Incident Management

Authors: Theresa Rowe, Kyle Enfield

Additional Resources

References from ORTP Guidance, “Outbreak Response and Incident Management: SHEA Guidance and Resources for Healthcare Epidemiologists in United States Acute-Care Hospitals,” additional tools, resources, and articles.

References

  1. Institute of Medicine (IOM). Emerging Infections: Microbial Threats to Health in the United States website.www.nap.edu/read/2008/chapter/1. Washington, DC: National Academy Press; published 1992.
  2. Kaye KS, Anderson DJ, Cook E, Huang SS, Siegel JD, Zuckerman JM, et al. Guidance for infection prevention and healthcare epidemiology programs: healthcare epidemiologist skills and competencies. Infect Control Hosp Epidemiol. 2015;36:369-80.
  3. Society for Healthcare Epidemiology of America (SHEA). The SHEA Handbook for SHEA-Sponsored Guidelines and Expert Guidance Documents website. www.shea-online.org/images/docs/2017_Handbook.pdf. Published 2017. Accessed January 2017.
  4. Hospital Preparedness Program (HPP), Office of the Assistant Secretary for Preparedness and Response (ASPR). National Incident Management System (NIMS) Implementation for Healthcare Organizations Guidance website. www.phe.gov/Preparedness/planning/hpp/reports/Documents/nims-implementation-guide-jan2015.pdf. Published 2015. Accessed January 2017.
  5. Federal Emergency Management Agency (FEMA), Emergency Management Institute (EMI). National Incident Management System (NIMS) website. https://training.fema.gov/nims/ Published 2015. Accessed November 2016.
  6. Emergency Medical Services Authority (EMSA). Hospital Incident Command System (HICS) Guidebook, Fifth Edition website. www.emsa.ca.gov/media/default/HICS/HICS_Guidebook_2014_11.pdfAvailable and: http://www.emsa.ca.gov/disaster_medical_services_division_hospital_incident_command_system. Published May 2015. Accessed November 2016.
  7. Stanford Health Care. The Hospital Incident Command System: A Guide for Hospital Personnel website. www.youtube.com/watch?v=14SGKLZM5c0&feature=youtu.be. Published 2015. Accessed January 2017.
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  11. FEMA. NIMS Appendix B: Incident Command System website. www.fema.gov/pdf/emergency/nims/NIMS_AppendixB.pdf. Published 2008. Accessed November 2016.
  12. ASPR. Healthcare Organization (HCO) Emergency Operations Plan (EOP) website. www.phe.gov/Preparedness/planning/mscc/handbook/chapter2/Pages/hcoemergen.aspx. Published November 2012. Accessed 2016.
  13. EMSA. Hospital Incident Command System (HICS) website. www.emsa.ca.gov/disaster_medical_services_division_hospital_incident_command_system_resources. Published 2014. Accessed November 2016.
  14. Association of Healthcare Emergency Preparedness Professionals (AHEPP). HICS (Hospital Incident Command System) for Small Hospitals website. https://ahepp.site-ym.com/?page=IncidentCommand. Published 2014. Accessed November 2016.
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  44. Bellevue Hospital Center. Ebola Virus Disease (EVD) Incident Response Guide website. http://netec.org/wp-content/uploads/2015/09/Bellevue-EVD-IRG.pdf. Published 2016. Accessed November 2016.
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Additional Resources, Tools, and Reading

Title URL/Citation Description
ASPR Healthcare Organization (HCO) Emergency Operations Plan (EOP) http://www.phe.gov/Preparedness/planning/mscc/handbook/chapter1/Pages/emergencymanagement.aspx

http://www.phe.gov/Preparedness/planning/mscc/handbook/chapter2/Pages/hcoemergen.aspx

