Transcript IS 700 - School of Nursing

NIMS (National
Incident Management
System) for Healthcare
Based upon Emergency
Management Institute ICS-700
Minnesota Emergency Readiness
Education and Training Program
(MERET)
MERET worked
with partners in
Minnesota to
adapt curriculum
to support the
Hospital Incident
Command System
(HICS) training
MERET is a program designed to educate and train Minnesota’s
health care workers in emergency preparedness, tailoring efforts
to the unique needs of specific communities as they prepare for
a health emergency or bioterrorism event. MERET is funded by
the Office of the Assistant Secretary for Preparedness and
Response (ASPR) of the U.S. Department of Health and Human
Services, and is administered by the University of Minnesota
Schools of Nursing and Public Health. Carol O’Boyle, PhD, RN,
at the School of Nursing, is the Principal Investigator.
Minnesota Emergency Readiness Education and Training (MERET) is funded under grant #TO1HP06412 from the
Office of the Assistant Secretary for Preparedness and Response (ASPR),DHHS, Bioterrorism Training and Curriculum
Development Program.
Hospital Command &
General Staff
Objectives







Identify the key principles of NIMS in the context of
healthcare.
Recall when it is appropriate to initiate an Area Command.
Name the functions and purpose of a Multiagency
Coordination Center.
Select the appropriate utilization of the Public Information
Systems within NIMS.
Compare how NIMS and HICS affect how healthcare
prepares for incidents and events.
Recognize the concepts and principles of resource
management under NIMS & HICS.
Identify the benefits of common communication and
information management standards.
What is NIMS?
“ – a consistent nationwide approach for federal,
state, tribal, and local governments to work
effectively and efficiently together to prepare
for, prevent, respond to and recover from
domestic incidents, regardless of cause, size or
complexity.”
- Secretary of Homeland Security directed
President of USA to develop & administer a
National Incident Management System (NIMS)
Homeland Security Presidential Directive / HSPD-5, 2003
What is NIMS?

A comprehensive, national approach
to incident management

Applicable at all jurisdictional levels
and across disciplines
Slide courtesy of FEMA
NIMS Concepts and
Principles
NIMS is:
Flexible and Standardized to
improve overall response and
interoperability and enable all
responding organizations to work
together.
Slide courtesy of FEMA
NIMS & NRP Relationship
National Incident Management System (NIMS)
Standardized process and procedures for
incident management
Incident
Local
Support or Response
State
Support or Response
NIMS aligns command & control, organization structure,
terminology, communication protocols,
resources and resource typing
DHS integrates
and applies Federal
resources
Resources,
knowledge,
and abilities from
all Federal agencies
Federal
Support or Response
NRP is activated for
Incidents of National
Significance
National Response Plan (NRP)
Activation and proactive application of
integrated Federal resources
http://www.nrt.org/production/NRT/NRTWeb.nsf/AllAttachmentsByTitle/A-319CharlieHessNIMS-NRPBrief/$File/Charlie_Hess_NIMSNRP_Brief.ppt?OpenElement#324,6,NIMS & NRP Relationship
Capabilities and Resources
Tiered Response Strategy
Federal Response
State Response
Regional / Mutual Response Systems
Local Response, Municipal and County
Minimal
Low
Medium
High
Increasing magnitude and severity
Catastrophic
'Medical Surge Capacity and Capability Handbook' by J. Barbera and A. Macintyre published by CNA Corporation.
Tiered
Response
HCF =Health Care Facility
'Medical Surge Capacity and Capability Handbook' by J. Barbera
and A. Macintyre published by CNA Corporation.
NIMS Training Deadlines
1.
2.
August 31, 2007 (ISC-100 HC)
 Emergency Managers (ICS-100 HC, ICS-200 HC, ICS-700
and IS-800)
 Command Staff (ICS-100 HC, ICS-200 HC and ICS-700)
• PIO
• Liaison Officer
• Incident Commander (only Commander title)
• Safety Officer
 General Staff(ICS-100 HC, ICS-200 HC and ICS-700)
• Section Chiefs (Operations, Planning, Logistics,
Finance—the only reference to Chiefs)
August 31, 2008 (ISC-100 HC)
• Staff filling boxes below section chiefs
NIMS Components
Command and Management
 Preparedness
 Resource Management
 Communications and Information
Management
 Supporting Technologies
 Ongoing Management and
Maintenance

