1. National Incident Management System (NIMS)
National Response Framework (NRF)
Incident Command System (ICS)
Independent Study – FEMA Courses
The University of South Alabama
Center 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.
August 7, 2012

2. NIMS - National Incident Management System
A standardized, all-hazard incident and resource management concept
A national approach to incident management that is applicable to all jurisdictional levels
Applicable across a full spectrum of incidents and scenarios, regardless of size
Improve coordination and cooperation between public and private entities
Response actions will be based on the ICS system
All Response Agencies must comply with NIMS

3. NIMS: NIMS Implementation Objectives:
Preparedness - Planning, Training and Exercises
Communication and Information Management
Command and Management
NIMS Adoption

4. NIMS - National Incident Management System
Established to create uniformity:
Organization Structure (ICS)
Plans
Training/Exercises
Resources
Communications/Technology
Organization

5. NIMS Implementation Requirements Activities for Health Care Agencies July 1, 2012
Consists of 11 Elements

6. NIMS Compliance
HSPD-5 (Management of Domestic Incidents) issued in 2004
For disaster response agencies and departments, NIMS is a condition for Federal Preparedness assistance
NIMS Implementation for Healthcare Organizations Guidance
Revised activities from 14 to 11
DHHS requires that healthcare organizations implement NIMS in order to eligible for preparedness funding through ASPR/HPP program.

7. Organizational Implementation Requirements
Adoption:
Element 1 - Adoption of NIMS…throughout the healthcare organization including all appropriate departments and business units.
NIMS objectives addressed in the facility’s Emergency Management Program (EMP/Emergency Operations Plan – EOP) documentation.
Include a statement of adoption of NIMS in the EOP
Refer to this tool and attach as an annex or sub-section of the EOP
Obtain leadership support and have them review/sign plans
Assign a NIMS Compliance Officer

8. Organizational Implementation Requirements
Adoption:
Element 2 – Federal Preparedness awards support NIMS Implementation…in accordance with the eligibility and allowable use of the awards.
Utilize the Hospital Preparedness Program (HPP) funding for NIMS training courses.
Document that HPP funds purchase standardized equipment in the county/state/ country.
The EMP documentation includes the use of ICS and associated activities.

9. Organizational Implementation Requirements
Preparedness: Planning
Element 3 – Revise and Update EOPs, SOPs and SOGs to incorporate NIMS components.
Revise plans as necessary to incorporate:
Planning
Training
Response
Exercises
Equipment
Evaluation
Corrective Action

10. Organizational Implementation Requirements
Preparedness: Planning
Element 4 - Mutual-Aid and/or Assistant Agreements…to include public/private sector and non-governmental organizations.
The EMP references Memorandums of Understanding (MOUs), agreements and/or mutual aid developed with hospitals, other healthcare providers, local public health, Emergency Medical Services (EMS), fire and safety, pharmacies, medical suppliers, water/food/fuel suppliers, etc.

11. Organizational Implementation Requirements
Preparedness: Training and Exercises
Element 5 – IS 100, 200 and 700.
Personnel to fill ICS Positions who must have documented training:
Physicians
Nurses
Ancillary
Materials/Resource
Managers
Security/Safety
Laboratory
Radiology
Inter-facility Transport
Maintain a record of completion and copies of completion certificates

12. Organizational Implementation Requirements
Preparedness: Training and Exercises
Element 6 – IS 800
Those who take the lead in key ICS positions
Key staff members – Liaison, Safety/Security, Legal…
Incident Commander
Emergency Management Planner
Maintain a record of completion.
Copies of completion certificates should also be maintained.

13. Organizational Implementation Requirements
Preparedness: Training and Exercises
Element 7 – Apply NIMS/ICS to training and exercises
Utilize HICS for disaster exercises and actual events
The EMP training and exercise documentation reflects the use of NIMS and HICS
Utilize Homeland Security Exercise and Evaluation (HSEEP)
Work in partnership with local/regional healthcare providers within the community to organize training and exercises that use NIMS and HICS
Hospital should develop goals and objectives to follow during a drill that tests their ability to activate HICS, open their Command Post, develop and implement an Incident Action Plan (IAP), and communicate with partners
Develop/use After Action Reports and Corrective Action Plans

14. Organizational Implementation Requirements
Communication and Information Management:
Element 8 – Processes, Equipment, Communication and Data interoperability
Facilitate collection and distribution of consistent & accurate information
Situational awareness of logistical resources
Equipment purchased through the HPP is standardized
The EMP documentation includes emphasis on the interoperability of response equipment and communications and data systems with external agencies
Systems such as AIMS, ALERT, Web-EOC, etc. show compliance if utilized among healthcare facilities, county/area or state-wide.

