NIMS, the National Incident Management System, is basically a plan that was developed to improve the ability of jurisdictions throughout the country to respond in a coordinated fashion to “incidents of national significance” – i.e., natural disasters such as hurricanes or earthquakes, and manmade disasters such as terrorist attacks. Under the Homeland Security Presidential Directive 5 (HSPD-5), all of the nation’s first responders are required to have received rudimentary training in and be familiar with the NIMS concept and operational procedures.
The principal component of NIMS with which most responders are familiar is the Incident Command System, or ICS. While NIMS provides the “big picture” organizational view – including the rules on how to organize support and to direct agency-level interactions – ICS deals with the practical actions affecting troops on the ground.
The first lesson that first responders must know about NIMS and ICS is to forget where they came from, but not what they know. ICS is about submerging personal and agency identities and working the problem with the resources available. In other words, it is about putting the best person for a specific job on that job.
Under the ICS scheme of operations, EMS resources perform a direct role by caring for the victims of the incident.
Like many other elements of a large, interagency response team, EMS personnel and physical resources often play a dual role because they can be used both in direct operations and in supporting other teams or agencies. Under the ICS scheme of operations, EMS resources perform a direct role in the operations section by caring for the victims of the incident. However, when EMS resources are used primarily to treat other responders who are injured or otherwise incapacitated, those resources are being used in a support role and are therefore considered part of the medical unit of the logistics section.
As previously noted, there are certain minimum levels of training required under both NIMS and ICS. That training is provided, at no cost to the state and/or city agencies involved, by the Federal Emergency Management Agency (FEMA).
The Everyday Practicalities
As with all strategic plans and overarching concepts, the implementation of ICS will be efficient to a greater or lesser degree, compared to the ideal, depending on the specific circumstances related to and/or affecting a particular incident. There are, of course, many factors contributing to or detracting from that efficiency. In many if not all cases at least some of those factors are out of the control both of the agencies primarily involved and of the troops on the ground.
Many agencies simply do not have the management depth required – the number of staff members needed, for example, or the ICS experience levels necessary – to be set up day to day along the organizational concepts envisioned in the ICS plans. In addition, certain EMS responses may have as few as two responders involved. In such circumstances, setting up an ICS structure might not necessarily be difficult but it would almost always be superfluous.
Over a decade ago, New York City’s EMS educators (and their counterparts in other major cities) were teaching emergency medical technicians (EMTs) and paramedics that they should be thinking about the possible ICS implications of every incident in which they might be involved. Although that may sound impractical, the message was not that the EMTs might personally have to decide who should serve as the incident commander (and, as a corollary task, fill out the rest of a complicated ICS table of organization), but that responders should always be thinking about what ICS rules and guidelines would come into play if the incident becomes bigger and more complex.
Using the ICS concept for every job model has two advantages. The first is that the EMS staff remains conversant with the system by thinking about it in their day-to-day work. The second is that when an incident does escalate to the point where it is necessary to start filling in a table of organization, the personnel already on the scene will not have to shift gears in their thinking.
Maintaining an ICS mindset is often more of a mental exercise than an actual functional component of the response operations. However, if practiced, this exercise will keep the responders’ minds, and mindsets, both limber and flexible – and that is always an operational asset worth striving for.
Links for additional information NIMS: https://www.fema.gov/emergency-managers/nims
NIMS, ICS, and other FEMA Training: https://www.firstrespondertraining.gov/frts/npcc
Joseph Cahill is the director of medicolegal investigations for the Massachusetts Office of the Chief Medical Examiner. He previously served as exercise and training coordinator for the Massachusetts Department of Public Health and as emergency planner in the Westchester County (N.Y.) Office of Emergency Management. He also served for five years as citywide advanced life support (ALS) coordinator for the FDNY – Bureau of EMS. Before that, he was the department’s Division 6 ALS coordinator, covering the South Bronx and Harlem. He also served on the faculty of the Westchester County Community College’s paramedic program and has been a frequent guest lecturer for the U.S. Secret Service, the FDNY EMS Academy, and Montefiore Hospital.