department of Agriculture
ESF #11 – Agriculture and Natural Resources
Department of Agriculture
ESF #12 – Energy
Department of Energy
ESF #12 – Energy
Department of Energy
•Oil and hazardous materials (chemical, biological, radiological, etc.) response •Environmental short- and long-term cleanup
•Oil and hazardous materials (chemical, biological, radiological, etc.) response •Environmental short- and long-term cleanup
•Nutrition assistance •Animal and plant disease and pest response •Food safety and security •Natural and cultural resources and historic properties protection and restoration •Safety and well-being of household pets
•Nutrition assistance •Animal and plant disease and pest response •Food safety and security •Natural and cultural resources and historic properties protection and restoration •Safety and well-being of household pets
•Energy infrastructure assessment, repair, and restoration •Energy industry utilities coordination •Energy forecast
•Energy infrastructure assessment, repair, and restoration •Energy industry utilities coordination •Energy forecast
Scope of Emergency Support Functions
ESF #13 – Public Safety and Security Department of Justice
ESF #13 – Public Safety and Security Department of Justice
ESF #14 – Long-Term Community Recovery
Homeland Security/FEMA
ESF #14 – Long-Term Community Recovery
Homeland Security/FEMA
ESF #15 – External Affairs
Homeland Security/FEMA
ESF #15 – External Affairs
Homeland Security/FEMA
•Facility and resource security •Security planning and technical resource assistance •Public safety and security support •Support to access, traffic, and crowd control
•Facility and resource security •Security planning and technical resource assistance •Public safety and security support •Support to access, traffic, and crowd control
•Social and economic community impact assessment •Long-term community recovery assistance to States, local governments, and the private sector •Analysis and review of mitigation program implementation
•Social and economic community impact assessment •Long-term community recovery assistance to States, local governments, and the private sector •Analysis and review of mitigation program implementation
•Emergency public information and protective action guidance •Media and community relations •Congressional and international affairs •Tribal and insular affairs
•Emergency public information and protective action guidance •Media and community relations •Congressional and international affairs •Tribal and insular affairs
Scope of Emergency Support Functions
HICS is:• A Proven Emergency Management System Based on Military
and Fire Management Chains of Command
• Designed for all hazards and all sizes of response, as necessary
• Flexible and adaptable – only activate what is needed.
• Manages routine or planned events
• Provides logistical & administrative support to operational personnel
• Improves Communication – Formal and Informal
• Cost effective – avoids duplication of effort
• Allows for adaptation into a common response structure (100-2-16; 200-2-9; 200-6-5/7)
Characteristics of ICS
• Common Terminology (100-3-6/9)
• Modular organization• Reliance on an Incident Action Plan (IAP)• Management by objectives• Chain of command and Unity of command (200-2-6)
• Unified Command (700-6-17)
• Manageable Span of Control (100-3-19/21; 200-3-4)
• Emergency Operations Centers• Resource Management• Information, Intelligence and Communications
Sections
• Organizational levels with responsibility for a major functional area of the incident
• Operations• Planning• Logistics• Finance/Administration
• The person in charge is the Chief
Divisions and GroupsDivisions
– Divide an incident geographically – Is led by a Supervisor
Groups– Established based on the needs of an
incident. – Labeled according to the job that they are
assigned– Managed by a Supervisor– Work wherever their assigned task is
needed and are not limited geographically
Branches and UnitsBranches
– Established if the number of Divisions or Groups exceeds the span of control
– Have functional or geographical responsibility for major parts of incident operations
– Managed by a Branch Director
(200-4-24)
Units– Organizational elements that have
functional responsibility for a specific activity
Task Forces
• Task Forces are a combination of mixed resources with common communications
• Operate under the direct supervision of a Task Force Leader
Strike Teams
Strike Teams are a set number of resources– Of the same kind and type– With common communications – Operate under the direct supervision of a
Strike Team Leader
Resources• Single: An individual(s) or piece of equipment with its personnel
complement; or,
• A crew or team of individuals with an identified supervisor
• Staging Areas hold resources waiting for operational assignment. (100-3-26; 200-4-19)
• Typing: Identifies size, capability and staffing qualifications. (200-6-14)
• Assigned, Available or Out-of-Service (100-4-4)
ICS Supervisory TitlesOrganizational
Level
Title Support Position
Incident Command Commander
Deputy(* Able to assume command!)
