Topic Collection Cover Page

Incident Management
Topic Collection
October 16, 2019

Topic Collection: Incident Management

In the aftermath of a disaster, medical providers must work collaboratively with other responders, on the scene and at healthcare facilities. An incident command structure is critical to organize the response within a healthcare facility, agency, or across disciplines to assure common structures, terminology, communications, development of objectives, and management of information and resources. Use of incident management structures and techniques assures an effective, efficient response. Learning about and exercising these models before a crisis occurs is imperative.

The following resources highlight incident management resources with a healthcare emphasis. (It is incumbent upon the reader to ensure they are using the most recent versions of any forms or templates.) Resources specific to multi-agency coordination are included because most healthcare coalitions function in a coordination, rather than a command, role. For more information, access the Healthcare Coalition Response Operations and Emergency Operations Plans/ Emergency Management Program Topic Collections. 

Each resource in this Topic Collection is placed into one or more of the following categories (click on the category name to be taken directly to that set of resources). Resources marked with an asterisk (*) appear in more than one category.

Must Reads


Backer, H., Smiley, D., Schoenthal, L. et al. (2014). Hospital Incident Command System (HICS) Guidebook: Fifth Edition, May 2014. California Emergency Medical Services Authority.
This latest version of the HICS guidebook meets the needs of all types of hospitals, regardless of location, size, or patient care capabilities and provides event-based templates and resources in addition to the system framework and job action sheet templates. Specifying the ICS used and how it is implemented is a key component of the EOP.
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Barbera, J.A. and Macintyre, A.G. (2007). Medical Surge Capacity and Capability: A Management System for Integrating Medical and Health Resources During Large-Scale Emergencies. U.S. Department of Health and Human Services, Office of the Assistant Secretary for Preparedness and Response.
This handbook describes the changes to the federal public health and medical response structure since the development of the original MSCC handbook in 2004. The MSCC Management System describes a framework of coordination of public and private entities across six tiers of response, of which tier two is the management of healthcare coalitions (see Chapter 3). This document is considered to be a foundational document for coalition development that describes the response system and its integration into the community response structure..
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California Department of Public Health (CDPH) and the California Association of Health Facilities (CAHF). (2017). NHICS: Nursing Home Incident Command System. American Health Care Association.
This webpage includes information on the nursing home incident command system (NHICS), which can be used by facilities regardless of size or resident care capabilities, and is intended to assist with their emergency planning and response efforts for all hazards. Links to the NHICS guidebook, forms, response guides, Job Action Sheets (JAS), and training are included.
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Federal Emergency Management Agency. (2012). Incident Action Planning Guide.
This resource is a comprehensive guide to FEMA’s incident action planning process and can be used and applied by any agency / facility.
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Federal Emergency Management Agency. (2019). National Incident Management System (NIMS).
The National Incident Management System is a comprehensive, nationwide systematic approach to incident management and is composed of a core set of doctrine, concepts, principles, terminology and organizational processes. The Hospital Incident Command System (HICS) builds upon National Incident Management concepts.
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Federal Emergency Management Agency. (2019). National Incident Management System Training. U.S. Department of Homeland Security.
This webpage includes links to FEMA’s Incident Command System (ICS) training courses (e.g., Introduction to Incident Command System, Public Information Systems, and NIMS Intrastate Mutual Aid - An Introduction) and other related resources.
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Hick, J.L., Koenig, K.L., Barbisch, D., and Bey, T.A. (2008). Surge Capacity Concepts for Health Care Facilities: The CO-S-TR Model for Initial Incident Assessment. (Abstract only.) Disaster Medical Public Health Preparedness. 2(Suppl 1): S51-S57.
The CO-S-TR model is designed to be implemented in the immediate aftermath of an incident, and complements the Incident Command System by aiding incident assessment and surge capacity responses at the healthcare facility level. "CO" stands for command, control, communications, and coordination; "S" considers the logistical requirements for staff, stuff, space, and special (event-specific) considerations; "TR" comprises triage, treatment, tracking, and transportation. Access the related poster/reference card here: https://files.asprtracie.hhs.gov/documents/co-st-r-guide.pdf.
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Hospital Incident Command System. (n.d.). Hospital Incident Command System. (Accessed 2/18/2019).
This website provides access to the Hospital Incident Command System (HICS) 2014 Guidebook, HICS forms and Job Aids.
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The Institute for Crisis, Disaster, and Risk Management (ICDRM) at the George Washington University (GWU) for the Veterans Health Administration (VHA), US Department of Veterans Affairs (VA). Washington, D.C. (2010). Emergency Management Principles and Practices for Health Care Systems, 2nd Edition.
This document provides a thorough overview of the framework for emergency management of a healthcare system and can be useful to any agency or organization involved with the delivery of healthcare services. The authors explain incident management concepts and how they can be applied in the healthcare system within the broader context of a holistic approach to facility emergency management.
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U.S. Coast Guard. (2014). Incident Management Handbook. U.S. Department of Homeland Security.
This handbook was designed to help personnel use the National Incident Management System. It provides summaries and checklists for the planning cycle (e.g., planning meeting agendas, operational briefing formats), and other useful materials for commanders and section chiefs including an illustration of the planning "P."
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Education and Training


