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Command and Control in Evacuations

OSHA Training Institute – Region IXUniversity of California, San Diego (UCSD) - Extension

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Purpose:

To ensure you learn effective training and presentation techniques well enough to become an effective outreach trainer of command and control during health care facility evacuations

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Objectives State how the National Incident Management

System influences large scale evacuations Discuss the development of Standard

Emergency Management System and how it works in disaster management

Identify how the Hospital Incident Command System (HICS) or Incident Command System (ICS) are used in evacuations

Identify three purposes of HICS or ICS

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National Response Plan

“At the federal level, the National Response Plan (NRP) provides a framework for how the federal government is to assist states and localities in managing domestic incidents, including both incidents of national significance and those of lesser severity.”

GAO Report; GAO-06-826, Congressional Quarterly, Inc. July 20, 2006

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National Incident Management System (NIMS) “…a consistent nationwide approach for federal,

state, tribal, and local governments to work effectively and efficiently together to prepare for, prevent, respond to, and recover from domestic incidents, regardless of cause, size, or complexity.” -HSPD-5

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NIMS - Synopsis

NIMS What it is…Core set of:DoctrineConceptsPrinciplesTerminologyOrganizational

processesApplicable to all

hazards

NIMS What it is not…

Not an operational or resource allocation plan

Not a terrorism or WMD-specific plan

Not designed for international events

FEMA. NIMS. SEMS Advisory Committee Meeting, Mather, CA March 2005

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NIMS

Overall conceptual framework for incident management applicable to all hazards

FEMA. NIMS. SEMS Advisory Committee Meeting, Mather, CA March 2005

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NIMS Components

Command and Management Preparedness Resource Management Communications and Information Management Supporting Technologies Ongoing Management and Maintenance

FEMA. NIMS. SEMS Advisory Committee Meeting, Mather, CA March 2005

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National Incident Management System(NIMS)

Relationship: NIMS and NRP

LocalResponse

StateResponse or Support

FederalResponse or Support

.

National Response Plan (NRP) provides support at the Federal level and is activated for events of

national significance.

Incident

Used for all events

FEMA. NIMS. SEMS Advisory Committee Meeting, Mather, CA March 2005

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SEMS

Standardized Emergency Management System (SEMS) Developed in California

Local entities must use SEMS in order to be eligible for State funding for response related personnel costs in California

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The History of ICS Developed in the 1970s following devastating

California fires. Resulted in deaths, injuries and huge property losses. Resources and tactical ability were available Inadequate management resulted in:

Lack of accountability Poor communication Lack of a planning process Overloaded Incident Commanders No method to integrate interagency requirements

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SEMS was Developed to Improve: Coordination between/among agencies The flow of information and resources The rapid mobilization, resource tracking and

deployment

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SEMS Framework

SEMS includes the: Incident Command System (ICS) Multi-agency or inter-agency coordination Master Mutual Aid Agreement (MMAA) and

system The operational area concept

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Legal Basis for SEMS in California

Government Code Section 8607 became effective 1993

The intent of the code is to improve coordination of State and local emergency response in California

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What Is ICS and HICS?

The Incident Command System (ICS): Is a flexible standardized, on-scene, all-hazard

incident management concept that can be expanded to handle the demands and potential complexities of single or multiple incidents

ICS in healthcare is called Hospital Incident Command System (HICS) and is based on the 2006 version of the Hospital Emergency Incident Command System (HEICS)

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Hospital Incident Command System Organizational core of a crisis management

system Built on the principles and structure of ICS It is the same crisis management system used

by other response agencies Offers a universal link with outside resources

HICS

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How HICS Works

Chain of command Common language Flexibility Job action sheets Mutual aid Documentation for financial recovery

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Why Use the Incident Command System in the Hospital?

Efficiency

Coordination

Communication

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ICS Purposes

ICS helps to ensure:Achievement of

tactical objectivesEfficient use of

resourcesSafety of responders

and othersHospital Exercise using HICS

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ICS Features Common terminology Organizational resources Manageable span of control Organizational facilities Use of position titles Reliance on an Incident Action Plan Integrated communications Accountability

Slide Credit: FEMA IS100-HC

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Structure of ICS and HICS

Flexible Built on successful

business practice Built on decades of

lessons learned from the management and organization needed in emergency incidents

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ICS Structure

SafetyOfficer

LiaisonOfficer

InformationOfficer

Finance Logistics Operations Plans

Incident Commander

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Chain of CommandChain of command is an orderly line of authority within the ranks of the incident management organization.

