The Hospital Incident Command System

March 20, 2019 | Healthcare Risk, Quality, & Safety Guidance


Healthcare facilities must be prepared for emergencies as required by a variety of federal and state laws, as well as by Joint Commission's emergency management standards and other organizations' standards. Emergencies may be internal (e.g., fire, utility failure, chemical contamination), or they may involve external events that impact the broader community. For example, mass-casualty events, such as a mass shooting, a serious school bus crash, a hurricane, or a terrorist attack, may significantly affect the community at large, and may require the healthcare facility to exceed its day-to-day operational capability.

The hospital incident command system (HICS) is grounded in the following elements:

Source: California Emergency Medical Services Authority. Hospital incident command system guidebook. 5th ed. 2014 May cited 2018 Oct 2.

Healthcare organizations, therefore, must be prepared for incidents that affect the entire surrounding community. When such an event occurs, the healthcare facility is only one of many organizations involved in an emergency response, all of which must be able to work together efficiently and effectively. Accordingly, a hospital's role may go beyond simply treating casualties. For example, when a large-scale bombing or widespread infectious disease outbreak occurs, hospitals may be best suited to provide governmental authorities or the media with the most reliable indicator of the size and scale of the event (FEMA "NIMS"). In natural disasters such as flooding, hospitals may serve as places of refuge for both their own employees and the general public.

A large, complex, or very unusual medical incident that requires a response exceeding the organization's day-to-day operational capability simultaneously creates two sets of demands. The first set, referred to as hazard-generated demands, arises from the hazard itself and therefore varies by incident. The casualties associated with a large-scale hurricane, for example, are far different from those associated with an avian flu pandemic. Similarly, a hospital fire requires a different set of actions than would a response to chemical contamination. Correctly identifying the hazards and needs is crucial. The response should fit the needs. (Quarantelli)

The second set of demands, referred to as response-generated demands, arises from the response to the hazard (Quarantelli). Research has shown that these demands are predictable and similar, regardless of the incident (ICDRM). For example, whether responding to a large-scale hurricane or an avian flu pandemic, a hospital must always maintain situational awareness, process information, mobilize resources, communicate internally and with the public, and deal with political and bureaucratic issues.

The incident command system (ICS) facilitates management of both the original hazard-generated demands (e.g., casualties of a terrorist attack) and the response-generated demands (e.g., maintaining situational awareness about the nature of the attack and injuries). ICS is based on five management functions that...

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