Incident Command System
How it’s supposed to work.
So, how do you deal with major disasters? The answer is: We already know that answer.
Way back in the 1970s, when Emergency Medical Services were first being invented, when the 9-1-1 national emergency telephone number first came online, when the Jaws of Life was patented, when the Star of Life was trademarked, some folks out in California noticed that the response to disasters (in their case, wildfires) was a clusterfuck.
At that time, too many people reported to one supervisor, different emergency response organizational structures were used, incident information was lacking or unreliable, radio systems were inadequate and incompatible, coordinated planning between agencies was practically non-existent, terminology differed between agencies, lines of authority were unclear, and probably the worst problem was that incident objectives were unclear or unspecified.
Well, what with this and that, some clever buggers came up with the Incident Command System as an answer. Like Herman Wouk once described the US Navy: A system designed by geniuses to be operated by idiots. ICS allows multiple agencies over multiple jurisdictions to work together and actually accomplish something useful. Wildfires don’t wait while you get your act together.
Notice that the word “Command” is part of the name of the system. You have to take command early. How the first five minutes go can determine how the next five hours will go, and how those five hours go can determine how the next five days go.
ICS scales up and down as the situation develops. You always have a measurable objective or goal in a specific timeperiod. You put that goal in writing. That way you can track what’s happened, and what’s happening. Goals can change as the situation develops.
The ICS is based on three principles: First, somebody has to be in charge. One person.
Second, No one can keep everything in their head. In fact, experimental evidence (confirmed by years of experience) is that one person can direct three to seven others with five people being optimum.
Third, no man can serve two masters. You only get orders from one person, and you know who that person is.
[Note—military structures reflect this; so do Boy and Girl Scout troops. A squad leader gives orders to three fireteam leaders, each of whom has three members in his fire team. The squad leader reports to and gets orders from the platoon leader. The platoon leader orders three squad leaders, and reports to one company commander. The company commander orders three platoon leaders (four in a reinforced rifle company). In Caesar’s legions, each cohort had ten centuries, each centurion ordered ten decurions, and each decurion ordered ten men. This is known tech.]
For I also am a man set under authority, having under me soldiers, and I say unto one, Go, and he goeth; and to another, Come, and he cometh; and to my servant, Do this, and he doeth it. (Luke 7:8)
Smallest incident, at a minimum, there’s always an Incident Commander. There’s always an Incident Command Post, and there’s always a Staging Area. Largest incident: There’s still one Incident Commander, in one command post. His or her identity is known to everyone, and that person is only getting reports from, and giving orders to, a bare handful of subordinates. Each of those subordinates is getting information from, and giving orders to, three to seven subordinates.
Everyone reports to just one person (and knows explicitly who that person is) and commands just a few subordinates. And so on, down the line.
Who’s the incident commander? The first responder on scene. As other responders arrive, the Incident Commander may change, but everyone still knows who it is.
Authority can be delegated. Responsibility can not.
The IC has a command staff and a general staff.
The priorities are, in order:
Given limited resources, you save life. With more resources, you save lives and keep the incident from expanding. With all the resources you want, you save lives, put out the fire, and protect other property.
“I have always found that plans are useless, but planning is indispensible.” —Dwight D. Eisenhower
I’m going to talk about the Medical sector on a smaller event—say train vs. school bus—because that’s the area I’m most familiar with.
The Medical Branch commander will most likely be the senior paramedic on scene. He or she will report to the Operations Officer or directly to the IC.
The Medical Branch will have his or her own subordinates: The Triage Officer, the Transportation Officer, the Treatment officer, the Logistics officer, and the Staging officer.
Triage identifies numbers and severity of patients, and reports back to the Medical Branch Commander: “We have forty patients; Six red tags, twelve yellow tags, twenty green tags, and two black tag.”
The Medical branch commander passes the numbers of patients to the Treatment officer (who passes it on to the Red Sector, Yellow Sector, Green Sector, and Black sector team leaders—the Red Sector leader doesn’t need to know, or care, how many Green tags are on scene).
The Medical Sector commander then turns to the Transportation officer and says “I need three helicopters, six ambulances, a bus, and the morgue wagon. Go get ‘em.” The Transportation officer goes off to find, get, or obtain the transport. He or she doesn’t care about treating the patients, just transporting them.
Meanwhile, the various sectors (with the aid of the firefighters, coordinated up and down the chain of command) have gathered into their various casualty collection points the sick and injured. They determine the supplies they need, pass the lists up to the Treatment officer, who consolidates and prioritizes them, then passes the list to the Medical Sector Commander. The Medical Sector commander turns to the Logistics officer and says (for example), “Get six bags of normal saline to the red sector, three backboards to the yellow sector, and a teddy bear to the green sector.” The Logistics officer does so, or directs subordinates to make it so, bringing supplies from where they have been placed by the Staging officer.
Information and orders move up and down the chain, not side-to-side. The folks who are providing treatment don’t go off freelancing scrounging the supplies they need—they ask up the chain, supplies are provided, as available and in order of priority.
Meanwhile the Transportation officer is finding hospitals to take all the patients, in order of priority (red first, then yellow, then green, then black).
The idea is to maximize efficiency and minimize confusion in a chaotic, fast-moving situation.
Who talks to who is defined. Only the transportation office talks to hospitals: “Rampart General, this is Hill Street Transportation sector. How many patients are you prepared to handle?”
“Hill Street, this is Rampart. We can take one red tag, two yellow tags, and six green tags.”
“Roger that. I am sending you one red tag, patient #224098, elderly female, decreased level of consciousness, at this time. ETA plus six minutes.”
“Hill Street, Rampart, roger, out.”
And so it goes, right the way through debriefing, cleanup, restocking, lessons learned, continued training for the next time.
Anyway, that’s the way it’s supposed to go. The system is scalable: From a national-level emergency down to a nasty car wreck. (In fact, since you fight the way you train, it’s a good plan to use ICS for everything, including the Memorial Day Parade and your kid’s birthday party.)
One thing that Logistics can do prior to an event is figure out what all the need-to-have, good-to-have, and nice-to-have items are, and make out undated purchase orders for the lot of them. Put the purchase orders in a folder. Then, when the world is collapsing around you at two in the morning, and the mayor says “Anything! Anything at all! Say the word!” you just slap that folder into his hand and say “Start signing.”
You have to have the system in place, everyone trained, reading off the same page, using the same terms. It’s really good to find out in advance whether your radios can talk to the radios of the folks you need to coordinate with before the day you need to talk with ‘em.
Several states have adopted the ICS as their standard. ICS is required by federal law in all HAZMAT incidents. Natural disasters, however, don’t require ICS.
Right now, I’m told, Homeland Security, through FEMA, is trying to impliment ICS nationwide as NIIMS: National Interagency Incident Management System. And that might point out a problem: Notice the difference between “Command” and “Management.”
Anyone who wants to learn all about the Incident Command System can take FEMA’s independent study course: http://training.fema.gov/EMIWeb/IS/is195.asp
Take this online course and you personally will be more qualified than FEMA director Michael Brown to manage the Hurricane Katrina response.
Copyright © 2005 by James D. Macdonald
I am not a physician. I can neither diagnose nor prescribe. This post is presented for entertainment purposes only. Nothing here is meant to be advice for your particular condition or situation.
Wheel, Re-invention of by James D. Macdonald is licensed under a Creative Commons Attribution-Noncommercial-Share Alike 3.0 United States License.
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