Command Staff Officer Assistant
General Staff (Section)
Chief Deputy
Branch Director Deputy
Division/Group Supervisor N/A
Unit Leader Manager
Strike Team/Task Force
Leader Single Resource Boss
Other Command Issues& Terms
Initiation of Command
Transfer of Command
Termination of CommandDemobilization (700-5-15, pg 121) - Facilitates accountability
Credentialing (700-5-23, pg 129) - Competence and proficiency
Area Command, On-Scene Command
(700-6-20, pg 155) - multiple incidents handled by separate IC orgs.
Specific Command Issues
Initiation of Command:
• IC or Temporary IC need to know what they do
• Must be able to recognize the need to activate HICS
• Need a list of criteria to make the decision
• Have a group or select staff to ask for advice
• Update EOP with “Activation” section
• Need to understand “Transfer of Command”
Specific Command Issues
Transfer of Command:
• Follow EOP guidelines after “Initiation of Command”
• Upon arrival, the higher ranking individual will assume command, maintain command or reassign to a third party. (200-7-5)
• Delegation of authority can occur if the scope of the response is complex or beyond capabilities or authority.
(200-3-8)
• All with a need to know should be told the effective time and date of the transfer. (200-7-6)
Specific Command IssuesTermination of Command:
• IC needs to know what they do
• Must be able to recognize the time to de-activate HICS
• Need a list of criteria to make the decision
• Have a group or select staff to ask for advice
• Update EOP with “Activation” section
• Need to understand demobilization and what is involved
Specific Command Issues
Demobilization: The process of standing down
•Getting back to a normal schedule and routine
•Replacing equipment and supplies
•Adjusting personnel back to routine
•Planning begins at the same time as mobilization
•Facilitates accountability and efficiency
•Occurs in the Planning Section (700-5-15)
Specific Command Issues
Credentialing: Evaluation and documentation of an individual's:
• Current certification, license, or degree• Training and experience• Competence or proficiency • Critical for health care agencies• National, state, local AND agency requirements• Legal implications
(700-5-23)
Specific Command Issues
Area Command: Creates to oversee the management of:
• Multiple incidents that are each being handled by an Incident Command System organization
• A very large incident that has multiple Incident Management Teams assigned to it
• Designed to ensure the effective management of assigned incidents
(700-6-20)
Incident Occurs
Tactical Response
ICS LaunchedIncident Reported
& Identified
Management by Objectives
Chiefs Meeting:Develop Strategy& Tactics to Meet
ObjectivesIncident
Action Plan
IC Sets Objectives
Tactical ResponseInitiatedOperation Reports
Tactical Results, Needs,Engage Liaison,
Logistics, Planning,Finance for support
Planning EvaluatesProgress Reports
Chiefs & OfficersSet Meeting withIC to Re-evaluate
(100-3-15/18)(700-6-11)
(200-5-7)
ICS Form 201 – Incident Briefing Form
•An eight-part form that provides an Incident Command/Unified Command with basic information that can be used to brief incoming resources, an incoming Incident Commander or team, or an immediate supervisor.
•The basic information includes the:
•Incident situation (map and significant events).•Incident objectives.•Summary of current actions.
•Status of resources assigned to or ordered for the incident or event.
•Can serve as the initial Incident Action Plan (IAP) for the first shift change and will remain in force and continue to develop until the response ends, or until a Planning Section has been established and generates, at the direction of the Incident Commander, an IAP.
