Engineering the Incident Command and Multiagency Coordination Systems

During the wildfires in California in the 1970s, the Incident Command System (ICS) was developed to create a standardized approach for firefighters to use in order to conduct an efficient response effort. Over the last 44 years, this system evolved into an all-hazards system used all over the world to mitigate a myriad of incidents from hurricanes to terrorist attacks to oil spills. Although ICS was developed as a standard system, both internationally and within the United States, this system and the training on this system were not always implemented or conducted in the same manner. The size and scope of the response which followed the 2010 Macondo Well Blowout (Deepwater Horizon) reinforced the need for continual, standardized training in ICS. Public and private sector response organizations have all become engaged in this effort to standardize the training used to prepare responders to participate as members of an Incident Management Team. The National Incident Management System (NIMS) model for ICS is now recognized as this standard internationally. Changes in the regulatory landscape since the implementation of the Oil Pollution Act of 1990 have served to increase NIMS ICS acceptance and utilization among federal, state and local government agencies, as well as U.S.-based private industry. Recently, response organizations from around the world have begun training in NIMS ICS. This global standardization will enhance the response posture of the entire response community. Examples of training and exercises conducted all over the world will illustrate the initialization of international standardization of ICS.

Dear Editor, Preparing and increasing efficiency in hospitals in disasters need to launch a common protocol named Hospital Emergency Incident Command System (HEICS). HEICS provide more coordination between hospitals and other institutions involved in emergency incidents by utilizing logical management structure, duty descriptions, creating clear reporting channels as well as developing a common and simple nomenclature system. Researches indicated that applying and establishing HEICS is necessity for Iranian hospitals and it can be helpful for use in both emergency and non-emergency situations, such as moving the facilities dispensing medications to hospital staff, or planning for a large hospital or community event. Developing training program on HEICS for hospital managers as well as establishing it seems necessary regarding our country’s condition. In this paper we point out establishing HEICS have to be in agenda for policy maker’s managers in Iranian health system and affiliated hospitals. Critical incidents are sudden, unanticipated events or situations that require quick decisions. Experiences from all around the world show that confusion and chaos are the most common issues which are confronted in hospitals when there is a serious crisis (1). Clearly a timely and effective management system with accurate organization and proactive plans and activities could minimize negative consequences of such incidents and maximize efficiency of emergency services (2-4). Incident command system (ICS) is currently the most common system of incident management in the world, gaining more recognition due to its successful outcomes (2, 4). In ICS, the incident commander, is responsible for directing other peoples to be well organized and involved. ICS is founded on some basic principles, which ensure using resources effectively, and on the other hand, reduce disturbances in decision making and doing proper operations, by responsible organizations (5). In other words, successful response to crisis requires coordination among all hospital wards and units as well as collaboration with pre-hospital emergency forces (such as EMS, Red Crescent agency), police, firefighting in order to make sure communication lines are established. Although certain level of flexibility needed to respond to variety of crisis (6). Instead of ICS, preparing and increasing efficiency in hospitals in such circumstances, a common protocol named Hospital Emergency Incident Command System (HEICS) has been proposed which is extracted from basis ICS (2). HEICS was created in the late 1980s as an important foundation for the 5815 registered hospitals in the United States in their efforts to prepare for and respond to various types of disasters (7). In fact, HEICS is an incident management system composed of some specific roles in the form of an organizational table. Each of these roles has a specific mission during crisis situation, and there is a list of individual job description which guide appointed person in the crisis situation carefully. Actually HEICS allows providing as much responsibilities as required at any time, and it means more effectiveness and lower cost. Thus HEICS has capability of adapting with different kinds of incidents and crisis in any scale (8-10). HEICS provide more coordination between hospitals and other institutions involved in emergency incidents by utilizing logical management structure, duty descriptions, creating clear reporting channels as well as developing a common and simple nomenclature system (2, 4, 11). HEICS provides a commanding system which doesn’t rely on specific people, but it is flexible (6). Significant and effective features in HEICS, especially in its third version (1998) have made it one of the most common and most comprehensive hospital management systems. In developing the fourth edition of HEICS, the value and importance of using an incident management system to assist as well with daily operations, preplanned events, and non-emergency situations became apparent. Thus, the HEICS was created as a system for use in both emergency and non-emergency situations, such as moving the facility, dispensing medications to hospital staff, or planning for a large hospital or community event (7). Developing training program on HEICS for hospital managers as well as establishing it seems necessary regarding our country’s condition. In spite of the necessity of establishing such a system, many developing countries still do not have to establish this system. According Yarmohammadian and his colleagues, barriers for HEICS establishment in Iranian hospitals are classified into two categories: internal and external. Internal barriers are related to health care sector and external barriers are referred to out of health care sector. Some of internal barriers include high cost implementation, lack of motivation in the hospital managers and staff, lack of common language, lack of competitive atmosphere for progress and excellence, involvement of administrative managers in daily activities, lack of empowerment, lack of feeling the need for crisis management, and lack of knowledge in managers. External barriers include lack of authorities support and non-commitment of managers, lack of qualified managers, absence of statutory requirements, too many decision maker authorities, lack of administrative culture for crisis management, poor communication and coordination in crisis team, constant change in regulations, and lack of emergency incident command system in the country (12). According to these barriers some solutions are: using other people’s experience and preparation of training packages related to unexpected disasters, support of department of ministry of health and considering extra and specific budget for it, concept building in different dimensions, creating interest in personnel, appointing qualified managers, training and informing managers in all levels in order to create shared language among them and culture-making, designing instructions and legal bylaws for hospitals and legal requirements, elimination of daily and limited concerns of managers and removing complex administrative processes, inclusion of emergency incident management in managers’ job description and regarding it in evaluation of hospital managers, preparation of indexes and standards related to implementation of circular by managers and selection of managers, job description and monitoring of managers, establishment of regular committee for managers so that they can have planning and implementation of this system in macro level and creating a single organization in the whole community (12-14). It is concluded that, since this system is one of the necessary needs of hospitals, it is recommended that such barriers should be eliminated and responsible entities including Ministry of Health and Medical Education (MoHME) and affiliated hospitals provide codified and ordered plans for establishment of this system. MoHME through approving and notifying rules and regulations can be established such valuable and proactive system for affiliated hospitals as well as private ones.

