Hospital Incident Management System Dan Cass MD FRCPC Chief, Emergency Medicine St. Michael’s Hospital, Toronto

Hospital Incident Hospital Incident Management Management

SystemSystem

Dan Cass MD FRCPCDan Cass MD FRCPC

Chief, Emergency Chief, Emergency MedicineMedicine

St. Michael’s Hospital, St. Michael’s Hospital, TorontoToronto

ObjectivesObjectives

• Outline the evolution of the Incident Outline the evolution of the Incident Management System (IMS) modelManagement System (IMS) model

• Provide an overview of the principles Provide an overview of the principles of IMSof IMS

• Illustrate how IMS can be used as a Illustrate how IMS can be used as a framework for emergency response framework for emergency response for health care institutionsfor health care institutions

• Provide some practical applications Provide some practical applications of IMS in the hospital settingof IMS in the hospital setting

What is IMS?What is IMS?

• A way of creating (some!) order A way of creating (some!) order

out of chaosout of chaos

• A frameworkA framework

• A toolA tool

TerminologyTerminology

• For our purposes, For our purposes, allall of these of these

terms are interchangeable:terms are interchangeable:– Incident Management System (IMS)Incident Management System (IMS)

– Incident Command System (ICS)Incident Command System (ICS)

– Hospital Emergency Incident Hospital Emergency Incident

Command System (HEICS)Command System (HEICS)

Where Does IMS Come Where Does IMS Come From?From?

Origins of IMSOrigins of IMS

• California wildfires, 1980s – California wildfires, 1980s – “FIRESCOPE”“FIRESCOPE”– Multiple fire agencies involvedMultiple fire agencies involved

• Local, regionalLocal, regional

– Coordination of local / state / federal Coordination of local / state / federal resourcesresources

• Many challenges…Many challenges…– Lack of common terminology / Lack of common terminology /

organizational structure / rolesorganizational structure / roles– Incompatible equipment (radios; Incompatible equipment (radios;

firefighting)firefighting)


• Fire protection agencies developed Fire protection agencies developed common organizational and response common organizational and response structurestructure– Evolved into IMSEvolved into IMS

• Deployed across CaliforniaDeployed across California– Subsequently to much of USA and Subsequently to much of USA and

CanadaCanada

• Began to expand to all pre-hospital Began to expand to all pre-hospital providers (fire / ambulance / police)providers (fire / ambulance / police)– Eventually into hospitalsEventually into hospitals


• 1987: Hospital Council of 1987: Hospital Council of Northern CaliforniaNorthern California– Adapted IMS into “Earthquake Adapted IMS into “Earthquake

Preparedness Guidelines for Preparedness Guidelines for Hospitals”Hospitals”

• 1991: Orange County EMS1991: Orange County EMS– Used IMS principles to develop Used IMS principles to develop

Hospital Emergency Incident Hospital Emergency Incident Command System (HEICS)Command System (HEICS)

Why Should We Care??Why Should We Care??

• In day-to-day operations, hospitals In day-to-day operations, hospitals often very insularoften very insular– ““Our” procedures don’t have to be Our” procedures don’t have to be

same as “their” proceduressame as “their” procedures– Applies Applies withinwithin as well as as well as betweenbetween

institutionsinstitutions

• In mass casualty incident, we In mass casualty incident, we cannotcannot operate in a vacuum! operate in a vacuum!– Need way to communicate / coordinate Need way to communicate / coordinate

effortsefforts

IMS - ComponentsIMS - Components

1.1. Unified commandUnified command structurestructure2.2. Common terminologyCommon terminology3.3. Modular organizationModular organization4.4. Integrated communicationIntegrated communication5.5. Consolidated action plansConsolidated action plans6.6. Job Action SheetsJob Action Sheets7.7. Manageable & sensible span of Manageable & sensible span of

controlcontrol8.8. Designated facilitiesDesignated facilities9.9. Comprehensive resource managementComprehensive resource management


1.1. Unified command structureUnified command structure2.2. Common terminologyCommon terminology3.3. Modular organizationModular organization4.4. Integrated communicationIntegrated communication5.5. Consolidated action plansConsolidated action plans6.6. Job Action SheetsJob Action Sheets7.7. Manageable & sensible span of Manageable & sensible span of


IMS StructureIMS Structure

Command

Operations Planning LogisticsFinance /

Administration


Command


Administration

Doers Thinkers Getters Payers

Incident Incident CommandCommand

• Directs activities of personnel in Directs activities of personnel in

Emergency Operations Centre (EOC)Emergency Operations Centre (EOC)

• Most senior trained responderMost senior trained responder– In hospital model, may In hospital model, may startstart as on-duty as on-duty

Emergency Physician or Charge NurseEmergency Physician or Charge Nurse

• As response progresses, IC position may As response progresses, IC position may

be “handed off” to more senior personbe “handed off” to more senior person

Incident Commander

Operations Planning Logistics Finance

OperationsOperations

• Directs “front-line” response to eventDirects “front-line” response to event• Implements response activities as Implements response activities as

determined by Incident Commanderdetermined by Incident Commander• Maintains communication between Maintains communication between

