Hospital Incident Management System

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					                                                                    Objectives
   Hospital Incident Management
                                                 • Provide an overview of the principles of the Incident
               System                              Management System (IMS) model
                                                 • Illustrate how IMS can be used as a framework for
                Daniel Kollek MD                   emergency response for health care institutions,
                  Dan Cass MD                      including application during a pandemic
              Centre for Excellence in           • Provide some practical examples of IMS in the hospital
             Emergency Preparedness                setting




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                What is IMS?                                        Terminology

• A way of creating (some!) order out of chaos    • For our purposes, all of these terms are
                                                    interchangeable:
• A framework
                                                     – Incident Management System (IMS)

• A tool                                             – Incident Command System (ICS)
                                                     – Hospital Emergency Incident Command
                                                       System (HICS)


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              Origins of IMS                                             Origins of IMS

• California wildfires, 1980s – “FIRESCOPE”               • Fire protection agencies developed common
  – Multiple fire agencies involved                         organizational and response structure
      • Local, regional                                      – Evolved into IMS
  – Coordination of local / state / federal               • Deployed across California
    resources
                                                             – Subsequently to much of USA and Canada
• Many challenges…
                                                          • Began to expand to all pre-hospital providers
  – Lack of common terminology /
                                                            (fire / ambulance / police)
    organizational structure / roles
  – Incompatible equipment (radios; firefighting)            – Eventually into hospitals (HICS)

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      Why Should We Care??                                              IMS - Components
                                                          1.   Unified command structure
• In day-to-day operations, hospitals often very          2.   Common terminology
  insular                                                 3.   Modular organization
   – “Our” procedures don’t have to be same as            4.   Integrated communication
     “their” procedures
                                                          5.   Consolidated action plans
   – Applies within as well as between institutions
                                                          6.   Job Action Sheets
• In mass casualty incident, we cannot operate in a
  vacuum!                                                 7.   Manageable & sensible span of control
   – Need way to communicate / coordinate efforts         8.   Designated facilities
                                                          9.   Comprehensive resource management
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                                                                                                                2
             IMS - Components                                           IMS Structure
1.   Unified command structure
2.   Common terminology                                                            Command
3.   Modular organization
4.   Integrated communication
                                                                                                        Finance/
5.   Consolidated action plans                             Operations    Planning       Logistics
                                                                                                      Administration
6.   Job Action Sheets
7.   Manageable & sensible span of control
8.   Designated facilities
9.   Comprehensive resource management
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              IMS Structure                                             IMS Structure
                                                                                  Command
                       Command
                                                                        Safety
                                                                                        Information
                                          Finance/
Operations      Planning    Logistics                                   Liaison
                                        Administration

                                                           Operations   Planning        Logistics     Finance/
                                                                                                      Administration
     Doers      Thinkers     Getters         Payers



                                                      11                                                        12




                                                                                                                       3
                                                                                                                                              Manageable and Sensible Span of control




                                                                                                                                                                                        Provincial
                                                                                                                                                                                         Provincial
             IMS - Components                                                                                                                                                              Information
                                                                                                                                                                                              Officer
                                                                                                                                                                                                               Incident
                                                                                                                                                                                                              Commander
                                                                                                                                                                                                                       Liaison
                                                                                                                                                                                                                       Officer


                                                                                                                                                                                                Safety



1.   Unified command structure
                                                                                                                                                                                                Officer

                                                                                                                                                                            Operations                                 Planning         Logistics          Finance
                                                                                                                                                                             Section                                    Section         Section            Section
                                                                                                                                                                              Chief                                      Chief           Chief              Chief

                                                                                                                                                                Branch                   Branch



2.   Common terminology
                                                                                                                                                                Director                 Director                     Units                      Units
                                                                                                                                                    Division             Division Division             Division
                                                                                                                                                   Supervisor           Supervisor Supervisor         Supervisor

                                                                                                                                          Task Forces           Task Forces         Task Forces               Task Forces



3.   Modular organization
                                                                                                                                          And Strike            And Strike          And Strike                And Strike
                                                                                                                                            Teams                 Teams               Teams                     Teams




4.   Integrated communication                                                                                                                                                              Regional
                                                                                                                                                                                           Regional
                                                                                                                                                                                                             Incident



5.   Consolidated action plans
                                                                                                                                                                                                            Commander
                                                                                                 Incident                                                                                        Information          Liaison                                                                                   Incident
                                                                                                Commander                                                                                           Officer           Officer                                                                                  Commander
                                                                                     Information          Liaison                                                                                                                                                                                    Information         Liaison
                                                                                        Officer           Officer                                                                                   Safety                                                                                              Officer          Officer
                                                                                                                                                                                                    Officer
                                                                                          Safety                                                                                                                                                                                                        Safety