 Emergency Management and Incident Command System to understand the benefits of this structure, and role in ICS.   Helpful for administrators of the non-acute healthcare facilities (like outpatient setting or long term care setting) who might
have to coordinate with hospitals in an emergency event.
ASPR Healthcare Preparedness Capabilities National Guidance for Healthcare System Preparedness http://www.phe.gov/preparedness/planning/hpp/reports/documents/capabilities.pdf Detailed guidance for healthcare systems that wish to implement a comprehensive disaster preparedness plan. This information is aimed at hospital leadership.
ASPR NIMS Implementation for Healthcare Organizations Guidance http://www.phe.gov/Preparedness/planning/hpp/reports/Documents/nims-implementation-guide-jan2015.pdf Describes for hospital leadership how a hospital can develop a NIMS-compliant emergency plan, including leadership during emergencies, personnel training, record keeping, use of plain language to facilitate clear communication, establishment of
HICS, establishment of Mutual Aid Agreements/Memorandums of Understanding/Memorandums of Agreement with nearby local facilities to coordinate resources if needed.
Assessing Hospital Emergency Management Plans A Guide for Infection Preventionists http://www.ncbi.nlm.nih.gov/pubmed/19699558 Outline of infection prevention recommendations from various planning agencies and researchers in a single planning guide. Facilitates assessment of the hospital emergency management plans from an infection prevention point of view.
CDC Avian Flu Information for Healthcare Providers http://www.cdc.gov/flu/avianflu/healthprofessionals.htm Interim guidelines case definitions, reporting, testing, infection control, laboratories, prophylaxis and treatment guidelines, and status of vaccine development. Plans for updates noted on site.
CDC Emergency Preparedness and Response Preparation & Planning http://emergency.cdc.gov/planning/
Adapting Standards of Care under Extreme Conditions: Guidance for Professionals During Disasters, Pandemics, and Other Extreme Emergencies http://nursingworld.org/MainMenuCategories/WorkplaceSafety/Healthy-Work-Environment/DPR/TheLawEthicsofDisasterResponse/AdaptingStandardsofCare.pdf   Bioterrorism Readiness Plan: A Template for Healthcare Facilities (http://emergency.cdc.gov/bioterrorism/pdf/13apr99apic-cdcbioterrorism.pdf		 How lay people can protect themselves during infectious/biologic emergencies, and what the public can expect from federal, state and local authorities.
CDC Hospital All-Hazards Self-Assessment http://www.cdc.gov/phpr/healthcare/documents/hah_508_compliant_final.pdf Tool to determine the hospital’s level of preparedness.
CDC Hospital Legal Preparedness Relevant Resources http://www.cdc.gov/phlp/publications/topic/hospital.html Liability protections, situational regulations, legal and ethical issues during declared emergencies.
CDC Interim Guidance for Infection Control Within Healthcare Settings When Caring for Confirmed Cases, Probable Cases, and Cases Under Investigation for Infection with Novel Influenza A Viruses Associated with Severe Disease http://www.cdc.gov/flu/avianflu/novel-flu-infection-control.htm Recommends a higher level of infection control measures than for seasonal influenza: changes to contact and airborne precautions, higher level of personal protective equipment for healthcare personnel, including eye protection (required) and the
expanded use of respirators (i.e., for all patient-care activities). For seasonal influenza, eye protection is not required in all instances and respirator use is recommended only during aerosol-generating procedures conducted on influenza patients.
CDC MERS Information for Healthcare http://www.cdc.gov/coronavirus/mers/hcp.html Comprehensive site with valuable information and strategic plans.
CDC Pandemic Influenza Planning Checklist http://www.flu.gov/planning-preparedness/hospital/hospitalchecklist.pdf 3-section, 10 page checklist:

