The current version of the Hospital Incident Command System, otherwise known as HICS, was sponsored by the California Emergency Medical Services Authority (EMSA) with federal grant funding and devised by a multidisciplinary group of subject matter experts in 2006. Reportedly used by 80 percent of hospitals in the United States, HICS provides a number of incident command system tools – including an IMT (incident management team) chart, job action sheets, and response forms.
On 11-12 October 2011, the California EMSA held a stakeholders “Summit Meeting” to begin laying the groundwork for the next version of HICS.
An Efficient Meeting Format & High-Level Participation Invited to the day-and-a-half-long meeting were representatives from key healthcare and government organizations directly involved with and/or assigned specific HICS responsibilities. Among the 38 persons attending were senior representatives from the U.S. Department of Homeland Security (DHS), the U.S. Department of Health and Human Services (HHS), the Joint Commission, the National Association of County and City Health Officials, the American Medical Association, the American Hospital Association, the American College of Emergency Physicians, and the Center for HICS Education and Training. Also among the invited participants were five vendors representing several HICS educational systems.
The meeting began with presentations on the origins of HICS and what the medical literature says about it. One additional presentation – on the results of the 2009-2010 national survey on use of the Center for HICS Education and Training – also helped to provide severaleas for group discussion. A personal testimony – by Scripps Health President and CEO Chris Van Gorder (FACHE) – on how HICS is regularly used, and a presentation (by Peter Brewster, Interim NDMS (National Disaster Medical System) Director) on Effective Methods to Train Hospital Staff on HICS, also helped put HICS into perspective for the Summit attendees.
For the rest of the meeting, attendees worked in small groups to answer questions such as the following: (a) How is HICS working now? (b) What are the impediments to utilizing HICS? (c) What are some of the “best practices” recommended for implementing HICS? With help from a facilitator and note taker, each small group formulated its own answers to those and other questions and presented them to the larger group. Additional discussions followed and consensus opinions were developed (if and when possible).
Each small group was also assigned one of the HICS tools – e.g., an Incident Management Team (IMT) Chart; Job Action Sheets (JASs); Incident Planning Guides/Incident Response Guides (IPGs/IRGs); and various other types of educational materials – to review and comment on possible improvements. The results of the team discussions also were discussed with all of the meeting attendees. Throughout the process, copious notes were taken for inclusion in a Conference Proceedings report, which will be given to EMSA by the Center for Collaborative Policy of the California State University at Sacramento – the contractor hired to plan and facilitate the Summit Meeting.
Meaningful Results, Plus Recommendations for Improvement The discussions at each small- and large-group session were particularly lively, with numerouseas shared. There was unanimous agreement on the importance of HICS, and much of the current material was considered to be both vital and useful. Among the many suggested refinements offered during the Summit were the following:
- Continue HICS, as much as possible, as a NIMS-based system;
- Revise some of the more repetitive wordings in the Operations and Logistics Section to reduce redundancy;
- Add a Mental Health position to the IMT;
- Format an IMT design for small hospitals and after-business-hours use;
- Reformat and streamline the JAS;
- Regroup some of the IPGs/IRGs and add new ones relevant to such important topics and/or situations as medical gas, vacuum failure, active shooter/hostage barricades, and wildfires;
- Make the numbers and purposes of all forms easier both to read and to understand;
- Place the forms in order of intended purpose – i.e., Incident Action Plan, resource management, patient tracking, etc.;
- Address the topic of inclusion with Corporate and/or Coalition command structures; and
- Revise the Guidebook as necessary: (a) to reflect additional changes as they occur in the future; and (b) to provide additional details on implementation strategies.
“Leadership in Action” – Now and in the Future Although the Summit was very successful inentifying potential improvements, it was only the first in a series of steps being taken by the California EMSA to revise HICS. The Summit facilitators are now preparing a comprehensive proceedings report to submit to EMSA. This information will be given to the Center for HICS Education and Training – which EMSA anticipates contracting with for the next HICS revision. The Center’s personnel served as the contractors for HICS V4.
As another part of the development process, those attending the Summit will be asked to review the newly devised/revised materials. A second larger group of volunteers will also be asked to review the materials. Personnel with a hospital background who are familiar with the HICS policy and guidelines can apply (see footnote below) to serve as one of the 80 secondary-review group members.
In the words of Van Gorder, “HICS is leadership in action.” The HICS National Summit proved to be a very positive start. By building on the past, stakeholders are preparing a new and improved HICS for the future.
Craig DeAtley, PA-C, is director of the Institute for Public Health Emergency Readiness at the Washington Hospital Center, the National Capital Region’s largest hospital. He also is the emergency manager for the National Rehabilitation Hospital, and co-executive director of the Center for HICS (Hospital Incident Command System) Education and Training. He previously served, for 28 years, as an associate professor of emergency medicine at The George Washington University. In addition, he has been both a volunteer paramedic with the Fairfax County (Virginia) Fire and Rescue Department and a member of the department’s Urban Search and Rescue Team. An Emergency Department PA at multiple facilities for over 40 years, he also has served, since 1991, as the assistant medical director for the Fairfax County Police Department.