Hospital Incident Hospital Incident Command System Command System (HICS)(HICS)

Command, Control, and Coordination during an Emergency at UCSF MC

Chau Vu, MEPEmergency Preparedness Manager

2011

SECURITY SERVICES

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AGENDAAGENDA• What is an Emergency• Types of Emergencies• Medical Center Wide Emergency• Isolated Emergency• 4 Phases of Emergencies• CCC• What is HICS?• History• HICS Structure

– Command, Operations, Planning, Logistics, and Finance

• The Use of HICS• Hospital Command Center• Administrator On-Call (AOC)• Initiation of HICS• Anticipated Emotions• Your Role• What to Have in Your Hands• Go Bag• Personal Preparedness at Work• Personal Preparedness at Home• Calling in an Emergency• Disaster Hotline• EM Resources

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WHAT IS AN EMERGENCY?WHAT IS AN EMERGENCY?• There are numerous

definitions for “Emergency.”

• Joint Commission defines emergency as – a natural, unintentional, or intentional incident that significantly disrupts the environment of care. An emergency is also an incident that significantly disrupts care and treatment or results in sudden, significantly changed, or increased demands for the organization’s service.

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TYPES OF EMERGENCIES TYPES OF EMERGENCIES

Natural (Earthquakes) Accidental (Fires) Intentional (Terrorist)

MEDICAL CENTER WIDE EMERGENCYMEDICAL CENTER WIDE EMERGENCY

• When an emergency incident/event occurs, affecting the majority of the Medical Center (i.e., Earthquake), you may find out via: internet, television, radio, witnessing the event, or hearing it word of mouth.

• Report back to your supervisor or contact the Administrator On-Call.

ISOLATED EMERGENCYISOLATED EMERGENCY

• There will be some emergencies that will not require any HICS activation.

• Utilize the Emergency Conditions and Basic Staff Response Chart (Rainbow Chart) to troubleshoot the situation.

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4 PHASES OF EMERGENCY 4 PHASES OF EMERGENCY MANAGEMENTMANAGEMENT

• Mitigation refers to activities which actually eliminate or reduce the chance of occurrence or the effects of a disaster.

• Preparedness is planning how to respond in case an emergency or disaster occurs and working to increase resources available to respond effectively.

• Response activities occur during and immediately following a disaster. They are designed to provide emergency assistance to victims of the event and reduce the likelihood of secondary damage.

• Recovery continues until all systems return to normal, or near normal. Short-term recovery returns vital life support systems to minimum operating standards. Long-term recovery may go on for years until the entire disaster area is completely redeveloped, either as it was in the past or for entirely new purposes that are less disaster-prone.

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C C CC C C• Events lead to the three

C’s:

– Confusion

– Chaos

– Consequences

• We want the other three C’s:

– Command

– Control

– Coordination

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WHAT IS HICS?WHAT IS HICS?

• HICS is the abbreviation of Hospital Incident Command System

• HICS is a systematic way of providing command, control, and coordination to an emergency within the medical center

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HISTORYHISTORY

• Major wildfires in California in 1970’s

• Local, state and federal authorities

• Investigated problems from these fires

• Resolved organizational and documentation issues

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HICS STRUCTUREHICS STRUCTURE

• The HICS structure organizationally divides the operations of the emergency under five distinct sections:

– Command

– Operations

– Planning

– Logistics

– Finance

• The structure is headed by an Incident Commander

Incident Commander

Planning Section Chief

LogisticsSection Chief

Operations Section Chief

Finance/Admin. Section Chief

Liaison Officer

Medical/Technical Specialist

Safety Officer

Public Information Officer

Procurement Unit Leader

Compensation/Claims Unit

Leader

Time Unit Leader

Cost Unit Leader

Service Branch Director

Support Branch Director

Resources Unit Leader

Situation Unit Leader

Documentation Unit Leader

Demobilization Unit Leader

Medical Care Branch Director

Infrastructure Branch Director

HazMat Branch Director

Security Branch Director

Business Continuity

Branch Director

Power/Lighting UnitWater/Sewer UnitHVAC UnitBuilding/Grounds Damage UnitMedical Gases UnitMedical Devices UnitEnvironmental Services UnitFood Services Unit

Inpatient UnitOutpatient UnitCasualty Care UnitMental Health UnitClinical Support Services UnitPatient Registration Unit

Detection and Monitoring UnitSpill Response UnitVictim Decontamination UnitFacility/Equipment Decontamination Unit

Access Control UnitCrowd Control UnitTraffic Control UnitSearch UnitLaw Enforcement Interface Unit

Information Technology UnitService Continuity UnitRecords Preservation UnitBusiness Function Relocation Unit

Personnel Staging TeamVehicle Staging TeamEquipment/Supply Staging TeamMedication Staging Team

Personnel TrackingMateriel Tracking

Patient TrackingBed Tracking

Communications UnitIT/IS UnitStaff Food & Water Unit

Employee Health & Well-Being UnitFamily Care UnitSupply UnitFacilities UnitTransportation UnitLabor Pool & Credentialing Unit

Biological/Infectious DiseaseChemicalRadiologicalClinic AdministrationHospital Administration

Staging Manager

Legal AffairsRisk ManagementMedical StaffPediatric CareMedical Ethicist

HICS @ UCSF MEDICAL CENTERHICS @ UCSF MEDICAL CENTER

• H1N1 2009-2010

• CNA Nursing Strike (2010)

• Mt. Zion Power Outages (2010)

• Drills

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COMMAND SECTIONCOMMAND SECTION

• In an incident command organization, the Command Staff typically includes a Public Information Officer, a Safety Officer, and a Liaison Officer, who report directly to the Incident Commander.

