Abstract
The COVID-19 pandemic has placed unprecedented demands on health systems, where hospitals have become overwhelmed with patients amidst limited resources. Disaster response and resource allocation during such crises present multiple challenges. A breakdown in communication and organization can lead to unnecessary disruptions and adverse events. The Federal Emergency Management Agency (FEMA) promotes the use of an incident command system (ICS) model during large-scale disasters, and we hope that an institutional disaster plan and ICS will help to mitigate these lapses. In this article, we describe the alignment of an emergency department (ED) specific Forward Command structure with the hospital ICS and address the challenges specific to the ED. Key components of this ICS include a hospital-wide incident command or Joint Operations Center (JOC) and an ED Forward Command. This type of structure leads to a shared mental model with division of responsibilities that allows institutional adaptations to changing environments and maintenance of specific roles for optimal coordination and communication. We present this as a model that can be applied to other hospital EDs around the country to help structure the response to the COVID-19 pandemic while remaining generalizable to other disaster situations.
Highlights
The COVID-19 pandemic has placed unprecedented demands on health systems, where hospitals have become overwhelmed with patients amidst limited resources
In the former, communication was problematic as both cellular towers and landlines stopped working; hospitals switched to using ham radios and walkie-talkies as a result.[4]
We describe the incident command system (ICS) at our institution during the COVID-19 pandemic, focusing on the unique aspect of the emergency department (ED) serving as the Forward Command, which Federal Emergency Management Agency (FEMA) defines as the location nearest to the affected area used to direct activities and coordinate field teams.[11]
Summary
The COVID-19 pandemic has placed unprecedented demands on health systems, where hospitals have become overwhelmed with patients amidst limited resources. Key components of this ICS include a hospital-wide incident command or Joint Operations Center (JOC) and an ED Forward Command This type of structure leads to a shared mental model with division of responsibilities that allows institutional adaptations to changing environments and maintenance of specific roles for optimal coordination and communication. S ignificant advances have been made in the realm of disaster preparedness over the past few decades Models and systems, such as the United States National Incident Management System (NIMS), have been created to address challenges relating to communication, resource use, and coordination of efforts.[1,2,3]. It follows that an ICS structure adapted to respond to the COVID-19 pandemic needs to include an ED component to be maximally efficient
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