Biomedical Engineering Reference
In-Depth Information
command center, decontaminate patients and
lock-down the facility and its perimeter.
The fire service and other first response agencies
have followed an “Incident Command” model for
years. Historically, the fire department will main-
tain the command of the incident and the police
department will preserve the integrity and safety
of the scene. The EMS Agent will concern itself
with the treatment, destination, and transportation
based upon the status of the receiving acute care
hospital facilities in the area contiguous to the inci-
dent. In planning for an emergency, the hospital
may have to deal with emergencies that require
more resources than they have to provide and for
a longer time than they have to give. The senior
level administration may or may not be available
at the time of the incident to make command deci-
sions and the Supervisor “In-charge” of the hospital
when an incident occurs may not have the opera-
tional experience necessary to make vital decisions
to maintain the operational integrity of the insti-
tution. Therefore, the hospital is challenged with
identifying a system that will assist in the creation
of an incident command model when resources are
depleted and the typical administrative positions
are unavailable.
Fortunately, there are several models that have
been developed to meet these needs and assist in
the deployment of an incident command center
or EOC in a hospital. These systems identify,
through an organizational chart, key leadership
positions that need to be filled in order to miti-
gate the disaster from an operations perspective.
However, the positions are ambiguous and can be
filled by various members of the hospitals staff.
For each one of these positions, a “Job Action
Sheet” (Figure 22.4) is written which identifies the
immediate, intermediate, and tended needs of a
position whether it is the Incident Commander or
the Environmental Services Unit Leader. This job
action sheet is written to assist a position in making
decisions for the first 24 hours of a sustained emer-
gency operations center.
The “Hospital Emergency Incident Command
System”(HEICS) is a program that was devel-
oped in 1991 by the Orange County Healthcare
Agency and funded by the California Emergency
Medical Services Authority due to the frequency of
natural disasters and how they affect the healthcare
system. HEICS is a system of scripted command
positions developed for: “Uncomfortable Officials
in unfamiliar surroundings, playing uncomfortable
roles, making unpopular decisions with inadequate
information in far too little time” [4]. To date,
HEICS is the most commonly used hospital inci-
dent command system in the United States. It
is recognized as a “Best Practice” by acute care
hospitals across US and plays an integral role in
hospital drills and exercises.
When a drill or real emergency takes place, the
Hospital uses a set of covert overhead announce-
ments to alert the staff that an emergency exists
and how to respond to that specific emergency.
Hospital alerts vary from facility to facility which
may invoke some confusion, however, employees
are taught the emergency codes during employee
orientation, are refreshed to the specific codes on
an annual basis through competency based educa-
tion and during the drill activities. Many of the
hospitals have developed codes for preparation,
full-scale response as well as recovery for an
incident on top of the ordinary fire alarms and
electrical testing announcements. The codes are
kept covert to disguise its intent for the patient
and the visitor so as not to invoke unnecessary
panic. Employees should practice communicating
the intent of the overhead alerts to the inquisitive
patient and/or visitor so they are not “caught off
guard” and provide too much information that can
instill fear or anxiety.
Once activated, the hospital incident command
center becomes the central “Hub” of operational
activity. The HEICS system supports the concept
of interoperability and collaboration, which facili-
tates the ability to make executive level decisions
in an emergent situation. The members of the
executive management team and/or their designee
assume the role in the incident command center
that is most consistent with his/her daily obliga-
tions in the institution.
The following organizational chart demonstrates
the leadership matrix within the emergency opera-
tions center (Figure 22.5).