Slide courtesy of FEMA
NIMS Components
Command and Management
 Preparedness
 Resource Management
 Communications and Information
Management
 Supporting Technologies
 Ongoing Management and
Maintenance

Command and Management

Incident Command System (ICS)


Hospital Incident Command System (HICS)
You learned this in ICS-100 HC and ICS-200
HC
• Proven management system based on best
practices
• Span of control may vary from 3 – 7
• Use common terminology to reduce confusion
between ICS position and day-to-day position
• Embraces management-by-objectives in
developing Incident Action Plans
• Recognizes Multiagency Coordination Entity when
resources cannot be obtained locally
Slide courtesy of FEMA
Command and Management
In some situations, NIMS
recommends variations in incident
command
 Most common variations are:

Unified Command
 Area Command

Slide courtesy of FEMA
“Unified Command”


Used when more than one agency is
involved such as with a hazardous
material spill
Collective / collaborative approach
Agency 1
Agency 2
Agency 3
ONE Incident Action Plan
Photos courtesy of FEMA
How Does “Unified
Command” Work?

Agencies work together to:






Analyze intelligence information
Establish single set of objectives &
strategies for multiple agencies
Create single Incident Action Plan (IAP)
Improved information flow & coordination
Agencies understand joint priorities &
restrictions
Unified Command does not change other
features of ICS.
Slide courtesy of FEMA
How is “Area Command”
Organized?
Area Command
Planning
Logistics
Finance/
Administration
Slide courtesy of FEMA
What Does “Area Command”
Do?








Sets overall strategy and priorities
Allocates resources
Ensures proper management
Ensures objectives are met
Ensures strategies are followed
Is particularly relevant to public health emergencies because
incidents where area command are used:
–
Are not site specific
–
Are not immediately identifiable
–
Are geographically dispersed and evolve over time
Area Command does not include an Operations Section
because operations are conducted on-scene.
May become a “Unified Command Area”
Slide courtesy of FEMA
How is “Area Command”
Organized?
Area Command
ICP 1
ICP 2
ICP 3
Slide courtesy of FEMA
Command and Management

“Multiagency Coordination Center”




For large or wide-scale emergencies
Aids in resource allocation decisions based
on incident priorities
Emergency Operations Centers may support
the need for multiagency coordination and
Joint Information activities
Handles requests for items that IC cannot
obtain locally
Slide courtesy of FEMA
“Multiagency Coordination Center”
(MAC)






NOT ‘Area Command’
Function & scope is incident-driven
Coordinate incident-related information
Resource management center for agencies
Strategic planning
 Surveillance and Epidemiology
 Patient Care
 Population-based Interventions
 Personnel management
Liaison with jurisdictional agencies and EOCs to
coordinate issues regarding incident management
policies, priorities & strategies
Slide courtesy of FEMA
MAC
Simple and brief in use or complex and
protracted based on event
 Coordination Center that can also be
activated to assist “Area Command” for:

Multiple concurrent health-related incidents
 Incidents that are non-site specific
 Incidents that are geographically dispersed
 Incidents that evolve over time

Slide courtesy of FEMA
MAC for Health Care








EMS
Hospitals
Public Health
Emergency Management
Activation
Site
Staffing
Authority
Slide courtesy of FEMA
Hospital C
Hospital B
Clinics
Hospital A
Health System
Regional Hospital
Resource Center
Multi-Agency Coordination
Center
EM
A
EMS
PH
A
B
Jurisdiction
Emergency
Management
B
C
C
A
B
EMS Agencies
C
Public Health
Agencies
Slide courtesy of John Hicks
Command and Management


