Hospital Incident Management System

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Hospital Incident Management System Powered By Docstoc
					 Hospital Incident
Management System
     Dan Cass MD FRCPC
  Chief, Emergency Medicine
St. Michael’s Hospital, Toronto
                Objectives
• Outline the evolution of the Incident
  Management System (IMS) model
• Provide an overview of the principles of IMS
• Illustrate how IMS can be used as a
  framework for emergency response for
  health care institutions
• Provide some practical applications of IMS
  in the hospital setting
              What is IMS?

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

• A framework

• A tool
              Terminology
• For our purposes, all of these terms are
  interchangeable:
  – Incident Management System (IMS)
  – Incident Command System (ICS)
  – Hospital Emergency Incident Command
    System (HEICS)
Where Does IMS Come From?
               Origins of IMS
• California wildfires, 1980s – “FIRESCOPE”
  – Multiple fire agencies involved
     • Local, regional
  – Coordination of local / state / federal resources
• Many challenges…
  – Lack of common terminology / organizational
    structure / roles
  – Incompatible equipment (radios; firefighting)
              Origins of IMS
• Fire protection agencies developed common
  organizational and response structure
  – Evolved into IMS
• Deployed across California
  – Subsequently to much of USA and Canada
• Began to expand to all pre-hospital
  providers (fire / ambulance / police)
  – Eventually into hospitals
             Origins of IMS
• 1987: Hospital Council of Northern
  California
  – Adapted IMS into “Earthquake Preparedness
    Guidelines for Hospitals”
• 1991: Orange County EMS
  – Used IMS principles to develop Hospital
    Emergency Incident Command System
    (HEICS)
       Why Should We Care??
• In day-to-day operations, hospitals often
  very insular
  – “Our” procedures don’t have to be same as
    “their” procedures
  – Applies within as well as between institutions
• In mass casualty incident, we cannot
  operate in a vacuum!
  – Need way to communicate / coordinate efforts
             IMS - Components
1.   Unified command structure
2.   Common terminology
3.   Modular organization
4.   Integrated communication
5.   Consolidated action plans
6.   Job Action Sheets
7.   Manageable & sensible span of control
8.   Designated facilities
9.   Comprehensive resource management
             IMS - Components
1.   Unified command structure
2.   Common terminology
3.   Modular organization
4.   Integrated communication
5.   Consolidated action plans
6.   Job Action Sheets
7.   Manageable & sensible span of control
8.   Designated facilities
9.   Comprehensive resource management
             IMS Structure

                        Command




                                            Finance /
Operations   Planning         Logistics
                                          Administration
                IMS Structure

                        Command




                                                Finance /
Operations   Planning             Logistics
                                              Administration




  Doers      Thinkers             Getters        Payers
  Incident Command
                                                  Incident Commander




                                  Operations   Planning        Logistics   Finance




• Directs activities of personnel in Emergency
  Operations Centre (EOC)
• Most senior trained responder
   – In hospital model, may start as on-duty Emergency
     Physician or Charge Nurse
• As response progresses, IC position may be “handed
  off” to more senior person
                                        Incident Commander



        Operations
                        Operations   Planning       Logistics   Finance




• Directs “front-line” response to event
• Implements response activities as determined
  by Incident Commander
• Maintains communication between EOC and
  site
• Requests and assigns resources as directed
       Planning
                                      Incident Commander




                       Operations   Planning      Logistics   Finance




• “What’s next?”
• Control and flow of all information
• Data collection, analysis and forecasting
• Development of response and recovery
  objectives and strategies
• Mutual Aid requests
        Logistics
                                         Incident Commander




                          Operations   Planning      Logistics   Finance




• Support Operations
• Acquire and allocate resources and provide
  all materials, equipment, and personal
  required
• Application of additional resources provided
  by Mutual Aid
         Finance
                                          Incident Commander




                         Operations   Planning       Logistics   Finance




• Tracking of expenses
• Funding
• Government Financial Aid requests
• Financial Aid distribution
             IMS Structure
                       Command

             Safety          Information


             Liaison


                                             Finance /
Operations    Planning       Logistics
                                           Administration

Response
 Team(s)
             IMS - Components
1.   Unified command structure
2.   Common terminology
3.   Modular organization
4.   Integrated communication
5.   Consolidated action plans
6.   Job Action Sheets
7.   Manageable & sensible span of control
8.   Designated facilities
9.   Comprehensive resource management
                                                                                                                                                                                                                                                                                                                                                                                                                                                   Provincial
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           Incident
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         Commander

                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               Information                                           Liaison
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  Officer                                            Officer


                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     Safety
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     Officer



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


                                                                                                                                                                                                                                                                                                                                                                                                                                Branch                                                                          Branch                                           Units                                           Units
                                                                                                                                                                                                                                                                                                                                                                                                                                Director                                                                        Director


