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 Alabama
Center for Strategic Health Innovation
© University of South Alabama Center For Strategic Health Innovation. All Rights Reserved.
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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
– Resources
– Communications/Technology
Organization
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 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
(7003-5)
Relationship: NIMS vs. NRF
NIMS
 Aligns command, control,
organization structure, terminology,
communication protocols, &
resources/resource-typing
Resources
 Used for all events
Knowledge
Federal
Response or Support
Abilities
State
Response
or Support
Local
Response
Incident
(700-3-5)
NRF
 Integrates & applies Federal
resources, knowledge, &
abilities before, during, & after an
incident
 Implemented for incidents
requiring Federal coordination
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
NRF Structure
Base Framework
Describes the domestic incident management
structures and processes
Appendixes
Include acronyms, definitions, authorities, and
a compendium of national interagency plans
Emergency Support
Function Annexes - 15
Describe the structures and responsibilities
for coordinating incident resource support
Support Annexes
Provide guidance for the functional processes
and administrative requirements
Incident Annexes
Address contingency or hazard situations
requiring specialized application of the NRF
Scope of Emergency Support Functions
ESF #1 – Transportation
Department of Transportation
ESF #2 – Communications
Homeland Security/NCS
ESF #3 – Public Works and
Engineering
Department of Defense
US Army Corps of Engineers
ESF #4 – Firefighting
Department of Agriculture
•Aviation/airspace management and control
•Transportation safety
•Restoration/recovery of transportation infrastructure
•Movement restrictions
•Damage and impact assessment
•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
•Infrastructure protection and emergency repair
•Infrastructure restoration
•Engineering services and construction management
•Emergency contracting support for life-saving and lifesustaining services
•Coordination of Federal firefighting activities
•Support to wildland, rural, and urban firefighting
operations
Scope of Emergency Support Functions
ESF #5 – Emergency
Management
Homeland Security/FEMA
ESF #6 – Mass Care,
Emergency Assistance,
Housing, and Human
Services
•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
Homeland Security/FEMA
ESF #7 – Logistics
Management and Resource
Support
Homeland Security/FEMA
ESF #8 – Public Health and
Medical Services
Dept Health & Human Srvcs.
•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
Scope of Emergency Support Functions
ESF #9 – Search and Rescue
Homeland Security/FEMA
ESF #10 – Oil and Hazardous
Materials Response
EPA
ESF #11 – Agriculture and
Natural Resources
Department of Agriculture
ESF #12 – Energy
Department of Energy
•Life-saving assistance
•Search and rescue operations
•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
•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 #14 – Long-Term
Community Recovery
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
•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
ICS
Incident Command System
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
ICS Terminology
Sections
Divisions
Groups
Branches
Task Forces
Strike Teams
Resources
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 Groups
Divisions
– 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 Units
Branches
– 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 Titles
Organizational
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
1. Distinct titles = most qualified 2. Standard titles = easy requests 3. Titles = common standard
(100-5-10; 200-2-41; 200-4-7)
Other Command Issues
& Terms
Initiation of Command
Transfer of Command
Termination of Command
Demobilization (
) - Facilitates accountability
Credentialing (
) - Competence and proficiency
Area Command, On-Scene Command
(
) - multiple incidents handled by separate IC orgs.
700-5-15, pg 121
700-5-23, pg 129
700-6-20, pg 155
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 Issues
Termination 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)
Management by Objectives
Incident
Occurs
Incident
Reported
& Identified
IC Sets
Objectives
Tactical
Response
Chiefs Meeting:
Develop Strategy
& Tactics to Meet
Objectives
ICS Launched
Incident
Action Plan
(200-5-7)
(100-3-15/18)
(700-6-11)
Chiefs & Officers
Set Meeting with
IC to Re-evaluate
Planning Evaluates
Progress Reports
Operation Reports
Tactical Results, Needs,
Engage Liaison,
Logistics, Planning,
Finance for support
Tactical Response
Initiated
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)
ICS Form 201
Page 1 of 8 pages
See handouts
Incident Command System
Organizational 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 Command System (ICS) Model
Incident Commander
Public Information
Officer
Liaison
Officer
Safety & Security
Officer
Logistics Section
Chief
Command
Staff
(100-5-17)
Planning Section
Chief
Finance/Admin
Section Chief
General
Staff
Operations Section
Chief
(100-5-17; 200-6-6; 700-6-15)
HOSPITAL INCIDENT COMMAND SYSTEM
HICS (2003)
HOSPITAL INCIDENT COMMAND SYSTEM
HICS (2006)
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.