Public Information coordination across responding
agencies is important for the public to receive
accurate, timely, and consistent information that is
easy to understand
The Public Information Officer (PIO) is part of the
command staff
 PIO operates within the parameters of a Joint
Information System when established as part of a
Multiagency Coordination or “Area Command”
 Each agency or organization contributing to the Joint
Information System retains their organizational
independence while using the Joint Information
System protocols
Slide courtesy of FEMA
NIMS Components
Command and Management
 Preparedness
 Resource Management
 Communications and Information
Management
 Supporting Technologies
 Ongoing Management and
Maintenance

How Does NIMS Define
Preparedness?
Taking actions to establish and
sustain prescribed levels of capability
 Ensures mission integration and
interoperability

Slide courtesy of FEMA
Comprehensive Emergency
Management Cycle

4 Phases:
Mitigation – prevention or activities
that reduce impact of hazard
 Preparedness – build response
capacity/capability
 Response – gain control of an event
 Recovery – return to pre-disaster state

Slide courtesy of FEMA
Community- Based
Hazard Vulnerability
Analysis (HVA)
(images courtesy of USA.gov)
MDH
Regions
Slide courtesy of John Hicks
Preparedness
Mutual Aid Agreements and Emergency
Management Assistance Compacts

facilitate timely delivery of assistance
Slide courtesy of FEMA
Preparedness

Metropolitan Hospital Compact




Since April 9, 2002
27 hospitals operating 4800 beds
7 counties participate
Agreement provides for:




Staff and supply sharing
Staffing off-site facilities for first 48h
Communications, JPIC
Regional Hospital Resource Center (HCMC)
Slide courtesy of John Hicks
NIMS Components
Command and Management
 Preparedness
 Resource Management
 Communications and Information
Management
 Supporting Technologies
 Ongoing Management and
Maintenance

Resource Management

Resource management is an important
concept for preparedness organizations at
all levels and helps to:



Establish guidelines and protocols for
resource management
Establish procedures to track resources from
mobilization through demobilization
Categorize resources (resource typing)
based on measurable standards of capability
and performance
Slide courtesy of FEMA
Resource Management
Regional Hospital Resource Center (RHRC)
 Designated hospital in a geographic or
functional region that is the coordinating
hospital for information and requests
 Acts as ‘broker’ for patient transfers into / out
of the region
 May help make allocation decisions for
resources (eg: staffing)
 Represents hospital needs and issues to
Multi-Agency Coordination Center
Slide courtesy of John Hicks
Capacity vs. Capability


Surge Capacity – ‘the ability to manage
increased patient care volume that otherwise
would severely challenge or exceed the existing
medical infrastructure’
Surge Capability – ‘the ability to manage
patients requiring unusual or very specialized
medical evaluation and intervention, often for
uncommon medical conditions’
• Barbera and Macintyre
Surge Capacity/Patient Care
Coordination
Neighborhood
Emergency Help
Centers
LTC Facilities
Mass Dispensing Clinics
Screening Centers
Home
In-Home
Family Care
Homecare
Alternate Care Site
Facilities
Clinics and/or
Private MDs
Treatment/Triage
e.g., Procedure Centers,
Churches, Hotels, Community/
Recreation Centers, Warehouses
Urgent Care
Centers
Hospitals
MAC
From the Minnesota Department of Health, Pat Tommet
NIMS Components
Command and Management
 Preparedness
 Resource Management
 Communications and Information
Management
 Supporting Technologies
 Ongoing Management and
Maintenance

Communications & Information
Management through the Joint
Information System (JIS) Protocols

To ensure consistency among all who respond,
all responding agencies must have a common
operating picture
 PIOs operate within the parameters of a JIS
 Keys to a common operating picture:
• Interoperable communications across all
agencies and jurisdictions
• Information systems based on common
architecture
Slide courtesy of FEMA
Joint Information Center (JIC)
Physical location where public
information staff collocate/organize
factual information
 Provides the structure for coordinating
and disseminating official/critical
information