  • Planning preparedness committee membership, roles, contact information
  • Development for a written preparedness document
  • Elements of influenza pandemic plan
  • Checklist for communication plan components, including designation of media spokespeople and contacts
  • Education/training checklist
  • Vaccine and antiviral plan in place
  • Surge capacity planning
CDC Preparedness resources (MERS) http://www.cdc.gov/coronavirus/mers/preparedness/resources-preparedness.html
  • Guidance on managing calls and call centers (911 services etc.) during a pandemic
  • Identifies resources required to manage outbreak of SARS
  • Clinical guidance for identifying possible SARS patients is provided – this is important for case finding and ensuring health care facilities are protecting themselves during an outbreak (and between outbreaks)
  • Outline of who should be involved in outbreak preparedness (mandatory and optional membership)
  • Links to hospital all-hazards interactive tool, IOM crisis standards of care
  • Link to document outlining surveillance for SARS in the absence of significant person-to-person transmission worldwide
CDC Waste Management for Ebola http://www.cdc.gov/vhf/ebola/healthcare-us/cleaning/waste-management.html Reviews the waste management for PUI and confirmed Ebola Virus Diseases (EVD) in the hospitals and healthcare settings and specifics related to laws/regulation with DOT, hazardous substances
CMS Declared Public Health Emergencies – All Hazards Health Standards and Quality Issues FAQs https://www.cms.gov/About-CMS/Agency-Information/Emergency/Downloads/Provider-Survey-and-Certification-Frequently-Asked-Questions.pdf “Modifications and flexibilities” (i.e., waivers) during a declared emergency, and scope and limitations of such waivers.
Emerging Infectious Diseases: Concepts in Preparing for and Responding to the Next Microbial Threat chapter from the second edition of Disaster Medicine: Comprehensive Principles and Practice https://www.acep.org/uploadedFiles/ACEP/practiceResources/issuesByCategory/publichealth/The%202014%20Ebola%20Virus%20Outbreak.pdf Koenig & Schultz’s. Koenig KL, Schultz C. Disaster Medicine: Comprehensive Principles and Practices. 2nd ed. Cambridge, England: Cambridge University Press; 2016.
Facing Highly Infectious Diseases New Trends and Current Concepts Brouqui, P. Clinical Microbiology and Infection. 15(8)700-5. Facing Highly Infectious Diseases New Trends and Current Concepts
www.clinicalmicrobiologyandinfection.com/article/S1198-743X(14)60454-7/fulltext		 Article discusses:

  • Biosafety levels and biosecurity
  • Planning, design, and operation of an special pathogen/high level isolation unit
  • Issues in the management of patient with highly infectious disease
FEMA Emergency Management Institute (EMI) National Incident Management System (NIMS) https://training.fema.gov/nims/ Introduces the HE to important topic areas of Incident Management and nomenclature such as Incident Command System (ICS), National Response Framework (NRF), National Incident Management System (NIMS), Incident Action Plan (IAP), Emergency Operations
Plan (EOP), etc.Includes sublinks relevant to communication
http://www.fema.gov/media-library-data/20130726-1623-20490-0276/basic_guidance_for_pios_final_draft_12_06_07.pdf,
background for NIMS, a glossary
https://www.fema.gov/pdf/emergency/nims/NIMS_core.pdf, leadership, resource management, prioritization, and negotiation.
EMSA Hospital Incident Command System (HICS) http://www.emsa.ca.gov/disaster_medical_services_division_hospital_incident_command_system_resources Manual to instruct hospitals in why HICS is important for each hospital and how to build a framework to prepare for and handle emergencies.
Joint Commission Requirements for Emergency Management Oversight https://www.jointcommission.org/assets/1/18/JCP0713_Emergency_Mgmt_Oversight.pdf Requirements for emergency management leadership oversight within hospitals in the event of an emergency, delegation of responsibilities, staff input, gap analysis, prioritization of improvement efforts   Gives accountability for 6 domains:
communications, resources and assets, safety and security, staff responsibilities, utilities, and patient clinical and support activities
NACCHO Infectious Disease Emergency Response Toolkit http://apc.naccho.org/Products/APC20102190/Pages/ider_intro.aspx
http://apc.naccho.org/Products/APC20102190/Documents/Toolkit%20Overview%208.25.11.pdf		 Incident command system Understanding the various federal agencies during emergency response

This is a web-based FEMA course focused on organizations responsible for planning and executing incident response Information about managing Incident
Command Online FEMA training module about incident command response
Physical Interventions to Interrupt or Reduce the Spread of Respiratory Viruses Systematic Review Jefferson, T., Foxlee, R., Del Mar, C. et al. Emergency Medicine Journal. 23(5)349-53. Physical Interventions to Interrupt or Reduce the Spread of Respiratory Viruses Systematic Review. BMJ. 336(7635)77-80.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2190272/

