Hospital Incident Command System (HICS)
WHAT is HICS?
Since March you have probably heard a lot of emergency management jargon such as Incident Command, Section Chiefs, span & control, among others. But what does this all mean for us navigating response to the COVID-19 Pandemic?
ICS-Incident Command System
The Incident Command System (ICS) is a nationally used approach to assess, manage, and maintain a consistent response to emergency incidents. HICS is the model used specifically for healthcare and hospital emergency management. HICS provides a structured, formalized approach for both planned and unplanned events that do or have the potential to interrupt hospital operations.
Benefits of Using HICS
There are many benefits to using HICS including:
- It is scalable and flexible, meaning that based on size and complexity of the incident, roles can be activated to manage the needs of the situation. The simplicity or complexity of the HICS structure is dictated by the needs of the event.
- Roles and responsibilities are clearly defined and assigned to take action; ensure there is not a duplication of efforts or gaps in response; and fulfill resource needs.
- It is an all-hazards tool so regardless of the specific hazard or threat (natural, man-made, technological, etc.), the tenants of ICS are always applicable.
- Because it is a nationally accepted system there is easy integration when we need to coordinate with other responders such as EMS, fire, police, and Offices of Emergency Management during community-wide events.
IMT-Incident Management Team
Response is managed by members of our Hospital Incident Management Team (IMT) who are key stakeholders with decision-making authority. The purpose of an IMT is to ensure we have a highly reliable team that is prepared to:
· Respond RAPIDLY to an incident requiring attention
· Problem solve for things we expect and things we do not
· Break down silos and roadblocks
· Respond as a team, not a collection of departments
Our IMT is composed of a robust group of stakeholders who serve in HICS roles to best use expertise, skill, and ensure a coordinated flow of communication and organized response. The roles of HICS fall into two categories: Command Staff and General Staff. Command Staff are charged with maintaining overall management of an incident by setting incident objectives and priorities, devising and approving strategies, establishing a communication cadence, and ensuring mission completion.
The Incident Commander is responsible for overall management of the incident within the health system. The Incident Commander can be thought of as “The Boss,” and directs all of the activities within Incident Command, sets the operational periods, and devises strategies and priorities to address those objectives that are communicated in an Incident Action Plan. Throughout the COVID-19 Response, the DHHA Incident Commander has set operational period objectives, facilitated twice daily briefings, ensured accountability on tasks from other HICS staff, and provided approval for acquisition of critical resource needs.
“When an event warrants activation of the Incident Management Team, the Incident Commander’s role is to ensure that the Hospital Command Center gets stood up timely and key HICS roles are assigned. The Incident Commander is ultimately responsible for guiding Command and General staff, that responsibilities of these roles are accomplished, and that required documentation is completed. In this role, I facilitate structured daily briefings to ensure progress is made on essential work and that we communicate response efforts with the DHHA community at large. I help connect Command Officers and Section Chiefs with the necessary subject matter experts to complete tasks and provide approvals for tracking and documentation purposes. The documentation required in the Command Center structure is what allows us to get reimbursement from FEMA and in the case of COVID-19 CARES.”
– Michelle Fournier-Johnson, Chief Human Resource Officer, Incident Commander
The Public Information Officer is responsible for sending internal communications to employees and staff, and external communications to patients, visitors, and the community. During any imminent emergency or planned event, coordinated and timely communication is critical to effective response. The PIO is also responsible for communicating with the media, and/or coordinating with other agencies, as necessary, with incident related information. During the COVID-19 Pandemic, the PIO has drafted and disseminated updates for employees such as Huddle Sheets, coordinated Townhalls, crafted patient-facing language for signage; and composed talking points for providers and staff.
Safety Officers are charged with maintaining a safety environment during response. They help ensure the health and safety of those responding to an event by preventing any secondary injuries or illness. This role has the authority to stop or pause response operations in the event the situation becomes unsafe. Throughout pandemic response, the DHHA Safety Officer’s overall mission has been to prevent nosocomial infections of COVID by guiding contact tracing; ensuring appropriate use of PPE; encouraging adherence to public health measures such as physical distancing and appropriate hand hygiene; and coordinating vaccine distribution.
“The Safety Officer provides medical expertise pertaining to the incident and uses this information to inform the development of strategies to promote staff and patient safety. During the COVID pandemic, we have utilized our infectious disease experience to work with colleagues to develop policies and procedures to prevent the spread of COVID among our staff and patients, treatment strategies in a rapidly changing therapeutic landscape, and vaccine distribution plans.” – Tim Jenkins, MD, Safety Officer
The Liaison Officer helps coordinate with external agencies either municipal or private who have a stake in DHHA response. They serve as the point of contact for representatives of other agencies to provide input on their response practice and policy, share resource availability, and provide other incident related information. Your DHHA Liaison Officer has assisted with advocating for our employees and patients to governmental authorities, coordinating with metro EMS and Fire agencies, partnering with Public Health, and collaborating with our hospital and healthcare colleagues across the state to ensure appropriate patient transfers and care.