• Additional positions may be required depending on the nature, scope, complexity, and location(s) of the incident(s) or according to specific requirements established by the Incident Commander (IC).

Incident Commander

Liaison Officer

Medical/Technical Specialist

Safety Officer

Public Information Officer

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OPERATIONS SECTIONOPERATIONS SECTION

• The Operations Section is responsible for all tactical activities focused on reducing the immediate hazard, saving lives and property, establishing situational control, and restoring normal operations.

Operations Section Chief

Medical Care Branch Director

Infrastructure Branch Director

HazMat Branch Director

Security Branch Director

Business Continuity

Branch Director

Staging Manager

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PLANNING SECTIONPLANNING SECTION

• The Planning Section collects, evaluates, and disseminates incident situation information and intelligence to the IC and incident management personnel.

• This Section then prepares status reports, displays situation information, maintains the status of resources assigned to the incident, and prepares and documents the Incident Action Plan (IAP).

Planning Section Chief

Resources Unit Leader

Situation Unit Leader

Documentation Unit Leader

Demobilization Unit Leader

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LOGISTICS SECTIONLOGISTICS SECTION

• The Logistics Section is responsible for all service support requirements needed to facilitate effective and efficient incident management, including ordering resources.

• This section also provides facilities, supplies, equipment maintenance and fuel, food services, communications and information technology support.

LogisticsSection Chief

Service Branch Director

Support Branch Director

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FINANCE SECTIONFINANCE SECTION

• A Finance/Administration Section is established when the incident management activities require on-scene or incident-specific finance and other administrative support services.

• Some of the functions that fall within the scope of this Section are recording personnel time, maintaining vendor contracts, administering compensation and claims, and conducting an overall cost analysis for the incident.

Finance/Admin. Section Chief

Procurement Unit Leader

Compensation/Claims Unit

Leader

Time Unit Leader

Cost Unit Leader

THE USE OF HICSTHE USE OF HICS• A predictable chain of

command

• A flexible organizational chart that can be scaled to fit the nature and size of the emergency

• Span of Control: 1:7

• Each position (title) within HICS has a job action sheet (JAS) that defines the functions and responsibilities of the title

THE USE OF HICS CONT.THE USE OF HICS CONT.• The chart and job action

sheet outline the reporting structure to be used in an emergency

• Improved documentation

• Common language to communicate and facilitate outside assistance

• All U.S. hospitals and most external agencies use a form of ICS to manage emergencies

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HOSPITAL COMMAND CENTER (HCC)HOSPITAL COMMAND CENTER (HCC)

• Provides a central location from which the Medical Center can provide interdepartmental coordination and executive decision making in support of the incident response.

• Located in M-169

• Mt. Zion HCC Location TBD

ADMINISTRATOR ON CALL (AOC)ADMINISTRATOR ON CALL (AOC)

• The AOC is the person in charge and has the authority to initiate HICS based on information and guidance.

• If you are on scene, then you are ultimately in charge until the AOC is briefed and takes over.

INITIATION OF HICSINITIATION OF HICS

• The time between the event and initiation of HICS could take seconds, minutes, hours or not at all dependent on the incident/event and AOC.

• Initial information regarding the emergency incident/event will be minimal and at times conflicting.

ANTICPATED EMOTIONSANTICPATED EMOTIONS

• You will feel myriad sets of emotions throughout the incident/event.

• Frustration, Confusion, Sense of Accomplishment, Happiness, etc.

• Remember – TEAMWORK!

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YOUR ROLEYOUR ROLE

HOMEPLAN

OFFICEPLAN

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WHAT TO HAVE IN YOUR HANDSWHAT TO HAVE IN YOUR HANDS

HOME GO-BAG

OFFICE GO-BAG

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WHAT TO HAVE IN YOUR GO-BAGWHAT TO HAVE IN YOUR GO-BAG

A Go-Bag is a collection of items you can use in the event of an evacuation. A Go-Bag should be sturdy, lightweight and portable. Because you may be away from home when disaster strikes, you are advised to keep an office Go-Bag as well as a Go-Bag at home.

PERSONAL PREPAREDNESS @ PERSONAL PREPAREDNESS @ WORKWORK• Below is a partial listing of essential suggested items to consider in

preparing your office Go-Bag.

PERSONAL PREPAREDNESS AT PERSONAL PREPAREDNESS AT HOMEHOME• Below is a partial listing of essential suggested items to consider in

preparing your home Emergency Supply Kit.

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CALLING IN AN EMERGENCYCALLING IN AN EMERGENCY

DIAL 9-911

• At the Medical Center, an emergency that requires the police, fire, medical, or hazardous materials spill:

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DISASTER HOTLINEDISASTER HOTLINE

• To find out the latest information pertaining to the Medical Center during a declared emergency call:

415.885.STAT (7828)

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FOR MORE INFORMATIONFOR MORE INFORMATION

• Visit Emergency Management on the Intranet by typing in “EM” into your web browser

THANK YOUTHANK YOUSecurity Services Department – Emergency ManagementChau H. Vu, MEPEmergency Preparedness Manager

chau.vu@ucsfmedctr.org415.885.7489http://em