Incident Command System

The Incident Command System (ICS) provides a total-systems approach for response in emergency situations that require assistance above that available from a one-organization response. ICS provides an on-scene structure of management-level positions, dividing functions into four primary areas: planning, operations, logistics, and finance (Figure1). The functional ICS components given in the list that follows provide the keys to effectively planning the management of any incident:

§  Common terminology

§  Integrated communications

§  Modular organization

§  Unified command structure

§  Manageable span of control

§  Consolidated action plans

§  Comprehensive resource management

Figure 1: The Incident Command System

Within ICS, roles are defined and the chain of command is established, which incorporates four sections—planning, operations, logistics, and finance—under the overall leadership of an incident commander. Each of the four sections operates under its own section chief and has its own tasks or job descriptions. These tasks identify priorities that arise during a disaster event and provide for a uniformly structured response and recovery efforts. The four section chiefs are described below.

1.  The plans chief provides current information on the facility situation and projects short- and long-term needs for recovery and return to normal operation.

2.  The operations chief directs the execution of initial response functions and the reporting of results and situation status to the incident commander and other section chiefs.

3.  The logistics chief coordinates the use of existing resources and the procurement of needed resources to ensure the health and safety of residents, staff, and volunteers.

4.  The finance chief is responsible for overseeing the processing and documentation of all costs associated with the disaster and response efforts.

The Hospital Emergency Incident Command System (HEICS), described below, is one example of how ICS can be applied to healthcare facilities. Where community responder agencies are organized based on ICS, hospitals benefit from this unique system designed specifically to meet the needs of healthcare institutions.

OVERVIEW OF EMERGENCY MANAGEMENT SYSTEMS

The public health community is charged with organizing the preparedness and response of the health and medical services in the United States. After years of decay, public health is evolving in its leadership role for domestic disaster organizational response. For healthcare executives to engage in domestic preparedness, it is essential to develop solid relationships with local and regional public health officials, local and area emergency management agencies (EMAs), and local responder organizations.

Before establishing the Department of Homeland Security (DHS), the approach to disaster management for terrorist events was divided into two discrete functions: crisis management and consequence management. Crisis management is a security/law enforcement function focused on identifying the perpetrators of an event, collecting and protecting evidence and the chain of custody, and ensuring justice for those involved. At the federal level, crisis management currently falls under the jurisdiction of the Federal Bureau of Investigation. Consequence management refers to addressing the consequences of a disaster and is currently under the jurisdiction of the Federal Emergency Management Agency (FEMA). Under DHS, federal guidelines will merge the elements of crisis and consequence management into a unified command structure.

 CDC Grant Programs to Improve Public Health Preparedness and Response for Bioterrorism

Planning and readiness assessment establishes strategic leadership, direction, assessment, and coordination of activities (including the Strategic National Stockpile response) to ensure statewide readiness; interagency collaboration; and local and regional preparedness (both intrastate and interstate) for bioterrorism, other outbreaks of infectious disease, and other public health threats and emergencies.

Surveillance and epidemiology capacity focuses on enabling state and local health departments to enhance, design, and/or develop systems for rapid detection of unusual outbreaks of illness that may be the result of bioterrorism, other outbreaks of infectious disease, and other public health threats and emergencies.

Laboratory capacity—biologic agents develops the capability and capacity at all state and major city/county public health laboratories to conduct rapid and accurate diagnostic and reference testing for select biologic agents likely to be used in a terrorist attack.

Health Alert Network (HAN) enables state and local public health agencies to link public health and private partners around the clock through Internet capability. The program provides for rapid dissemination of public health advisories and ensures secure electronic data exchange.

Communication of health risks and dissemination of health information ensures timely information dissemination to citizens during a bioterrorist attack, other outbreak of infectious disease, or other public health threat or emergency.

Education and training assesses the training needs of key public health professionals, infectious-disease specialists, emergency department personnel, and other healthcare providers related to preparedness for and response to bioterrorism, other outbreaks of infectious disease, and other public health threats and emergencies.

Source: Centers for Disease Control and Prevention (CDC). 2003. “Continuation Guidance for Cooperative Agreement on Public Health Preparedness and Response for Bioterrorism—Budget Year Four.” [Online article; retrieved 8/03.] http://www.bt.cdc.gov/planning/continuationguidance/pdf/guidance_intro.pdf.

The Department of Homeland Security, with embedded elements of DHHS, provides a federal structure and system for coordination and oversight of resources that are essential for assisting areas affected by disaster. FEMA’s ten geographical regions work closely with state and local EMAs, ensuring consistency of services to all areas and citizens.

