Evolution of Incident Command in Healthcare

1
Evolution of Incident Command in Healthcare An
Implementation of HICS IV in a Multi-Hospital
Healthcare System
Presented by Canadian Centre for Emergency
Preparedness
2

• History, Trends Debates ICS in Healthcare
• Current Implementation of HICS at Caritas
• Integrating HICS into an Emergency Management
  Plan
• Taking It Back to Your Organization
• Tools (www.bcpwho.org)

3
About Caritas Christi Healthcare

• 13,000 Employees
• 6 hospitals
• Home Care
• Physician Network

• Hospice Care
• St. Marys Women Childrens Center
• Por Christo
• Laboure College

Founded in 1985 Caritas is the second largest
healthcare system in New England, providing
community-based medicine and tertiary care in
eastern Massachusetts, southern New Hampshire and
Rhode Island.
4
About BCPWHO

• Founded in 2005
• Over 70 Members from Hospitals and Healthcare
  Organizations in North America, Europe, Asia and
  Australia
• Active Website www.bcpwho.org and used by
  thousands of professionals in over 30 countries
• The Business Continuity Planning Workgroup for
  Healthcare Organizations is the healthcare
  industry's membership organization exclusively
  focused on providing leadership in the
  advancement of business continuity, disaster
  recovery and emergency management

5
History of ICS in Healthcare

• HICS was initiated after the Northridge
  earthquake of 1994
• Grants to Orange County (CA) EMS
• Modeled after standard ICS
• Updated by San Mateo County (CA) in 96 and 98
• HEICS III Increasingly Adopted Nationwide After
  9-11
• HICS IV Released in Fall 2006

6
Trends Debates
7
NIMS Command and Management

• ICS
• Multiagency Coordination Systems
• Public Information Systems (part of ICS)
• NIMS Integration Center
• Under New Federal Grants Hospitals Full NIMS
  Compliance by August 2008

8
ICS Fire Service and Hospitals

• A little bit about what that looks like

9
(No Transcript)
10
Online or Classroom?
11
Theory and Application

• HICS in the EMP
• Organizational culture

12
The ApplicationCurrent Implementation of HICS
at Caritas
13
HICS Implementation Components

• HICS and EMP Mapping w/staff assignments (see
  matrix)
• Develop the Plan
• Develop the Training
• Organize the Conference
• Drills and Exercises

14
(No Transcript)
15
The EMP Whats in the Plan?

• Plan Activation Procedures
• Security Procedures
• Crisis Communications
• Operations Section
• Medical Care Surge, Inpatient, Outpatient and
  Casualty Care
• Mental Health
• Clinical Support Services
• Patient Registration
• Public Health BioHazards
• Mass Fatality

16

• HAZMAT Branch
• Business Continuity Branch
• Staging Procedures
• Planning Section
• Finance Section

• Logistics Section
• Communications
• Information Services
• Food Water
• Employee Health
• Family Care
• Labor Pool Credentialling
• Supply Unit
• Transport Unit
• Infrastructure

Job Action Sheets are at the back of each section!
17

• Event Specific Response
• Severe Weather
• IS Failure
• Telecom Failure
• Flood
• Suspicious Package/Bomb Threat
• Hospital Evacuation Procedures
• Departmental Procedures

18
Code Disaster Terms and General Description
Source Steve Monteiro, Boston Childrens Hospital
19
(No Transcript)
20
HICS Organizational Chart and Disaster Phase C
Source Steve Monteiro, Boston Childrens Hospital
21
HICS Implementation Results to Date

• EMP with HICS Integration Complete
• HICS w/IS 100 and IS 700 Curriculum Developed and
  Conducted for over 300 Executive and Frontline
  Leaders
• Online IS100 and IS700 Completed by over 100
  Leaders and Staff
• Leadership Conference Developed and Conducted for
  100 Executive and Frontline Leaders
• Evacuation Tabletop and Full Scale Drill at CSEMC
  using HICS IV
• Implementation of Full Program 90 Complete at
  CSEMC
• Implementation of Full Program at Remaining
  Facilities 50

