1. HOSPITAL EMERGENCY INCIDENT COMMAND SYSTEM Presented by Carleen Penny VCU Health System

2. Uh-oh… A full school bus is involved in a collision one block from an ER… A Thanksgiving dinner at a homeless shelter sickens 50… An ice storm causes hundreds of collisions and falls… A fire causes evacuation of a hospital… What happens next?

3. Hospitals Face Many Types of Disasters…

5. Shortfalls of Past disaster Plans Not “User Friendly” Tested Infrequently One-Person’s Plan Fallback to Day-to-Day Management Plan Work Poorly when Managers Not Present Staff Often Work in More than 1 Facility Threats/Liabilities are More Than Ever

6. Disaster plans  JCAHO, NFPA standards  Compliance achieved on paper  Source of motivation  Plans vs. practice  Plan support  Plan communication  Plan adoption  Exercise and improvement  Unsupervised implementation  Interfacility consistency

7. HEICS attributes Chain & unity of command Common terminology Flexibility Prioritized job action sheets Documentation Adaptability Standardization  With public safety, police, ems  Interfacility  Familiarity for “shared employees”  Corporate benefits from common plan

8. What HEICS is…  Organizational basis for emergency plan  Focus and direction  Organization chart  Same role as ICS for public safety, police etc.  Standards  Checklists and supporting forms  Common terminology

9. What HEICS isn’t…  Turn-key system  No incident manages itself…  Policy  Still need appropriate Policy & Procedures, management support  Need disaster plan with specific annexes  Replacement for training & exercises  Need both for this - and any plan - to succeed

10. ICS staff positions

11. The big one …

12. Six stages of Incident Command Preplanning and training Initial response Operations Stabilization De-escalation Termination

13. Functional responsibility COMMAND = Overall responsibility OPERATIONS = Direct tactical actions PLANNING = Collect/analyze data, prepare action plan LOGISTICS = Support response Finance = Cost accounting & procurement

14. Command skills Interpersonal skills - Ability to communicate Management skills - Ability to delegate Decision-making ability Flexibility

15. ICS management Planning Directing Organizing Coordinating Communicating Delegating Evaluating

16. Incident Commander  Organize and direct EOC  Major decision maker  Appoints section chiefs and Medical Staff Director  Authorize resource allocation

17. Public Information Officer  Provide information to News agencies  Valuable asset

18. Liaison Officer  Serves as a line of communication to representatives from other agencies  Other EOC’s  Other hospitals  State and federal centers

19. Safety & Security Officer  Organize and enforce scene/facility protection and traffic security  May limit access of staff to damaged areas  Establish ambulance entry and exit routes in conjunction with transportation unit leader

20. Logistics Logistics Chief Faculty Unit Leader Damaged Assessment & Control Officer Sanitation Systems Officer Communications Unit Leader Transportation Unit Leader Materials Supply Unit Leader Nutritional Supply Unit Leader

21. Logistics Chief Organize and direct operations associated with the maintenance of the physical environment Assure adequate levels of food, shelter, and supplies The “what do we got” person

22. Planning Planning Chief Situation Status Unit Leader Labor Pool Unit Leader Medical Staff Unit Leader Nursing Unit Leader Patient Tracking Officer Patient Information Officer

23. Planning Chief  Ensure the dissemination of critical information  Complete scenario/resource projections  Long range planning  The “what if” and “what can I do” person

24. Finance Finance Chief Time Unit Leader Procurement Unit Leader Claims Unit Leader Cost Unit Leader

25. Finance Chief  Responsible for the expenditures during crisis management  Oversees the acquisition of needed resources  The “how much” person

26. Operations Operations Chief Medical Staff Director Medical Staff Director Medical Care Director Medical Care Director Ancillary Services Director Ancillary Services Director Human Resource Director Human Resource Director

27. Operations  Responsible for the actual patient care operations during crisis mode  Coordinate subsection of medical services, ancillary services, and human services (internal customers)

28. Strategic planning Start early! Consider: - Response/transport times - System resources - Terrain, obstacles - Special needs - Changing circumstances Establish command organization

29. General “Officer” responsibilities Complete assigned objectives Account for assigned personnel Ensure operational safety Monitor progress Redirect as needed Coordinate with related/nearby units Monitor crew welfare Request resources Provide Updates to Command Reallocate resources Maintain appropriate documentation

30. Common responsibilities for ALL incident personnel  Receive/confirm your assignment  Bring specialized supplies, equipment  Follow check-in procedures  Obtain briefing upon arrival  Use clear text radio communication  Acquire necessary work materials  Organize and brief subordinates  Brief relief personnel  Complete required paperwork  Follow demobilization plan

31. Job Action Sheet (JAS)  One JAS for each position  Mission function statement with focused objective  Prioritized activity list  Should be customized to organization Job title and mission statement should NOT be altered.

32. Supporting forms  Forms provide prompts as well as standardization  Better documentation enhances fiscal recovery and decreases liability  More reliable communication (as opposed to notes, scraps, etc.)

33. Supporting forms  Activity Log  Section Personnel Time Sheet  Procurement Summary Report  Volunteer Staff Registration/Credentialing Form  Facility Systems Status Report  Resource Accounting Report  Patient Tracking Form  Action Plans  Emergency Incident Message Forms

34. A Word About Administrative Support …  The difference between getting by and success

35. Response Tools… They Matter!!! Position vests Quick start sheets Clipboards Section bins Pocket directions Pocket guides Status boards

36. Position Vests … Absolutely!  Valuable for Identification  Valuable for Organization

37. Process vs. Program  Once system is in place, evaluate  Modification may include:  Training frequency, content  Protocols  Ancillary equipment, procedures

38. Implementation  Provide briefing  Secure commitment  Establish implementation committee  Train management  Revise disaster plan

39. Implementation  Staff orientation  Build confidence!  Exercises: realistic, no-fault  Tabletop  Functional  Full-scale  By department  Use on small incidents  Updates and revisions

40. Well Prepared Officer…  Task Focused Manager  Direct Reporting=Accountability  Confidence  Inspiration to Team

41. HEICS Re-Asserts Itself As…  A simple plan  A community compatible plan  A plan A Plan With A Proven Track Record