                                                                                                                                                                                                                                                                                                                                                                                                       Division                                Division                             Division                                             Division
                                                                                                                                                                                                                                                                                                                                                                                                      Supervisor                              Supervisor                           Supervisor                                           Supervisor


                                                                                                                                                                                                                                                                                                                                                                                            Task forces and                                Task forces and                   Task forces and                                     Task forces and
                                                                                                                                                                                                                                                                                                                                                                                             Strike teams                                   Strike teams                      Strike teams                                        Strike teams




                                                                                                                                                                                                                                                                                                                                                                                                                                                         Regional


                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    Incident                                                                                                                                                                                                                                                                                                                                Incident
                                                                                                                                                                            Incident                                                                                                                                                                                                                                                                                                                                              Commander                                                                                                                                                                                                                                                                                                                               Commander
                                                                                                                                                                          Commander
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             Information                             Liaison                                                                                                                                                                                                                                                                                            Information                                      Liaison
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                Officer                              Officer                                                                                                                                                                                                                                                                                               Officer                                       Officer
                                                                                                                                                    Information                                     Liaison
                                                                                                                                                       Officer                                      Officer
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               Safety                                                                                                                                                                                                                                                                                                                                     Safety
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               Officer                                                                                                                                                                                                                                                                                                                                    Officer
                                                                                                                                                        Safety
                                                                                                                                                        Officer
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                Operations                                                                Planning                             Logistics                                Finance                                                                                                                                                                        Operations                                                                           Planning                Logistics                            Finance
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 section                                                                  Section                              Section                                  Section                                                                                                                                                                         section                                                                             Section                 Section                              Section
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  Chief                                                                     Chief                               Chief                                    Chief                                                                                                                                                                           Chief                                                                                Chief                  Chief                                Chief
                                                                                                                     Operations                                                                        Planning                    Logistics                                  Finance
                                                                                                                      section                                                                          Section                     Section                                    Section
                                                                                                                       Chief                                                                             Chief                      Chief                                      Chief                                                                                                                                                              Branch                                                                   Branch                             Units                                  Units                                                                                                                                                                                      Branch                                                             Branch                                    Units                   Units
                                                                                                                                                                                                                                                                                                                                                                                                                                                  Director                                                                 Director                                                                                                                                                                                                                                                             Director                                                           Director

                                                                                             Branch                                                                 Branch                                Units                       Units
                                                                                                                                                                                                                                                                                                                                                                                                                                    Division                  Division                                Division                                 Division                                                                                                                                                                                                                           Division                   Division                          Division                                 Division
                                                                                             Director                                                               Director                                                                                                                                                                                                                                                       Supervisor                Supervisor                              Supervisor                               Supervisor                                                                                                                                                                                                                         Supervisor                 Supervisor                        Supervisor                               Supervisor


                                                                                Division                 Division                              Division                                 Division                                                                                                                                                                                                                                 Task forces and         Task forces and                       Task forces and                         Task forces and                                                                                                                                                                                                                       Task forces and           Task forces and                 Task forces and                          Task forces and
                                                                               Supervisor               Supervisor                            Supervisor                               Supervisor                                                                                                                                                                                                                                 Strike teams            Strike teams                          Strike teams                            Strike teams                                                                                                                                                                                                                          Strike teams              Strike teams                    Strike teams                             Strike teams


                                                                        Task forces and            Task forces and                      Task forces and                           Task forces and
                                                                         Strike teams               Strike teams                         Strike teams                              Strike teams




                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               Local                                                                                                                                                                                                                                                                                                                      Local
                                                                                                                                  Local

                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     Incident
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   Commander

                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       Information              Liaison
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          Officer               Officer
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           Incident                                                                                                    Incident                                                                                                        Incident                                                                                                               Incident
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         Commander                                                                                                   Commander                                                                                                       Commander                                                                                                              Commander
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         Safety
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             Information              Liaison                                                                            Information              Liaison                                                                                Information              Liaison                                                                                       Information               Liaison                                                                                        Officer
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                Officer               Officer                                                                               Officer               Officer                                                                                   Officer               Officer                                                                                          Officer                Officer
                                                             Incident                                                                                                     Incident                                                                                                       Incident                                                                                                     Incident
                                                           Commander                                                                                                    Commander                                                                                                      Commander                                                                                                    Commander
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               Safety                                                                                                      Safety                                                                                                          Safety                                                                                                                 Safety                                                                                                  Operations                               Planning    Logistics   Finance
                                               Information              Liaison                                                                             Information              Liaison                                                                               Information              Liaison                                                                             Information              Liaison                                                                                       Officer                                                                                                     Officer                                                                                                         Officer                                                                                                                Officer                                                                                                  section                                 Section     Section     Section
                                                  Officer               Officer                                                                                Officer               Officer                                                                                  Officer               Officer                                                                                Officer               Officer                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    Chief                                    Chief      Chief       Chief


