Incident Management System: Application to Public Health Dan Cass, MD, FRCPC & Public health CBRN...

Incident Management System: Incident Management System: Application to Public HealthApplication to Public Health

Dan Cass, MD, FRCPC &

Public health CBRN course

Brian Schwartz MD, CCFP(EM), FCFPScientific Advisor, Emergency Management Unit, MOHLTC

Goals of SessionGoals of Session

Outline the evolution of the Incident Management System (IMS) model

Provide an overview of the principles of IMS

Illustrate how IMS can be used as a framework for emergency response for the health sector

Provide some practical applications of IMS for public health

What is IMS?What is IMS?

A way of creating (some!) order out of chaos

A framework

A tool

TerminologyTerminology

For our purposes, all of these terms

are interchangeable:

– Incident Management System (IMS)

– Incident Command System (ICS)

– Hospital Incident Command System

(HICS)

Where Does IMS Come From?Where Does IMS Come From?

Origins of IMSOrigins of IMS

California wildfires, 1980s – “FIRESCOPE”– Multiple fire agencies involved

• Local, regional

– Coordination of local / state / federal resources

Many challenges…– Lack of common terminology / organizational

structure / roles– Incompatible equipment (radios; firefighting)

Origins of IMSOrigins of IMS

Fire protection agencies developed common organizational and response structure– Evolved into IMS

Deployed across California– Subsequently to much of USA and Canada

Began to expand to all pre-hospital providers (fire / ambulance / police)– Eventually into other areas of health sector

Origins of IMSOrigins of IMS 1987: Hospital Council of Northern California

– Adapted IMS into “Earthquake Preparedness Guidelines for Hospitals”

1991: Orange County EMS– Used IMS principles to develop Hospital

Emergency Incident Command System (HEICS)• 2006 Hospital Incident Command System (HICS)

Has been adapted to a variety of health sectors / environments (including public health)

Why Should We Care??Why Should We Care??

In day-to-day operations, health care organizations often very insular– “Our” procedures don’t have to be same as

“their” procedures– Applies within as well as between

organizations

In mass casualty incident, we cannot operate in a vacuum!– Need way to communicate / coordinate efforts

IMS - ComponentsIMS - Components

1. Unified command structure2. Common terminology3. Modular organization4. Integrated communication5. Consolidated action plans6. Job Action Sheets7. Manageable & sensible span of control8. Designated facilities9. Comprehensive resource management

IMS StructureIMS Structure

Command

Operations Planning LogisticsFinance /

Administration

IMS StructureIMS Structure

Command


Administration

Doers Thinkers Getters Payers

Incident CommandIncident Command

Directs activities of personnel in Emergency

Operations Centre (EOC)

Most senior trained responder

– In Public Health, may start as on-call Medical Officer

of Health, Nurse, Manager or Public Health Inspector

As response progresses, IC position may be

“handed off” to more senior person

Incident Commander

Operations Planning Logistics Finance

OperationsOperations

Directs “front-line” response to eventImplements response activities as

determined by Incident CommanderMaintains communication between EOC

and siteRequests and assigns resources as

directed

Incident Commander


PlanningPlanning

“What’s next?” Control and flow of all information Data collection, analysis and forecasting Development of response and recovery

objectives and strategies Mutual Aid requests

Incident Commander


LogisticsLogistics

Support OperationsAcquire and allocate resources and

provide all materials, equipment, and personnel required

Application of additional resources provided by Mutual Aid

Incident Commander


FinanceFinance

Tracking of expenses

Funding

Government Financial Aid requests

Financial Aid distribution

Incident Commander


IMS StructureIMS StructureCommand


Administration

ResponseTeam(s)

