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U.S. Department of Health and Human Services

3.2 Incident Recognition

The ability to recognize circumstances that may indicate the need for emergency response has importance not only for the Healthcare Coalition, but for individual organizations as well. Optimal recognition of the need to activate the HCRT and determine the earliest possible and appropriate response actions may be the most important factor in a successful outcome. A specific process for incident recognition and supporting procedures should be established.

3.2.1 What Constitutes an Incident for the Healthcare Coalition?

As discussed in Chapter 1, a situation becomes an “incident” for a healthcare organization when it requires the organization to activate its EOP. Activation of response systems by public health and medicine is commonly delayed due to narrow incident definitions based on casualty numbers. There are many situations in which few or no incident patients can be expected and yet activation of the EOP is warranted (e.g., utility disruption or other challenges to continuity of operations). Although it is important, the casualty count is not the sole indicator of the severity of issues that healthcare organizations will face during an incident.

In determining whether response action is warranted for the HCRT, it is important to remember that the Coalition’s response is scalable. Initial incident parameters may not warrant a full activation, but partial activation may be enough to address the anticipated response functions. With this concept integrated into Healthcare Coalition procedures, early activation will have only limited cost and minimal operational impact. Thus, more frequent activations of the Coalition are justifiable in anticipating potential support needs of healthcare organizations.

Provided below is general guidance on whether a situation is an incident for a Healthcare Coalition. Each Healthcare Coalition should develop its own specific guidance based on its situation.

Activation of a healthcare organization (Tier 1): Almost any declared incident (and subsequent EOP activation) for a Healthcare Coalition member organization is, by default, an incident for the Coalition. Although the affected organization may not immediately request assistance, the Healthcare Coalition should consider partial activation of the HCRT to promote situational awareness and to be ready to assist as needed.

Activation of a Jurisdictional Agency (Tier 3): The activation of a Jurisdictional Agency’s EOP may indicate the need for activation of the HCRT. The Healthcare Coalition Notification Center Technician should notify the Coalition’s Duty Officer to determine whether the HCRT should be activated. Even when an incident will not likely have a major impact on individual healthcare organizations, there is often merit in providing advisories or alerts to the Healthcare Coalition. For example, if the Jurisdictional Agency activates its EOP for a brush fire, an “alert” may be issued to healthcare organizations. This promotes readiness to rapidly transition into more robust operations, if needed.

Activation of a nearby Healthcare Coalition: In regions where multiple Healthcare Coalitions exist, activation of the EOP by one Coalition may suggest partial activation by less directly impacted Coalitions. This will enable the neighboring Coalition to maintain situational awareness for its healthcare organizations and anticipate requests for assistance.

Additional criteria for considering Healthcare Coalition activation include the following:

  •  If the Jurisdictional Agency (Tier 3) requests activation of the HCRT
  •  If there is evidence that incident circumstances could expand, especially in an intentional situation, such as terrorism, or if incident details are unclear
  •  If a similar incident in the past required activation of the HCRT
  •  If the Coalition’s Senior Policy Group requests HCRT activation.

3.2.2 Methodology and Requirements for Incident Recognition

To determine whether an incident exists for a Healthcare Coalition, the Coalition needs a method to be alerted about an anomaly, gather information, and conduct a balanced decision-making process. Decision makers should have well defined, incremental activation options. They should not be constrained to an “all-or-none” decision tool, which can be detrimental to timely incident recognition. Exhibit 3-2 provides several considerations for the Healthcare Coalition.

Exhibit 3-2. Healthcare Coalition Incident Recognition

To simplify decision-making processes, the Healthcare Coalition may establish two categories for initial incident information:

  1. Incident details that clearly indicate the need for notifications to Coalition member organizations and/or activation of the HCRT. Large-scale, sudden onset incidents, such as earthquakes, transportation accidents, or terrorist attacks qualify as potential incidents that warrant notifications to Coalition members and activation of the HCRT, even if only limited initial information is available. The Coalition may establish a list of incident types to facilitate decision-making processes.
    • Requests from certain entities, such as a local or State Public Health department, may warrant notifications to Coalition member organizations and activation of the HCRT.
  2. Incident information that does not clearly indicate the need for notifications to Coalition member organizations or activation of the HCRT.
    • A process should be established for making decisions under these circumstances. For example, the information may be vetted by the Coalition Duty Officer to determine whether a notification should be sent out and what it should include. Alternatively, the Duty Officer could attempt to obtain more information to determine next steps.

The Healthcare Coalition should strive to maintain a low threshold for recognizing anomalies as “incidents” for the Coalition. Early recognition has critical implications for the remaining stages of incident response. A low threshold is defensible if it triggers only a low-impact, limited HCRT activation until more information is known.

There are many sources that can provide relevant information to help determine whether an incident exists for the Coalition. Connectivity to these sources, which are highlighted below, should be addressed during preparedness planning to ensure the Coalition’s ability to rapidly share information.

  • Individual healthcare organizations (Tier 1) may provide initial information indicating the need for HCRT activation.
  • Jurisdictional authorities (Tier 3), such as Fire, EMS, Emergency Management, Law Enforcement, and Public Health may have critical information for healthcare organizations during the early stages of an incident.
  • Other public sector entities, including State or Federal agencies (Tiers 4 and 6, respectively), may provide relevant information (e.g., public health advisory) to the Healthcare Coalition. This is often (but not always) communicated to the Coalition through the appropriate jurisdictional authorities (Tier 3).
  • Other regional Healthcare Coalitions may share information about an evolving hazard, such as an infectious disease, that prompts incident recognition.
  • Media may broadcast information that helps the Coalition Duty Officer decide whether to activate the HCRT. Information verification is critical when media reports are used for decision-making.
  • Utility services providers (e.g., water, electricity, gas) may be a valuable source of information about a hazard impact and the extent and projected length of a utility outage.
  • Alarm systems that exist in some regions may warn of the possibility of an actual or impending hazard impact. Examples include weather warning systems, flash flood warning systems, and environmental surveillance systems such as Bio-Watch.[2] Having specific points of contact available to the Coalition and established reporting mechanisms is critical to timely incident recognition.

  1. Shea DA, Lister SA. The BioWatch Program: Detection of Bioterrorism (November 19, 2003). Congressional Research Service Report No. RL 32152, Available at:

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  • This page last reviewed: February 14, 2012