                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                Operations                               Planning    Logistics        Finance                               Operations                               Planning       Logistics   Finance                                     Operations                               Planning       Logistics     Finance                                          Operations                                Planning         Logistics   Finance                      Branch                                  Branch                  Units    Units
                                                 Safety                                                                                                       Safety                                                                                                         Safety                                                                                                       Safety
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 section                                 Section     Section          Section                                section                                 Section        Section     Section                                      section                                 Section        Section       Section                                           section                                  Section          Section     Section                      Director                                Director
                                                 Officer                                                                                                      Officer                                                                                                        Officer                                                                                                      Officer
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  Chief                                    Chief      Chief            Chief                                  Chief                                    Chief         Chief       Chief                                        Chief                                    Chief         Chief         Chief                                             Chief                                     Chief           Chief       Chief

                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           Division                Division        Division                Division
                                                                                                                                                                                                                                                                                                                                                                                                                                                                             Branch                                  Branch                  Units    Units                              Branch                                  Branch                  Units       Units                               Branch                                  Branch                  Units       Units                                      Branch                                   Branch                  Units         Units                      Supervisor              Supervisor      Supervisor              Supervisor
                                  Operations                               Planning    Logistics   Finance                                     Operations                               Planning      Logistics   Finance                                     Operations                               Planning    Logistics   Finance                                     Operations                               Planning      Logistics    Finance
                                   section                                 Section     Section     Section                                      section                                 Section       Section     Section                                      section                                 Section     Section     Section                                      section                                 Section       Section      Section                       Director                                Director                                                            Director                                Director                                                                Director                                Director                                                                       Director                                 Director
                                    Chief                                    Chief      Chief       Chief                                        Chief                                    Chief        Chief       Chief                                        Chief                                    Chief      Chief       Chief                                        Chief                                    Chief        Chief        Chief
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        Task forces and     Task forces and     Task forces and      Task forces and
                                                                                                                                                                                                                                                                                                                                                                                                                                                                 Division                Division        Division                Division                                    Division                Division        Division                Division                                        Division                Division        Division                Division                                               Division                Division         Division                Division                                            Strike teams        Strike teams        Strike teams         Strike teams
               Branch                                  Branch                  Units    Units                               Branch                                  Branch                  Units      Units                               Branch                                  Branch                  Units    Units                               Branch                                  Branch                  Units      Units                        Supervisor              Supervisor      Supervisor              Supervisor                                  Supervisor              Supervisor      Supervisor              Supervisor                                      Supervisor              Supervisor      Supervisor              Supervisor                                             Supervisor              Supervisor       Supervisor              Supervisor
               Director                                Director                                                             Director                                Director                                                               Director                                Director                                                             Director                                Director

                                                                                                                                                                                                                                                                                                                                                                                                                                                              Task forces and     Task forces and     Task forces and      Task forces and                               Task forces and      Task forces and     Task forces and      Task forces and                                    Task forces and     Task forces and     Task forces and      Task forces and                                           Task forces and     Task forces and      Task forces and     Task forces and
   Division                Division        Division                Division                                     Division                Division        Division                Division                                       Division                Division        Division                Division                                     Division                Division        Division                Division                                           Strike teams        Strike teams        Strike teams         Strike teams                                  Strike teams         Strike teams        Strike teams         Strike teams                                       Strike teams        Strike teams        Strike teams         Strike teams                                              Strike teams        Strike teams         Strike teams        Strike teams
  Supervisor              Supervisor      Supervisor              Supervisor                                   Supervisor              Supervisor      Supervisor              Supervisor                                     Supervisor              Supervisor      Supervisor              Supervisor                                   Supervisor              Supervisor      Supervisor              Supervisor


Task forces and     Task forces and     Task forces and      Task forces and                                 Task forces and     Task forces and     Task forces and      Task forces and                                   Task forces and     Task forces and     Task forces and      Task forces and                                 Task forces and     Task forces and     Task forces and      Task forces and
 Strike teams        Strike teams        Strike teams         Strike teams                                    Strike teams        Strike teams        Strike teams         Strike teams                                      Strike teams        Strike teams        Strike teams         Strike teams                                    Strike teams        Strike teams        Strike teams         Strike teams
             IMS - Components
1.   Unified command structure
2.   Common terminology
3.   Modular organization
4.   Integrated communication
5.   Consolidated action plans
6.   Job Action Sheets
7.   Manageable & sensible span of control
8.   Designated facilities
9.   Comprehensive resource management
         Modular Organization
• IMS model is scaleable
• Position = role
   • One person may have several roles, especially in
     smaller-scale response
• Activate only those positions you need for a
  given response
   • HEICS - concept of “minimal activation”
             IMS - Components
1.   Unified command structure
2.   Common terminology
3.   Modular organization
4.   Integrated communication
5.   Consolidated action plans
6.   Job Action Sheets
7.   Manageable & sensible span of control
8.   Designated facilities
9.   Comprehensive resource management
   Integrated Communications
Who?
• Liaison Officer (in EOC)
  – Point of contact with external agencies (EMS;
    other hospitals, etc.)


