The successful implementation of an incident command system (ICS) by first responders and first receivers requires that the users be familiar with certain fundamental principles and practices. Over the past several years, public-safety personnel in the ICS field have developed various incident-command tools to help those assigned to command positions to perform in an optimum fashion. The recently released Hospital Incident Command System (HICS) documents include, as part of an overall policy-and-guidelines package, a number of new command tools to assist those responsible for leading a hospital through natural as well as man-made and/or terrorism-related incidents. Following are brief synopses of some of the more important of those tools:
Incident Planning Guides (IPGs): Hospitals now have planning guidance available for 14 of the 15 all-hazards training scenarios (e.g., the plague, cyber-terrorism, an earthquake, and similar natural or manmade disasters) hypothesized by the federal government as well as 13 “internal” scenarios – a major fire, a bomb threat, a child Each incident-planning guide is organized according to the four principal emergency-management functions (mitigation, preparedness, response, and recovery operations) abduction, and similar “events” and “incidents.” Each incident-planning guide (IPG) is organized according to the four principal emergency-management functions (mitigation, preparedness, response, and recovery operations). A series of questions in each section of a typical IPG allows users to compare their emergency operations plan with the content that a reasonably comprehensive plan might include. Hospitals currently lacking a plan, of course, can use the IPGeas to create their own plans. Revised Job Action Sheets (JASs): Job Action Sheets have always been a fundamental component of the basic HICS package, but two important additions are included in the new JAS guidelines. A section titled Demobilization/System Restoration has been added to the original three time periods – Immediate (0-2 hours), Intermediate (2-12 hours), and Extended (greater than 12 hours) – postulated on each of the JASs. The content in this section provides users with a number of “suggested actions” they would be well advised to consider in winding down their command responsibilities and to help return the hospital to more normal operations. Another noteworthy improvement is a new “Document/Tools Section” found at the end of each JAS. This section provides a suggested inventory of administrative and technical items that each position should have available as well as a list of the specific forms that the persons holding certain positions are responsible for reviewing and/or completing as part of their assigned duties. Incident Response Guides (IRGs): Incident Response Guides also have been written for each of the 27 scenarios previously mentioned. Each IRG format postulates the same time periods indicated on the JAS. In each time period there is a listing of the incident-management decisions for each command and general staff position that should be considered for that particular situation. Like the JAS, the IRG is formatted so that decisions made by a person assigned to a particular position can be recorded on the form itself. FEMA and Other Required Forms: The HICS package also includes twenty (20) forms that can and should be used to assist with various aspects of incident planning and documentation. Thirteen (13) of them are Federal Emergency Management Agency (FEMA) forms that are applicable for hospital use during an emergency. Each retains the title and number of the original FEMA form to ensure standardization and, when appropriate, to facilitate the effective sharing of information throughout the responder community. The remaining seven forms were designed and are intended to allow for the documenting of additional information not found elsewhere on the FEMA forms (e.g., information related to patient evacuations, casualty/fatality records, and similar data). Each of these additional forms has a unique number as well as a title that implies its purpose. All twenty forms in the package can be completed either on a computer or in longhand. Accompanying the forms (for the first time) are individual instruction sheets that spell out such information as the purpose of the form, who specifically (i.e., what position) should be responsible for completing the form, and where the completed form should be sent. All of these tools (and others) can be downloaded at no cost from either the California Emergency Medical Services website or the Center for HICS Education and Training website. Like the ICS tools already used by public-safety personnel, proper use of the new HICS tools requires continuous education and training. Once their intended use is mastered, these tools should help hospital personnel carry out their HICS responsibilities both more competently and with greater confidence. ______________________________ Craig DeAtley is the director of the Institute for Public Health Emergency Readiness at the Washington Hospital Center, the District of Columbia’s largest hospital and co-executive director of the Center for HICS Education and Training. Prior to his current position, he was an Associate Professor of Emergency Medicine at George Washington University, for 28 years before leaving to start the Institute. He also works as a Physician Assistant at Fairfax Hospital, a Level Trauma Center in Northern Virginia, he has been a volunteer paramedic with the Fairfax County Fire and Rescue Department since 1972, and a member of their Urban Search and Rescue Team since 1991. He currently serves as the team’s Medical Team Coordinator and also serves as the Assistant Medical Director for the Fairfax County Police Department. For the past 11 years he has been working as a consultant on projects related to DOD’s/DOJ’s WMD Domestic Preparedness Programs, and a variety of HHS/CDC’s Public Health Department projects regarding preparedness and response. He also worked for the HHS Office of Emergency Preparedness in developing and facilitating a new Public Health Emergency Practicum Program for medical, emergency management, public health, and public safety personnel.