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Hospital Incident Command System (HICS)

Hospital Incident Command System (HICS)

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In the United States, the Hospital Incident Command System (HICS) is an incident command system (ICS) designed for hospitals and intended for use in both emergency and non-emergency situations. It provides hospitals of all sizes with tools needed to advance their emergency preparedness and response capability—both individually and as members of the broader response community.

HICS is based upon the Hospital Emergency Incident Command System (HEICS), which was created in the late 1980s as an important foundation for the 5,815 registered hospitals in the United States in their efforts to prepare for and respond to various types of disasters.

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 HICS 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.

HICS was developed by a national work group of twenty hospital subject-matter experts from across the United States. In addition to the contributions of the national work group, ex officio members were included to ensure consistency with governmental, industrial, and hospital accreditation planning efforts and requirements.

The California EMS Authority is the sponsor and copyright holder of the Hospital Incident Command System (HICS) 2014 Guidebook. The Guidebook is provided in CD (compact disc) format and includes not only the HICS 2014 Guidebook itself, but a wealth of hospital-specific guidance materials and tools (more information follows below).

You may download the CD disc image by clicking here: Hospital Incident Command System (HICS) 2014 – CD/Data DVD ISO Image

Overview of Incident Command System Principles

An ICS is designed to:

  • Be usable for managing all routine or planned events, of any size or type, by establishing a clear chain of command
  • Allow personnel from different agencies or departments to be integrated into a common structure that can effectively address issues and delegate responsibilities
  • Provide needed logistical and administrative support to operational personnel
  • Ensure key functions are covered and eliminate duplication

The incident planning process takes place regardless of the incident size or complexity. This planning involves six essential steps:

  • Understanding the hospital’s policy and direction
  • Assessing the situation
  • Establishing incident objectives
  • Determining appropriate strategies to achieve the objectives
  • Giving tactical direction and ensuring that it is followed (e.g., correct resources assigned to complete a task and their performance monitored)
  • Providing necessary back-up (assigning more or fewer resources, changing tactics, et al.)

The Hospital Emergency Management Program

HICS incident management team charts depict the hospital command functions that have been identified and represent how authority and responsibility are distributed within the incident management team. In the 2014 HICS Guidebook, the term “Incident Management Team” was changed to “Hospital Incident Management Team” or “HIMT”, in order to eliminate any potential for confusion with other response agencies that may be deployed to aid in managing the incident. Download the most updated HIMT organizational chart.

The activities at the Hospital Command Center (HCC) are directed by the Incident Commander, who has overall responsibility for all activities within the HCC. The Incident Commander may appoint other Command Staff personnel to assist.

Many incidents that likely will occur involve injured or ill patients. The Operations Section will be responsible for managing the tactical objectives outlined by the Incident Commander. Branches of this section include: Department Level, Patient Care, Infrastructure, Business Continuity, Security, and HazMat.

The Planning Section will “collect, evaluate, and disseminate incident situation information and intelligence to Incident Command” and includes a Resources Unit, Situation Unit, Documentation Unit, and Demobilization Unit. Support requirements will be coordinated by the Logistics Section, and the Finance/Administration section will account for the costs associated with the response.

Also, several additional incident command principles and practices are covered in this section, including incident command staff identification, building incident command staff depth, job action sheets, and incident response guides.

Example HICS Structure

Incident Commander – Administrator-in-Charge, (may re-delegate position, and provide control of the Command Center (CC)). Three Officers plus medical / technical specialists report directly to the Incident Commander:

  1. Public Information Officer – provides official information to media.
  2. Liaison Officer – connects to external agencies in response efforts.
  3. Safety Officer – Identifies hospital threats and takes steps to ensure continued safety of the facility, employees, and patients.
  4. Medical / Technical Specialists – i.e. CDC Doctor, and other specialists such as Biologic/Infectious Disease, Chemical, Radiological, Clinical Administration, Hospital Administration, Legal Affairs, Risk Management, Medical Staff, Pediatric Care, Medical Ethicist.