• Public Information Officer (in EOC)
  – Deals with media / public
   Integrated Communications
How?
• Ensure able to communicate
  – Established means
    • Dedicated lines
  – Established frequencies
    • Encryption!
  – BACKUP plan!
             IMS - Components
1.   Unified command structure
2.   Common terminology
3.   Modular organization
4.   Integrated communication
5.   Consolidated action plans
6.   Job Action Sheets
7.   Manageable & sensible span of control
8.   Designated facilities
9.   Comprehensive resource management
         Incident Action Plan
• Part of Incident Commander’s role =
  development of Incident Action Plan (IAP)
  –   Assessment
  –   Objectives
  –   Resources
  –   Needs
• Constantly updated / revised based on new
  information and progress of response
          Incident Action Plan

• Each Section Chief (Operations, Planning,

  Logistics, Finance) develops IAP for their area

  – Immediate / Intermediate / Extended

• Integrates with overall IAP
             IMS - Components
1.   Unified command structure
2.   Common terminology
3.   Modular organization
4.   Integrated communication
5.   Consolidated action plans
6.   Job Action Sheets
7.   Manageable & sensible span of control
8.   Designated facilities
9.   Comprehensive resource management
                Job Action Sheet
                      INCIDENT COMMANDER
                      Job Action Sheet, Page 1 of 1

•   Role title                                        INCIDENT COMMANDER


•   Reports to        Mission:
                                      Organize and direct the Incident Command Center (ICC). Give overall
                                      direction for the incident response.


•   Mission           Immediate       ____ Initiate the Incident Command System by assuming role of the
                                      Incident Commander.
                                      ____ Read this entire Job Action Sheet.

•   Tasks                             ____ Appoint required Section Chiefs and distribute the:
                                           Job Action Sheets for each position
                                           Forms pertinent to Section & positions


     – Immediate
                                      ____ 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

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

     – Extended                       ____ 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:
             IMS - Components
1.   Unified command structure
2.   Common terminology
3.   Modular organization
4.   Integrated communication
5.   Consolidated action plans
6.   Job Action Sheets
7.   Manageable & sensible span of control
8.   Designated facilities
9.   Comprehensive resource management
Span of Control: The number of subordinates
that a superior can manage effectively




   Ineffective                   Effective

• Each person responsible for a maximum of 3
to 7 subordinates
   –Ideal = 1:5 command ratio
•Each person reports up to one supervisor
             IMS - Components
1.   Unified command structure
2.   Common terminology
3.   Modular organization
4.   Integrated communication
5.   Consolidated action plans
6.   Job Action Sheets
7.   Manageable & sensible span of control
8.   Designated facilities
9.   Comprehensive resource management
             IMS - Components
1.   Unified command structure
2.   Common terminology
3.   Modular organization
4.   Integrated communication
5.   Consolidated action plans
6.   Job Action Sheets
7.   Manageable & sensible span of control
8.   Designated facilities
9.   Comprehensive resource management
How Does This Work in Real Life?
• Incident occurs
• Notification
  – Official (eg – EMS to ED via amblance phone)
  – Unofficial (ie people start showing up…!)

• On-Scene Leader (Emerg Physician /
 Nurse) becomes Incident Commander
Initial Response


    Emerg Doc or RN
      Initial Response (cont’d)

• Priorities and objectives established
• On-site command developed
• Multi agency communication established
• Resource needs and allocation identified
          NEEDS EXCEED
       AVAILABLE RESOURCES
     The Incident Progresses…
• Decision to initiate hospital disaster plan
• Fan-Out process
  – Clinical staff
  – Leadership
• Senior on-site leader assumes IC role
  – Establishes EOC / Command Post**
  – Begins to assign roles / responsibilities
• May be replaced by more senior staff as they
  arrive
EOC



Command
  Post
      Hospital-Wide Response
• Incident Commander appoints key personnel
  – Four section Chiefs
  – Liaison / Information / Security
• Job Action Sheets distributed and checklists
  begin
• Priorities and objectives established
  – Incident Action Plan(s) developed
• Span(s) of control established
Hospital-Wide Response (cont’d)

• Multi-agency communication established
• Resource allocation identified
• Tracking, Evaluation, and cost recovery
  initiated
• Off-site command established (as needed)
• Information released to media / public
                     Summary
• IMS is a framework for emergency response
  – Ideal for health care environment
• 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