Medical/Technical Specialists are assigned by the Incident Commander, as needed. These individuals have specialized expertise related to the incident and may be asked to provide crucial insight and recommendations for an efficient and safe response. Medical-Technical Specialists may be assigned anywhere in the HICS structure as needed. During COVID-19, DHHA has not assigned someone to the role of Medical-Technical Specialist.
General Staff are divided in sections and led by corresponding chiefs. As needed, there may be branches and units assigned under these sections. This helps ensure all needs are met while maintaining span of control.
· Finance / Administration
The Operations Section are the “doers.” They are responsible for operationalizing tactics to achieve the incident objectives. Ultimately, Operations makes sure we continue patient care throughout an event. ALL roles in the HICS structure are supporting operations to achieve this. During COVID response, clinical leadership has served as this Section Chief to help ensure patients with confirmed or suspected COVID as well as though requiring hospitalization for other medical reasons were appropriately care for. Operations included multiple sub-branches to also address needs for patients in the ACS environment; laboratory; pharmacy; and research & education, among others.
“Because the COVID pandemic is a medical emergency, the Operations section of the Incident Management Team was set up as a Medical Operations section. The role of the Operations Section Chief is to gather input on a daily basis from all medical operations in our large organization, including physicians, nurses, hospital and ICU, clinics etc. After daily input is provided (at our 3 PM meeting as well as multiple ad hoc calls and meetings), the Section Chief coordinates responses with other key branches of the Incident Management Center, including Safety, Logistics, Planning, Liaison, and Finance. Examples of our work include the hospital surge plan, staffing for the Virtual Hospital at Home initiative, increased staffing for testing sites, the roll out of antibody therapy at Pena Urgent Care, standing up additional medicine and ICU teams, and coordinating with the Safety branch for the roll out of vaccine.” – Simon Hambidge, MD, PhD, Operations Section Chief
The Planning Section collects, collates, evaluates, and disseminates information for situational awareness and eliciting action throughout a response. Because of this, they are the “planners.” Planning helps with drafting and maintaining critical documentation for internal response activity and external information sharing. The DHHA Planning Section chief has helped plan optimal location and corresponding needs for maintaining high quality patient care during COVID. Planning strategizes how we can best care for our patients and community during times of surge while ensuring the safety of our employees.
“As IC Planning Chief I coordinate with the other IC branches to optimize our hospital bed space to respond to the COVID-19 pandemic. I help create and adjust the Surge Plan, and work with others that we have adequate staffing and materials to care for our patients and staff.” – Walker Keach, MD, Planning Section
“We own the creation of the full surge plan (beds, infrastructure, and staffing requirements) to then hand the plan to others for full implementation.” – Mara Prandi-Abrams
“The planning section is responsible for collecting, evaluating and collaborating on information about how the incident is developing. We collaborate with teams to identify plans to obtain and implement needed resources. We prepare and document incident plans and conduct contingency plans as well.” – Nicole Stafford
The Logistics Section is focused on resource needs during a response. This Section is the “getter” and leads the procurement, acquisition, and distribution of critical items from both internal and external sources. Throughout the COVID-19 response, the DHHA Logistics Section Chief has helped identify, procure, acquire, stage, distribute, replace, and refresh critical resource needs. This includes physical resources such as medical equipment, technological items like iPads, and personnel such as nurse staffing for surge planning.
As one of the Logistics Section Chiefs, Mark Wright is “responsible for getting all supplies, personnel, equipment, and other resources necessary to respond to the incident. In the case of the COVID 19 response at Denver Health, the Logistics Chief works closely with Medical Operations, Planning and Finance Section Chiefs to procure the resources necessary to address the impacts of the pandemic. The Logistics Chief oversees four branches:
- Labor Branch: Focuses on recruiting the personnel required to meet the different capacity surge levels.
- Services Branch: In charge of addressing infrastructure requirements to include IT/Equipment, coordinating engineering or construction requirement to needed changes to the physical space.
- Support Branch: Focuses on Patient Experience, Employee Health and Well-Being, Transportation, Visitor policy, COVID Screeners, Security
- Supply Chain: Responsible for the procurement and maintaining adequate supplies of items needed to address Denver Health’s response to COVID 19 to include but not limited to adequate levels of PPE.”
The Finance-Administration Section are the “keep-trackers” and are responsible for all financial considerations surrounding an incident. This can include tracking accrued costs; timekeeping personnel for overtime pay; approving expenses; and initiating reimbursement to individuals, agencies, and departments. Documentation from Finance-Administration is crucial for reimbursement under mutual aid agreements, and state and federal emergency declarations. Our DHHA Finance Sections Chiefs have established tracking systems for collating approved expenses reimbursed through federal CARES funding.