Speakers in this 1.5 hour ASPR TRACIE webinar share an overview of hospital-based incident command and lessons learned from activating their systems in response to recent incidents (e.g., Hurricane Sandy and the 2017 California wildfires).
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This webinar features speakers from small and rural hospitals who have experienced a recent emergency and activated their hospital-based incident command systems. They provided an overview of the incident, described how they implemented their incident command system, discussed tools and shared lessons learned for small and rural hospitals, and shared how they have incorporated these lessons into their current systems and plans. Links to speaker biographies and Q&A are provided on the first slide.
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Buchman, T. (2011). Using the Hospital Incident Command Forms: Which Ones, When and Why. Creighton University and University of Nebraska, Center for Preparedness Education.
The speakers in this webinar discuss the appropriate forms to complete before and after activating hospital incident command, and why accurate and complete forms are crucial during an incident.
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California Hospital Association. (n.d.). HICS Education. (Accessed 7/23/2019.)
The California Hospital Association provides links to training courses that may be of interest to healthcare emergency preparedness professionals.
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Center for Domestic Preparedness. (n.d.). Framework for Healthcare Emergency Management. (Accessed 10/16/2019.) Federal Emergency Management Agency.
Emergency healthcare providers and planners can learn about development, implementation, maintenance, and administration of emergency management programs and plans for healthcare facilities. The course includes lectures and guided discussions on topics such as emergency management issues for healthcare, personal protective equipment, decontamination, and isolation and quarantine.
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Center for Domestic Preparedness. (n.d.). Healthcare Leadership for Mass Casualty Incidents. (Accessed 10/16/2019.) Federal Emergency Management Agency.
This four-day course for healthcare leaders focuses on critical disaster emergency preparedness decision making, management of different facets of the hospital response, and considerations for the community. The course applies to any incident with multiple casualties requiring surge capacity implementation and emphasizes the importance of incident command in thehospital
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Center for Domestic Preparedness. (n.d.). Incident Command: Capabilities, Planning and Response Actions for All Hazards. (Accessed 7/23/2019.) Federal Emergency Management Agency.
Incident Command: Capabilities, Planning, and Response Actions for All Hazards (IC) is a three-day course that provides management-level responders with knowledge of how decisions made by responders from various disciplines can impact the handling of a chemical, biological, radiological, nuclear, or explosive (CBRNE) incident.
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Federal Emergency Management Agency. (2019). National Incident Management System Training. U.S. Department of Homeland Security.
This webpage includes links to FEMA’s Incident Command System (ICS) training courses (e.g., Introduction to Incident Command System, Public Information Systems, and NIMS Intrastate Mutual Aid - An Introduction) and other related resources.
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This free 30-minute online simulation is geared towards epidemiologists and provided in collaboration with the Society for Healthcare Epidemiology of America (SHEA). It is designed to highlight effective leadership techniques in the face of various health crises. Expert faculty provide their insights on hospital incident command systems; communications with staff, media, the general public; and patient safety concerns.
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This video provides an overview of the Hospital Incident Command System (HICS) and is intended to highlight information necessary for physicians who may assume the role of a Medical Technical Specialist.
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This video provides an overview of the Hospital Incident Command System (HICS), highlights position descriptions and defines roles and responsibilities for each position.
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University of Rochester Medical Center. (n.d.). Hospital Command Center Course Materials. (Accessed 7/23/2019.)
These course materials review planning and operations considerations for the hospital command center and may help other facilities as they set up and build their emergency management infrastructure.
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Guidance