ICS – Command Section
Incident Commander
Public Information
Officer
Liaison
Officer
Safety & Security
Officer
Logistics Section
Chief
Planning Section
Chief
Finance/Admin
Section Chief
General
Staff
Command
Staff
Operations Section
Chief
Incident Commander
• 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)
Public Information Officer
• 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.
Safety & Security 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.
(100-518)
Liaison 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)
Legal 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.
Incident Command System (ICS) Model
Incident Commander
Public Information
Officer
Liaison
Officer
Safety & Security
Officer
Logistics Section
Chief
Planning Section
Chief
Finance/Admin
Section Chief
General
Staff
Command
Staff
Operations Section
Chief
Logistics Section
“Boy, do I
need stuff”
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 Command System (ICS) Model
Incident Commander
Public Information
Officer
Liaison
Officer
Safety & Security
Officer
Logistics Section
Chief
Planning Section
Chief
Finance/Admin
Section Chief
General
Staff
Command
Staff
Operations Section
Chief
Planning
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
Situation Status Unit Leader
Labor Pool Unit Leader
Medical Staff Unit Leader
Patient Tracking Officer
Patient Information Officer
Incident Command System (ICS) Model
Incident Commander
Public Information
Officer
Liaison
Officer
Safety & Security
Officer
Logistics Section
Chief
Planning Section
Chief
Finance/Admin
Section Chief
General
Staff
Command
Staff
Operations Section
Chief
Finance Section
MONEY
$$
MONEY
MONEY
$$
MONEY
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; 200-435)
Finance Chief
Time Unit Leader
Procurement Unit Leader
Claims Unit Leader
Cost Unit Leader
Incident Command System (ICS) Model
Incident Commander
Public Information
Officer
Liaison
Officer
Safety & Security
Officer
Logistics Section
Chief
Planning Section
Chief
Finance/Admin
Section Chief
General
Staff
Command
Staff
Operations Section
Chief
Operations Section
• Day to Day activities – On Steroids!
• Provision of Care – “Your Hospital’s
Mission”
• Known as the Tactical Response:
Operations, Objectives and Direction.
(100-64/5)
(200-4-17)
(700-6-11)
Operations Chief
Medical Staff Director
Medical Care Director
Ancillary Services Director
Human Services Director
Operations Chief
Medical Staff Director
In-Patient Areas
Supervisor
Medical Care Director
Treatment Areas
Supervisor
Surgical Services
Unit Leader
Triage
Unit Leader
Discharge
Unit Leader
Maternal & Child
Unit Leader
Immediate Tx
Unit Leader
Morgue
Unit Leader
Critical Care
Unit Leader
Delayed Tx
Unit Leader
General Nursing
Unit Leader
Minor Tx
Unit Leader
Out-Patient
Services Leader
Operations Chief
Human Services Director
Staff Support
Unit Leader
Psychological Support
Unit Leader
Dependent Care
Unit Leader
Operations Chief
Ancillary Services Director
Laboratory
Unit Leader
Pharmacy
Unit Leader
Radiology
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!!!
Public Health ICS System
(PHICS)
PHICS
Incident Commander
Public Information Officer
Liaison Officer - External
Liaison Officer -Internal
Safety and Security Officer
Logistics Chief
Planning Chief
Legal Officer
Finance Chief
Operations Chief
Incident Management
Advisory Group/
CEP
Incident
Commander
Public Information Officer
Liaison Officer Internal
Legal Officer
Safety and Security Officer
Liaison Officer External
Logistics Chief
Planning Chief
Finance Chief
Communications
Unit Leader
Situation Status
Unit Leader
Time Unit Leader
Damage
Assessment Unit
Leader
Human Resources
Unit Leader
Procurement Unit
Leader
Transportation
Unit Leader
Materials Supply
& Nutrition Unit
Leader
Operations Chief
Operations Section
continued on next
page
Strategic
Epidemiology &
Surveillance Unit
Leader
ADPH Incident Command System
Positions Chart
January 4, 2010
Incident Commander
Public Information Officer
Liaison Officer Internal
Legal Officer
Safety and Security Officer
Incident Management
Advisory Group/
CEP
Liaison Officer External
Operations
Chief
Laboratory
Branch
Field Surveillance
Branch
Social Service
Coordination Branch
Environmental
Group
Food Safety
Group
Laboratory
Branch
Medical Care
Branch
Medical Needs Shelter
Pharmaceutical Support
Pharmacy
Pharmaceutical Support
Vaccination
ADPH Incident Command System
Positions Chart - Operations
January 4, 2010
EMS Group
Patient Management Group
Patient Placement Unit
Subject Matter Experts
Biological
Chemical
Radiation
Zoonotic
Infection Control
TRAINING
http://training.fema.gov/IS/crslist.asp
Questions