Public Health Emergency - Leading a Nation Prepared
The incident command process describes an ordered sequence of actions that accomplishes the following:
Actions during the initial phases of incident response should be guided by checklist procedures established in the EOP. For any response of more than a few hours, management should transition to a method of proactive response by establishing incident-wide objectives. These overarching "control objectives" are further qualified by establishing measurable and attainable objectives for each operational period, and by defined strategies and tactics. All are documented in an IAP. Because event parameters and the status of the components of an asset will change, incident objectives will have to change as the response evolves.
This flux in incident and response conditions is best managed using a deliberate planning process that is based on regular, cyclical reevaluation of the incident objectives. Commonly known in ICS as the planning cycle (see Figure 1-5), this iterative process enhances the integration of public health and medical assets with other response agencies that operate planning cycles.
Figure 1-5. Basic Presentation of a Planning Cycle.
The timing of the development of incident action plans should be coordinated among disciplines so that updated information may be shared before strategies and objectives are established. As shown in Figure 1-5, the key steps in the planning cycle are:
The following critical points should be made about the planning cycle:
During an emergency, the normal administrative structure for an organization must continue to operate while actions are carried out under the EOP to address the incident. Issues not related to the incident are best managed, to the extent possible, by the usual, day-to-day administrative system. In a sense, the ICS structure works within and for the organization's usual administrative system. This concept may be obvious to some disciplines such as Fire Fighting (the entire Fire Department is not replaced by the ICS structure during response) but may not be as intuitive in the example of smaller organizations such as some healthcare facilities.
For this reason, it is generally NOT advisable for the Chief Executive Officer (CEO) or other senior executive to automatically assume the position of the Incident Commander (IC) for an organization. Instead, this individual may be better situated to serve in the role ICS denotes as "Agency Executive.". This individual maintains overall authority and responsibility for the organization, including the activated incident management team. The executive is involved in the incident by providing policy and strategic direction to the IC, as well as allocating the authority to the IC to manage the incident. The Agency Executive must have access to the IC and may be included in the incident planning meetings.
This concept of an Agency Executive is important for organizations to understand as they seek to develop an effective EOP and interface with other organizations. Even though the ICS for the organization may be clearly delineated, the role of the Agency Executive is not always well addressed.
Multiple organizations may have leadership responsibilities during a mass casualty and/or mass effect event. ICS has a designated model, Unified Command (UC), which allows multiple stakeholders to actively participate in incident management. When this occurs, the resulting UC team promotes cohesive action within the response system, and provides a uniform interface for integration with other tiers. This concept is critically relevant for participation by public health and medical disciplines since they bear a primary responsibility for the well-being of responders and the general population during emergencies or disasters. The UC model provides a mechanism for direct input from public health and medical practitioners at the decision-making level.
UC brings together incident managers of all major organizations involved in the incident to coordinate an effective response, while allowing each manager to carry out his/her own jurisdictional or discipline responsibilities. UC links response organizations at the leadership level, thus providing a forum for these entities to make joint decisions. Under UC, various jurisdictions and/or agencies and non-government responders may work together throughout the incident to create and maintain an integrated response system. UC may be established to overcome divisions from:
(Adapted from: U.S. Coast Guard Incident Management Handbook, U.S. Coast Guard COMDTPUB P3120.17, April 2001)
Unified, proactive incident command is accomplished through joint decision-making that establishes common incident objectives (i.e., management by objectives). During an incident, clearly delineated goals and objectives are agreed on and formally documented to form the basis of the IAP. To accomplish this strategic guidance throughout an incident, UC must entail:
As previously described, Command and Operations are primarily supported by three internal (within ICS) Sections: Logistics, Planning, and Administration/Finance. However, in large-scale or complex events, incident command may require additional support from entities outside the responsibility/authority of ICS. This commonly occurs through an emergency management operations function—known in NIMS as a Multiagency Coordination System (MACS)—that is usually based in an Emergency Operations Center (EOC).. For Tier 3, it is usually supervised by the jurisdiction's emergency manager.
Figure 1-6. Relationship of UC and the MACS that provide emergency management operations support to the UC.
Multiagency Coordination Systems provide the architecture to support coordination for incident prioritization, critical resource allocation, communications systems integration, and information coordination. The coordination center (EOC and others, see figure 1-7) is referred to in NIMS as the Multiagency Coordination Center (MACC) component of the MACS. It provides support and coordination to the Incident Command, facilitates logistical support, and develops and provides information. The component of the MACS that provides strategic decision-making and policy direction (senior policy groups and others) is referred to as the Multiagency Coordination Group (MAC Group). The MACC implements the MAC Group decisions.
Figure 1-7. Common types of Multiagency Coordination Groups and Centers
During response, the MACS:
Example: In the event of a widespread outbreak of SARS in a jurisdiction, the UC (with lead participation by public health and the acute-care medical community) would establish protocols to guide the medical evaluation and treatment of confirmed and suspected cases, and to address surge capacity needs. In addition, the UC would be responsible for limiting the spread of the disease (as defined by their IAP).
Addressing the needs of travelers stranded when mass transit is disrupted, addressing requests to minimize the effect of school or business closures, and other significant issues may be considered to be functionally outside the scope of the incident response system. The jurisdiction's EOC would manage these issues using its emergency management team and Emergency Support Functions (ESFs), or other task groups.
Because of its complex role, the EOC's organization and management processes must be well defined. The MACS functions should be physically separate from incident management activities, even if they are co-located in the same facility. This critical concept, which is not widely addressed by many medical and public health managers, ensures that the roles and responsibilities of each remain distinct.
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