Backer, H., Smiley, D., Schoenthal, L. et al. (2014). Hospital Incident Command System (HICS) Guidebook: Fifth Edition, May 2014. California Emergency Medical Services Authority.
This latest version of the HICS guidebook meets the needs of all types of hospitals, regardless of location, size, or patient care capabilities and provides event-based templates and resources in addition to the system framework and job action sheet templates. Specifying the ICS used and how it is implemented is a key component of the EOP.
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Barbera, J.A. and Macintyre, A.G. (2007). Medical Surge Capacity and Capability: A Management System for Integrating Medical and Health Resources During Large-Scale Emergencies. U.S. Department of Health and Human Services, Office of the Assistant Secretary for Preparedness and Response.
This handbook provides an overview of the Medical Surge Capacity and Capability (MSCC) Management System and describes how the model can be applied and integrated across six “tiers of response.” Chapter 1 provides an overview of the Incident Command Process, including incident action planning. Appendix C covers the Incident Action Plan.
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Federal Emergency Management Agency. (2012). Incident Action Planning Guide.
This resource is a comprehensive guide to FEMA’s incident action planning process and can be used and applied by any agency / facility.
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Federal Emergency Management Agency. (2016). National Response Framework (NRF).
The National Response Framework is a guide to how the Nation responds to all types of disasters and emergencies. It is built on scalable, flexible, and adaptable concepts identified in the National Incident Management System to align key roles and responsibilities across the Nation. Emergency Support Function # 8, Public Health and Medical Services, is introduced and described.
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Federal Emergency Management Agency. (2019). National Incident Management System (NIMS).
The National Incident Management System is a comprehensive, nationwide systematic approach to incident management and is composed of a core set of doctrine, concepts, principles, terminology and organizational processes. The Hospital Incident Command System (HICS) builds upon National Incident Management concepts.
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Hospital Incident Command System. (n.d.). Hospital Incident Command System. (Accessed 2/18/2019).
This website provides access to the Hospital Incident Command System (HICS) 2014 Guidebook, HICS forms and Job Aids.
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National Fire Protection Association. (2014). NFPA 1561: Standard on Emergency Services Incident Management System and Command Safety. (Free registration required to view 2014 version.)
This standard includes requirements for emergency services that can help protect the safety of emergency responders and others on the scene of an incident.
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The Institute for Crisis, Disaster, and Risk Management (ICDRM) at the George Washington University (GWU) for the Veterans Health Administration (VHA), US Department of Veterans Affairs (VA). Washington, D.C. (2010). Emergency Management Principles and Practices for Health Care Systems, 2nd Edition.
This document provides a thorough overview of the framework for emergency management of a healthcare system and can be useful to any agency or organization involved with the delivery of healthcare services. The authors explain incident management concepts and how they can be applied in the healthcare system within the broader context of a holistic approach to facility emergency management.
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* U.S. Coast Guard. (2014). Incident Management Handbook. U.S. Department of Homeland Security.
This handbook was designed to help personnel use the National Incident Management System. It provides summaries and checklists for the planning cycle (e.g., planning meeting agendas, operational briefing formats), and other useful materials for commanders and section chiefs including an illustration of the planning "P."
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U.S. Department of Health and Human Services, Office of the Assistant Secretary for Preparedness and Response. (2012). What is an Incident Action Plan?
This webpage defines an Incident Action Plan (IAP), lists key data points for inclusion in an IAP, and provides an example of an IAP for an individual healthcare organization as a reference.
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U.S. Department of Health and Human Services, Office of the Assistant Secretary for Preparedness and Response. (2015). NIMS Implementation for Healthcare Organizations Guidance.
This document includes 11 National Incident Management System (NIMS) implementation objectives tailored to health care organizations. NIMS compliance is required for health care organizations to receive national hospital preparedness program funding and for public health to receive PHEP funding. (Please note that the most current version of NIMS is dated 2017 and should be reviewed along with this document to better ensure alignment.)
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Lessons Learned