This paper investigates the use of the National Incident Management System (NIMS)'s Incident Command System (ICS) in law enforcement since Homeland Security Presidential Directive 5 was issued in 2003. It attempts to answer the following questions: (a) To what degree has law enforcement adopted the NIMS style ICS?; (b) To what degree has the NIMS/ICS framework been applicable to law enforcement?; and (c) Is the NIMS style ICS effective in the law enforcement response environment? The research includes a review of relevant case studies and literature and also includes the analysis of a survey instrument sent to 1,220 current and former law enforcement practitioners across the United States. The survey includes both open- and closed-ended questions. The data from closed-ended questions were compiled and displayed. Data from open-ended questions were grouped thematically. Responses were then assessed and compared with information gleaned from the literature review. Results indicate the system has been widely adopted by law enforcement, and its use is applicable and effective in some law enforcement responses. Its use in the highly chaotic initial phase of incidents, however, remains an open question.

Successful companies interpret the business landscape they operate in, adapt to changes in that environment and acquire the resources necessary to produce sufficient agility so they can continue to be learning organizations and prosper. Response efforts can resemble overnight conglomerate corporate structures with diverging or disparate missions, lack coherent strategy amongst units, or mismatch organizational structure to their position in the lifecycle of their business. The National Incident Management System (NIMS) Incident Command System (ICS) adopted by many Federal agencies for use in response management promotes many sound business practices but needs to equip senior management (incident commanders) with the tools necessary to create, run and disassemble their businesses effectively. What does the steward of a small, sometimes multi-million dollar business need to know to shepherd their organization through a business “lifecycle”? Key small business principles for efficient management of a short duration organization ought to reside in the ICS-400 curriculum. A starter assortment of “things they didn't teach you in ICS” is presented.

16 - The Clinical Engineering Department Role in Emergency Preparedness

Disasters and catastrophes are increasing in frequency, severity and complexity, meaning that effective multi-organisational response has never been more pertinent. The United States' National Incident Management System (NIMS), which includes the on-scene Incident Command System (ICS) component, is mandated for use at all levels of government and is often framed, somewhat narrowly, as a mechanistic hierarchy or an organic network. The related literature is divergent: academic critiques are lamented for lacking real-world insights whereas practitioner accounts are, unfairly, dismissed as anecdotal, meaning that novel insights that inform future preparedness are needed. Accordingly, this conceptual study reimagines NIMS/ICS using pragmatism, metaphorical analysis - informed by Morgan's seminal organisational metaphors, Pinto's 'Icehotel', and McCabe's 'Wonderland' metaphors - and symbolic logic. This paper demonstrates that NIMS/ICS is both mechanistic and organic, and much more at the same time. They engender much-needed novel and innovative perspectives which can be embedded within training and education activities to address the increasingly complex nature of disasters and catastrophes.

