Hospital Incident Command Systems Case Study

Strategies to Resolve
There are many government, state, local and tribal agencies and organizations working together to resolve the aftermath of a massive wildfire. The following will discuss the responsibilities of a Hospital Incident Command Systems (HICS) which is at the forefront for caring and treating individuals and communities affected. The HICS ensures pre-planning, planning, evaluating, and testing of the system has been done prior to an incident (CDC, 2011). The first step when an incident occurs is the hospital needs to assess the situation. Some questions to ask include (CDC, 2011). What geographical area(s) has been or may be adversely impacted? How many people are threatened, affected, exposed, injured, or dead? Have critical infrastructures been affected (electrical power, water supplies, sanitation, telecommunications, transportation)? Is the hospital and surrounding healthcare facilities affected? How will current and forecasted weather conditions affect the situation? Has the local, state, or

tribal Emergency Operations Center (EOC) been activated?
In the event of a wildfire, key personnel in the hospital must be contacted. Key personnel include an incident commander (person in charge), liaison officer (all operations), public information officer (update to public through media), safety officer (maintains safety for hospital staff and volunteers), and general staff including operations section (burn and respiratory specialists) and finance and administration (Reilly & Markenson, 2011). Another step is to develop initial health response objectives that are specific, measurable, achievable, and time-framed (CDC, 2011). Establish an action plan based on the assessment of the situation. Assign responsibilities and record all actions. The public information officer (PIO) must participate in the Emergency Operation Center. The PIO from the hospital should be assigned to establish communications and maintain close coordination with the local, state, and tribal Emergency Operation Center (EOC). The PIO may or may not be physically located in the EOC at the time of an incident (CDC, 2011). The PIO also distributes information from these agencies to the public. This is most often done during a press conference with all involved agencies and the media. The hospital safety officer ensures the site of the Health and Safety Plan is established, reviewed, and followed. The safety officer will identify hazards or unsafe conditions associated with the incident and immediately alert and inform appropriate supervisors and leadership personnel (CDC, 2011). This can be achieved through site safety briefings and at shift changes.
The HICS is responsible for establishing communications with key health and medical agencies, facilities, and organizations that have emergency response roles and responsibilities, and verify their treatment and support capacities (CDC, 2011).

Agencies include: Emergency Medical Services (EMS), other hospitals and clinics, laboratories, nursing homes/assisted living facilities, home health care agencies, mental and behavioral health and social services providers, liaisons to vulnerable populations, and other health and medical entities. All contacts and information must be recorded, including unsuccessful attempts, and any follow-up actions (CDC, 2011). Another step is assigning and deploying resources and assets. Effective allocation and monitoring of health resources and assets will be required to sustain 24-hour response operations (CDC, 2011). Examples includes medical supplies and equipment to treat patients, blood supplies, and safe water and

food.
Addressing requests for assistance and information is another step for the HICS. Ensuring that health-related requests for assistance and information from other agencies, organizations, and the public are either directed to appropriate personnel within your hospital or forwarded to appropriate agencies and organizations (CDC, 2011). This can be vital, as a wildfire can be unpredictable and move rapidly, which could put a hospital in harm’s way. Communication with fire agencies can also provide new information such as a surge of injuries on the way to the hospital which would better prepare staff for burns victims needing surgery and blood.
Another step, initiate risk communication, ensures contact has been established with appropriate personnel within the hospital. It’s important to remember to communicate public health messages in the appropriate language(s) to persons with limited English proficiency. Employ the STARCC Principle – simple, timely, accurate, relevant, creditable, and consistent information (CDC, 2011). This can alleviate fear, trust, and anger in the public. A public health information “hotline” can be established to address requests for information from the public (CDC, 2011).
Engage legal counsel as part of the HICS emergency response effort. Staying on top of legal issues as they emerge and consult with appropriate personnel within department and jurisdiction. The hospital legal department identifies state and local laws and regulations that would impact the institution’s ability to implement hospital emergency response (CDC, 2011) safely and effectively, reducing potential legal issues at a later time. Finally, detailed documentation of all response activities. Hospitals are mostly electronically based today. Hand written forms should be used and duplicated. The information is important data that will be shared and will be evaluated to avoid future problems and gaps in the response. When the event has been stabilized information can be imputed electronically.
Summary
Though much has been learned about wildfires, California will continue to be susceptible.
Populations moving to wildland areas, highly flammable vegetation, diverse topography, and climate such as high temperatures, relative humidity, erratic winds, dry lightning, and drought has left California vulnerable. Best efforts of keeping dry brush away from homes, structures, and businesses is not enough. The development of FIRESCOPE, ICS, MACS, and HICS have helped standardized an all-hazard emergency response approach, but the unpredictability of wildfires can affect coordination, communication, and cooperation of a plan. Its on-going planning, training, and testing plans by drills which helps reduce gaps in resources. The process must involve all levels of government agencies and organizations, communities, and the media by assisting and sharing information and resources.