Throughout history, hospitals and other municipal services have all had some way of responding to emergencies within the community. Prior to the creation of FEMA in 1978, municipal services often vied for control of emergency response during a disaster, as there was no defined set of procedures in place. Since the late 1980s, however, hospitals have responded to disasters using their own Hospital Incident Command System (HICS).

The HICS was created in California in order to integrate the incident command structure that was already in use by response agencies into the healthcare arena. In 2006, a group of 20 healthcare leaders got together and took the original version of the HICS (HEICS–Hospital Emergency Incident Command System) and made it National Incident Management System (NIMS) compliant. It evolved from being a system that was only used in emergencies to one that could be used to help manage people during any kind of event. More recently in 2013, the same work group was brought back together to update the materials and improve upon the system once again.

Job Action Sheets: Shaping Change in HICS

One of the central components of the HICS is the Job Action Sheet (JAS), designed to help providers define and perform a specific function within the organizational chart. By acting as a guide, the JAS helps providers collect information that is relevant to the event and their function when the HICS is activated.

In a small healthcare organization, the HICS could be activated with as few as one or two people who take on the different positions using the job action sheets to accomplish the most important tasks until more people arrive onsite. On the other hand, a large organization might have all positions filled up to 3 levels deep and whoever is onsite could be asked to fill one of them.

“Think of HICS as a toolbox—you have something that’s broken and you pull in the position on the organizational chart to fix it,” states Tracy Buchman, National Director of Healthcare Emergency Management. “[The JAS] ensure accountability and make sure that there is good bi-directional communication.”

Communication is what the JAS were designed for, but in addition to clarifying the responsibilities of providers within the organizational structure, they also serve a number of other important functions.

• FEMA Funding – Hospitals must fill out the HICS JAS and document an incident thoroughly in order to receive FEMA funding during a disaster. This is especially important when documenting incidents that occur outside the hospital environment, or which involve the community.
• Accountability – Disasters are unpredictable and in the heat of the moment, providers may have to make decisions concerning how and where to allocate resources that they normally wouldn't. The JAS provide them with a way to document their actions in the event they need to back them up later on.
• Development and Training – The job action sheets JAS provide healthcare organizations with a way to improve their response to both emergency and non-­‐emergency situations. Through the documentation and “Lessons Learned,” providers can identify what worked and what they need to work on.

It's this final point that has served as the driving force for the most recent revisions within the HICS. By bringing together members of the original work group, improvements were made based on information taken from JAS documentation from a variety of different hospitals and events.

The Future of HICS

“It’s a challenge for people to come to a disaster and have to start filling out a bunch of forms when what they really want to do is start responding,” states Tracy who, as part of the original work group, also helped make revisions for 2013.

The work group wanted to keep the HICS scalable, while complying with regulations and industry expectations and minimizing costs. The result was “a more standardized set of materials designed to help providers spend less time on documentation and more time taking action” says Tracy.

• Incident Action Plan (IAP) – Originally consisting of 5 separate forms, the IAP was consolidated into a two-­‐page front/back Quick Start IAP, which helps organizations get up and running quickly. The Quick Start IAP makes it easier for providers take a few extra minutes to create a plan of action so that they can better prioritize resources that might be scarce.
• The Job Action Sheets – The JAS have retained their core concept, but have been reformatted to provide clear directions and ease of documentation. They can now be modified with phone numbers, resources and capabilities, and also offer spaces for additional positions, start/end times and operational periods. “The goal was to make the JAS more user-friendly and entice hospitals to use them more often” explains Tracy, “ [we wanted] to make them more functional to the position of the person who is filling them out.”
• The Incident Planning and Response Guide – The 27 NIMS planning scenarios within the Incident Planning and Response Guide have been condensed down to 16 because many of them were redundant. The Guide now also includes a few new scenarios such as wildfire, active shooter, mass casualty incident and tornado.
• Formatting – The JAS have all been converted into Word documents, allowing organizations to customize them with their logo, phone number, location and other important information. The idea is to keep the forms structurally intact so that there is consistency between hospitals while still allowing for customization. Tracy points out “the new format makes documentation easier by reducing the amount of paperwork and keeping information all in one place.”

The idea was to improve upon a system that already worked, not make it different. With the new format in place, organizations can anticipate a reduction in the amount of paperwork and the consolidation of information in a simpler, more streamlined format.

The revised HICS forms and materials can be found at http://www.hicscenter.org/ or http://www.emsa.ca.gov/