Hospital Incident Command System Research Articles

6. Coordination and control

Any complex operation requires a system for management. In most societies, disaster management is the responsibility of the government. Coordination and control is a system that provides the oversight for all of the disaster management functions. The roles and responsibilities of a coordination and control centre include: (1) planning; (2) maintenance of inventories; (3) activation of the disaster response plan; (4) application of indicators of function; (5) surveillance; (6) information management; (7) coordination of activities of the BSFs; (8) decision-making; (9) priority setting; (10) defining overarching goal and objectives for interventions; (11) applying indicators of effectiveness; (12) applying indicators of benefit and impact; (13) exercising authority; (14) managing resources; (15) initiating actions; (16) preventing influx of unneeded resources; (17) defining progress; (18) providing information; (19) liasing with responding organisations; and (20) providing quality assurance. Coordination and control is impossible without communications. To accomplish coordination and control, three factors must be present: (1) mandate; (2) power and authority; and (3) available resources. Coordination and control is responsible for the evaluation of the effectiveness and benefits/impacts of all interventions. Coordination and control centres (CCCs) are organised hierarchically from the on-scene CCCs (incident command) to local provincial to national CCCs. Currently, no comprehensive regional and international CCCs have been universally endorsed. Systems such as the incident command system, the unified command system, and the hospital incident command system are described as are the humanitarian reform movement and the importance of coordination and control in disaster planning and preparedness.

Health care system hazard vulnerability analysis: an assessment of all public hospitals in Abu Dhabi

Hazard vulnerability analysis (HVA) is used to risk-stratify potential threats, measure the probability of those threats, and guide disaster preparedness. The primary objective of this project was to analyse the level of disaster preparedness in public hospitals in the Emirate of Abu Dhabi, utilising the HVA tool in collaboration with the Disaster Medicine Section at Harvard Medical School. The secondary objective was to review each facility's disaster plan and make recommendations based on the HVA findings. Based on the review, this article makes eight observations, including on the need for more accurate data; better hazard assessment capabilities; enhanced decontamination capacities; and the development of hospital-specific emergency management programmes, a hospital incident command system, and a centralised, dedicated regional disaster coordination centre. With this project, HVAs were conducted successfully for the first time in health care facilities in Abu Dhabi. This study thus serves as another successful example of multidisciplinary emergency preparedness processes.

Marathon Day at Massachusetts General

An emergency medicine physician discusses how being prepared helped him and his colleagues save lives after the Boston Marathon bombing.

Hospital incident command system (HICS) performance in Iran; decision making during disasters

BackgroundHospitals are cornerstones for health care in a community and must continue to function in the face of a disaster. The Hospital Incident Command System (HICS) is a method by which the hospital operates when an emergency is declared. Hospitals are often ill equipped to evaluate the strengths and vulnerabilities of their own management systems before the occurrence of an actual disaster. The main objective of this study was to measure the decision making performance according to HICS job actions sheets using tabletop exercises.MethodsThis observational study was conducted between May 1st 2008 and August 31st 2009. Twenty three Iranian hospitals were included. A tabletop exercise was developed for each hospital which in turn was based on the highest probable risk. The job action sheets of the HICS were used as measurements of performance. Each indicator was considered as 1, 2 or 3 in accordance with the HICS. Fair performance was determined as < 40%; intermediate as 41-70%; high as 71-100% of the maximum score of 192. Descriptive statistics, T-test, and Univariate Analysis of Variance were used.ResultsNone of the participating hospitals had a hospital disaster management plan. The performance according to HICS was intermediate for 83% (n = 19) of the participating hospitals. No hospital had a high level of performance. The performance level for the individual sections was intermediate or fair, except for the logistic and finance sections which demonstrated a higher level of performance. The public hospitals had overall higher performances than university hospitals (P = 0.04).ConclusionsThe decision making performance in the Iranian hospitals, as measured during table top exercises and using the indicators proposed by HICS was intermediate to poor. In addition, this study demonstrates that the HICS job action sheets can be used as a template for measuring the hospital response. Simulations can be used to assess preparedness, but the correlation with outcome remains to be studied.