Authority

There is only one person in charge until replaced by the next qualified person

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The Span of Control under ICS The span of control refers to the supervisory

structure of the organization and the number of individuals or resources one incident supervisor can manage effectively

The optimal reporting element is 5 elements per supervisor but may vary from 3 - 7

SupervisorSupervisor

Resource 1Resource 1

Resource 2Resource 2 Resource 3Resource 3 Resource 4Resource 4

Resource 5Resource 5

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Incident Operations Organization

COMMAND

SINGLERESOURCES

SINGLE RESOURCES

COMMAND

SECTIONS

BRANCHES

DIVISONS/GROUPS

RESOURCES

Small IncidentLarge Incident

Multiple layers as needed for span of control

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Management by Objectives ICS is managed by

objectives Objectives are

communicated throughout the entire ICS organization through the incident planning process

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Reliance on an Incident Action Plan Every incident should have an Incident

Action Plan (IAP) that:

Specifies the incident objectives. Lists the actions based on objectives Measurable strategic operations to

support the objectives and be achieved within operational period

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Elements of an Incident Action Plan Every IAP must have four

elements:What do we want to do? Who is responsible for doing

it? How do we communicate

with each other? What is the procedure if

someone is injured?

Slide credit - FEMA IS 100 HC

Incident Commander

Only the positions needed are filled to manage the incident. The expansion of incidents may require the delegation of authority to Operations, Planning, Logistics and Finance/Admin sections.

IncidentCommander

IncidentCommander

Public InformationOfficer

Public InformationOfficer

LiaisonOfficerLiaisonOfficer

SafetyOfficerSafetyOfficer

Command Staff

OperationsSection ChiefOperations

Section ChiefPlanning

Section ChiefPlanning

Section ChiefLogistics

Section ChiefLogistics

Section ChiefFinance/AdminSection Chief

Finance/AdminSection Chief

General Staff

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Incident Commander

The Incident Commander Provides overall leadership

for incident response. Established Command Post

Based on the requirements and complexity of the incident

Delegates authority to others Takes general direction from

agency administrator/official Assesses need for staff

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Incident Commander

Establishes incident objectives

Directs staff to develop the Incident Action Plan (IAP)

Is assisted by the Command Staff

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Public Information Officer Member of the

Command Staff Conduit between internal

and external stakeholders, including media interactions

Public Information Systems are required by National Incident Management System (NIMS)

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Safety Officer

Member of the Command staff

Monitors safety conditions

Develops measures for assuring the safety of all assigned personnel

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Liaison Officer

Command Staff Primary contact for

supporting agencies and organizations that are assisting at an incident, but are NOT participating within the ICS

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HICS Functional Areas

Operations section

Planning section Logistics section Finance /

Administration section

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Operations Section Chief

Conducts, develops, directs all tactical objectives, operations and resources

In HICS, the word “tactical” refers to the business of managing patient care and is not a reference to security

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Operations Section in HICS

Carries out the medical objectives to the best of the staff’s ability

The Medical Care Branch covers Clinical Care Ancillary Services Patient Registration

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Planning Section Chief

Manages the planning process by gathering, analyzing and disseminating information and intelligence.

Compiles the information that is included in the Incident Action Plan

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Planning Section

The Planning section also maintains status and situational reports, and patient tracking under the HICS structure

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Logistics Section Chief

Directs the resources and services required to support incident activities

May include ensuring personnel have a place to rest, are fed, have medical support, communications and transportation

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Logistics Section The Labor Pool is

managed under the Logistics Section in HICS. This is a change from the previous structure in which the labor pool was the responsibility of the Planning Section.

Staging Area/Labor Pool is the location where personnel and equipment are staged while waiting for tactical assignment

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Finance/Administration Section Chief

Manages costs related to incident

Performs accounting, procurement, time payroll recording and cost analysis

Funds medical objectives under HICS

Documents costs to maximize financial recovery and reduce liability

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Accountability Principles in ICS Check-In

All responders must report in and assignments are given in accordance with the procedures established by the Incident Commander

Incident Action Plan Response operations must

be coordinated as outlined in the Incident Action Plan

Unity of Command Principle that each individual

will be assigned to only one supervisor

FEMA IS - 100-HC

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Accounts for personnel. Tracks resources Prepares personnel for

assignments Locates personnel in

case of an emergency Organizes the

demobilization process

Check-In Purpose

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Summary

NIMS is an overall conceptual framework for incident management applicable to all hazards

NRP provides a federal framework to assist states and localities during disasters

ICS is flexible, can handle large or small events HICS is ICS in a healthcare setting and will be

used in evacuations

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References

FEMA. National Incident Management System. SEMS Advisory Committee Meeting, Mather, CA March 24, 2005. Slide Set

FEMA National Incident Management System (NIMS), An Introduction IS – 700. http://training.fema/gov

Homeland Security. Quick Reference Guide for the National Response Plan May 22, 2006, Version 4.0