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1.4 Relevant NIMS Principles for the Healthcare Coalition

The National Incident Management System (NIMS) was released by the U.S. Department of Homeland Security (DHS) on March 1, 2004, and a formal revision was published on December 18, 2008.[8] NIMS provides national guidance for government agencies, non-governmental organizations, and the private sector to prevent, protect against, respond to, and recover from all hazards. All domestic response organizations are required to follow its guidance to be eligible for Federal preparedness funding and to participate in emergency response in the U.S. The remainder of this chapter explains NIMS concepts that are relevant to the functions of a Healthcare Coalition during emergency response.[9]

1.4.1 Preparedness versus Response Organizations

A major focus of NIMS is on preparedness. Many organizations are involved in initiatives to enhance preparedness within and across levels of government. These initiatives often rely on committee meetings, teleconferences, and e-mail communications. Hospital associations, EMS councils, non-profit organizations, local emergency planning committees (LEPC), and public health/public safety agencies have all served as coordinating mechanisms for preparedness.[10] While these platforms, which are generally referred to in NIMS as “preparedness organizations” (see Exhibit 1-4), can be effective for preparedness planning, they can be problematic if used for emergency response due to their non-emergency nature and lack of 24/7 availability.

Exhibit 1-4. Definition of a Preparedness Organization

According to NIMS, a preparedness organization “provides coordination for emergency management and incident response activities before a potential incident. These organizations range from groups of individuals to small committees to large standing organizations that represent a wide variety of committees, planning groups, and other organizations (e.g., Citizen Corps, Local Emergency Planning Committees, Critical Infrastructure Sector Coordinating Councils).

U.S. Department of Homeland Security, National Incident Management System (NIMS), December 18, 2008; Available at: http://www.fema.gov/pdf/emergency/nims/NIMS_core.pdf.

For healthcare planners and participants in a Healthcare Coalition, it is important to distinguish the Coalition’s “preparedness organization” from the “response organization” that is needed for emergency response and recovery (Exhibit 1-5). The latter uses the structure and processes required to “get things done” under emergency conditions.

NIMS does not define a response organization, instead focusing on the ICS organization that commands incident response. However, the National Response Framework (NRF) uses “response organization” as the title of a chapter that highlights the importance of understanding “how we as a Nation are organized to implement response actions.”[11]

It emphasizes the need to define how an organization will be configured to effectively manage its emergency response. Exhibit 1-5 highlights the contrast between a preparedness and a response organization.

Exhibit 1-5. Preparedness versus Response Organization

Preparedness Organization:

  • Provides a structure and function to manage the coordination of emergency management activities, which take place in a non-emergency context.
  • Conducts emergency management program activities, including committee meetings, EOP development, preparedness planning, training, exercises, resource management, and program evaluation and improvement.

Response Organization:

  • Provides a structure and function to manage the coordination of actions to achieve objectives under emergency conditions.
  • Conducts information management, emergency decision-making, incident planning, actions to implement decisions, and coordination of resources.

1.4.2 Multiagency Coordination System (MAC System)

According to NIMS, “the primary function of a MAC System is to coordinate activities above the field level and to prioritize the incident demands for critical or competing resources, thereby assisting the coordination of the operations in the field.”[12] A common example of a MAC System is the traditional local jurisdiction or State Emergency Operations Center (EOC), which provides high-level support to the incident command entities. The MAC System coordinates the various organizations that are supporting the Incident Management Team (IMT). Since this is the intended function for the Healthcare Coalition, MAC System concepts should be understood by Coalition planners.

A MAC System can consist of a range of elements, but the most commonly referenced are the EOC and the Multiagency Coordination Group (MAC Group). Figure 1-2 highlights the contrast between the MAC Group and the EOC.


Figure 1-2. Comparison of the Central Elements of the MAC System 

Figure 1-2 highlights the contrast between the MAC Group and the EOC.

MAC Group, “decision-making,” consists of agency representatives with policy and decision-making authority; provides policy direction (beyond EOP); resolves strategic issues; is the arbiter for resource allocation; and convenes only as necessary.

EOC, “operational support,” consists of agency representatives with operational authority; implements policy (EOP) and MAC Group decisions; aggregates and returns incident information; facilitates resource support; provides other support and coordination.

Figure 1-2: Comparison of the Central Elements of the MAC system as described in previous paragraph.



While other models may be considered for the Healthcare Coalition response organization, the concepts inherent to a MAC System –specifically the EOC function and the MAC Group – are widely accepted and validated. They also conform to the national mandate that response organizations use NIMS principles. NIMS recognizes that these concepts are flexible and may be applied in the private sector.




  1. The National Incident Management System (NIMS) and related guidance are available at http://www.fema.gov/emergency/nims/.
  2. Additional information on NIMS implementation guidance for healthcare organizations is available at: http://www.fema.gov/pdf/emergency/nims/imp_hos.pdf.
  3. Maldin-Morgenthau B, Toner E, Waldhorn R, et al, Roundtable: Promoting Partnerships for Regional Healthcare Preparedness and Response. Biosecurity and Bioterrorism: Biodefense Strategy, Practice, and Science, Volume 5; 2007.
  4. U.S. Department of Homeland Security, National Response Framework (January 2008); Available at: http://www.fema.gov/pdf/emergency/nrf/nrf-core.pdf.
  5. NIMS Component IV: Command and Management, Section B. Multiagency Coordination Systems. The NIMS definition of a MAC System is provided in Appendix B.

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  • This page last reviewed: February 14, 2012