The Pediatric Hospital Incident Command System: An Innovative Approach to Hospital Emergency Management

The Pediatric Hospital Incident Command System: An Innovative Approach to Hospital Emergency Management

Allocating Scarce Resources in Disasters: Emergency Department Principles

Decisions about medical resource triage during disasters require a planned structured approach, with foundational elements of goals, ethical principles, concepts of operations for reactive and proactive triage, and decision tools understood by the physicians and staff before an incident. Though emergency physicians are often on the front lines of disaster situations, too often they have not considered how they should modify their decisionmaking or use of resources to allow the "greatest good for the greatest number" to be accomplished. This article reviews key concepts from the disaster literature, providing the emergency physician with a framework of ethical and operational principles on which medical interventions provided may be adjusted according to demand and the resources available. Incidents may require a range of responses from an institution and providers, from conventional (maximal use of usual space, staff, and supplies) to contingency (use of other patient care areas and resources to provide functionally equivalent care) and crisis (adjusting care provided to the resources available when usual care cannot be provided). This continuum is defined and may be helpful when determining the scope of response and assistance necessary in an incident. A range of strategies is reviewed that can be implemented when there is a resource shortfall. The resource and staff requirements of specific incident types (trauma, burn incidents) are briefly considered, providing additional preparedness and decisionmaking tactics to the emergency provider. It is difficult to think about delivering medical care under austere conditions. Preparation and understanding of the decisions required and the objectives, strategies, and tactics available can result in better-informed decisions during an event. In turn, adherence to such a response framework can yield thoughtful stewardship of resources and improved outcomes for a larger number of patients.

Assessment of Hospital Emergency Management in the Beijing Area

In recent years, the number of public health emergencies has increased. Improving hospital emergency management is an important challenge. This is a pilot study intended to assess hospital emergency management in the Beijing area, make recommendations to government health authorities and hospital managers, and offer references for similar studies. This was an observational, cross-sectional survey. Forty-five hospitals in the Beijing area were selected randomly. A self-administered questionnaire was used as a data collection tool. It comprised of three sections: (1) Section A was the introduction; (2) Section B asked for the respondent's personal information; and (3) Section C comprised the major part of the questionnaire and was intended to gather information regarding the hospital's general emergency management situation. The survey response rate was 44%, accounting for 29% of total hospitals that the study targeted. No hospital had an established emergency management department or full-time staff for emergency management. A total of 15-45% of the hospitals had established a hospital emergency management committee, performed a vulnerability analysis, or evaluated emergency management regularly. Twenty-five percent of respondents thought that the local government health authority had established an integrated hospital incident command system. A total of 40%-55% of hospitals contracted with outside institutions for supplements, backup of key functional systems and professional support. After the occurrence of the 2003 severe acute respiratory syndrome (SARS) epidemic, Chinese hospital managers took many measures to improve hospital resilience. However, most of these efforts lacked the guidance of theories, concepts, principles, and methods. An integrated, standardized, operational hospital emergency management model has not been established. Although the survey response rate was relatively low, some clues for further study were discovered, and suggestions to the health authority for hospital emergency management improvement were revealed.

Apply hospital incident command to manage multiple casualties during New Year and Songkran Festival

ObjectiveTo evaluate the modified Hospital Incident Command System (HICS) used to mange Multiple Casualty during New Year and Songkran Festival.BackgroundA New Year and Songkran Festival are the long holidays that...

Mass Transfer of Pediatric Tertiary Care Hospital Inpatients to a New Location in Under 12 Hours: Lessons Learned and Implications for Disaster Preparedness

To report an experience with large-scale rapid transportation of hospitalized children, highlighting elements applicable to a disaster event. This was a retrospective study of the relocation of an entire pediatric inpatient population. Mitigation steps included postponement of elective procedures, implementation of planned discharges, and transfer of selected patients to satellite hospitals. Drills and simulations were used to estimate travel times and develop contingency plans. A transfer queue was modified as necessary to account for changing acuity. The Hospital Incident Command System was used. Thirteen critical care teams, 5 general crews, 2 vans, and 4 other vehicles transferred a total of 111 patients 8.5 miles in 11.6 hours. Patients were transferred along parallel (vs series) circuits, allowing simultaneous movement of patients from different areas. Sixty-four patients (including 32 infants) were considered critically ill; 24 of these patients required ventilator support, 3 required inhaled nitric oxide, 30 required continuous infusions, and 4 had an external ventricular drain. There were no adverse outcomes. Mass inpatient pediatric transfers can be managed rapidly and safely with parallel transfers. Preexisting agreements with regional pediatric teams are imperative. Disaster preparedness concepts, including preplanning, evacuation priorities, recovery analysis, and prevention/mitigation, can be applied to this event.

