incident management system: application to public health
DESCRIPTION
Public health CBRN course. Incident Management System: Application to Public Health. Dan Cass, MD, FRCPC &. Brian Schwartz MD, CCFP(EM), FCFP Scientific Advisor, Emergency Management Unit, MOHLTC. Goals of Session. Outline the evolution of the Incident Management System (IMS) model - PowerPoint PPT PresentationTRANSCRIPT
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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
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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
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What is IMS?What is IMS?
A way of creating (some!) order out of chaos
A framework
A tool
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TerminologyTerminology
For our purposes, all of these terms
are interchangeable:
– Incident Management System (IMS)
– Incident Command System (ICS)
– Hospital Incident Command System
(HICS)
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Where Does IMS Come From?Where Does IMS Come From?
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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)
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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
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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)
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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
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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
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IMS StructureIMS Structure
Command
Operations Planning LogisticsFinance /
Administration
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IMS StructureIMS Structure
Command
Operations Planning LogisticsFinance /
Administration
Doers Thinkers Getters Payers
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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
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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
Operations Planning Logistics Finance
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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
Operations Planning Logistics Finance
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LogisticsLogistics
Support OperationsAcquire and allocate resources and
provide all materials, equipment, and personnel required
Application of additional resources provided by Mutual Aid
Incident Commander
Operations Planning Logistics Finance
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FinanceFinance
Tracking of expenses
Funding
Government Financial Aid requests
Financial Aid distribution
Incident Commander
Operations Planning Logistics Finance
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IMS StructureIMS StructureCommand
Operations Planning LogisticsFinance /
Administration
ResponseTeam(s)
Safety Information
Liaison
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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
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In fo rm ationO ffice r
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In form ationO fficer
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In form ationO fficer
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T a sk fo rces a ndS trike te a m s
D iv is io nS u p erv isor
T a sk fo rces a ndS trike te a m s
D iv is io nS u p erv isor
B ra n chD ire c to r
T a sk fo rces a ndS trike te a m s
D iv is io nS u p erv isor
T a sk fo rces a ndS trike te a m s
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B ra n chD ire c to r
O p e ra tio nsse c tionC h ief
U n its
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U n its
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F in an ceS e ction
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In form ationO fficer
L ia isonO fficer
S a fe tyO fficer
T a sk fo rces a ndS trike te a m s
D iv is io nS u p erv isor
T a sk fo rces a ndS trike te a m s
D iv is io nS u p erv isor
B ra n chD ire c to r
T a sk fo rces a ndS trike te a m s
D iv is io nS u p erv isor
T a sk fo rces a ndS trike te a m s
D iv is io nS u p erv isor
B ra n chD ire c to r
O p e ra tio nsse c tionC h ief
U n its
P la nn ingS e ction
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U n its
L o g is ticsS e ction
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C h ief
In c ide ntC o m m a n d er
In form ationO fficer
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S a fe tyO fficer
T a sk fo rces a ndS trike te a m s
D iv is io nS u p erv isor
T a sk fo rces a ndS trike te a m s
D iv is io nS u p erv isor
B ra n chD ire c to r
T a sk fo rces a ndS trike te a m s
D iv is io nS u p erv isor
T a sk fo rces a ndS trike te a m s
D iv is io nS u p erv isor
B ra n chD ire c to r
O p e ra tio nsse c tionC h ief
U n its
P la nn ingS e ction
C h ief
U n its
L o g is ticsS e ction
C h ief
F in an ceS e ction
C h ief
In c ide ntC o m m a n d er
In form ationO fficer
L ia isonO fficer
S a fe tyO fficer
T a sk fo rces a ndS trike te a m s
D iv is io nS u p erv isor
T a sk fo rces a ndS trike te a m s
D iv is io nS u p erv isor
B ra n chD ire c to r
T a sk fo rces a ndS trike te a m s
D iv is io nS u p erv isor
T a sk fo rces a ndS trike te a m s
D iv is io nS u p erv isor
B ra n chD ire c to r
O p e ra tio nsse c tionC h ief
U n its
P la nn ingS e ction
C h ief
U n its
L o g is ticsS e ction
C h ief
F in an ceS e ction
C h ief
In c ide ntC o m m a n d er
In form ationO fficer
L ia isonO fficer
S a fe tyO fficer
T a sk fo rces a ndS trike te a m s
D iv is io nS u p erv isor
T a sk fo rces a ndS trike te a m s
D iv is io nS u p erv isor
B ra n chD ire c to r
T a sk fo rces a ndS trike te a m s
D iv is io nS u p erv isor
T a sk fo rces a ndS trike te a m s
D iv is io nS u p erv isor
B ra n chD ire c to r
O p e ra tio nsse c tionC h ief
U n its
P la nn ingS e ction
C h ief
U n its
L o g is ticsS e ction
C h ief
F in an ceS e ction
C h ief
In c ide ntC o m m a n d er
In form ationO fficer
L ia isonO fficer
S a fe tyO fficer
T a sk fo rces a ndS trike te a m s
D iv is io nS u p erv isor
T a sk fo rces a ndS trike te a m s
D iv is io nS u p erv isor
B ra n chD ire c to r
T a sk fo rces a ndS trike te a m s
D iv is io nS u p erv isor
T a sk fo rces a ndS trike te a m s
D iv is io nS u p erv isor
B ra n chD ire c to r
O p e ra tio nsse c tionC h ief
U n its
P la nn ingS e ction
C h ief
U n its
L o g is ticsS e ction
C h ief
F in an ceS e ction
C h ief
In c ide ntC o m m a n d er
In form ationO fficer
L ia isonO fficer
S a fe tyO fficer
T a sk fo rces a ndS trike te a m s
D iv is io nS u p erv isor
T a sk fo rces a ndS trike te a m s
D iv is io nS u p erv isor
B ra n chD ire c to r
T a sk fo rces a ndS trike te a m s
D iv is io nS u p erv isor
T a sk fo rces a ndS trike te a m s
D iv is io nS u p erv isor
B ra n chD ire c to r
O p e ra tio nsse c tionC h ief
U n its
P la nn ingS e ction
C h ief
U n its
L o g is ticsS e ction
C h ief
F in an ceS e ction
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In c ide ntC o m m a n d er
Provincial
Regional
Local Local Local
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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
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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”
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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
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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
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Integrated CommunicationsIntegrated Communications
How?Ensure able to communicate
– Established means• Dedicated lines
– Established frequencies• Encryption!
– BACKUP plan!
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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
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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
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Incident Action PlanIncident Action Plan
Each Section Chief (Operations,
Planning, Logistics, Finance) develops
IAP for their area
– Immediate / Intermediate / Extended
Integrates with overall IAP
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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
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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)
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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
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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
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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
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Designated FacilitiesDesignated Facilities
May identify certain sites / units to
carry out specialized functions
– Public screening centres
– Immunization clinics
– Tracking / follow up
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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
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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
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Initial ResponseInitial Response
Incident Commander = On-Call MOH
Operations Planning Logistics Finance
PH Nurse orInspector
PH Nurse orInspector
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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
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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
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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
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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
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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
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Hospital IMS Model
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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