 Effectiveness of various infection control measures to prevent transmission of respiratory virus infection including isolation, quarantine, social distancing, barriers, personal protection, and hygiene in both community and hospital setting.
3I Tool (Identify, Isolate, Inform) http://escholarship.org/uc/item/9z75b667#page-4
  • Koenig KL, Shastry S, Mzahim B, et al. Mumps virus: Modification of the identify-isolate-inform tool for frontline healthcare providers. West J Emerg Med. 2016 Sep;17(5):490-6. doi: 10.5811/westjem.2016.6.30793. Epub 2016 Jun 30.
  • Koenig KL, Almadhyan A, Burns MJ. Identify-isolate-inform: A tool for initial detection and management of Zika virus patients in the emergency department. West J Emerg Med. 2016 May;17(3):238-4. doi: 10.5811/westjem.2016.3.30188. Epub 2016 Apr 4.
  • Chea N, Perz JF, Srinivasan A, et al. Background and considerations for Ebola virus disease preparedness in U.S. ambulatory care settings. Am J Infect Control. 2015 Nov;43(11):1244-45. doi: 10.1016/j.ajic.2015.06.032. Epub 2015 Aug 12.
  • Koenig KL. Identify-isolate-inform: A modified tool for initial detection and management of Middle East Respiratory Syndrome patients in the emergency department. West J. Emerg Med. 2015 Sep;16(5):619-24. doi: 10.5811/westjem.2015.7.27915. Epub 2015 Oct 20.
Education and Training
SHEA/CDC Outbreak Response Training Program (ORTP) http://ortp.shea-online.org/
  • Digital toolkits on preparedness, mitigation, response, recovery, implementation
  • In-person conference recordings
  • Communication strategies webinar recordings
  • Online simulation modules
CDC http://emergency.cdc.gov/cerc/index.asp
www.cdc.gov/hai/organisms/cre/cre-toolkit/index.html
www.cdc.gov/hai/outbreaks/outbreaktoolkit.html
www.cdc.gov/infectioncontrol/index.html
  • Preparedness and Emergency Response Learning Centers (PERLC)
  • Crisis and Emergency Risk Communication (CERC) training
  • Pathogen-specific toolkits (23)
  • Outbreak Investigation Toolkit (69)
  • Prevention Tool Kits and Transfer Forms (80)
CDC/ASPR National Ebola and Training Center (NETEC) Materials: http://netec.org/online-education/
Exercises: http://netec.org/exercise-materials/
Resources: http://netec.org/resources/		 Outlines what is required for respective designation (Assessment Hospital vs. Ebola Treatment Center) and the organizational needs for ongoing training, staffing models, environmental IC, waste, and activating under intense public awareness and
interest, etc.
Council for Outbreak Response: Healthcare-Associated Infections and Antimicrobial-Resistant Pathogens (CORHA) http://www.astho.org/Healthcare-and-Infection-Control/Council/ CSTE and ASTHO collaboration with CDC and numerous healthcare organizations to improve practices and policies at the local, state, and national levels for detection, investigation, control and prevention of healthcare-associated infection/antibiotic
resistant (HAI/AR) outbreaks across the healthcare continuum, including emerging infections and other risks with potential for healthcare transmission via production of tool kits and other projects.
Nebraska Medicine Ebola Courses for the General Public & Clinicians http://www.nebraskamed.com/biocontainment-unit/ebola Information and tools that can be adapted by healthcare epidemiology, including videos, apps, and exercises for frontline workers. Provides communication recommendations and practical tools for implementation. Extensive detail on the logistics,
equipment needed, practical tools, and other considerations for care of EVD patients.
Office of the Assistant Secretary for Preparedness and Response (ASPR) www.phe.gov/Preparedness/planning/hpp/reports/Documents/hpp-pmi-guidance-2017.pdf
https://asprtracie.hhs.gov
www.astho.org/Programs/Preparedness/Public-Health-Emergency-Law/Public-Health-and-Information-Sharing-Toolkit
  • Hospital Preparedness Program (HPP) Performance Measures and Implementation Guide
  • Technical Resources, Assistance Center, and Information Exchange (TRACIE)
  • Public Health and Information Sharing Toolkit
San Francisco Bay Area Advanced Practice Center Infectious Disease Emergency Response (APC IDER) http://sfbayapc.sfcdcp.org/APC_Products.html Tools for Infectious Diseases Emergencies