Integrating Physician Response Into an Academic Medical Center Emergency Operations Response Plan

Acoordinated physician response during a disaster is challenging in an academic medical center environment because of the size of the institution and variety of specialty services provided. As a result of internal and external drill debriefings, it became evident that there was an acute need to better organize physician response efforts at our institution. Previously, physicians were directed to respond to one physician coordination center located in the adult emergency department. This strategy led to chaos in an already congested area. We found that having the medical services coordinator role initially reporting to the operations officer led to minimizing the medical faculty’s roles and responsibilities in the event of emergency operations plan activation. In addition, our pediatric capabilities expanded to include a new freestanding children’s hospital, which, although it is in close proximity to the adult hospital, separated the adult and pediatric services. This physical separation of the facilities added new complexities to the overall emergency operations plan. As a result, Vanderbilt Medical Center (VMC) embarked on a project to develop a physician response sub-plan that coordinated the response of more than 1100 faculty members in the event of a health emergency. The goal in formulating the sub-plan was to outline responsibilities of medical faculty, house staff, and fellows in response to a health emergency. For the purpose of plan development, a mass casualty incident was defined to include health emergencies such as widespread influenza, severe weather, National Disaster Medical System activations, acts of terrorism, fires, hazardous material incidents, nuclear accidents, aircraft accidents, and earthquakes. Realizing that a coordinated approach to incident management is of utmost importance to ensure a safe and orderly response during an emergency incident, VMC adopted the Incident Command System (ICS) model for handling emergencies. The ICS system originated in Southern California in 1972 and is organized under the acronym, “FIrefighting REsources of Southern California Organized for Potential Emergencies (FIRESCOPE).” By legislative action, the FIRESCOPE Board of Directors and the Office of Emergency Services Fire and Rescue Service Advisory Committee were consolidated into a working partnership on September 10, 1986. The FIRESCOPE model was one of the first of its kind calling for the use of an established chain of command led by an incident commander. The FIRESCOPE Incident Management System was adapted and tested for hospital use in California in 1992. The hospital-adapted version of this system is called the Hospital Incident Command System (HICS). HICS is an incident management system based on the ICS that assists hospitals in improving their emergency management planning, response, and recovery capabilities for unplanned and planned events. Figure 1 shows the basic structure of the model, which is consistent with ICS and the National Incident Management System (NIMS) principles. Use of HICS strengthens hospital disaster preparedness activities in conjunction with community response agencies and allows hospitals to understand and assist in implementing the 17 elements of the hospital-based NIMS guidelines. This management structure has been used in managing a variety of incidents ranging from 9/11 to large crowd gatherings such as football games and concerts. The beauty of the system is that it allows for an appropriate Pam Hoffner is Emergency Preparedness Coordinator/Adjunct Faculty, Vanderbilt University Medical Center and Vanderbilt School of Nursing, Nashville, TN.

Who's In Charge? Using Hospital Incident Command System (HICS) for Tuberculosis Investigation in a Healthcare Worker

Who's In Charge? Using Hospital Incident Command System (HICS) for Tuberculosis Investigation in a Healthcare Worker

Cutting-edge Discussions of Management, Policy, and Program Issues in Emergency Care

Cutting-edge Discussions of Management, Policy, and Program Issues in Emergency Care

Organization of a Hospital-based Victim Decontamination Plan Using the Incident Command Structure

Hospitals are required to have the capability of performing patient decontamination. Incorporating the incident command structure provided by the National Incident Management System and the Hospital Incident Command System into their decontamination plans will enable hospitals to be better organized and efficient in managing events producing contaminated patients. HAZMAT Branch incident command includes the leadership positions of a HAZMAT Branch director and a Victim Decontamination Unit leader, as well as managers for each zone, logistics, triage, medical monitoring, and support roles. Coupling a well-developed decontamination command structure with staff practice in their roles will help to ensure an organized response. This article describes the specific roles and responsibilities included in an incident command system-based hospital decontamination plan than has been used successfully in a multi-hospital system.

