NIMS & ICS - A Road Map for U.S. Health Departments

The terms “Incident Command System” (ICS) and “National Incident Management System” (NIMS) have been used and heard in various emergency-services forums with growing frequency in recent years. Homeland Security Presidential Directive (HSPD) #5 dictates that local and state government agencies adopt the National Incident Management System as the preferred model for emergency-response policies, procedures, and protocol development and practice – but there are varying realities in how a health department can make the jump from NIMS/ICS awareness to implementation and compliance to actual competence in everyday operations.   Effective implementation and use of the Incident Command System can be difficult at best, and it is important to remember that ICS was originally developed specifically to help fire departments and law-enforcement agencies communicate and coordinate better during large-scale incidents. For that reason, a local health department (traditionally a social service agency, but with some regulatory responsibilities) will have to take a system originally developed for emergency-response agencies and organizations (with other distinct roles and responsibilities) and bring all of the pieces together into a comprehensive, organized system that is reasonably well prepared to cope with any incidents or events that may confront it. But for a health department to pull all of the components together, it must have a significant commitment to the ICS concept from the top levels of management.    This means that the department head, his or her principal assistants, and director-level managers also must understand and embrace ICS implementation and utilization. That common-sense requirement translates into allowing various levels of employees the time and opportunity to go through training and participate in emergency-preparedness exercises and drills.

Health departments must establish an ICS structure based on what is sometimes called the FLOP (finance, logistics, operations, and planning) line for all emergency operations

From Ground Level to the Command Superstructure 

However, that is only what might be called the ground-level requirement. It is not enough, though, for a health department’s entire ICS structure to be trained in basic or even intermediate-level courses such as ICS 100 and 200 or even 700 and 800; the department’s command-level staff must also have the knowledge obtained in the more advanced ICS 300 and 400 level es. In addition, health departments must establish an ICS structure based on what is sometimes called the FLOP (finance, logistics, operations, and planning) line for all emergency operations.  This means actually using the department’s planning section when planning for a mass event or incident. It also means using a motivated operations section possessing strong operational experience and an understanding of what actually has to get done. It means that the department’s finance staff will usually come from the administration section of the health department and have a true understanding of costs, personnel, and several other areas of responsibility, and it means that the logistics section should consist of those individuals whose day-to-day jobs involve the logistical realities – e.g., supplies, facilities, and communications – of a large social-service agency.   Following are some suggestions for staffing of the command-level positions:

• The incident commander could be the health department administrator, bioterrorism coordinator, emergency preparedness coordinator, health officer, or senior administrative officer.

• The liaison officer (or government liaison official) could be the health department’s administrator, bioterrorism coordinator, emergency-preparedness coordinator, community outreach specialist, bureau/unit director, or a senior administrative officer.

• The public information officer could be the health department’s administrator (or its PIO), emergency preparedness coordinator, community outreach specialist, bureau/unit director, or a senior administrative officer.

But even incorporating the ICS structure is not enough – the department also needs to use ICS not only in the development of plans and policies, but also in everyday operations. Experience has shown that this is the best and in many situations only way to develop, improve, and retain the ICS skills of the department’s staff. Those skills can be acquired and/or improved by room training and actual participation in all levels of exercises – tabletop, functional, and full-scale – as well as through monthly or quarterly section (including command-level staff) meetings.  Another way to actually use ICS skills is to handle all events as ICS events – so that planning, funding, and running annual events such as flu clinics (or even non-annual events such as an inauguration or other VIP situation) should be handled through the various ICS sections.   

First Responders – an Updated Definition 

A question that arises time and again is the following: Are health department staff considered first responders? The questions can be answered like this: Since the terrorist attacks of 11 September 2001 the world of emergency services has seen the previously somewhat loose definition of “first responders” expand from the traditional answer – firefighters, law-enforcement personnel, and emergency-services technicians (EMTs) – to include representatives at almost all levels of such non-traditional responder agencies and organizations such as local or state Offices of Aging, Departments of Transportation, and Health Departments. There will be many challenges, of course, as today’s health departments move toward the NIMS/ICS competence level mentioned earlier. Some of those challenges may have to do with labor/union issues, some may be based on the less-than-familiar ICS terminology, and some may be related to a learning curve as the department’s personnel become accustomed to the differences between their previous (and continuing) day-to-day roles and their ICS roles.  

But understanding and using NIMS policies and principles, along with those of its major component, the Incident Command System (ICS), will enable healthcare workers – in all agencies at all levels of government – to work in a comprehensive, cooperative, and cohesive framework when dealing with other agencies during large-scale incidents and events of all types, specifically including major disasters, both natural and man-made.  The system will also assist the healthcare community at large in planning for, preventing, and/or mitigating a healthcare emergency such as influenza or other disease epidemics or outbreaks.  In short, by implementing NIMS/ICS policies, principles, and operational guidelines, healthcare agencies and organizations will be much better prepared to promote and improve interoperability, compatibility, and communication between and among their federal, state, and local partners.  They also will have a better, and continuing, awareness of the greater “emergency management” structure to which they now belong.  This knowledge will assist them in knowing who needs what information to make better decisions in responding to, and containing, an event.  This happy result will not only be true at the state level, but will pay even greater dividends at the local level, where local and community agencies can truly assist and, if need be, lead the response to an event.  Once trained in NIMS/ICS, health departments could and should be major contributors to planning, and to response operations, and through their input will have greater overall impact in the development and implementation of responses appropriate to the greater good of the public they serve.