Imagine any of these scenarios playing out at your hospital:
- Your community is facing a large evacuation of all residents including your hospital. When you call the local ambulance service that you normally use for transports, they tell you they are unavailable. You remind them that they agreed in writing to be available at all times and have previously worked together to conduct the hospital drills. They tell you to take it up with the Unified Command Post Incident Commander.
- The hospital has been involved in what appears to be a possible terrorist attack. As you approach the scene, a police officer says that you are not allowed to enter the area; when you attempt to identify yourself as an employee, the officer tells you he has his orders from the FBI.
- There is a hostage situation at a school near the hospital. The captors are threatening to blow up the occupied school building. You are told to prepare for many injured. You want more information from the paramedic that called on the radio, but he says he is sorry, and that is all he can tell you. A short time later a person calls and identifies himself as a Logistics Chief and asks you to report to the Reception Area.
On February 28, 2003, President Bush issued Homeland Security Presidential Directive (HSPD) 5, which directs the Secretary of Homeland Security to develop and administer a National Incident Management System (NIMS). According to Chapter One of the NIMS document:
“This system will provide a nationwide approach for Federal, State, and local governments to work efficiently together to prepare for, respond to, and recover from domestic incidents, regardless of size, or complexity. To provide interoperability and compatibility among Federal, State and local capabilities, the NIMS will include a core set of concepts, principles, terminology, and technologies covering the incident command system; multi-agency coordination systems; unified command; training; etc… “
One important feature of this Directive is its national applicability. Local Governments will need to adopt and train for this new system in order to secure Federal funding for their communities. As a result, hospitals and local municipalities will have to train together, something common in many communities, yet rare in others. The emergency responders in your area may ask you to be part of a Unified Command Staff in the Command Post. They may refer to terms you have never heard of such as the “Reception Area.
For hospitals that have adopted the Hospital Emergency Incident Command System (HEICS) the changes are not all that significant. For those that have not adopted the HEICS system, this should be the catalyst for change. You must come to the realization that in order to work together, you must train together; in order to train together you must be operating with the same set of rules. Training should include role-playing through various levels of drills, and using various staffing levels to show the flexibility of the system. Following a similar set of rules allows people from the public safety community to also understand your roles and positions.
You must realize that a disaster that involves your hospital includes more than just response to the incident. It involves all phases of incident management including preparedness, response, recovery, and mitigation, which are the phases that the Federal Emergency Management Agency uses and are now part of the Joint Commission Standards.
Are you prepared for all of the hazards that may occur not only internally, but externally as well? Have you thought of how you would recover from an incident involving your hospital, either directly or indirectly? How long would it take and could you recover financially? Have you reduced the likelihood of incidents and their total impact through preparedness and mitigation?
Think about the scenarios presented at the start of this article, and their relationship to NIMS. Through preparedness and knowledge of NIMS, as well as HEICS, you would better understand the proper way to request the assistance of ambulances and personnel through the incident command system being used by your local responders. You can help them plan for evacuation during the planning stages by working in the Planning section as a health care representative.
During an incident involving a terrorist attack, the FBI and local law enforcement may become the lead agencies. It is important to understand their role in protecting evidence and apprehending the offender(s). A better understanding of their roles can be obtained by training with law enforcement in preparation for such an event. During a real event you will then be able to recognize the person you are working with or talking to, and will understand their role, and they will understand yours. One of the significant factors that helped the emergency response at the Pentagon on 9/11 was the fact that the local fire departments had trained with the local FBI personnel, and they knew each other well when they needed to work together.
NIMS involves the use of some new terms and a reminder of some of the old terms. Terms such as “Reception Area” or even “Intelligence Officer” may not be familiar to you, so the review of NIMS by your upper staff is an easy way to get acquainted with the concepts even if you do not try it out in a grandiose drill. By tying NIMS into your existing HEICS system, one thing is guaranteed: in the event of an actual event you will be better prepared to protect your employer, yourself, and your community. For your hospital plan to integrate into the community NIMS system, training of your employees will be essential!
For more information refer to the Office of Domestic Preparedness web page at www.ojp.usdoj.gov/odp/ The Federal Government has provided the free IS-700 on-line course which can provide a basic understanding of the NIMS system at http://training.fema.gov/EMIWeb/IS/crslist.asp Otherwise, contact a qualified healthcare emergency management consultant to assist you in setting up your plan, training your employees, or in planning, conducting, and evaluating your exercises. Having an outside view of your current drills may provide you with some very significant input.