6.   Job Action Sheets
                                                                                          Officer                                                                                        Operations                Planning      Logistics       Finance                                                Officer
                                                                                                                                                                                          Section                   Section      Section         Section
                                                                               Operations             Planning   Logistics      Finance                                                                                                                                                       Operations               Planning   Logistics      Finance
                                                                                                                                                                                           Chief                     Chief        Chief           Chief
                                                                                Section                Section   Section        Section                                                                                                                                                        Section                  Section   Section        Section
                                                                                 Chief                  Chief     Chief          Chief                                          Branch            Branch                                                                                        Chief                    Chief     Chief          Chief
                                                                                                                                                                                Director          Director
                                                                         Branch          Branch                                                                                                                     Units            Units                                             Branch         Branch



7.   Manageable & sensible span of control
                                                                         Director        Director                                                                  Division      Division Division            Division                                                                 Director       Director
                                                                                                       Units            Units                                                   Supervisor Supervisor                                                                                                                   Units            Units
                                                                      Division Division                                                                           Supervisor                                 Supervisor                                                                 Division Division
                                                        Division                                 Division                                                                                                                                                                  Division                               Division
                                                       Supervisor    Supervisor Supervisor      Supervisor                                                                                                                                                                Supervisor   Supervisor Supervisor     Supervisor
                                                                                                                                                                Task Forces               Task ForcesTask Forces
                                                                                                                                                                                Task Forces
                                                                                                                                                                And Strike      And Strike And Strike And Strike
                                                      Task Forces                         Task Forces
                                                                     Task ForcesTask Forces                                                                                                                                                                              Task Forces             Task ForcesTask Forces
                                                                                                                                                                                                                                                                                       Task Forces



8.   Designated facilities
                                                                                                                                                                  Teams           Teams     Teams      Teams
                                                      And Strike     And Strike And Strike And Strike                                                                                                                                                                    And Strike    And Strike And Strike And Strike
                                                        Teams          Teams      Teams     Teams                                                                                                                                                                          Teams         Teams     Teams      Teams




                                                                                Local                                                                                                        Local
9.   Comprehensive resource management                                                                                                                                                                                                                                                  Local

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             IMS - Components                                                                                            Modular Organization
1.   Unified command structure
2.   Common terminology                                          •                  IMS model is scaleable
3.   Modular organization                                                           •               Activate only those positions you need for a given
4.   Integrated communication                                                                       response
                                                                                    •               HICS - concept of “minimal activation”
5.   Consolidated action plans
                                                                 •                  Position = role
6.   Job Action Sheets
                                                                                    •               One person may have several roles, especially in smaller-
7.   Manageable & sensible span of control
                                                                                                    scale response
8.   Designated facilities                                                          •               Person filling role may change as more senior staff arrive
9.   Comprehensive resource management

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             IMS - Components                          Integrated Communications
1.   Unified command structure
2.   Common terminology
3.   Modular organization                         Who?
4.   Integrated communication                     • Liaison Officer (in EOC)
5.   Consolidated action plans                       – Point of contact with external agencies
                                                       (EMS; other hospitals, etc.)
6.   Job Action Sheets
7.   Manageable & sensible span of control
                                                  • Public Information Officer (in EOC)
8.   Designated facilities
                                                     – Deals with media / public
9.   Comprehensive resource management

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     Integrated Communications                                   IMS - Components
                                                  1.   Unified command structure
How?                                              2.   Common terminology
• Ensure able to communicate                      3.   Modular organization
   – Established means                            4.   Integrated communication
      • Dedicated lines                           5.   Consolidated action plans
   – Established frequencies                      6.   Job Action Sheets
      • Encryption!                               7.   Manageable & sensible span of control
   – BACKUP plan!                                 8.   Designated facilities
                                                  9.   Comprehensive resource management

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                                                                                                      5
             Incident Action Plan                                            Incident Action Plan
•   Part of Incident Commander’s role = development of
    Incident Action Plan (IAP)
                                                             • Each Section Chief (Operations, Planning,
     – Assessment
                                                                  Logistics, Finance) develops IAP for their
     – Objectives
     – Resources
                                                                  area
     – Needs
•   Constantly updated / revised based on new information
                                                                  – Immediate / Intermediate / Extended
    and progress of response

                                                             • Integrates with overall IAP
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                                                                                                   Job Action Sheet




                                                             Job Action Sheet
                                                                                   OPERATIONS LEAD (OL)
                 IMS - Components                             •   Role title       Emergency Response Function
    1.   Unified command structure                            •   Reports to       Checklist
    2.   Common terminology                                   •   Mission          Reports to: Public Health Manager
    3.   Modular organization
                                                              •   Tasks
                                                                                   (IM)
                                                                  – Immediate
    4.   Integrated communication                                 – Intermediate
                                                                                   Overall responsibility: To manage
    5.   Consolidated action plans                                – Extended       TPH overall response operations as
                                                                                   applicable to the event.
    6.   Job Action Sheets                                                         Immediate: (Tasks to be completed upon assuming the role)
                                                                                   Obtain a full briefing of the incident and obtain appropriate function checklists and
    7.   Manageable & sensible span of control                                     any pertinent forms.
                                                                                   Participate in developing objectives and strategies for the Incident Action Plan.