The Department of Homeland Security (DHS) has invested significant effort to assess whether cities and communities across the nation have the capabilities to respond effectively in the event of a potential chemical hazard release, terrorist attack, or natural disaster. The DHS strategy per Presidential Policy Directive 8: National Preparedness (PPD-8) is articulated in the National Preparedness Goal (2015) and efforts to achieve that goal require a capabilities-based planning approach. In an effort to assess these capabilities, Lawrence Livermore National Lab (LLNL) received funding from DHS to develop a Response Risk Assessment (RRA) process for potential chemical hazard events. The objective of the RRA process is to gather the essential information and data to evaluate limitations in overall response capabilities using rigorous quantitative analyses that focus on minimizing casualties. At the end of the process, a city or venue should be equipped with the actions it needs to take to meet capability standards articulated under the DHS national preparedness strategy. The RRA process uses the operational framework displayed in Figure ES-1 as a model to examine the emergency response system in detail, from initiation of an incident through definitive medical care. This operational framework is consistent with DHS/Federal Emergency Management Agency’s (FEMA) National Response Frameworks, particularly the core capabilities, Emergency Support Functions (ESF) (DHS, 2016) and National Incident Management System (NIMS)/Incident Command System (ICS) (DHS, 2017). The process framework is also consistent with the mission of the Department of Homeland Security Countering Weapons of Mass Destruction (CWMD) Office (DHS, 2018). Five municipalities across the nation worked with LLNL and DHS to implement demonstration projects that took place in partnership with local agencies, organizations, and other key stakeholders at the state and federal levels. Following the conclusion of the demonstration projects, LLNL prepared this document as a manual to guide users in implementing a Response Risk Assessment (RRA) for potential chemical hazard events. In addition to providing the background and foundation of the RRA approach, this document takes the reader through each part of the entire RRA process. Key timelines, meetings, and analysis actions are discussed and summarized in tables and figures. Critical information requirements to establish response timelines, assess population exposure, and consider capacity limitations that could increase casualties are presented in a manner that the RRA facilitator may employ to guide discussions with partners. Community partners may then establish actions for continual improvement in emergency response planning. To get facilitators off to a running start, examples of materials, tools, questionnaires, presentations, and templates used in an RRA are provided in the Attachments. They are encouraged to freely use and duplicate these materials. Finally, the document includes a summary of RRA enhancement areas and improvement opportunities identified by individuals, agencies, municipalities, and organizations involved in the demonstration projects. These nine enhancements are highlighted in Section 9.

To study the occupational safety and health systems used for emergency response workers in the USA, we performed interviews with related federal agencies and conducted research on related studies. We visited the Federal Emergency Management Agency (FEMA) and National Institute for Occupational Safety and Health (NIOSH) in the USA and performed interviews with their managers on the agencies' roles in the national emergency response system. We also obtained information prepared for our visit from the USA's Occupational Safety and Health Administration (OSHA). In addition, we conducted research on related studies and information on the website of the agencies. We found that the USA had an established emergency response system based on their National Incident Management System (NIMS). This enabled several organizations to respond to emergencies cooperatively using a National Response Framework (NRF) that clarifies the roles and cooperative functions of each federal agency. The core system in NIMS was the Incident Command System (ICS), within which a Safety Officer was positioned as one of the command staff supporting the commander. All ICS staff were required to complete a training program specific to their position; in addition, the Safety Officer was required to have experience. The All-Hazards model was commonly used in the emergency response system. We found that FEMA coordinated support functions, and OSHA and NIOSH, which had specific functions to protect workers, worked cooperatively under NRF. These agencies employed certified industrial hygienists that play a professional role in safety and health. NIOSH recently executed support activities during disasters and other emergencies. The USA's emergency response system is characterized by functions that protect the lives and health of emergency response workers. Trained and experienced human resources support system effectiveness. The findings provided valuable information that could be used to improve the occupational safety and health function in the Japanese system.

National Incident Management System and the Incident Command System

Two years ago, the U.S. Coast Guard (USCG) formally adopted the National Interagency Incident Management System (NIIMS) Incident Command System (ICS) as doctrine for response management to oil and hazardous materials incidents. USCG Marine Safety Office (MSO) San Francisco Bay has aggressively implemented ICS as the way it conducts spill response in addition to how it carries out many of its routine operations. In a comprehensive effort to improve readiness through ICS, the MSO has established an ICS implementation team. This team constructed an ICS-based organization chart, referred to as a Watch Quarter and Station Bill (WQSB), crafted a training program, prepared ICS equipment and supply “go kits” for spill deployment, and developed administrative measures to maintain and track the program. The MSO's training program is two pronged, consisting of ICS classroom training to teach best practices alternating with process tabletop exercises to reinforce lessons learned from responses. Each session is open for attendance by state and federal trustees as well as local USCG operational units. In this way, the MSO reaches out to the local response community to establish ICS expertise and enhance response relationships. The MSO's implementation plan has proven to be extremely valuable in building the knowledge of personnel, building relationships and better preparing everyone for future spills.

