The Hospital Incident Command System - No Longer HEICS

The Gulf Coast hurricanes, the shootings at Virginia Tech, and the bridge collapse in Minneapolis are among the numerous recent disasters that created major incident-management challenges not only for first responders but for hospitals as well. The effective use of an incident command system (ICS) – as spelled out in considerable detail in the most authoritative publications on the subject – has been the key to upgrading the ability of many hospitals to successfully meet the challenges associated with responding to natural and manmade emergencies.  Since its creation in the late 1980s the Hospital Emergency Incident Command System, or HEICS, has served as a basis of emergency preparedness for many of the 6,000 hospitals in the United States as well as many hospitals abroad. However, in large part because of  the many improvements and upgrades spelled out in the fourth edition of guidelines released in the fall of 2006 by the California Emergency Medical Services Authority, there is now a greater emphasis on ICS being used by hospitals not only for emergencies per se but also for non-emergency situations as well. For that reason, the shorthand HEICS name has been changed to Hospital Incident Command System, or HICS. The new and more useful HICS guidelines were developed by a multi-disciplinary group of twenty hospital-based professionals from throughout the United States. They Although many of the fundamental concepts in the original guidelines were preserved, the new HICS includes a number of important modifications, and an abundance of helpful new material represented hospitals ranging in size from 28 to 1,000 or more beds. Their expertise was complemented by input provided by representatives from the Joint Commission, the American Hospital Association, the American Society of Healthcare Engineers, the U.S. Department of Health and Human Services, the NIMS Integration Center, the Emergency Management Institute, and the U.S. Navy. More then 80 subject-matter experts serving as secondary review group members provided feedback on the HICS draft materials. 

Improvements and Upgrades Across the Board 

Although many of the fundamental concepts in the original HEICS guidelines were preserved, the new HICS includes a number of important modifications, and an abundance of helpful new material as well. Among the key components of the current HICS package of materials are the following:

  • An HICS Guidebook, which has been rewritten and provides a more comprehensive discussion of emergency planning for hospitals as well as a discussion of the overall HICS framework and philosophy and how it is configured and used during both emergent and non-emergency incidents.
  • An Incident Management Team chart, which has been reorganized, and compressed into one page, and puts greater emphasis on flexibility and scalability. Several new positions have been added (e.g., medical technical specialists) and several original positions have either been shifted to another section of the guidebook (e.g, “Staging” has moved to “Operations”) or put into an entirely new section (“Security,” for example).
  • The Job Action Sheets have been expanded and reformatted to include both a Demobilization/System Restoration time frame and a Tools/Documents Section.
  • The HICS Forms Section now includes 13 pertinent FEMA (Federal Emergency Management Agency) forms and seven other forms that hospitals may need to effectively manage and document their decision-making.
  • Several Appendices have been added that address topics such as Incident Planning Considerations, Recommended Resources, HEICS-to-HICS Implementation Steps, and NIMS Implementation Activities for Hospitals; also included is a helpful Glossary of Terms and Acronyms.
  • Numerous Incident Planning and Response Guides are now included to accompany 14 of the federal training scenarios and 13 internal hospital emergencies (e.g., infant abduction, fire, flood, hostage barricade, etc.) listed in the Guidebook.
  • Power Point-based educational modules have been developed for each chapter of the Guidebook.  

In January 2007, the Center for HICS Education and Training was created by the ER One Institute at the Washington Hospital Center in Washington, D.C., and the National Emergency Preparedness Office for Kaiser Permanente, the two organizations that served as the HEICS IV project management team. The mission of the HICS Center is to promote the availability and continued improvement of HICS and, at the same time, provide training on the materials listed above. The Center is composed of the original organizational members of the national work group and six of the original ex-officio agencies that developed the HICS concept and intellectual framework.   Note: The NIMS Integration Center (NIC) has determined that HICS does in fact meet the NIMS ICS requirements. In addition, the educational programs offered by the Center have been determined by the NIC to be the equivalent of the Emergency Management Institute’s IS 100/200 and 700 courses. Additional information about HICS can be found at 

Craig DeAtley

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.



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