The incident command system (ICS) is a management tool employed during disasters and emergency responses to organize and coordinate response operations. The current ICS developed from the work of a collaborative task force, Firefighting Resources of Southern California Organized for Potential Emergencies (FIRESCOPE), in response to issues and complications involved in organizing efforts to control wildfires in California in the 1970s. FIRESCOPE realized that many of the incident failures were due to lack of coordination and organizational issues as opposed to insufficient resources or personnel. Because many different organizations had to work together at these incidents, lines of command were not clear, specific objectives were not established, and planning and utilization of resources were not coordinated. The incident command system intended to ameliorate these potential problems by designing a framework which could be replicated at future events and incorporate responders from different regions and backgrounds. The mutual understanding of the system and its components aids responding agencies in coordinating their efforts.
National Incident Management System
ICS is a fundamental component of the National Incident Management System (NIMS) or the national guideline for managing emergency incidents.The components which form the foundation of NIMS are command and management, preparedness, communications and information management, resource management, and ongoing management and maintenance. Command and management consist of three principal systems: the incident command system, multiagency coordination systems, and public information. Based on the Homeland Security Presidential Directive 5 (2004), compliance with NIMS is a condition for federal disaster preparedness assistance. ICS addresses problems in organizing response efforts and coordinating various agencies at an incident, such as unwieldy span of control, different organizational structures, poor intra-agency communication, poor inter-agency communication, and nonspecific incident objectives.
Attributes of the Incident Command System
Multiple attributes were developed within the current ICS structure. Each position in the ICS structure has a manageable span of control, being responsible for only three to seven subordinates. Likewise, each position has the only supervisor, clarifying the chain of command. ICS is a hierarchical system, and the establishment of command and chain of command are formalized. Common terminology was established in ICS to clarify communication and roles. This universal terminology eliminates the miscommunication and misunderstanding which occurs when multiple organizations with varying structures attempt to coordinate their efforts. The structure of ICS is modular, meaning that it can adapt depending on the size and type of incident. For example, at a smaller scenario, all of the positions in the ICS model may not be filled if unnecessary. However, at a larger event or an incident of longer duration, additional units and divisions may need to be added. The design of ICS means that it can be used for any incident; in other words, it is an all-hazards model. ICS can be employed for natural or man-made disasters, terrorist attacks, or even smaller mass casualty incidents in the community. Management of the incident is based on clear, measurable objectives. Incident action planning and the writing of a formal incident action plan (IAP) are fundamental during responses. Input from each section is taken into account during the planning process, and the IAP is finalized and approved by the incident commander. In addition to the formality of the planning process and the establishment of clear objectives, communications are coordinated and interoperable in the ICS system.
Structure Incident Command System
ICS consists of the command staff and the general staff. The command staff is at the top of the hierarchical ICS structure. The general staff forms the functional components of the response. The command staff includes the incident commander, the public information officer, the safety officer, and the liaison officer.
Incident CommanderThe incident commander is the overall leader of the incident and has responsibility for managing the response. The incident commander formulates the objectives and goals during an operational period and approves the IAP. The incident commander is not, however, responsible for specific strategies and tactics to accomplish the goals. A unified command may occur when representatives from several different types of agencies work together as the incident commander. An example might be when a firefighter and a chief from Emergency Medical Services share the responsibilities of incident command and function as one position.
Public Information, Safety, and Liaison OfficersThe public information officer must coordinate the communication of information at an event and prepare updates for the public. This position is responsible for the flow of information from the branches and sections to the command staff and communication from the command staff to the functional units. The safety officer is in charge of ensuring the safety and well-being of incident personnel. The liaison officer organizes all activity between agencies. The liaison officer must be knowledgeable about all resources and capabilities available for an operation.
General StaffThe general staff is divided into four functional units: the operations section, the planning section, the logistics section, and the finance/administration section. At some operations, a fifth section, intelligence and investigations, is necessary. Each section of the general staff is led by a chief. The organizational units within each section are called branches and are headed by branch directors. Divisions or groups are the next subunits and are led by supervisors. Divisions are subunits based on geographical area, whereas groups are based on function.
Operations SectionThe operations section is responsible for all tactical activities. Priorities of the operations section are threefold: to save lives, to reduce immediate hazards, and to protect property. Divisions or groups may be broken down into strike teams, task forces, or single resources. Strike teams are composed of a single type of resource, whereas task forces are comprised of different types of resources working collaboratively.
Planning SectionThe planning section compiles all relevant data and information and disseminates it to other areas as appropriate. The planning section is typically divided into the resources unit, the situation unit, the demobilization unit, and the documentation unit.
Logistics SectionThe logistics section has the duty to supply service support requirements, such as housing, food, security, and transportation. Logistics divides into the service branch and the support branch. The communications unit, medical unit, and food unit form the service branch. The supply unit, facilities unit, and ground support unit comprises the support branch.
Finance and AdministrativeThe finance and administrative section works with the budgeting and expenses of the incident response and is responsible for record keeping and tracking personnel’s time. The units of the finance/administration section are the time unit, the procurement unit, the compensation/claims unit, and the cost unit. The intelligence/investigations section involves collecting information in an investigation.
In addition to having a strong conceptual understanding of ICS/NIMS, medical providers must participate in active training and exercises in order to enhance their ability to implement the system. Medical personnel may be involved in ICS at a number of levels. Depending on the type of event, they may function in the role of incident commander. Physicians and EMS providers may also need to act as a safety officer or a technical specialist depending upon the nature of the incident. Healthcare providers may be utilized in the operations section or logistics section. ICS Form 206 is the Medical Plan for the incident which will need to be completed by a medical specialist. Even when a healthcare provider is not directly involved in the ICS, he or she should be familiar with the structure and functioning of the system in order to interact with other personnel during an actual event. Hospital employees also need to review the Hospital Incident Command System, which is a framework for addressing an incident specific to the healthcare setting. 
|||Bajow NA,AlAssaf WI,Cluntun AA, Course in Prehospital Major Incidents Management for Health Care Providers in Saudi Arabia. Prehospital and disaster medicine. 2018 Dec; [PubMed PMID: 30261941]|
|||EMS, Disaster Planning And Operations, Cornelius AP,Kohn MD,,, 2018 Jan [PubMed PMID: 28613575]|
|||Cole LA,Natal B,Fox A,Cooper A,Kennedy CA,Connell ND,Sugalski G,Kulkarni M,Feravolo M,Lamba S, A Course on Terror Medicine: Content and Evaluations. Prehospital and disaster medicine. 2016 Feb; [PubMed PMID: 26751384]|
|||Literature review on medical incident command., Rimstad R,Braut GS,, Prehospital and disaster medicine, 2015 Apr [PubMed PMID: 25659266]|
|||Glow SD,Colucci VJ,Allington DR,Noonan CW,Hall EC, Managing multiple-casualty incidents: a rural medical preparedness training assessment. Prehospital and disaster medicine. 2013 Aug; [PubMed PMID: 23594616]|
|||Crabtree J, Emergency management and mass fatalities: who owns the dead? Journal of business continuity [PubMed PMID: 20378492]|