EOC and siteEOC and site• Requests and assigns resources as Requests and assigns resources as

directeddirected

Incident Commander


PlanningPlanning

• ““What’s next?”What’s next?”• Control and flow of all informationControl and flow of all information• Data collection, analysis and Data collection, analysis and

forecastingforecasting• Development of Development of responseresponse and and

recoveryrecovery objectives and strategiesobjectives and strategies• Mutual Aid requests Mutual Aid requests

Incident Commander


LogisticsLogistics

• Support OperationsSupport Operations

• Acquire and allocate resources Acquire and allocate resources and provide all materials, and provide all materials, equipment, and personal requiredequipment, and personal required

• Application of additional Application of additional resources provided by Mutual Aidresources provided by Mutual Aid

Incident Commander


FinanceFinance

• Tracking of expensesTracking of expenses

• FundingFunding

• Government Financial Aid Government Financial Aid

requestsrequests

• Financial Aid distributionFinancial Aid distribution

Incident Commander



Command


Administration

ResponseTeam(s)

Safety Information

Liaison




In fo rm ationO ffice r

L ia isonO ffice r

S a fe tyO ffice r

T a sk fo rces a ndS trike te a m s

D iv is io nS u p erv iso r



B ra n chD ire c to r






O p e ra tio nsse c tionC h ie f

U n its

P la nn ingS e ction

C h ie f

U n its

L o g is ticsS e ction

C h ie f

F in an ceS e ction

C h ie f

In c ide n tC o m m a n d er

In fo rm a tionO ffic e r

L ia is onO ffic e r

S a fe tyO ff ic e r

T a s k fo rc es a ndS trik e te a m s

D iv is io nS u p erv is o r









O p e ra tio nss e c tionC h ie f

U n its


C h ie f

U n its

L o g is t icsS e ction

C h ie f

F in an ceS e ction

C h ie f


In fo rm a tionO ff ic e r

L ia is onO ff ic e r













U n its


C h ie f

U n its


C h ie f

F in an ceS e ction

C h ie f


In form ationO fficer

L ia isonO fficer

S a fe tyO fficer


D iv is io nS u p erv isor









O p e ra tio nsse c tionC h ief

U n its


C h ief

U n its


C h ief

F in an ceS e ction

C h ief

In c ide ntC o m m a n d er

In fo rm a tionO ff ic e r

L ia is onO ff ic e r













U n its


C h ie f

U n its


C h ie f

F in an ceS e ction

C h ie f



L ia isonO fficer

S a fe tyO fficer












U n its


C h ief

U n its


C h ief

F in an ceS e ction

C h ief



L ia isonO fficer

S a fe tyO fficer












U n its


C h ief

U n its


C h ief

F in an ceS e ction

C h ief



L ia isonO fficer

S a fe tyO fficer












U n its


C h ief

U n its


C h ief

F in an ceS e ction

C h ief



L ia isonO fficer

S a fe tyO fficer












U n its


C h ief

U n its


C h ief

F in an ceS e ction

C h ief



L ia isonO fficer

S a fe tyO fficer












U n its


C h ief

U n its


C h ief

F in an ceS e ction

C h ief



L ia isonO fficer

S a fe tyO fficer












U n its


C h ief

U n its


C h ief

F in an ceS e ction

C h ief



L ia isonO fficer

S a fe tyO fficer












U n its


C h ief

U n its


C h ief

F in an ceS e ction

C h ief



L ia isonO fficer

S a fe tyO fficer












U n its


C h ief

U n its


C h ief

F in an ceS e ction

C h ief


Provincial

Regional

Local Local Local




Modular OrganizationModular Organization

• IMS model is IMS model is scaleablescaleable

• Position = Position = rolerole• One person may have several roles, One person may have several roles,

especially in smaller-scale responseespecially in smaller-scale response

• Activate Activate onlyonly those positions you those positions you

need for a given responseneed for a given response• HEICS - concept of “minimal HEICS - concept of “minimal

activation”activation”




Integrated Integrated CommunicationsCommunications

Who?Who?• Liaison Officer (in EOC)Liaison Officer (in EOC)

– Point of contact with external Point of contact with external agencies (EMS; other hospitals, agencies (EMS; other hospitals, etc.)etc.)

• Public Information Officer (in Public Information Officer (in EOC)EOC)– Deals with media / publicDeals with media / public

Integrated Integrated CommunicationsCommunications

How?How?• Ensure able to communicateEnsure able to communicate

– Established meansEstablished means• Dedicated linesDedicated lines

– Established frequenciesEstablished frequencies• Encryption!Encryption!

– BACKUP plan!BACKUP plan!




Incident Action PlanIncident Action Plan

• Part of Incident Commander’s role Part of Incident Commander’s role = development of Incident Action = development of Incident Action Plan (IAP) Plan (IAP) – AssessmentAssessment– ObjectivesObjectives– ResourcesResources– NeedsNeeds

• Constantly updated / revised based Constantly updated / revised based on new information and progress of on new information and progress of responseresponse

Incident Action PlanIncident Action Plan

• Each Section Chief (Operations, Each Section Chief (Operations,

Planning, Logistics, Finance) Planning, Logistics, Finance)

develops IAP for their areadevelops IAP for their area

– Immediate / Intermediate / ExtendedImmediate / Intermediate / Extended

• Integrates with overall IAPIntegrates with overall IAP




INCIDENT COMMANDER Job Action Sheet, Page 1 of 1

INCIDENT COMMANDER

Mission:

Organize and direct the Incident Command Center (ICC). Give overall direction for the incident response.