Slide courtesy of FEMA
JIC
State JIC
Local JIC 1
Local JIC 2
Agency 1
PIO
Agency 2
PIO
IC/UC/Area
Command
PIO
(at incident JIC)
Slide courtesy of FEMA
JIC Characteristics





Includes representatives of all players in the response:
both private and public organizations
Has procedures and protocols for communicating and
coordinating with other JICs
May be established at various levels of government
In case of “Unified Command”—agencies contributing
retain their organizational independence
When multiple JICs are established, each JIC
contributes to the overall unified message using joint
information system protocols
Slide courtesy of FEMA
JIC Components
Joint Information
Center
Press Secretary
(jurisdictional)
Research Team
Liaison
(as required)
Media Team
Logistics Team
Slide courtesy of FEMA
NIMS Components
Command and Management
 Preparedness
 Resource Management
 Communications and Information
Management
 Supporting Technologies
 Ongoing Management and
Maintenance

Supporting Technologies
800MHz radios
 HAM radios
 Mission Mode
 MN-TRAC
 HAN (Health Alert Network)
Slide courtesy of FEMA
NIMS Components
Command and Management
 Preparedness
 Resource Management
 Communications and Information
Management
 Supporting Technologies
 Ongoing Management and
Maintenance

Ongoing Management and
Maintenance


NIMS Integration Center
 Maintains and manages national-level preparedness
standards
 Facilitates definition of general training requirements
and approved courses
 Reviews and approves equipment lists meeting
national standards
 Defines minimum levels of training, experience,
fitness, capability and currency by establishing
certification and credentialing standards for key
personnel
Develops Corrective Action Plan based on lessons
learned from actual incidents
Slide courtesy of FEMA
Group efforts:









Information sharing (ARC, MAC, CST)
Communications (web-based future system,
800Mhz, amateur radio)
Education (bio, chemical, radiation)
Personal Protective Equipment
HRSA grant requirements
Infectious disease protocols / response
Workforce issues
Pharmaceutical cache storage and release
Drills
Slide courtesy of John Hicks
Federal Assets
National Disaster Medical System (NDMS)
 Urban Search and Rescue (eg: Nebraska
TF-1)
 Commissioned Corps Readiness Force
 Military (NORTHCOM)
 Federal Medical Stations
 CDC SNS and VMI

Slide courtesy of John Hicks
NDMS



Disaster Medical Assistance Teams
Specialty teams (DMORT, VMAT, Burn, etc)
Patient movement:
Public / private partnership
 Voluntary commitment of civilian hospital
beds for defense or disaster use – accept
casualties from affected area
 Response, evacuation, and definitive care
 2000 hospitals, 65 FCCs

Slide courtesy of John Hicks
NDMS Patient Movement






During crisis, system placed on alert
Bed counts submitted to FCC / GPMRC
Patient needs matched to beds available
Patients arrive by military airlift
Distributed to area hospitals
Never fully activated until Hurricane
Katrina

More mass evacuation than transfers
Slide courtesy of John Hicks
Summary: NIMS
Components






Command and
Management
Preparedness
Resource Management
Communications and
Information
Management
Supporting
Technologies
Ongoing Management
and Maintenance
Are You Ready for the Test?
MERET Acknowledges its Partners:
1. Healthcare System Preparedness Program Partners
a. Minnesota Department of Health–Office of Emergency
Preparedness
b. MDH Metropolitan Hospital Compact
c. Regional Hospital Resource Center Focus Group:
• Michelle Allen, Northwest
• Clyde Annala, Northeast
• Jill Burmeister, South Central
• Chuck Hartsfield, Central
• Marla Kendig, Southeast
• Emily Parsons, MDH-OEP
• Justin Taves, West Central
• Eric Weller, South Central
2. FEMA Independent Study Program