Hospital Emergency Incident Command System Presented by: Jersey City Medical Center Emergency Medical Services

Establishing the Need “As part of America's vital health care infrastructure, hospitals play a key role in disaster readiness throughout our country.” Source: American Hospital Association Website

Establishing the Need A New York hospital responded to the first outbreak of West Nile Virus back in 1999. There was the potential for a large number of actual patients, and many people who had “perceived” symptoms.

Establishing the Need The components of a hospital network’s emergency preparedness plan were put in place when the first of a series of devastating hurricanes threatened the coast of North Carolina in 1996.

Establishing the Need A Virginia hospital treated victims from the Pentagon on September 11 and postal workers that contracted Anthrax in October 2001.

H E I C S- Current State of Preparedness A recent study concluded that of the 30 hospitals in FEMA Region III (WV, PA, MD, VA and DC)… 0% able to handle a biologic event 17% able to handle a chemical event 17% able to handle a radiologic event Source: Treat, K. , et al. (2001) . Hospital Preparedness for weapons of mass destruction incidents (Annals of Emergency Medicine)

Current State of Preparedness The same report also concluded that… 73% had only ONE room for decontamination 27% incorporated WMD preparedness into their disaster plans 50% had the ability to “lock down” the hospital 96% had no awareness of the threat to hospital as primary terrorist targets

A Local Perspective Some factors to take into account in disaster planning: Hudson County, with a population of 610,000 residents is the most densely populated of New Jersey’s 21 counties Jersey City, alone, has a surge population of over 1 million people during the day Brennan Court House- A Hudson County Landmark

A Local Perspective The County serves as one of the major transportation hubs in the U.S.A., with direct access to New York City via the Lincoln and Holland Tunnels, PATH and passenger ferries. The NJ Turnpike, Interstates 78, 95 and 280, routes 1&9 and the Hudson-Bergen Light Rail system all run through the County

A Local Perspective Hudson County is home to 4 colleges and seven parks, including Liberty State Park and the Ellis Island National Historic Landmark.

A Local Perspective For all of it’s many public attractions , landmarks and density of population, Hudson County has only 7 hospitals (only ONE of which is a trauma center) to deal with any potential disasters. Clearly there is a demonstrated need for a comprehensive hospital disaster plan for the Liberty Health System

HELP! HELP! Our Disaster Recovery Plan goes something like this… Current State of Preparedness Our Disaster Recovery Plan goes something like this… HELP! HELP!

Establishing the Need Common problem areas identified in hospital disaster response include: Communication break down Power failures Water supply depletion Water supply contamination Physical/structural damage HAZMAT exposure Unorganized evacuations Resource allocation

All initial response is local!! Current State of Preparedness Must improve state of readiness All initial response is local!! Training and equipment lacking

Current State of Preparedness Lack training & equipment Few hospitals are truly OSHA hazmat prepared Not well integrated into city and county disaster planning Not typically included in the “funding loop”

What is HEICS? Hospital Emergency Incident Command (HEICS) is a TOOL to help hospitals manage an emergency incident more effectively and efficiently. Always use the correct size tool for the job!

What is HEICS?

What is HEICS? The benefits of using HEICS is that the system includes… Logical Management Structure Defined Responsibilities Clear Reporting Channels Common nomenclature to help unify hospitals with other responders

What is HEICS? COSTS C H O I E S ISSUES TIME

Because the Regulatory Agencies are here to “help” us. Tell me again WHY we need HEICS… Because the Regulatory Agencies are here to “help” us. OSHA EPA SARA Title III JCAHCO NFPA STATE Health Regulations Local Health Department

Hospitals must develop written plans and exercise them twice a year Tell me again WHY we need HEICS… Hospitals must develop written plans and exercise them twice a year Plans must cover every employee and every department in the institution Hospitals must coordinate with Local Emergency Planning Committees (LEPC’s)

What is HEICS? Based on ICS Hospital Council of Northern California Developed and used by fire service in 70s Used for large and small scale operations Hospital Council of Northern California Adaptation of ICS to hospital emergency response functions completed in 1987 Earthquake Preparedness Guidelines for Hospitals served as cornerstone to HEICS implementation California EMSA Grants Provided 1991, 1992, 1998 (Third Edition)

FLEXIBLE What is HEICS? Based on Organizational Chart Four Branches (Operations, Planning, Logistics, Finance) overseen by an Incident Commander Clearly Defines a Chain of Command Clear Job Action Sheets Designed to direct the assigned individual in disaster recovery tasks Job descriptions with list of emergency response tasks depending on size and nature of event and staff resources available FLEXIBLE

What is HEICS? The end goal of HEICS is to provide comprehensive emergency management in four areas Preparedness Response Mitigation Recovery

The Basic Structure

The Basic Structure The organizational chart structure helps to promote meaningful communication among those managing an incident.

Incident Command Finance Operations Logistics Planning Color Scheme The Five Main Functions Incident Command Finance Operations Logistics Planning Color Scheme Note the

To define and plan the mission and ensure its completion The Command Staff Function: To define and plan the mission and ensure its completion

The Logistics Section Function: To provide an environment and materials for the overall medical objective or incident needs

The Planning Section Function: To develop the action plan so as to accomplish the medical objectives; collects and evaluates information; maintains the status of resources

The Finance Section Function: Provide funding for present objectives, and stress facility- wide documentation for later financial recovery

The Operations Section

The Operations Section close up Function: Conducts Medical Operations to carry out action plan. Directs all direct patient care resources.

In-Patient Medical Branch The Operations Section close up In-Patient Medical Branch

Out-Patient Medical Branch The Operations Section close up Out-Patient Medical Branch

The Operations Section close up Human Services Branch

Ancillary Services Branch The Operations Section close up Ancillary Services Branch

The BIG Picture

One JAS for Each Position Job Action Sheets (JAS) One JAS for Each Position Mission (Function) Statement with Focused Objective Prioritized Activity List To Be Customized to the Organization (Except Title and Mission Statement)

Job Action Sheets (JAS)

Activity Log Action Plan Personnel time sheet Supporting Forms Forms Help Drive Positions Aid in Documentation Activity Log Action Plan Personnel time sheet

Valuable for Identification Position Vests Valuable for Identification Valuable for Organization

Emergency Ops Center (EOC) The Emergency Operations Center (EOC) serves as the “nerve center” of all HEICS activities

Location Supplies Operating Protocols Communications Emergency Ops Center (EOC) There are many factors to consider in setting up an EOC Location Supplies Operating Protocols Communications

Emergency Ops Center (EOC) Emergency Operations Centers (EOC) should be highly specialized facilities primarily designed to capture, distribute, and assess emergency information to facilitate rapid and accurate decision-making.

This is a Process Implementation Implementing HEICS means taking the time to do it right! Administrative “buy-in”/support Staff education Adequate resources and funding

Questions?