Disasters and Mass Casualties: I. General Principles of Response and Management

Disaster planning and response to a mass casualty incident pose unique demands on the medical community. Because they would be required to confront many casualties with bodily injury and surgical problems, surgeons in particular must become better educated in disaster management. Compared with routine practice, triage principles in disasters require an entirely different approach to evaluation and care and often run counter to training and ethical values. An effective response to disaster and mass casualty events should focus on an "all hazards" approach, defined as the ability to adapt and apply fundamental disaster management principles universally to any mass casualty incident, whether caused by people or nature. Organizational tools such as the Incident Command System and the Hospital Incident Command System help to effect a rapid and coordinated response to specific situations. The United States federal government, through the National Response Plan, has the responsibility to respond quickly and efficiently to catastrophic incidents and to ensure critical life-saving assistance. International medical surgical response teams are capable of providing medical, surgical, and intensive care services in austere environments anywhere in the world.

Measures of Effectiveness of Hospital Incident Command System Performance

Measures of Effectiveness of Hospital Incident Command System Performance

Hospital preparedness analysis using the hospital emergency analysis tool (the HEAT)

Study objectives: We examine the level of emergency preparedness in 24 hospitals in the US Navy Medical Department and 10 civilian medical facilities and also identify hospital emergency preparedness strengths and vulnerabilities through the use of the Hospital Emergency Analysis Tool (HEAT). Methods: A study was instituted using the HEAT, an instrument that gathers data through assessment of 240 critical preparedness factors (CPFs) to assess a hospital's level of emergency preparedness. Each CPF is considered important in a hospital's ability to respond effectively in an emergency situation. The HEAT is administered by a multidisciplinary team. Data were gathered from 2002 to 2004 at 34 facilities through structured, face-to-face interviews of hospital personnel and review of polices, plans, and meeting minutes. Results: A number of significant strengths are resident in these hospitals, as well as vulnerabilities that could detract from the effectiveness of emergency response. Factors found to contribute to effective hospital emergency response include (1) use of the hospital incident command system; (2) antidote and emergency drug caches; (3) physical security and facility lockdown procedures; and (4) basic health care professional knowledge of chemical, biological, radiologic, nuclear, and high-yield explosive emergency response. Weaknesses noted in the first phase of assessment include (1) potential for communications failure; (2) lack of biosurveillance; (3) inadequate inpatient surge capacity; and (4) inadequate isolation capability. Self-assessment scores were found to be significantly higher than those determined by analysis with a team of experts. Conclusion: Early results indicate the HEAT is a powerful tool that can assist hospitals in the identification of critical strengths and weaknesses in their emergency planning efforts. Once identified, factors found to be absent or deficient can be remedied. Follow-up analysis of each facility is planned to evaluate progress. More hospitals need to be examined in the military health system and in the civilian health sector. Study objectives: We examine the level of emergency preparedness in 24 hospitals in the US Navy Medical Department and 10 civilian medical facilities and also identify hospital emergency preparedness strengths and vulnerabilities through the use of the Hospital Emergency Analysis Tool (HEAT). Methods: A study was instituted using the HEAT, an instrument that gathers data through assessment of 240 critical preparedness factors (CPFs) to assess a hospital's level of emergency preparedness. Each CPF is considered important in a hospital's ability to respond effectively in an emergency situation. The HEAT is administered by a multidisciplinary team. Data were gathered from 2002 to 2004 at 34 facilities through structured, face-to-face interviews of hospital personnel and review of polices, plans, and meeting minutes. Results: A number of significant strengths are resident in these hospitals, as well as vulnerabilities that could detract from the effectiveness of emergency response. Factors found to contribute to effective hospital emergency response include (1) use of the hospital incident command system; (2) antidote and emergency drug caches; (3) physical security and facility lockdown procedures; and (4) basic health care professional knowledge of chemical, biological, radiologic, nuclear, and high-yield explosive emergency response. Weaknesses noted in the first phase of assessment include (1) potential for communications failure; (2) lack of biosurveillance; (3) inadequate inpatient surge capacity; and (4) inadequate isolation capability. Self-assessment scores were found to be significantly higher than those determined by analysis with a team of experts. Conclusion: Early results indicate the HEAT is a powerful tool that can assist hospitals in the identification of critical strengths and weaknesses in their emergency planning efforts. Once identified, factors found to be absent or deficient can be remedied. Follow-up analysis of each facility is planned to evaluate progress. More hospitals need to be examined in the military health system and in the civilian health sector.