scholarly journals Command and control in hospitals during SARS-CoV-2 pandemic: The windmill model of disaster response

2020 ◽  
Vol 18 (7) ◽  
pp. 19-22
Author(s):  
Thomas Wurmb, MD ◽  
Georg Ertl, MD ◽  
Ralf-Ingo Ernestus, MD ◽  
Patrick Meybohm, MD
Keyword(s):  
Disaster Response ◽  
Command And Control ◽  
Disaster Medicine ◽  
Crisis Leadership ◽  
Incident Command System ◽  
Incident Command ◽  
Complex Processes ◽  
Response Plan ◽  
Improve Hospital ◽  
And Control

Hospitals are the focus of the fight against SARSCoV-2 pandemic. To meet this challenge hospitals need a Disaster Response Plan and a Hospital Incident Command System (HICS) as a crisis leadership tool. The complex dependency between the systems staff, supplies, and space during the SARS-CoV-2 pandemic is a major problem for hospitals. To take the appropriate countermeasures, the effects of the crisis on these systems must be detected, analyzed, and displayed. The presentation and interpretation of such complex processes often poses serious problems for the hospitals’ incident commanders.In this article, we describe a new model that is able to display these complex interrelationships within the command process. The model was developed and deployed during the disaster response to SARS-CoV-2 pandemic in order to facilitate the entire command process and to improve hospital disaster response. The approach of the model is as simple as it is innovative. It perfectly symbolizes the basic principle of disaster medicine: keep is safe and simple. It will help hospitals to improve command and control and to optimize the disaster response during SARS-CoV-2 pandemic.

ICS: Can it Be a National Incident Management System?1

2003 ◽  
Vol 2003 (1) ◽  
pp. 1179-1183
Author(s):  
Duane Michael Smith
Keyword(s):  
Management System ◽  
Command And Control ◽  
Fire Service ◽  
Incident Management ◽  
Incident Command System ◽  
National Incident Management System ◽  
Incident Command ◽  
National Model ◽  
System 1 ◽  
And Control

ABSTRACT There are likely few that would argue with the proposal that a national incident management system would be of benefit. Numerous articles have been put forward over time, both for and against the adoption of an incident command system (ICS) as the model for a national incident management system. Those in favor of its adoption point out to its many successes, from major wildfires to the 2002 Olympics. Many seem to view ICS as simply another way of expressing the term command and control. In reality, ICS is not another way to say command and control; rather it is a specific of command and control system. The question then is whether ICS, and in particular the National Inter-agency Incident Management System – Incident Command System (NIIMS-ICS) is the model upon which this national system should be based. Most of the studies and papers regarding the use and adoption of ICS have focused on its use within the fire service community. This may be somewhat intuitive, given the origins of the system; however, if we are to truly gauge the applicability of this system to all risks, we must begin to exam it in those other events. It was a series of disasters that led to the development of the initial ICS system. It has been a subsequent series of disasters or national emergencies that have led to the continued evolution of ICS toward a national model. The question now before us is whether we need another disaster to take that final step to a truly national incident management system or are we willing to go there now. In this time of heightened national security we owe it to ourselves to have the best incident management system in the world.

scholarly journals Development and Implementation of First Hospital-Based Epidemic Outbreak Management Plan: Lessons Learned from Nepal

2019 ◽  
Vol 34 (s1) ◽  
pp. s56-s56
Author(s):  
Ashis Shrestha ◽  
Michael Khouli ◽  
Sumana Bajracharya ◽  
Rose House ◽  
Joshua Mugele
Keyword(s):  
National Level ◽  
Disaster Medicine ◽  
Lessons Learned ◽  
World Health ◽  
High Fidelity ◽  
Disaster Plan ◽  
Outbreak Management ◽  
Incident Command ◽  
Hospital Systems ◽  
Response Plan

Introduction:Patan Hospital, located in Kathmandu Valley, Nepal is a 400-bed hospital that has a long history of responding to natural disasters. Hospital personnel have worked with the Ministry of Health (MOH) and the World Health Organization (WHO) to develop standardized disaster response plans that were implemented in multiple hospital systems after the earthquake of 2015. These plans focused primarily on traumatic events but did not account for epidemics despite the prevalence of infectious diseases in Nepal.Aim:To develop and test a robust epidemic/pandemic response plan at Patan Hospital in Kathmandu that would be generalizable to other hospitals nationwide.Methods:Using the existing disaster plan in conjunction with public health and disaster medicine experts,we developed an epidemic response plan focusing on communication and coordination (between the hospital and MOH, among hospital administration and staff), logistics and supplies including personal protective equipment (PPE), and personnel and hospital incident command (IC) training. After development, we tested the plan using a high-fidelity, real-time simulation across the entire hospital and the hospital IC using actors and in conjunction with the MOH and WHO. We adjusted the plan based on lessons learned from this exercise.Results:Lessons learned from the high-fidelity simulation included the following: uncovering patient flow issues to avoid contamination/infection; layout issues with the isolation area, specifically accounting for donning/doffing of PPE; more sustained duration of response compared to a natural disaster with implications for staffing and supplies; communication difficulties unique to epidemics; need for national and regional surveillance and inter-facility planning and communication. We adjusted our plan accordingly and created a generalizable plan that can be deployed at an inter-facility and national level.Discussion:We learned that this process is feasible in resource-poor hospital systems. Challenges discovered in this process can lead to better national and system-wide preparedness.