•Suitable for briefing assigned and newly arriving Command and General Staff members.• (200-4-38)
Incident Command SystemOrganizational Charts
Theoretically, your ICS chart should not correlate with any administrative organizational chart in you facility:
Creates confusion over position titles and duties. (100-5-3)
In reality, for hospitals, an HICS chart that matches (or comes close to matching) your day-to-day organizational chart is much more effective
and understood during an event.
Incident Commander
Public Information Officer
Logistics Section Chief
Incident Command System (ICS) Model
Liaison Officer
Safety & Security Officer
Planning Section Chief
Finance/Admin Section Chief
Operations Section Chief
Command Staff
General Staff
(100-5-17; 200-6-6; 700-6-15)
(100-5-17)
The Five Sections
• Command = the buck stops here
• Planning = creates & develops incident plan
• Operations = implement the plan.
• Logistics = supports the plan.
• Finance = pays for the plan.
Incident Commander
Public Information Officer
Logistics Section Chief
ICS – Command Section
Liaison Officer
Safety & Security Officer
Planning Section Chief
Finance/Admin Section Chief
Operations Section Chief
Command Staff
General Staff
• Manages all emergency activities, including development, implementation, and review of strategic decisions from the Command Post, as well as post event assessment during recovery. Top priority = Safety! (100-3-26; 200-2-15; 700-6-5; 700-6-11)
• Serves as the authority for all emergency response efforts and supervisor to the Public Information Officer (PIO), Liaison Officer, Safety Officer, Operations Section Chief, Planning Section Chief, Logistics Section Chief, and Finance & Administration Section Chief.
• May serve as any or all of the positions in the Command and General Staff depending on the complexity of the event.
• Is IC until authority is transferred to another person. (100-5-7)
• The only position ALWAYS staffed in an ICS activation. (100-5-6)
Incident Commander
• Responsible for relaying incident related information to the public, other organizations and the media. (100-5-18; 700-6-30)
• Participate in a Joint Information System (JIS) and work in the local Joint Information Center (JIC) when activated.
• Communicates with other agencies’ public information officers.
• Be the organizer of correct information.
• Manage the facility’s Public Information Plan.
Public Information Officer
• Monitors, evaluates and recommends procedures for all incident operations for hazards and unsafe conditions.
• Monitors, evaluates and recommends procedures for all incident operations, including the health and safety of emergency responder personnel.
• Organizes and reinforces scene/facility protection and traffic.
• Establish a security command post.
(100-5-18)
Safety & Security Officer
• Is responsible for coordinating with external partners, such as the city, state, federal agencies, and public and private resource groups, as well as other Health Care Facilities.
• Serves as the incident contact person for representatives from other agencies and may work from the local Emergency Operations Center.
• Communicates into and out of the hospital.
• Works closely with the IC and PIO(100-5-18; 200-4-11/12)
Liaison Officer
• Provides legal and ethical advice to the IC, Command Staff, General Staff and the agency.
• Brought about by recent issues in hospitals in New Orleans post Katrina.
Legal Officer
Incident Commander
Public Information Officer
Logistics Section Chief
Incident Command System (ICS) Model
Liaison Officer
Safety & Security Officer
Planning Section Chief
Finance/Admin Section Chief
Operations Section Chief
Command Staff
General Staff
Logistics Chief• Organize and direct operations associated with
the maintenance of the physical environment:
– Food
– Shelter
– Supplies
– Comms Equipment
– Transportation
– Medical support (100-6-34; 200-4-32)
Logistics Chief
Facility Unit Leader
Communications Unit Leader
Transport Unit Leader
Materials Supply Unit Leader
Nutritional Supply Unit Leader
Incident Commander
Public Information Officer
Logistics Section Chief
Incident Command System (ICS) Model
Liaison Officer
Safety & Security Officer
Planning Section Chief
Finance/Admin Section Chief
Operations Section Chief
Command Staff
General Staff
Planning Chief
• Organize and direct all aspects of the planning section - Incident Action Plan
• Usually runs the Operational Period briefing (Team Chief strategy meeting)
• Document and distribute the facility action plan.
• Ensure distribution of critical information/data.