Safety Information

Liaison

In fo rm ationO ffice r

L ia isonO ffice r

S a fe tyO ffice r

T a sk fo rces a ndS trike te a m s

D iv is io nS u p erv iso r



B ra n chD ire c to r






O p e ra tio nsse c tionC h ie f

U n its

P la nn ingS e ction

C h ie f

U n its

L o g is ticsS e ction

C h ie f

F in an ceS e ction

C h ie f

In c ide n tC o m m a n d er

In fo rm a tionO ffic e r

L ia is onO ffic e r

S a fe tyO ff ic e r

T a s k fo rc es a ndS trik e te a m s

D iv is io nS u p erv is o r









O p e ra tio nss e c tionC h ie f

U n its


C h ie f

U n its

L o g is t icsS e ction

C h ie f

F in an ceS e ction

C h ie f


In fo rm a tionO ff ic e r

L ia is onO ff ic e r













U n its


C h ie f

U n its


C h ie f

F in an ceS e ction

C h ie f


In form ationO fficer

L ia isonO fficer

S a fe tyO fficer


D iv is io nS u p erv isor









O p e ra tio nsse c tionC h ief

U n its


C h ief

U n its


C h ief

F in an ceS e ction

C h ief

In c ide ntC o m m a n d er

In fo rm a tionO ff ic e r

L ia is onO ff ic e r













U n its


C h ie f

U n its


C h ie f

F in an ceS e ction

C h ie f



L ia isonO fficer

S a fe tyO fficer












U n its


C h ief

U n its


C h ief

F in an ceS e ction

C h ief



L ia isonO fficer

S a fe tyO fficer












U n its


C h ief

U n its


C h ief

F in an ceS e ction

C h ief



L ia isonO fficer

S a fe tyO fficer












U n its


C h ief

U n its


C h ief

F in an ceS e ction

C h ief



L ia isonO fficer

S a fe tyO fficer












U n its


C h ief

U n its


C h ief

F in an ceS e ction

C h ief



L ia isonO fficer

S a fe tyO fficer












U n its


C h ief

U n its


C h ief

F in an ceS e ction

C h ief



L ia isonO fficer

S a fe tyO fficer












U n its


C h ief

U n its


C h ief

F in an ceS e ction

C h ief



L ia isonO fficer

S a fe tyO fficer












U n its


C h ief

U n its


C h ief

F in an ceS e ction

C h ief



L ia isonO fficer

S a fe tyO fficer












U n its


C h ief

U n its


C h ief

F in an ceS e ction

C h ief


Provincial

Regional

Local Local Local

Modular OrganizationModular Organization

• IMS model is scaleable

• Position = role One person may have several roles,

especially in smaller-scale response

• Activate only those positions you need

for a given response HICS - concept of “minimal activation”

Integrated CommunicationsIntegrated Communications

Who?Liaison Officer (in EOC)

– Point of contact with external agencies (EMS; other Public Health Units, hospitals, MOHLTC etc.)

Public Information Officer (in EOC)– Deals with media / public

Integrated CommunicationsIntegrated Communications

How?Ensure able to communicate

– Established means• Dedicated lines

– Established frequencies• Encryption!

– BACKUP plan!

Incident Action PlanIncident Action Plan• Part of Incident Commander’s role =

development of Incident Action Plan (IAP) – Assessment– Objectives– Resources– Needs

Constantly updated / revised based on new information and progress of response

Incident Action PlanIncident Action Plan

Each Section Chief (Operations,

Planning, Logistics, Finance) develops

IAP for their area

– Immediate / Intermediate / Extended

Integrates with overall IAP

Job Action SheetJob Action Sheet Role title Reports to Mission Tasks

– Immediate– Intermediate– Extended

OPERATIONS LEAD (OL)

Emergency Response Function Checklist

Reports to: Public Health Incident Manager (PHIM) Overall Responsibility: To manage TPH overall response operations as

applicable to the event. Immediate (Tasks to be completed first upon assuming the role) Obtain a full briefing of the Incident and obtain appropriate Function

Checklists and any pertinent forms Participate in developing and implementing objectives and strategies for the

Incident Action Plan, Assist in determining appropriate resources for Operations function to initiate

the response Intermediate (Tasks to be completed after the immediate tasks are

addressed) Brief all Operations sub-function leads on current situations and add or delete

tasks to corresponding Function Checklists as appropriate Maintain communications with field operations staff through each sub-function

lead in each established Operational sub-function (e.g. hotline, case management and contact tracing)

