Public Health Emergency - Leading a Nation Prepared
1.5 Concept of Operations
The management process delineated in the MSCC Management System is best presented in relation to the various stages of incident response.
Figure 1-8. Stages of Incident Response
These stages provide the context in which to describe the critical actions that must occur at different times during incident response.
Incident recognition is the point in time when a response agency becomes aware that a significant event (i.e., one requiring emergency response beyond baseline operational capability) is imminent or occurring. This is not always obvious, particularly with the onset of an infectious agent or chemical toxin. For example, one or two patients presenting to scattered HCOs with progressive paralysis indicating botulism may not be immediately recognized as a major public health problem until they are linked to a single toxin source. Because of this potential ambiguity, the process used to move from an early suspicion to recognizing that incident response is indicated should be carefully considered. Early convening of the jurisdiction's (Tier 3) UC, for example, may provide the necessary understanding of any public health impact associated with an event, and it may clarify whether an event needs to be formally declared an emergency.
Notification/activation refers to the activities required to inform appropriate assets within the response system about an incident onset or an important change in incident parameters. "Notification" conveys critical details (if available) and an indication as to whether the notified asset should undertake response actions. Full activation of every response component under UC is often not necessary and, therefore, the activation request in each asset's notification message may vary depending on the type of event.
Many notification/activation categories and schemes have been promulgated. Those selected for use should be consistent within tiers and easily understood across other tiers. To further prevent confusion, the categories should be clearly defined on each communication. The Federal Urban Search and Rescue System (and other Federal agencies) have used one notification/activation categorization for over a decade because of its clarity and simplicity.
Federal Urban Search and Rescue Notification/Activation Categories:
Other information is conveyed through "updates" during the course of the incident response.
Sources: Adapted from FEMA Urban Search and Rescue System; J. A. Barbera and A. G. Macintyre. Jane's Mass Casualty Handbook: Hospital; Jane's Information Group, Ltd., Surrey, UK, 2003.
The notification process should include a "confirmation of receipt" reply from the intended recipient. This reply should also contain a brief status report from the notified asset (using a standard format developed during preparedness planning) to allow immediate assessment of the response asset's capabilities.
Mobilization marks the transition from baseline operations to the response level designated in the notification. It may be triggered by a hazard that has already occurred, or it may result from a credible threat or an impending hazard (such as an approaching hurricane). Designating the response level enables an organization to execute specific actions delineated in its EOP for that level, such as providing contact information to ensure that the asset can integrate with other mobilizing response entities. For the mobilization process to function efficiently, each step must be clearly defined during preparedness planning and staff must learn the steps through training.
Incident operations encompasses efforts that directly address the hazard impact. Two critical actions that should occur early during operations are:
When incident response involves multiple disciplines and levels of government, it becomes operationally important to synchronize, as much as possible, the planning activities of participants so that response actions can be coordinated (Figure 1-9). This promotes consistency across tiers in defining the incident objectives and follow-on tactics. It also ensures consistency in the development of public messages.
As Figure 1-9 shows, the planning cycles and operational periods for the jurisdiction (Tier 3) and State (Tier 4) are concurrent; those for the Federal response (Tier 6) are slightly staggered. This allows for information exchange during planning activities. The agency representative meeting enables the evolving IAP to be reviewed in time to identify conflicts before briefing the operational units. This meeting can be conducted face-to-face or via teleconference. A formal media briefing to release incident details could occur after the agency representative meeting to ensure that responders are informed first and to promote a consistent message.
Figure 1-9. Coordination of Planning Activities
Demobilization refers to activities that focus on disengaging response resources as the incident objectives are met, transitioning remaining incident responsibilities to ongoing assets, and promoting rapid return of demobilized response resources to their normal function. There are several important considerations:
Recovery refers to longer-term activities that extend beyond demobilization and other response activities. It includes the rehabilitation of personnel and equipment, resupply, and actions related to physical and financial restoration. Returning the overall system to its pre-incident state—the goal of the recovery stage—is addressed by developing and implementing strategic plans for full restoration and system improvement.
Post-incident "organizational learning" is achieved through a timely and objective after-action report process that is designed to capture the positive aspects and the shortcomings of the response system. Findings should be documented in an outline format that can be organized on a spreadsheet and tracked. One basic format that has been widely successful is designed to capture, for each issue, a brief description of the issue, background information, recommendations, and follow-up actions. Improvements should focus on the EOP organization, processes, and training or equipment/supply issues, rather than on individual personnel actions. The review should also examine how effectively each asset integrated into the overall system, as well as how the response tiers coordinated with each other. Indicated changes should be accomplished based on priority and incorporated into the appropriate documentation.
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