Operations Chief – Organizes and directs essential activities given by the CC and facilitate proper hospital staffing, with the following direct reports:

  1. Staging Manager
  2. Medical Care Branch Director
  3. Infrastructure Branch Director
  4. HAZMAT Branch Director
  5. Security Branch Director
  6. Business Continuity Branch Director
  7. Patient Family Assistance Branch Director (added in the 2014 version)

Planning Chief – Develops action plan for operations sustainment in 4-, 8-, 24-, and 48-hour increments after the disaster incident. Direct reports:

  1. Resources Unit Leader
  2. Situation Unit Leader
  3. Documentation Unit Leader
  4. Demobilization Unit Leader

Logistics Chief – Directs maintenance and supply operations to ensure patient care, supplies, equipment, and utilities for essential hospital functions. Direct Reports:

  1. Service Branch Director
  2. Support Branch Director

Finance Chief – Tracks expenditures for repayment and special purchases.

  1. Time Unit Leader
  2. Procurement Unit Leader
  3. Compensation/Claims Unit Leader
  4. Cost Unit Leader

In emergency situations, the Incident Commander has the ability to waive certain policies and procedures in order to assure that immediate assistance is rendered to all patients coming into the hospital. This allows the hospital to handle a surge in patients and render life-saving care to the greatest number of patients.

Life cycle of an incident

  • Alert and notification
  • Situation assessment and monitoring
  • EOP Implementation
  • Establishing the HCC
  • Building the ICS structure
  • Incident action planning
  • Communications and coordination
  • Staff health and safety
  • Operational considerations
  • Legal and ethical considerations
  • Demobilization
  • System recovery
  • Response evaluation and organizational learning

A Set of 16 Incident Planning and Response Guides

The HICS disc includes 16 Incident Planning guides and 16 Incident Response guides, for the following incident scenarios:

  • Active Shooter
  • Chemical Incident
  • Earthquake
  • Evacuation, Shelter-in-Place, & Hospital Abandonment
  • Explosive Incident
  • Hostage or Barricade Incident
  • Infectious Disease
  • Information Technology (IT) Failure
  • Mass Casualty Incident
  • Missing Person
  • Radiation Incident
  • Severe Weather with Warning
  • Staff Shortage
  • Tornado
  • Utility Failure
  • Wildland Fire

Understand that these are not necessarily incidents that directly impact the hospital facility. Some are incidents occurring in the community for which the hospital must be prepared to respond with emergency medical treatmtent within the hospital facility and possibly off-site as well.

Use of Incident Planning Guides (IPGs) and Incident Response Guides (IRGs)

Incident Planning Guides (IPGs) and Incident Response Guides (IRGs) are tools hospitals and healthcare partners may use to evaluate and improve their level of preparedness.

Incident Planning Guides outline strategic considerations for hospitals to assess when writing their response plans.

Incident Response Guides help you develop incident-specific response guides for the hazards that may impact the hospital.

The guide materials is organized as follows:

  • The Incident Scenario – Each guide includes a sample scenario which the Incident Planning Guide (IPG) and Incident Response Guide (IRG) are based upon. The scenarios may be customized, expanded, or revised by individual hospitals to meet their unique needs and strengths. The scenarios may be used to launch planning activities or as exercise scenarios for the hospital.
  • The Incident Planning Guide (IPG) – Each IPG identifies potential actions or strategies the hospital may use in preparing for the identified hazard. The IPG actions are grouped into the four phases of emergency management: mitigation, preparedness, response, and recovery. This allows the emergency manager to ensure that activities within each of the emergency management phases are considered during plan development. The IPG should be viewed as a template, with hospitals carefully considering the recommended actions for their customized plans.
  • The Incident Response Guide (IRG) – Each IRG identifies actions that may be undertaken in the Immediate, Intermediate, Extended, and Demobilization/System Recovery phases of an event. These actions are suggestions and should be reviewed by the hospital for applicability to their unique needs and capabilities. IRGs are meant to be customized by the hospital, including the insertion of hospital specific actions for each identified hazard.
  • Documents and Tools – recommended documents and tools including Job Actiopn Sheets and HICS Forms
  • Hospital Incident Management Team (HIMT) Activation Chart – a recommended for each response period

If a hospital identifies a threat or risk that has not been developed into an Incident Planning Guide (IPG) or IRG template within this guidebook, Chapter 9 provides guidance on how to develop and customize the IPGs and IRGs.