The Hospital ICS: Mainstream Solution, or Barely Used?

The latest version of the Hospital Incident Command System (HICS) was released in 2006. Several noteworthy changes were made at that time, including the incorporation of a revised Incident Management Team (IMT) design, revised Job Action Sheets (JASs), a new Users Guide, and new tools such as Incident Planning Guides and Incident Response Guides. Intended to help hospitals of all sizes prepare for and respond to all-hazard emergencies, the system materials – including education modules – are available at no cost from two websites.

These were significant and much-needed changes and improvements. However, the way that the HICS guidelines and the new materials have been received has not been well studied. The best proof of that assertion, perhaps, was provided in 2009, when the Center for HICS Education and Training – headquartered at the Washington, D.C., Hospital Center – conducted a national survey of healthcare personnel to investigate user perspectives on the importance of HICS and each of its key attributes.

A SurveyMonkey program was used as the method for responders to share their online responses to 64 questions – which ranged from information about job roles and responsibilities, and the use of HICS guidelines, to questions specific to each of the individual HICS tools and attributes. Each question was followed by multiple-choice answers, some of which included the option of adding written comments and suggestions. Personal contact, mass emailings, and general publicity (usually generated by the American Hospital Association) were used to promote participation in the survey. The survey “tool” remained available for completion for three weeks; by the end of that time there had been 886 participants – enough, probably, to develop some general but not necessarily definitive conclusions.

Anatomy of a Well Planned Survey

The responders came primarily from hospitals (95.5 percent), with many serving as emergency program managers (59.2 percent), followed by safety officers (27 percent), and department heads (25.5 percent). Their responses represented hospitals of all sizes: 25-100 beds (28.3 percent), 150-200 beds (16.9 percent), more than 250 beds (20.6 percent), and more than 500 beds (11.4 percent). [Because of “rounding errors,” dual-purpose responsibilities, and similar factors some response totals are above 100 percent.]

The results revealed that 96.8 percent follow Incident Command System (ICS) guidelines, with 89.5 percent indicating they use the more specific 2006 HICS guidelines. The remaining 10.5 percent said they use the Hospital Emergency Incident Command System (HEICS). Training in National Incident Management System equipment standards (NIMS ICS) 100 and 200 classes had been provided by 95.3 percent of the hospitals to their staff. There were no questions asked about completion of more advanced courses such as IC 700 and 800.

The Guidebook, which was included as one of the principal HICS tools, was considered to be well organized (90.6 percent) and was frequently used – by the hospital representatives responding to the survey – to evaluate or develop their emergency operations plans (EOPs, 80.6 percent). Some respondents suggested improvements such as expanding the information provided on implementation and/or incident action planning.

The new Incident Planning Guides (IPGs) were reported to be used to evaluate or develop their EOPs by 57.1 percent of those surveyed. Evacuation (65.5 percent), bomb threat (42.6 percent), and severe weather (40.5 percent) are the IPGs most frequently used. The Incident Response Guides (IRGs) were used by 46.9 percent of those responding. Evacuation (67.3 percent), bomb threat (53.1 percent), loss of power (46.1 percent), and pandemic flu (46.1 percent) were the most often used IRGs – but many others were not far behind. Suggested improvements included the addition of IPGs and/or IRGs on active-shooter, tornadoes, and wildland-firefighting situations.

The IMT design is used by 73.9 percent of those responding; a large majority (71.8 percent) of them agreed that the IMT chart was easily adaptable by their respective facilities. The accompanying job-action sheets (JASs) are used by an impressively high percentage of the responders (83.7 percent). Suggested improvements included providing additional and more detailed information on certain JASs, but limiting unnecessary redundancy. The HICS forms now used have been included, usually as part of an EOP, at 74.5 percent of the hospitals represented – 82.6 percent of the hospitals reported that their staff has been provided training on use of the HICS forms.

Less than half (39.6 percent) of those responding reported using the education modules included as part of the HICS materials. However, 71.7 percent indicated they would be interested in attending an HICS course, particularly if instructions on implementation (76.0 percent) and/or Incident Action Planning (77.7 percent) were being taught.

A Few Tentative Conclusions

Although the survey has several limitations – including its design, scope, and relatively small sample size – the results and implications drawn do seem to indicate that HICS is the incident command system most often used by hospitals of all sizes.

The 2006 improvements in the original HEICS materials – e.g., IMT, Guidebook, JASs, and forms – as well as the new materials included (IPGs and IRGs, for example) – are seen as particularly beneficial. The education modules were not rated highly – but that semi-conclusion may be, at least in part, the result of responders not being familiar with the availability of the modules.

The Center for HICS Education and Training is continuing to review the results, but has already started the process of formulating improvement suggestions in all of the HICS materials. Those suggestions will be discussed at a future HICS Stakeholders Conference sometime in 2011 and included in future training programs developed by the Center.