15. Organizational Implementation Requirements
Communication and Information Management:
Element 9 – Common and consistent terminology
The EMP includes emphasis on the use of plain English by staff during emergencies. Review and update EOP annually.
Document a statement to this effect in the EMP documentation or EOP.
Utilize a HICS acronym list.

16. Organizational Implementation Requirements
Command and Management:
Element 10 – Manage events with ICS
The EOP explains the use of HICS, particularly incident action planning, a common communications plan and five specific activities: Initiation of Command, Transfer of Command, Termination of Command, Demobilization and Credentialing.
Documentation utilization of HICS or other approved ICS structures as detailed in #7.

17. Command Issues & Terms Initiation of Command Transfer of Command
Termination of Command
Demobilization - Facilitates accountability
Credentialing - Competence and proficiency

18. 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
Understand how to transition into “Transfer of Command”

19. 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.
Delegation of authority can occur if the scope of the response is complex or beyond capabilities or current/initial Incident Commander
All with a need to know should be told the effective time and date of the transfer.

20. 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 “De-Activation” section
Understand the transition into demobilization

21. 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

22. Specific Command Issues
Credentialing: Evaluation/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

23. Organizational Implementation Requirements
Command and Management:
Element 11 – Adopt Public Information (PI) principles by using both JIS and JIC during events (Examples)
The EOP explains the management and coordination of public information with external entities
Indentify a PIO who is responsible for medial and public information as it pertains to an event. The PIO should establish working relationships, prior to an event with local media, EMA, law enforcement, public health, EMS, and other responding agencies
PIO understands the relationship with the Joint Information System and Joint Information Center
Documentation that the hospital participates in the JI process locally

24. Questions and/or a copy of the NIMS compliance manual:

25. 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

26. Relationship: NIMS vs. NRF NIMS
Aligns command, control, organization structure, terminology, communication protocols, & resources/resource-typing
Used for all events
NRF
Integrates & applies Federal resources, knowledge, & abilities before, during, & after an incident
Implemented for incidents requiring Federal coordination
Federal
Response or Support
State
Response or Support
Local
Response
Incident

27. NRF Structure Base Framework
Describes the domestic incident management structures and processes
Appendixes
Include acronyms, definitions, authorities, and a compendium of national interagency plans
Describes the structures and responsibilities
for coordinating incident resource support
Emergency Support Function Annexes
Support Annexes
Provide guidance for the functional processes and administrative requirements
Incident Annexes
Address contingency or hazard situations requiring specialized application of the NRF

28. Scopes of ESFs ESF #1 – Transportation Department of Transportation
Aviation/airspace management and control
Transportation safety
Restoration/recovery of transportation infrastructure
Movement restrictions
Damage and impact assessment
ESF #2 – Communications
Homeland Security/NCS
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
ESF #3 – Public Works and Engineering
Department of Defense
US Army Corps of Engineers
Infrastructure protection and emergency repair
Infrastructure restoration
Engineering services and construction management
Emergency contracting support for life-saving and life-sustaining services
ESF #4 – Firefighting
Department of Agriculture
Coordination of Federal firefighting activities
Support to wild land, rural, and urban firefighting operations

29. Scopes of ESFs ESF #5 – Emergency Management
Homeland Security/FEMA
Coordination of incident management and response efforts
Issuance of mission assignments
Resource and human capital
Incident action planning
Financial management
ESF #6 – Mass Care, Emergency Assistance,
Housing, and Human Services
Homeland Security/FEMA
Mass care
Emergency assistance
Disaster housing
Human services
ESF #7 – Logistics Management and Resource Support
Homeland Security/FEMA
Comprehensive, national incident logistics planning, management, and sustainment capability
Resource support (facility space, office equipment and supplies, contracting services, etc.)
ESF #8 – Public Health and Medical Services
Dept Health & Human Services
Public health
Medical
Mental health services
Mass fatality management