    8.   Designated facilities                                                     Assist in determining appropriate resources for Operations function to initiate the
                                                                                   response.
                                                                                   Intermediate: (Tasks to be completed after the immediate tasks are addressed)
    9.   Comprehensive resource management                                         Brief all Operations sub-function leads on current situations and add or delete
                                                                                   tasks to corresponding Function Checklists as appropriate.
                                                                                   Maintain communications with field operations staff through each sub-function
                                                                                   lead in each established operational sub-function (eg: hotline, case management
                                                        23                         and contact tracing).                                                      24
                                                                                   Coordinate on-site resources and equipment.
                                                                                   Monitor operations function to achieve objectives- requires t resources as needed
                                                                                   through M.
                                                                                   Ensure staff assigned to operations is aware of potential hazards and appropriate
                                                                                   precautionary and/or take appropriate measures, wear personal protective
                                                                                   equipment provided and have obtained training.
                                                                                   Extended:
                                                                                   Observe staff for signs of stress and report concerns to operations-psychosocial
                                                                                   intervention.
                                                                                   Ensure rest periods and relief for staff.
                                                                                   Prepare end of shift briefing and update for backup Operations lead.
                                                                                                                                                                           6
                                                                                   Plan for the possibility of extended deployment.
                                                                                   Attend meetings designated by IM as part of the emergency planning cycle.
                                                                                   Monitor and review work progress of operations sub-functions.
                                                                                   Routinely update Operations sub-function leads on the status of the incident.
                                                                                   Maintain communications with other function leads eg: Liaison, planning.
                                                                                   Verify that operations staff is performing work safely.
                                                Job Action Sheet




Job Action Sheet
                             Immediate: (Tasks to be completed upon assuming the role)
                             Obtain a full briefing of the incident and obtain appropriate function checklists and any pertinent
                             forms.
                                                                                                                                                IMS - Components
                             Participate in developing objectives and strategies for the Incident Action Plan.
                             Assist in determining appropriate resources for Operations function to initiate the response.
                                                                                                                                   1.   Unified command structure
• Tasks          Intermediate: (Tasks to be completed after the immediate tasks are addressed)                                     2.   Common terminology
                 Brief all Operations sub-function leads on current situations and add or delete tasks to corresponding
  – Immediate Function Checklists as appropriate.
                 Maintain communications with field operations staff through each sub-function lead in each                        3.   Modular organization
  – Intermediate established operational sub-function (eg: hotline, case management and contact tracing).
  – Extended
                 Coordinate on-site resources and equipment.
                 Monitor operations function to achieve objectives- requires t resources as needed through M.                      4.   Integrated communication
                             Ensure staff assigned to operations is aware of potential hazards and appropriate precautionary
                             and/or take appropriate measures, wear personal protective equipment provided and have obtained
                             training.
                                                                                                                                   5.   Consolidated action plans
                             Extended:                                                                                             6.   Job Action Sheets
                             Observe staff for signs of stress and report concerns to operations-psychosocial intervention.
                             Ensure rest periods and relief for staff.
                             Prepare end of shift briefing and update for backup Operations lead.                                  7.   Manageable & sensible span of control
                             Plan for the possibility of extended deployment.
                             Attend meetings designated by IM as part of the emergency planning cycle.
                             Monitor and review work progress of operations sub-functions.
                                                                                                                                   8.   Designated facilities
                             Routinely update Operations sub-function leads on the status of the incident.
                             Maintain communications with other function leads eg: Liaison, planning.                              9.   Comprehensive resource management
                             Verify that operations staff is performing work safely.
                             Repot regularly to the incident manager.
                             Forward all expense claims to Finance-Administrations.
                             Maintain appropriate documentation (function/service log).
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    Span of Control: The number of subordinates that a
    superior can manage effectively
                                                                                                                                                IMS - Components
                                                                                                                                   1.   Unified command structure
                                                                                                                                   2.   Common terminology
                                                                                                                                   3.   Modular organization
                                                                                                                                   4.   Integrated communication
                   Ineffective                                                          Effective
                                                                                                                                   5.   Consolidated action plans
          • Each person responsible for a maximum                                                                                  6.   Job Action Sheets
          of 3 to 7 subordinates                                                                                                   7.   Manageable & sensible span of control
             –Ideal = 1:5 command ratio                                                                                            8.   Designated facilities
          •Each person reports up to one supervisor                                                                                9.   Comprehensive resource management

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                                                                                                                                                                                     7
             IMS - Components
 1.   Unified command structure
 2.   Common terminology
 3.   Modular organization                              How Does This
 4.   Integrated communication
 5.   Consolidated action plans                        Work in Real Life?
 6.   Job Action Sheets
 7.   Manageable & sensible span of control
 8.   Designated facilities
 9.   Comprehensive resource management

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                      Summary
• IMS is a framework for emergency response
   – Ideal for health care environment
   – Can work for short or long-term responses
• Many advantages:
   – Scaleable to size of event
   – Common terminology / organization of roles
   – Manageable span of control
   – Task-oriented approach
       • Job action sheets
       • Incident Action Plan


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