One of the many outcomes from the September 11, 2001 Trade Center attacks was the realization there is no standard language used among hospitals, emergency responders, smaller providers like ambulatory and surgical centers. Two fire departments responding to a fire may use different terms for the same event. A large metro hospital may defer non-critical cases to smaller regional medical facilities, all while asking for key personnel that does not exist in one facility or another. To standardize the lexicon and system, Congress authorized the organization and regulation of a standard procedure that became known as the National Incident Command System (NIMS).
“In the classes and exercises we’ve been doing recently, attendance is up because of regulation,” says Troy Jester. Jester, a 20-year veteran of Parkview Health in Fort Wayne, a retired firefighter, and a long-time hospital evaluator now with Vantage Point Consulting teaches Incident Command training and exercises. “We sometimes hear from people that they’re at training because their work requires it,” he says, adding, “We tell people the regulation is there because it’s a good regulation to assure they plan and prepare for emergencies.”
Within Indiana, it’s not difficult to imagine a scenario that could require a district-wide emergency response. A flood in Columbus or a tornado in Lafayette is a highly possible scenario. Within a real emergency, patients may be evacuated by air from small regional hospitals to Indianapolis. Fire departments from multiple counties may be called to assist. Police departments from the entire state may send officers to help control traffic and bring in electrical crews to restore utilities.
“Every time we hold training or exercise, there’s always a few people who understand Incident Command systems and lingo. A lot more, even if they’ve been through training before, don’t understand it,” says Mary Kay Hood. Hood is a 17 ½ veteran of Hendricks Regional Health and their HazMat Decontamination team. She now teaches Incident Command systems and conducts evaluations for Vantage Point.
Hood says there are two answers to the problem of ill-prepared personnel. “First, the way to solve it is more practice. If you can get more people to the training the better off you’ll be. If you can immerse people in these terms and the way to think about emergency response, the more comfortable they’ll be. The second answer is what I always tell everyone when I do an evaluation: if you can employ the whole Incident Command process in one of your community events, rolling out new software, or any other “everyday event” that isn’t an emergency, you’ll be comfortable when there is an emergency.”
Hood says it’s critical hospitals, ambulatory centers, surgical centers, and ancillary providers to emergencies understand Incident Command before it causes confusion during a real crisis. “I can think of an organization I was evaluating that had an org chart and structure that made sense to them. But they needed to take it one step further and fold their organization into the Incident Command structure to comply with a standard Incident Command System,” says Hood.
In a typical Incident Command structure, there’s a Commander at the top overseeing all events. But in small hospitals across Indiana and the Midwest, the Commander is often the CEO of the Hospital. “That doesn’t always make the most sense,” says Hood. The CEO should be available as the communicator to the board of trustees and other members of the community while providing authorization when necessary to the Incident Commander.
Under the Commander are vital professionals identified as Section Chiefs: logistics, operations, planning, and finance. Together these individuals ensure staff and supplies arrive promptly, the public is well informed, police and law enforcement are in place and operating, and accounting is handled for future reimbursement by insurance or the government. Within this system, if a nearby hospital calls to offer additional medications or blood supplies, they know to ask for the Logistics Chief.
“Within the one organization I was evaluating, they had six chiefs and it was broken down further from there. They didn’t even know what a logistics chief was. They were so focused on their organization that if they had a real emergency they would have caused confusion and delays,” says Hood. “It’s important people understand why the government set the standards and mandates this stuff,” she adds.
“Facilities that are going to function well within Incident Command are those that practice it on a normal basis,” says Jester. “If they don’t keep exercising their staff, they’ll have some disconnects later.”
“It’s not uncommon to see smaller facilities that just don’t have enough staff to handle a proper Incident Command System,” says Hood. “For instance, a small 24-bed hospital will usually delegate their department heads as their logistics, PIO, and so on. But what happens when one of them is on vacation or at a conference when the crisis occurs?”
Department heads are often not the ones performing the work responsibilities in an emergency, either. “Smaller healthcare organizations need to spread the wealth and make sure their leadership isn’t holding on to responsibilities for fear they might be letting go of something. Lives may be at stake if they don’t,” says Hood.