30. NRF – ESF 8 at the Federal Level

31. Alabama EOP – ESF 8 at the State Level

32. Tier
Federal Response
DHHS
Tier
Inter-state Coordination
Region 4 DHHS
Tier
Intra-state Coordination
ADPH/CEP
Area Jurisdiction Response:
Area Health Care Coalition
Tier 3---
Area PH
County Jurisdiction Response:
County Health Care Coalition
Tier 2 ---
County PH
Tier 1----
Health Care Facility Response
HCF

33. Scopes of ESFs ESF #9 – Search and Rescue Life-saving assistance
Homeland Security/FEMA
Life-saving assistance
Search and rescue operations
ESF #10 – Oil and Hazardous Materials Response
EPA
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
ESF #11 – Agriculture and Natural Resources
Department of Agriculture
ESF #12 – Energy
Department of Energy
Energy infrastructure assessment, repair, and restoration
Energy industry utilities coordination
Energy forecast

34. Scopes of ESFs ESF #15 – External Affairs Homeland Security/FEMA
ESF #13 – Public Safety and Security
Department of Justice
Facility and resource security
Security planning and technical resource assistance
Public safety and security support
Support to access, traffic, and crowd control
ESF #14 – Long-Term Community Recovery
Homeland Security/FEMA
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
ESF #15 – External Affairs
Homeland Security/FEMA
Emergency public information and protective action guidance
Media and community relations
Congressional and international affairs
Tribal and insular affairs

35. Incident Command System
ICS
Incident Command System

36. Incident Command System (ICS) Model
Incident Commander
Public Information
Officer
Liaison
Officer
Command
Staff
Safety & Security
Officer
Logistics Section
Chief
Planning Section
Chief
Finance/Admin
Section Chief
Operations Section
Chief
General
Staff

37. 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.
In reality, for hospitals, a HICS chart that matches (or comes close to matching) your day-to-day organizational chart is much more effective and understood during an event.

38. HOSPITAL INCIDENT COMMAND SYSTEM
HICS (2003)

39. HOSPITAL INCIDENT COMMAND SYSTEM
HICS (2006)

40. Management by Objectives Tactical Results, Needs,
Incident
Occurs
Incident
Reported
& Identified
Tactical
Response
ICS Launched
Chiefs Meeting:
Develop Strategy
& Tactics to Meet
Objectives
IC Sets
Objectives
Incident
Action Plan
Chiefs & Officers
Set Meeting with
IC to Re-evaluate
Tactical Response
Initiated
Operation Reports
Tactical Results, Needs,
Engage Liaison,
Logistics, Planning,
Finance for support
Planning Evaluates
Progress Reports

41. 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.

42. Operations Section Incident Commander Logistics Section Chief
Planning Section
Chief
Finance/Admin
Section Chief
Safety & Security
Officer
Public Information
Officer
Liaison
Officer
Command
Staff
Incident Commander

43. ICS – Command Section Incident Commander Public Information Officer
Liaison
Officer
Command
Staff
Safety & Security
Officer
Logistics Section
Chief
Planning Section
Chief
Finance/Admin
Section Chief
Operations Section
Chief
General
Staff

44. Incident Commander
Manages all emergency activities, usually from the Command Post.
Top priority = Safety!
Serves as the authority for the response efforts and is supervisor to the Command and General Staff.
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.
The only position ALWAYS staffed in an ICS activation.

45. Public Information Officer
Responsible for relaying incident related information to the public, other organizations and the media.
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.
The organizer of correct information.
Manage the facility’s Public Information Plan.

46. 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.

