Hospital incident command system

HICS Command Structure

One basic tenet of ICS is the clear chain of command, consisting of the Incident Commander and four sections: Operations, Planning, Logistics, and Finance/Administration. Depending on how complex the incident is, each HICS section can be further divided into branches, units, and teams, led by branch directors, unit or team leaders. The title of “manager” is reserved for tasks that might cross multiple other divisions, such as a staging manager or a patient tracking manager. In traditional ICS, there are additional subdivisions that are not typically used in HICS.

One of the ways that leaders in HICS are identified is by wearing color-coded vests with their titles clearly visible. The colors associated with each section are included below.

Incident Command Staff (White Vests)

The Incident Commander (IC) is responsible for everything that happens when he or she is in charge of the incident. The IC will guide and support the four section chiefs to set objectives and meet them. In the event of confusion or disagreement, the Incident Commander makes the final decision. The IC may have additional staff if necessary, such as a Public Information Officer or a Safety Officer. The size of the Incident Commander’s staff is driven by the size and complexity of the incident.

The Incident Commander is likely to be a high-ranking hospital administrator, such as the CEO, COO, Chief Medical Officer (CMO), or Chief Nursing Officer (CNO). Some hospitals will use the Emergency Program Manager, which is likely going to be the person with the best working knowledge of HICS. Since incidents happen at all hours, day or night, it is also quite reasonable to assume that a nursing supervisor or an on-call administrator might need to fill the role until a higher-ranking administrator can get there.

In many cases, there will be multiple people with responsibility for the overall response to an incident (fires, violence, or natural disasters, for example). In these cases, representatives from each agency with responsibility for the incident will collaborate in what is known as Unified Command. From this Unified Command group, someone will be designated to act as Incident Commander.

Operations Section Staff (Red Vests)

The Operations Section is where the bulk of the work gets done. All of the tactical decisions to achieve the incident objectives are made by the Operations Section Chief (Ops Chief) who reports to the Incident Commander. This position requires a high degree of technical knowledge on hospital operations and therefore it will draw from the same group of candidates as the Incident Commander. Remember that nursing supervisor who had to be Incident Commander when the incident began at 3:00 in the morning? She’s the best person for the job of Ops Chief as soon as the CEO shows up to take over as IC.

Most of the additional branches and units will appear under in the Operations Section as an incident grows and becomes more complex. it’s really important for the Ops Chief to use branches to maintain a manageable span of control.

  • The Medical Care Branch Director will report to the Ops Chief and will oversee all aspects of patient care. Under the Medical Care Branch Director, there could be an Inpatient Unit Leader, an Outpatient Unit Leader, a Casualty Care Unit Leader, a Behavioral Health Unit Leader, a Clinical Support Unit Leader, and a Patient Registration Unit Leader.
  • The Infrastructure Branch Director is responsible for the facility. In most hospitals, this would be the maintenance staff. Under the Infrastructure Branch Director, there could be a Power/Lighting Unit Leader, a Water/Sewer Unit Leader, an HVAC Unit Leader, a Building/Grounds Unit Leader, or a Medical Gases Unit Leader.
  • The Security Branch Director is pretty self-explanatory and could oversee an Access Control Unit Leader, a Crowd Control Unit Leader, a Traffic Control Unit Leader, a Search Unit Leader, and a Law Enforcement Interface Unit Leader.
  • The HazMat Branch Director is responsible for any decontamination of patients or facility and for responding to any spills. Units under the HazMat Branch include Detection and Monitoring, Spill Response, Victim Decontamination, and Facility/Equipment Decontamination.
  • The Business Continuity Branch Director is the one who keeps the computers running. This is usually an IT leadership position. Under the Business Continuity Branch would be the IT Systems and Application Unit, the Services Continuity Unit, and the Records Management Unit.
  • The Patient Family Assistance Branch Director oversees two vital roles: the Social Services Unit and the Family Reunification Unit. Depending on the type of incident, these units will be two of the busiest. While it seems like a small branch, it could have the most impact on the public’s perception of how well an incident was handled.

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