• Compile scenario projections from all section chiefs and effect long range planning.
• Ensure adequate personnel for response.(100-6-23/24;
200-5-8)
Planning Chief
Labor Pool Unit Leader
Medical Staff Unit Leader
Patient Tracking Officer
Patient Information Officer
Situation Status Unit Leader
Incident Commander
Public Information Officer
Logistics Section Chief
Incident Command System (ICS) Model
Liaison Officer
Safety & Security Officer
Planning Section Chief
Finance/Admin Section Chief
Operations Section Chief
Command Staff
General Staff
Finance Section
• Monitor the utilization of financial assets.• Oversee the acquisition of supplies and services
to carry out the medical mission.• Supervise the documentation of expenditures
relevant to the emergency incident.• Pre-planning for a rainy day• Business RECOVERY
(100-4-46/47; 200-4-35)
Incident Commander
Public Information Officer
Logistics Section Chief
Incident Command System (ICS) Model
Liaison Officer
Safety & Security Officer
Planning Section Chief
Finance/Admin Section Chief
Operations Section Chief
Command Staff
General Staff
Operations Section
• Day to Day activities – On Steroids!• Provision of Care – “Your Hospital’s Mission”• Known as the Tactical Response: Operations, Objectives and
Direction.(100-6-4/5)
(200-4-17) (700-6-11)
Operations Chief
Medical Staff Director
Medical Care Director
Ancillary Services Director
Human Services Director
Operations ChiefMedical Staff Director Medical Care Director
In-Patient Areas Supervisor
Treatment Areas Supervisor
Surgical ServicesUnit Leader
General NursingUnit Leader
Out-Patient Services Leader
Maternal & ChildUnit Leader
Critical CareUnit Leader
Delayed TxUnit Leader
Immediate TxUnit Leader
TriageUnit Leader
Minor TxUnit Leader
MorgueUnit Leader
Discharge Unit Leader
Operations Chief
Human Services Director
Staff SupportUnit Leader
Psychological SupportUnit Leader
Dependent Care Unit Leader
Operations Chief
Ancillary Services Director
Laboratory Unit Leader
Radiology Unit Leader
Pharmacy Unit Leader
Cardiopulmonary Unit Leader
Job Action Sheets
• Each role’s assignments
• Checklists
• Prioritizes duties
• No duplication of duties
• Responsibilities outlined
• Important that staff know to read their Job Action Sheet at the START!!!
Incident Commander
Public Information Officer
Safety and Security Officer
Liaison Officer -Internal
Logistics Chief Planning Chief Finance Chief Operations Chief
PHICS
Liaison Officer - External
Legal Officer
Safety and Security OfficerPublic Information Officer
Incident Commander
ADPH Incident Command System Positions Chart January 4, 2010
Incident ManagementAdvisory Group/
CEP
Materials Supply & Nutrition Unit
Leader
Transportation Unit Leader
Damage Assessment Unit
Leader
Communications Unit Leader
Planning Chief
Situation Status Unit Leader
Human Resources Unit Leader
Strategic Epidemiology & Surveillance Unit
Leader
Finance Chief
Time Unit Leader
Procurement Unit Leader
Logistics Chief Operations Chief
Liaison Officer ExternalLegal OfficerLiaison Officer Internal
Operations Section continued on next
page
Safety and Security OfficerPublic Information Officer
Legal Officer
Incident Commander Incident ManagementAdvisory Group/
CEP
Liaison Officer Internal Liaison Officer External
Food Safety Group
Patient Management Group
EMS Group
Patient Placement Unit
Medical Needs Shelter
Pharmaceutical SupportPharmacySocial Service
Coordination Branch
LaboratoryBranch
EnvironmentalGroup
Medical Care Branch
Field SurveillanceBranch
Subject Matter Experts Biological Chemical Radiation Zoonotic Infection Control
Operations Chief
Pharmaceutical SupportVaccination
LaboratoryBranch
ADPH Incident Command System Positions Chart - Operations
January 4, 2010