At the state level, EMAs assume a multitude of different organizational structures. The emergency management community consists of professional emergency managers, emergency operations center personnel, 911 telecommunicators, and first responders—that is, fire departments, emergency medical services, medical transport, and law enforcement. When activated for disasters, the EMA expands to coordinate all primary agencies with designated roles in response to a declared disaster. These may vary in number and are dependent on the size and extent of the disaster. However, once a governor has declared a state of emergency, the EMA becomes the coordinating hub for activation of the local and/or state emergency operations plan. Mirroring the Federal Response Plan, representatives from each of the emergency support functions coordinate services from the EMA.

Emergency management uses an “all hazards” framework based on the premise that most incidents will draw on similar resources and will apply a similar structure in managing the response to an incident, as opposed to identifying a different structural response for different types of emergencies. In developing an all-hazards plan, unique aspects of incidents are addressed in annexes to existing plans rather than in a separate plan produced for each event.

BIOTERRORISM PREPAREDNESS FUNDING

Two primary funding efforts by the federal government have been instituted since 9/11 that have significantly shifted the focus of planning and preparedness in healthcare facilities to ensure improved response to bioterrorism or other disease-based mass-casualty events. These programs are described below.

National Bioterrorism Hospital-Preparedness Program

The Department of Health and Human Services (DHHS) Health Resources and Services Administration (HRSA) began in early 2002 to provide monies for public health departments to develop programs to upgrade the preparedness of the nation’s hospitals and for collaborating entities to respond to bioterrorism and deal with nonterrorist epidemics of rare diseases. The program focuses on identifying and implementing bioterrorism preparedness plans and protocols for hospitals and other participating healthcare entities (HRSA 2003). Grant awards were designed for the development and implementation of regional plans to improve the capacity of hospitals and their emergency departments, outpatient centers, EMS systems, and other collaborating healthcare entities to respond to incidents requiring mass immunization, treatment, isolation, and quarantine in the aftermath of bioterrorism or other outbreaks of infectious disease.

CDC Bioterrorism Cooperative Agreement

The Centers for Disease Control and Prevention (CDC) Bioterrorism Cooperative Agreement is a grant program designed to upgrade state and local public health jurisdictions’ preparedness for and response to bioterrorism, other outbreaks of infectious disease, and other public health threats and emergencies (CDC 2003). DHHS requires each state that receives funds to develop a statewide plan identifying how it will respond to a bioterrorism event and other outbreaks of infectious disease and also how it will strengthen core public health capacities in all relevant areas. The program initially identified the following six focus areas for improvement:

1.  Planning and readiness

2.  Surveillance and epidemiology

3.  Biological-laboratory capacity

4.  Communications and information technology

5.  Health information dissemination

6.  Education and training

Federal Guidelines and Legislation for Disaster Relief

Stafford Act. The 1993 Robert T.Stafford Disaster Relief and Emergency Assistance Act, as amended (Public Law 93–288), provides federal assistance to states to manage the consequences of domestic disasters by expediting the rendering of aid, assistance, and emergency services and the reconstruction and rehabilitation of devastated areas.

Weapons of Mass Destruction (WMD) Act of 1996. Title XIV of the Defense Against Weapons of Mass Destruction (Public Law 104–201), which became known as the WMD Act of 1996, provided funding for equipment and training for local first responders for the effective management of incidents involving WMD. The Department of Defense was charged with initiating the Domestic Preparedness Program in the nation’s 120 largest cities for training first responders, including healthcare facility personnel.

Bioterrorism Act. The Public Health Security and Bioterrorism Preparedness and Response Act of 2002, commonly called the Bioterrorism Act (Public Law 107–108), was designed to improve the ability of the United States to prevent, prepare for, and respond to bioterrorism and other public health emergencies. This law established the Office of Public Health Preparedness under the Department of Health and Human Services.

Homeland Security Act of 2002. The Department of Homeland Security (DHS) was created under the Homeland Security Act (Public Law 107–296). Many of the functions of different federal agencies were consolidated under a single department. The bill

§transferred the National Pharmaceutical Stockpile, later renamed the Strategic National Stockpile, to DHS, requiring DHS to consult with the Centers for Disease Control and Prevention (CDC) on administration of the program;

§transferred the Office of Emergency Response, which oversees the National Disaster Medical System, from the Department of Health and Human Services to DHS; and

§required CDC to establish the Bioterrorism Preparedness and Response Division.

Homeland Security Presidential Directives (HSPDs). Presidential directives designed to promulgate presidential decisions on homeland security matters are designated Homeland Security Presidential Directives.

§HSPD-5: Management of Domestic Incidents

§HSPD-6: Integration and Use of Screening Information

§HSPD-7: Critical Infrastructure Identification, Prioritization, and Protection

§HSPD-8: National Preparedness

CDC funding, through the state public health departments to the local community, is projected to continue for a number of years to ensure continuity of programs in public health. The regional or local coordinator is responsible for working with healthcare organizations to improve preparedness and response capability in each of the focus areas