Introduction

Disasters can occur at any time and preparation is essential. In the 1970s a series of forest fires produced significant morbidity, mortality and property damage despite adequate resources. After a study of the management of these forest fires, many problems were revealed. Multiple organizations had to work together. However, their differing command structures made instituting and continuing leadership challenge. Other problems that were also noted were a lack of communication between agencies with significant differences in terminology that supervisors had too large a breadth of people they were supervising, and planning and resource distribution that was poorly managed. Out of this event, it was recognized that a better and more structured approach to disasters was needed. The incident command system (ICS) was developed to combat these issues.[1][2][3][4]

Issues of Concern

The national incident management system (NIMS) is a framework under which numerous agencies from many different areas can work together during disasters. NIMS is adaptable to large and small scale incidents but is very structured in the way the incident is managed. NIMS is based on five elements: preparedness, communication and information management, resource management, command and management and ongoing management and maintenance. The ICS is a part of the command and management element.[5][6][7][8]

ICS served to fix many of the problems encountered in past disasters. Common terminology was instituted to make communications easier and more functional. A modular organization for the disaster response was developed that builds from the top down and can be expanded or contracted to fit any size response.  ICS necessitates that event management be by incident objectives with specific plans and assignments of personnel to address these objectives. The incident action plan communicates the objectives formally. The number of people that can be supervised by one person is limited to 3-7 persons as above this number effective leadership and supervision is difficult. ICS also designates specific types of facilities to be set up for operations. All resources, including personnel, are kept track of in real time with full accountability. ICS makes plans for communication to be interchangeable from organization to organization. Formal processes for establishment and change of command procedures are described. Chain of command is clearly laid out in this system.  The many different agencies that respond to an event are expected to work together and provide an incident command. This is known as a unified command.  ICS also controls which resources are deployed and where they are going.  Information is managed in an orderly fashion from the individual responders to the command staff. This gives the command staff a complete picture of the response so they can better manage it.

Clinical Significance

 Planning is essential to good disaster response and begins long before an event and continues through the event. When the threat of a disaster event is imminent (such as a hurricane), planning begins immediately. The first step is to understand the situation and what resources will be required, what resources that will be available and the possible scale of the event. Next incident objectives will be established based on the overall big picture of the event. These objectives will be fleshed out into an overall plan that will elucidate the tactics to be used as well as how the resources are allocated. After the plan is finished, then it is distributed and activated. After this, the plan is constantly evaluated and revised. This is referred to as the planning “P.”

When no disaster event is imminent, it is still very important for planning to occur. The first step in long-term planning for your local community is performing a hazard vulnerability analysis. First, specific hazards are to be noted. Consider geographical features such as damns, fault lines and features of your community that could cause limited access to a portion of your coverage area. Climate is also a consideration. Seasonal variations and weather conditions that would have an impact on ems operations must be considered. Other factors to consider are the economic environment in the community and the local crime statistics. For all of the hazards describe any history of the incident, possible impacts on the vulnerable areas of the community and the probability of it happening. All these factors together form a community hazard vulnerability analysis.[9]

Each agency develops an emergency operations plan (EOP). The EOP should reference NIMS and use the principles of ICS. The EOP will outline the agencies disaster response framework and should be flexible and scalable for the event encountered. There are multiple elements contained in an EOP.  The EOP contains a clear list of circumstances under which to consider implementing the plan. A person/position responsible for activating the plan is also named, usually the highest ranking staff person on duty. A command chain is laid out as well as how actions will be coordinated with other agencies. How to protect people and property is also included in the EOP. This includes vulnerable populations such as special needs children and adults. A plan to address the needs of uninjured children, especially those separated from their parents, should also be included. In Identify resources such as personnel, supplies, facilities, equipment, and other resources from within your area and also from outside your area that you have established agreements for use. This includes federal resources. Requirements of your agency or other agencies/areas are settled through agreements. Mitigation concerns during the event and recovery should be included.

The EOP specifies the requirements to effectively manage a disaster response. These requirements are then used to understand the type of training and exercises needed to prepare. Therefore, the EOP sets the preparedness training needed for your agency. Exercises can take this a step further allowing you to confirm plans and response procedures as well as gauging the personnel’s skills. Divergence in the in the performance of the staff can be discovered and addressed through additional training or addition of equipment found lacking. Other response problems can also be discovered and remedied through technology and boosting current agreements or forging new ones. The EOP can also be adjusted to correct for response problems stemming from the EOP itself.