Goralnick, E., Halpern, P., Loo, S., and Gates, J. (2015). Leadership During the Boston Marathon Bombings: A Qualitative After-Action Review. (Abstract only; supplementary materials available.) Disaster Medicine and Public Health Preparedness. 9(5): 489-495.
The project team analyzed qualitative data from focus groups and interviews conducted with physician leaders from seven hospitals who handled patients injured during the Boston Marathon bombings. Challenges with technology were discussed (along with other issues) as were plans for incorporating lessons learned.
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Krilich, C. and Currie, J. (2018). What Hospital Leaders Learned from the Wildfire. American Association for Physician Leadership.
This article discusses lessons learned from hospitals in California during the 2017 wildfires. The authors credit following an established command structure for incident management as one of the reasons they were able to remain open. They also note the importance of focusing on capacity and staff care during disaster response.
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Moynihan, D. (2009). The Network Governance of Crisis Response: Case Studies of Incident Command Systems. Journal of Public Administration Research and Theory. 19(4):895-91.
The author discusses why the Incident Command System should be viewed as a network, rather than as a strict hierarchy, and how this impacts its implementation.
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This After Action Report (AAR) describes the events related to response to the Boston Marathon Bombings and associated incidents. The report attempts to constructively evaluate and assess public safety, public health, and medical response actions with the goal of providing agencies and organizations involved in the incident with practical recommendations to address them. Unified command, multi-agency coordination, decentralized decision-making, and use of the incident command system are recurring themes in the document.
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Rimstad, R., Sollid, S. (2015). A Retrospective Observational Study of Medical Incident Command and Decision-Making in the 2011 Oslo Bombing. International Journal of Emergency Medicine. 8:4.
This retrospective study examined decisions made by ambulance and medical commanders in the aftermath of the 2011 government district terrorist bombing in Norway. The authors also discuss situational assessment and critical decision-making among first responders when faced with uncertainties and limited resources.
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Sauer, L., Romig, M., Andonian, J., et al. (2019). Application of the Incident Command System to the Hospital Biocontainment Unit Setting. (Abstract only.) Health Security. 17(1).
This article reviews the adaptation and use of the Incident Command System (ICS) to manage patients with high-consequence infectious diseases, and how this Biocontainment Unit ICS interfaced with the overall hospital ICS to limit negative effects on hospital operations. The authors describe how it was tested and refined through functional and tabletop exercises.
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This thesis is a case study in the identification of critical factors leading to the successful implementation of HICS by Stanford Medicine in response to the Asiana plane crash of July 6, 2013.
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Timm, N. and Gneuhs, M. (2011). The Pediatric Hospital Incident Command System: An Innovative Approach to Hospital Emergency Management. (Free registration required; abstract only.) Journal of Trauma-Injury Infection & Critical Care. 71(5): S549-S554.
This article highlights lessons learned from the adaptation of the Hospital Incident Command System to a pediatric hospital.
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Multi-Agency Coordination


