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

LocalSupport or Response

National Incident Management System (NIMS) Standardized process and procedures for

incident management

StateSupport or Response

FederalSupport or Response

NIMS aligns command & control, organization structure, terminology, communication protocols,

resources and resource typing

National Response Plan (NRP)Activation and proactive application of

integrated Federal resources

Incident

NRP is activated forIncidents of National

Significance

Resources, knowledge,

and abilities from all Federal agencies

DHS integratesand applies Federal

resources

http://www.nrt.org/production/NRT/NRTWeb.nsf/AllAttachmentsByTitle/A-319CharlieHessNIMS-NRPBrief/$File/Charlie_Hess_NIMS-NRP_Brief.ppt?OpenElement#324,6,NIMS & NRP Relationship

Cap

abili

ties

an

d R

eso

urc

es

Federal Response

Regional / Mutual Response SystemsState Response

Increasing magnitude and severity

Local Response, Municipal and County

Tiered Response Strategy

Minimal Low Medium High 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. 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)

2. 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 CommandArea 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 incidentsIncidents that are non-site specificIncidents that are geographically dispersedIncidents 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 A

Hospital B

Hospital C

Clinics

Health System

Public HealthAgenciesEMS Agencies

JurisdictionEmergency Management

AA

B

C A

B

C C

B

Regional Hospital Resource Center

Multi-Agency CoordinationCenter

EM EMS PH

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/capabilityResponse – gain control of an eventRecovery – 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 Compactsfacilitate 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

Alternate Care Site Facilities

e.g., Procedure Centers, Churches, Hotels, Community/

Recreation Centers, Warehouses

Home

Clinics and/orPrivate MDs

Treatment/Triage

In-Home Family Care

LTC Facilities

Urgent Care Centers

Neighborhood Emergency Help

CentersMass Dispensing Clinics

Screening Centers

Homecare

Hospitals

Surge Capacity/Patient Care Coordination

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

Research Team Media Team Logistics Team

Press Secretary(jurisdictional)

Liaison(as required)

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 partnershipVoluntary commitment of civilian hospital

beds for defense or disaster use – accept casualties from affected area

Response, evacuation, and definitive care2000 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 Partnersa. Minnesota Department of Health–Office of Emergency

Preparednessb. MDH Metropolitan Hospital Compactc. 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