scholarly journals Beyond ICS: How Should We Govern Complex Disasters in the United States?

2019 ◽  
Vol 16 (2) ◽  
Author(s):  
Branda Nowell ◽  
Toddi Steelman
Keyword(s):  
Disaster Response ◽  
Large Scale ◽  
National Policy ◽  
The United States ◽  
Network Governance ◽  
Governance Structures ◽  
Incident Command System ◽  
Incident Command ◽  
Complex Disasters ◽  
Private Actors

Abstract The complexity of large-scale disasters requires governance structures that can integrate numerous responders quickly under often chaotic conditions. Complex disasters – by definition – span multiple jurisdictions and activate numerous response functions carried out by numerous legally autonomous public, nonprofit, and private actors. The command operating structure of the Incident Command System (ICS) is a hierarchical structure used to manage complex incidents. Increasingly, complex disasters are seen as networks of multiple actors. Improving our capacity to respond to large-scale, complex disasters requires moving beyond the “hierarchy versus networks” debate to understand the conditions under which governance structures can best serve disaster response goals. Understanding the capabilities and limitations of the governance structures embedded in our national policy tools and frameworks can enhance our ability to govern effectively in networked contexts. In this article, we suggest the need to shift focus to build greater capacity for hybrid and network governance approaches, including a more sophisticated understanding of the conditions under which these governance forms are most effective.

scholarly journals Hospital incident command system, the pillar of COVID-19 outbreak response: An experience from Patan Hospital, Nepal

2020 ◽  
Vol 7 (1) ◽  
pp. 80-84
Author(s):  
Sunil Adhikari ◽  
Suraj Rijal ◽  
Paras Kumar Acharya ◽  
Bishnu Prasad Sharma ◽  
Imran Ansari ◽  
...  
Keyword(s):  
Epidemic Outbreak ◽  
Outbreak Response ◽  
Timely Manner ◽  
Mortality And Morbidity ◽  
Incident Command System ◽  
Incident Command ◽  
Response Plan

In times of disaster, hospital’s preparedness for disaster and response plan contributes significantly to better functioning of the hospital and reducing mortality and morbidity. Activating Hospital incident command system in a timely manner in Patan Hospital has showed how the hospital is better prepared to handle this epidemic outbreak.  

scholarly journals The effectiveness of training with an emergency department simulator on medical student performance in a simulated disaster

CJEM ◽  
2010 ◽  
Vol 12 (01) ◽  
pp. 27-32 ◽  
Author(s):  
Jeffrey Michael Franc-Law ◽  
Pier Luigi Ingrassia ◽  
Luca Ragazzoni ◽  
Francesco Della Corte
Keyword(s):  
Medical Students ◽  
Student Performance ◽  
Intervention Group ◽  
Command And Control ◽  
Disaster Medicine ◽  
Simulated Patients ◽  
Control Group ◽  
Number Of Patients ◽  
Simulation Based ◽  
And Control

ABSTRACT Objective: Training in practical aspects of disaster medicine is often impossible, and simulation may offer an educational opportunity superior to traditional didactic methods. We sought to determine whether exposure to an electronic simulation tool would improve the ability of medical students to manage a simulated disaster. Methods: We stratified 22 students by year of education and randomly assigned 50% from each category to form the intervention group, with the remaining 50% forming the control group. Both groups received the same didactic training sessions. The intervention group received additional disaster medicine training on a patient simulator (disastermed.ca), and the control group spent equal time on the simulator in a nondisaster setting. We compared markers of patient flow during a simulated disaster, including mean differences in time and number of patients to reach triage, bed assignment, patient assessment and disposition. In addition, we compared triage accuracy and scores on a structured command-and-control instrument. We collected data on the students' evaluations of the course for secondary purposes. Results: Participants in the intervention group triaged their patients more quickly than participants in the control group (mean difference 43 s, 99.5% confidence interval [CI] 12 to 75 s). The score of performance indicators on a standardized scale was also significantly higher in the intervention group (18/18) when compared with the control group (8/18) (p < 0.001). All students indicated that they preferred the simulation-based curriculum to a lecture-based curriculum. When asked to rate the exercise overall, both groups gave a median score of 8 on a 10-point modified Likert scale. Conclusion: Participation in an electronic disaster simulation using the disastermed.ca software package appears to increase the speed at which medical students triage simulated patients and increase their score on a structured command-and-control performance indicator instrument. Participants indicated that the simulation-based curriculum in disaster medicine is preferable to a lecture-based curriculum. Overall student satisfaction with the simulation-based curriculum was high.