SE Minnesota Disaster Health Coalition. (2016). Healthcare Multi-Agency Coordinating Center (MACC).
This document can serve as a template for healthcare coalitions interested in creating a Healthcare Multi-Agency Coordination Center (H-MACC). The scope of this document involves H-MACC activities; information should be integrated within organizational and community operational documents as applicable.
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This handbook provides the framework for Multi-Agency Coordination (MAC) Group activities during an emergency with medical/health (M/H) implications affecting some or all of California Mutual Aid Region 2. It is intended to provide guidelines and procedures for use by a coordination organization, which may be tasked with making policy recommendations, allocating scarce resources, or making scarce resource allocation recommendations from a regional perspective, using decision-making protocols that differ from day-to-day operations.
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Nursing Home Incident Command System


California Department of Public Health (CDPH) and the California Association of Health Facilities (CAHF). (2017). NHICS: Nursing Home Incident Command System. American Health Care Association.
This webpage includes information on the nursing home incident command system (NHICS), which can be used by facilities regardless of size or resident care capabilities, and is intended to assist with their emergency planning and response efforts for all hazards. Links to the NHICS guidebook, forms, response guides, Job Action Sheets (JAS), and training are included.
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Florida Health Care Association. (n.d.). Emergency Preparedness. (Accessed 7/23/2019.)
This website provides links to nursing home and long term care incident command system information and other tools and templates staff can customize for their own facilities.
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Podlucky, J. and Smith, J. (n.d.). Overview of the Incident Command System (ICS). (Accessed 10/11/2019.) Health Planning Council of Southwest Florida.
Primarily a brief overview of the Incident Command System (ICS), this presentation includes slides listing position crosswalks that show how day-to-day nursing home staff positions may align with ICS positions to assist with emergency assignments.
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Plans, Tools, and Templates


Federal Emergency Management Agency. (n.d.). ICS Forms. (Accessed 9/16/2019.)
This webpage contains links to fillable and printable Incident Command System (ICS) forms, as well as the forms instructional booklet.
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Glarum, J. (2017). Healthcare Emergency Incident Management Operations Guide. 1st Edition. (Book available for purchase.)
This resource is “a comprehensive guide to the HICS and can be referenced during initial and refresher training as well as during event management.” It includes initial incident Action Plan considerations for common disaster events, as well as mini-exercises for training.
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Hick, J.L., Koenig, K.L., Barbisch, D., and Bey, T.A. (2008). Surge Capacity Concepts for Health Care Facilities: The CO-S-TR Model for Initial Incident Assessment. (Abstract only.) Disaster Medical Public Health Preparedness. 2(Suppl 1): S51-S57.
The CO-S-TR model is designed to be implemented in the immediate aftermath of an incident, and complements the Incident Command System by aiding incident assessment and surge capacity responses at the healthcare facility level. "CO" stands for command, control, communications, and coordination; "S" considers the logistical requirements for staff, stuff, space, and special (event-specific) considerations; "TR" comprises triage, treatment, tracking, and transportation. Access the related poster/reference card here: https://files.asprtracie.hhs.gov/documents/co-st-r-guide.pdf.
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The Center for HICS Education and Training. (2014). Hospital Incident Management Team Organizational Chart.
This online, fillable PDF form represents the typical incident management structure under the Hospital Incident Command System. It can be completed online and printed, sent via e-mail, or saved by the users.
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The Center for Preparedness Education. (n.d.). Hospital Resources: HICS for Small Hospitals. (Accessed 9/18/2019.)
This webpage includes links to HICS resources specifically adapted for use by small hospitals, including an Incident Management Team Chart, Job Action Sheets, and Job Aids.
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* U.S. Coast Guard. (2014). Incident Management Handbook. U.S. Department of Homeland Security.
This handbook was designed to help personnel use the National Incident Management System. It provides summaries and checklists for the planning cycle (e.g., planning meeting agendas, operational briefing formats), and other useful materials for commanders and section chiefs including an illustration of the planning "P."
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Agencies and Organizations


California Hospital Association. Hospital Incident Command System (HICS).
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Department of Homeland Security, Federal Emergency Management Agency. Incident Command Resources.
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Department of Homeland Security, Federal Emergency Management Agency. National Incident Management System (NIMS).
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