Hospital Incident Command System (HICS)

What and Who 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? Over the past several weeks we have seen a steady decline in the number of COVID+ cases and hospitalizations, and with an increased focus on administering the COVID-19 Vaccinations, our Hospital Incident Command has pivoted to focus on these efforts.

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.

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.

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. With a focus on COVID vaccinations, the DHHA Incident Commander sets operational period objectives, facilitates daily briefings with the Incident Management Team, ensures accountability on tasks from other HICS staff, and provides approval for acquisition of critical resource needs.

During any imminent emergency or planned event, coordinated and timely communication is critical to effective response. The Public Information Officer is responsible for sending internal communications to employees and staff, and external communications to patients, visitors, and the community. The PIO is also responsible for communicating with the media, and/or coordinating with other agencies, as necessary, with incident related information. With a focus on COVID vaccinations, the PIO drafts and disseminates communications to employees such as Huddle Sheets, coordinates Townhalls and informational sessions on the COVID vaccine, crafts patient and community-facing language; and composes 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. For COVID vaccine efforts, the DHHA Safety Officer’s mission is to provide counsel to Divisions and Branches of potential safety impacts, prevent unsafe practices and raise safety concerns, make recommendations on appropriate PPE usage, and review and provide recommendations on use new vaccine manufacturers.

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 assists 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 and nation.

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.

· Operations

· Planning

· Logistics

· Finance / Administration

The Operations Section are the “doers.” They are responsible for operationalizing tactics to achieve the incident objectives. Ultimately, Operations is making sure we are getting shots in arms! ALL roles in the HICS structure are supporting operations to achieve this. Our operational leaders to help ensure employees, patients, community healthcare providers, and others eligible for vaccine in the current phase (defined by the state government) receive one. Operations include branches for geographic locations of vaccine clinics, and crucial communication components to operations such as the Appointment Center.

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 is working to draft a high-level strategy map to open, maintain, sustain, and expand vaccine clinics throughout the DHHA Enterprise; maintain documentation for the Incident Action Plan; support development of clinic layouts and plans; collaborate with Pharmacy to align vaccine supply/inventory with clinic appointment availability; and developing projection analysis and visualization of inventory data.

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. For COVID-19 vaccine efforts, the DHHA Logistics Section helps acquire, allocate, stage, and distribute supplies, equipment, and pharmaceuticals. This includes physical resources such as syringes and Band-Aids for clinics, technological items like laptops, and personnel to staff vaccine clinics.

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 design, sustain, and collaborate with Operations and Planning on optimal financial processes for tracking, reimbursement, and all other appropriate revenue capture and expense stewardship.

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