Quality control in disaster medicine training—Initial regional medical command and control as an example

2010 ◽  
Vol 5 (1) ◽  
pp. 35-40 ◽  
Author(s):  
Heléne Nilsson, RN ◽  
Tore Vikström, MD, PhD ◽  
Anders Rüter, MD, PhD
Keyword(s):  
Quality Control ◽  
Command And Control ◽  
Disaster Medicine ◽  
Regional Medical ◽  
And Control

Perceiving the effects of scale on command and control: A conceptual metaphor approach

2020 ◽  
Vol 18 (2) ◽  
pp. 91-104
Author(s):  
Tony McAleavy, BA (Hons), MSc, PhD
Keyword(s):  
Command And Control ◽  
Resource Depletion ◽  
The United States ◽  
Incident Command ◽  
Emergency Managers ◽  
Golden Thread ◽  
Gold Silver ◽  
The Usa ◽  
The Uk ◽  
And Control

Objective: This study investigates emergency manager’s perceptions of Command and Control to answer the question “how do emergency managers metaphorically interpret Command and Control?”Design: An interpretivist paradigm, verbatim transcription, and content and linguistic metaphor analysis were used within this study.Setting: Fifteen interviews per country, three per selected organization were conducted in the United Kingdom and the United States of America.Subjects: Purposive sampling identified suitable participants from key organizations engaged in emergency management at local, subnational, and national levels.Interventions: The study consisted of 30 semi-structured face-to-face interviews conducted within the work-place.Main Outcome Measure(s): The inductive and qualitative nature of the study resulted in a 300,000-word corpus of data from which the two posited theories emerged.Results: The UK Gold, Silver, Bronze model and the USA Incident Command System were considered tried and tested although they are conceptually misunderstood. Moreover, they are believed to be essential, scalable, and flexible. Able to manage the perceived chaos of increasing scales of disaster which contradicts the existing literature.Conclusions: Two conceptual metaphors are theorized to create flexible learning tools that challenge the entrenched nature of these findings. Command and Control as a Candle demonstrates the effects of increasing disaster scale on systemic efficacy. Command and Control as a Golden Thread illustrates problems caused by time, distance, resource depletion, and infrastructure degradation. These tools engender deeper more critical perspectives by linking theory to practice through metaphor to engender perceptual change.

scholarly journals Use of Incident Command System for Disaster Preparedness: A Model for an Emergency Department COVID-19 Response

2020 ◽  
pp. 1-6 ◽  
Author(s):  
Andra Farcas ◽  
Justine Ko ◽  
Jennifer Chan ◽  
Sanjeev Malik ◽  
Lisa Nono ◽  
...  
Keyword(s):  
Emergency Department ◽  
Disaster Preparedness ◽  
Disaster Response ◽  
Large Scale ◽  
Disaster Plan ◽  
Incident Command System ◽  
Incident Command ◽  
Optimal Coordination ◽  
Multiple Challenges ◽  
Operations Center

ABSTRACT The COVID-19 pandemic has placed unprecedented demands on health systems, where hospitals have become overwhelmed with patients amidst limited resources. Disaster response and resource allocation during such crises present multiple challenges. A breakdown in communication and organization can lead to unnecessary disruptions and adverse events. The Federal Emergency Management Agency (FEMA) promotes the use of an incident command system (ICS) model during large-scale disasters, and we hope that an institutional disaster plan and ICS will help to mitigate these lapses. In this article, we describe the alignment of an emergency department (ED) specific Forward Command structure with the hospital ICS and address the challenges specific to the ED. Key components of this ICS include a hospital-wide incident command or Joint Operations Center (JOC) and an ED Forward Command. This type of structure leads to a shared mental model with division of responsibilities that allows institutional adaptations to changing environments and maintenance of specific roles for optimal coordination and communication. We present this as a model that can be applied to other hospital EDs around the country to help structure the response to the COVID-19 pandemic while remaining generalizable to other disaster situations.

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