47. Liaison Officer
Is responsible for coordinating with external partners, such as the county, 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

48. Legal Officer
Provides legal and ethical advice to the IC, Command Staff, General Staff and the agency.

49. Incident Command System (ICS) Model
Incident Commander
Public Information
Officer
Liaison
Officer
Command
Staff
Safety & Security
Officer
Logistics Section
Chief
Planning Section
Chief
Finance/Admin
Section Chief
Operations Section
Chief
General
Staff

50. Logistics Section
“Boy, do I need stuff”

51. Logistics Chief Facility Unit Leader Communications Unit Leader
2003
Facility Unit Leader
Communications Unit Leader
Transport Unit Leader
Materials Supply Unit Leader
Nutritional Supply Unit Leader

52. Logistics Chief Service Branch Director Support Branch Director 2006
Communications Unit
ITAS Unit
Staff Food and Water Unit
Support Branch Director
Employee Health and Well-Being Unit
Family Care Unit
Supply Unit
Facilities Unit
Transportation Unit
Labor Pool and Credentialing Unit

53. Incident Command System (ICS) Model
Incident Commander
Public Information
Officer
Liaison
Officer
Command
Staff
Safety & Security
Officer
Logistics Section
Chief
Planning Section
Chief
Finance/Admin
Section Chief
Operations Section
Chief
General
Staff

54. Planning

55. Planning Chief Situation Status Unit Leader Labor Pool Unit Leader
2003
Situation Status Unit Leader
Labor Pool Unit Leader
Medical Staff Unit Leader
Patient Tracking Officer
Patient Information Officer

56. Planning Chief 2006 Resource Unit Leader Situation Unit Leader
Personnel Tracking
Material Tracking
Situation Unit Leader
Personnel Tracking
Material Tracking
Documentation Unit Leader
Demobilization Unit Leader

57. Incident Command System (ICS) Model
Incident Commander
Public Information
Officer
Liaison
Officer
Command
Staff
Safety & Security
Officer
Logistics Section
Chief
Planning Section
Chief
Finance/Admin
Section Chief
Operations Section
Chief
General
Staff

58. Finance Section
$$ $$
MONEY
MONEY
MONEY
MONEY

59. Finance Chief Time Unit Leader Procurement Unit Leader
2003
Finance Chief
Time Unit Leader
Procurement Unit Leader
Claims Unit Leader
Cost Unit Leader

60. Finance Chief Cost Unit Leader Time Unit Leader
2006
Finance Chief
Time Unit Leader
Procurement Unit Leader
Compensation/Claims Unit
Leader
Cost Unit Leader

61. Incident Command System (ICS) Model
Incident Commander
Public Information
Officer
Liaison
Officer
Command
Staff
Safety & Security
Officer
Logistics Section
Chief
Planning Section
Chief
Finance/Admin
Section Chief
Operations Section
Chief
General
Staff

62. Operations Chief Medical Staff Director Medical Care Director
2003
Operations Chief
Medical Staff Director
Medical Care Director
Ancillary Services Director
Human Services Director

63. Operations Chief 2003 Medical Staff Director Medical Care Director
In-Patient Areas
Supervisor
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

64. Psychological Support
Operations Chief
2003
Human Services Director
Staff Support
Unit Leader
Psychological Support
Unit Leader
Dependent Care
Unit Leader

65. Operations Chief Ancillary Services Director 2003 Radiology
Laboratory
Unit Leader
Pharmacy
Unit Leader
Radiology
Unit Leader
Cardiopulmonary
Unit Leader

66. Operations Chief 2006 Staging Manager Medical Care Branch Director
Personnel Staging Team
Vehicle Staging Team
Equipment/Supply Staging Team
Medication Staging Team
Medical Care Branch Director
Inpatient Unit
Outpatient Unit
Casualty Care Unit
Mental Health Unit
Clinical Support Services Unit
Patient Registration Unit

67. Operations Chief 2006 Infrastructure Branch Director
Power/Lighting Unit
Water/Sewer Unit
HVAC Unit
Building/Grounds Damage Unit
Medical Gases Unit
Medical Devices Unit
Environmental Services Unit
Food Services Unit
Haz-Mat Branch Director
Detection/Monitoring Unit
Spill Response Unit
Victim Decontamination Unit
Equipment Decontamination Unit

68. Operations Chief 2006 Security Branch Director
Access Control Unit
Crowd Control Unit
Traffic Control Unit
Search Unit
Law Enforcement / Interface Unit
Business Continuity Branch Director
Personnel Staging Team
Vehicle Staging Team
Equipment/Supply Staging Team
Medication Staging Team

69. FEMA TRAINING NIMS Elements 5 & 6
IS 100
IS 200
IS 700
IS 800

70. training.fema.gov/is/

71. Required Courses

73. Questions