Coordinate on-site TPH resources and equipment Monitor Operations function to achieve objectives – request resources as

needed through PHIM. Ensure that staff assigned to Operations are aware of potential hazards and

appropriate precautionary and/or take appropriate measures, wear personal protective equipment provided and have obtained appropriate training

Extended Observe staff for signs of stress and report concerns to Operations-

Psychosocial Intervention. Ensure rest periods and relief for staff Prepare end of shift briefing and update for back up Operations lead Plan for the possibility of extended deployment Attend meetings designated by PHIM as part of the emergency planning cycle Monitor and review work progress of Operations sub-functions Routinely update Operations sub-function leads on the status of the incident Maintain communications with other function leads e.g. Liaison, Planning Verify that Operations staff are performing work safely Report regularly to the Public Health Incident Manager Forward all expense claims to Finance-Administration Maintain appropriate documentation (function/service log)

Span of Control: Span of Control: The number of subordinates that a The number of subordinates that a superior can manage superior can manage effectivelyeffectively

Each person responsible for a maximum of 3 to 7 subordinates

–Ideal = 1:5 command ratio

Each person reports up to one supervisor

IneffectivIneffectivee

Effective

Designated FacilitiesDesignated Facilities

May identify certain sites / units to

carry out specialized functions

– Public screening centres

– Immunization clinics

– Tracking / follow up

How Does This Work in Real Life?How Does This Work in Real Life?

Incident occurs

Notification

– Official (eg – Police / MOHLTC EMU)

– Unofficial (ie people start calling…!)

On-call Medical Officer of Health becomes

Incident Commander/Manager

Initial ResponseInitial Response

Incident Commander = On-Call MOH


PH Nurse orInspector

PH Nurse orInspector

Initial Response (cont’d)Initial Response (cont’d)

Priorities and objectives established

On-site command developed

Multi agency communication established

Resource needs and allocation identified

NEEDS EXCEED NEEDS EXCEED AVAILABLE AVAILABLE RESOURCESRESOURCES

The Incident Progresses…The Incident Progresses… Decision to initiate local / regional plans Fan-Out process

– Health unit staff– Leadership

Senior on-site leader assumes IC role– Establishes EOC / Command Post– Begins to assign roles / responsibilities

Replaced by more senior staff as they arrive

Full-Scale PH ResponseFull-Scale PH Response Incident Commander appoints key personnel

– Four section Chiefs– Liaison / Information / Security

Job Action Sheets distributed and checklists begin

Priorities and objectives established– Incident Action Plan(s) developed

Span(s) of control established

Full-Scale PH Response (cont’d)Full-Scale PH Response (cont’d) Multi-agency communication established Resource allocation identified Tracking, evaluation, and cost recovery

initiated Off-site command established (as needed) Information released to media / public Recovery processes developed

Public Health Incident Manager

Liaison

Public Information

Operations Planning Logistics Administration

Mass Vaccination/Post Exposure Prophylaxis

Hotline Operation

Case Management/Contact Tracing

Environmental Inspection/ Sampling

Situation Assessment

Staffing & Resource Needs

Resource Deployment

Documentation

Demobilization & Recovery

Facilities

Human Resources

Nutrition/staff accommodation

Claims/Compensation

Costing

Procurement Reception Centre/Mass Care

Communications Equipment

Chair, Board of Health Medical Officer of Health Senior Management Team

Epidemiological Investigations

Psychosocial Intervention

Public Health IMS Model

Miscellaneous Supplies

Hospital IMS Model

SummarySummary

IMS is a framework for emergency response– Ideal for health sector

Many advantages:– Scaleable to size of event– Common terminology / organization of roles– Manageable span of control – Task-oriented approach

• Job action sheets• Incident Action Plan

Incident Management System: Application to Public Health Dan Cass, MD, FRCPC & Public health CBRN...

Documents

Transcript of Incident Management System: Application to Public Health Dan Cass, MD, FRCPC & Public health CBRN...