The emergency responses required during large-scale crises or disasters are extremely knowledge-intensive processes and are usually characterized by a high degree of unpredictability and unrepeatability. An emergency response is mission- and time-critical, unstructured, very dynamic, and it is very difficult to predefine or even to anticipate all possible response scenarios. Therefore, designing and implementing a software system to support such a response system is highly complicated and challenging. This research aims to investigate and discuss how Adaptive Case Management (ACM) can be leveraged in the design and implementation of a case-based emergency response system. In particular, this research considers the best practices of the National Incident Management System (NIMS), which is an essential part of the National Response Framework (NRF) developed in the United States. As a proof-of-concept, a prototype demonstration has been carried out on a leading commercial ACM platform. In addition, a walkthrough scenario is discussed to elaborate how ACM can support emergency response activities in real settings using the Incident Command System (ICS) organizational structure. The key benefit of this research is to guide the development and implementation of cased-based emergency response systems with a flexible and agile approach.

Law and Lawyers in the Incident Command System

The COVID-19 pandemic has stretched limited public health resources beyond measures, particularly at the local level. What started as an interesting report of pneumonia of unknown etiology in late December 2019 in Wuhan, China, bloomed into an international crisis by mid-January 2020. However, it was not until late January, when the first case was reported in the United States, that a new reality took shape for US public health agencies. After all, severe acute respiratory syndrome never made it to this country, and the only 2 cases of Middle East respiratory syndrome here were imported and never spread. Local public health agencies are notoriously short-staffed and underfunded. Therefore, when a crisis looms, personnel from a multitude of areas within the agencies are called upon to help out. Under its innovative and forward-thinking leadership, the St. Louis County Department of Health internally implemented the Incident Command System, a component of the National Incident Management System. While reassignment of individuals to new responsibilities under a new and temporary reporting structure did not always go perfectly, Incident Command System kept its promise to be adaptable to a fast-evolving situation, to clearly outline needed areas of responsibility, and to provide scaffolding that kept the Department of Health functional in chaotic times. It was able to be implemented quickly within hours of the first confirmed COVID-19 case in St. Louis County and enhanced the quality and timeliness of the public health response. This experience is being shared to provide a model of how organizations with limited personnel can use the Incident Command System to reorganize and meet unexpected challenges with increased success.

While developing its new crisis management plan in 1989, BP America (BPA) modified the incident command system (ICS) for use as the organizational structure of its oil spill response team. This was done to be compatible with the post-Exxon Valdez organization of the Alyeska response team and for certain advantages it would provide for responses in other locations and in other types of crisis situations. The ICS was originally developed for fighting wildfires in California and has since been widely adopted by other fire and emergency services in the U. S. While retaining most of the ICS structure, ?PA developed modifications necessary to fit the unique requirements of oil spill response. The modified ICS was used during a full scale test of ?PA's draft crisis management plan in December 1989, and thus was familiar to ?PA's top executives and other participating response team members. When the American Trader spill occurred in February 1990, BPA's management used the modified ICS organization even though the crisis management plan had not been finalized or widely distributed within the company. Details of the organizational structure evolved as the spill response progressed, in part due to the changing requirements of the response over time and in part because of previously unrecognized issues. This paper describes that evolution and the resulting final structure. Essential differences between the original ICS and BPA's oil spill version of it are highlighted. Despite the unrecognized issues and the unfamiliarity of some team members with the ICS, the organization worked well and can be credited with a share of the success of the American Trader response.

The incident command system (ICS) is a framework for organizing and directing on-site, tactical responses to a particular event or series of events. ICS provides a command structure for coordination, information flow, analysis, decision-making, communications, and implementation in an authoritative and standardized manner. The ICS framework has been used for emergency response in a variety of situations where the environment, human health, or other resources are at risk, including wildfires, natural disasters, terrorist attacks, oil and chemical spills, infectious disease outbreaks, and invasive species. This paper outlines the key components of ICS, as well as major elements for building ICS capacity. It concludes with a list of considerations for applying ICS in the invasive species context.