Immediate ____ Initiate the Incident Command System by assuming role of the Incident Commander. ____ Read this entire Job Action Sheet. ____ Appoint required Section Chiefs and distribute the: Job Action Sheets for each position Forms pertinent to Section & positions ____ Appoint Public Information Officer, Liaison Officer, and Safety and

Security Officer; distribute Job Action Sheets. ____ Conduct a size up. ____ Announce a status/action plan meeting of all Section Chiefs to be

held within 5 to 10 minutes. ____ Assign someone as Documentation Recorder/Aide. ____ Receive status report and discuss an initial action plan with

Section Chiefs. ____ Assure that contact and resource information has been

established with outside agencies through the Liaison Officer. Intermediate ____ Authorize resources as needed or requested by Section Chiefs. ____ Designate routine briefings with Section Chiefs to receive status

reports and update the incident action plan. ____ Communicate status to C.E.O of the Hospital or the designee. Extended ____ Approve media releases submitted by P.I.O. ____ Observe all staff, volunteers and patients for signs of stress and

inappropriate behavior. Provide for staff rest periods and relief. ____ Other concerns:

Job Action SheetJob Action Sheet• Role titleRole title• Reports toReports to• MissionMission• TasksTasks

– ImmediateImmediate– IntermediaIntermedia

tete– ExtendedExtended




Span of Control: Span of Control: The number of The number of subordinates that a superior can subordinates that a superior can manage manage effectivelyeffectively

• Each person responsible for a Each person responsible for a maximum of 3 to 7 subordinatesmaximum of 3 to 7 subordinates

–Ideal = Ideal = 1:51:5 command ratio command ratio

•Each person reports up to Each person reports up to oneone supervisorsupervisor

IneffectivIneffectivee

Effective







How Does This Work in How Does This Work in Real Life?Real Life?

• Incident occursIncident occurs

• NotificationNotification

– Official (eg – EMS to ED via amblance Official (eg – EMS to ED via amblance

phone)phone)

– Unofficial (ie people start showing up…!)Unofficial (ie people start showing up…!)

• On-Scene Leader (Emerg Physician / On-Scene Leader (Emerg Physician /

Nurse) becomes Incident CommanderNurse) becomes Incident Commander

Initial ResponseInitial Response

Emerg Doc or RN

Initial Response (cont’d)Initial Response (cont’d)

• Priorities and objectives establishedPriorities and objectives established

• On-site command developedOn-site command developed

• Multi agency communication establishedMulti agency communication established

• Resource needs and allocation identifiedResource needs and allocation identified

NEEDS EXCEED NEEDS EXCEED AVAILABLE AVAILABLE RESOURCESRESOURCES

The Incident The Incident Progresses…Progresses…

• Decision to initiate hospital disaster Decision to initiate hospital disaster planplan

• Fan-Out processFan-Out process– Clinical staffClinical staff– LeadershipLeadership

• Senior on-site leader assumes IC roleSenior on-site leader assumes IC role– Establishes EOC / Command Post**Establishes EOC / Command Post**– Begins to assign roles / responsibilitiesBegins to assign roles / responsibilities

• May be replaced by more senior staff May be replaced by more senior staff as they arriveas they arrive

EOC

Command Post

Hospital-Wide ResponseHospital-Wide Response

• Incident Commander appoints key Incident Commander appoints key personnelpersonnel– Four section ChiefsFour section Chiefs– Liaison / Information / SecurityLiaison / Information / Security

• Job Action Sheets distributed and Job Action Sheets distributed and checklists beginchecklists begin

• Priorities and objectives establishedPriorities and objectives established– Incident Action Plan(s) developedIncident Action Plan(s) developed

• Span(s) of control establishedSpan(s) of control established

Hospital-Wide Response Hospital-Wide Response (cont’d)(cont’d)

• Multi-agency communication Multi-agency communication establishedestablished

• Resource allocation identifiedResource allocation identified

• Tracking, Evaluation, and cost Tracking, Evaluation, and cost recovery initiatedrecovery initiated

• Off-site command established (as Off-site command established (as needed)needed)

• Information released to media / publicInformation released to media / public

SummarySummary

• IMS is a framework for emergency IMS is a framework for emergency responseresponse– IdealIdeal for health care environment for health care environment

• Many advantages:Many advantages:– Scaleable to size of eventScaleable to size of event– Common terminology / organization of Common terminology / organization of

rolesroles– Manageable span of control Manageable span of control – Task-oriented approachTask-oriented approach

• Job action sheetsJob action sheets• Incident Action PlanIncident Action Plan

Documents

Hospital Incident Management System Dan Cass MD FRCPC Chief, Emergency Medicine St. Michael’s Hospital, Toronto