22
HICS Implementation Where We Are Going

• 5 Additional Frontline Leadership Conferences
• Completion of EMP Rollout at all Facilities
• Conduct a 2 Hour Conference Follow Up for Section
  Chiefs
• Section Specific Considerations
• Complete Final EMP and Job Action Sheet Revisions
• Section Chief and Unit Leader Detailed Training,
  Q A
• Address Open Items from After Action and
  Evaluations
• Increase Score of HICS Knowledge from 3.73 to 4
• Continue to Identify Metrics and Measure Progress
• Further Enhance System Wide Integration

23
Challenges

• Who goes first?
• What goes first, training or the EMP?
• Time and resources
• Standardization People like it until they have
  to do it
• People dont like change
• Emergency management as a compliance mandate
  rather than value add

24
Challenges

• The HICS Chart
• Infrastructure Branch
• Facilities and Food Units
• Planning Section Redundancy?
• Business Continuity Branch Where BCP is today
  in healthcare
• Ambulatory Care Centers
• Information Systems

25
Benefits

• Hospital Org Charts vs Use of HICS Consistency
  in COBTH hospitals
• Advancing BCP/COOP in Healthcare
• Opportunity to Renew Interest/Educate
• Improve the Emergency Management Plan

26
Taking It Back To Your Organization

• STEP 1 Leadership Governance
• Endorse and Communicate
• Adoption of HICS
• New EMP HICS Assignments (see template with plan
  TOC, HICS role, training, etc)
• Staff Assignments w/Deadlines
• Upcoming Training

27
Taking It Back To Your Organization

• STEP 2 Program Development
• New EMP Drafted
• Curriculum Developed
• Schedule Training

28
Taking It Back To Your Organization

• STEP 3 Enrollment
• Meet Stakeholders
• Review EMP
• Follow Through

29
Taking It Back To Your Organization

• STEP 4 Big Bang
• Off Site Conference
• Training
• Tabletop

30
Taking It Back To Your Organization

• STEP 5 Use It
• Immediate Full Scale Drill

31
Taking It Back To Your Organization

• STEP 6 Measure It
• Capture Data from Training Drill
• Measure Report

32
Taking It Back To Your Organization

• STEP 7 Improve It
• Take Action on Findings
• Follow up/Report Actions Taken
• Set Goals for Improvement Measure Progress Over
  Time
• Targeted Ongoing Training

33
Taking It Back To Your Organization

• STEP 8 Do It Again
• In a crisis you do what you have to do, but
  its better to do what you planned to do.
• James Lee Witt

34
Does It Really Work?
35
Oklahoma City, 4/19/95. This is the only fatality
in the bombing of the Murrah Building who was not
killed or injured in the initial blast and
collapse. Becky Anderson, 37, was a nurse who
saw the incident on TV and rushed to the site to
help. She is the 169th (and final) chair at
the OKC memorial. This is not shown to criticize
or cast blame, but illustrates an example of the
importance of command and control to manage
issues such as spontaneous volunteers to
demonstrate that freelancing can lead to real and
undesirable consequences. This is a good reminder
that the ultimate responsibility of supervisory
personnel is the safety of everyone in the
organization.
36
What HICS Is

• Organizational basis for emergency plan
• Focus and guidance
• Org chart, prompts
• Same role as ICS for public safety, EM
• Standardized job descriptions
• Checklists
• Common terminology
• Training support
• Lesson plans
• Exercises

37
What HICS Isnt

• Turn-key system
• No incident manages itself
• Policy
• Sample policies and procedures included
• Still need appropriate PP, management support
• Need EM plan with specific annexes
• Replacement for training exercises
• Need both for this and any plan to succeed

38
Resources

• Hospital Incident Command System Information
  (www.emsa.gov)
• Emergency Management Principles and Practices for
  Healthcare (http//www1.va.gov/emshg/docs/EMA_Unit
  3_Healthcare_System_Response_and_Recovery.pdf)
• www.bcpwho.org (Training, Drill Conference
  Documents)

39
(No Transcript)
40
Contact Information

• Angela Devlen
• Caritas Christi Healthcare
• 617-789-2424
• angela.devlen_at_caritaschristi.org