August 31, 2008, is not nearly as far away as it seems – and that is the deadline by which all U.S. hospitals are required to comply with the National Incident Management System (NIMS). The U.S. Department of Health and Human Services (HHS) has designated the Hospital Incident Command System IV (HICS IV) as the hospital industry’s route to achieving NIMS compliance. The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) also has announced its support for HICS IV (as part of its accreditation process). Developed by leading experts, including Craig DeAtley at the Washington (D.C.) Hospital Center, Director of the HICS Center that developed HICS IV, HICS IV uses an “All Hazards” approach to assist hospitals in improving their emergency preparedness, mitigation, response, and recovery capabilities. This approach represents a substantial raising of the bar for hospital disaster-management best practices. Following are four steps that hospitals can take today to help ensure on-time HICS IV compliance: 1. Assess how HICS IV will affect existing disaster-management plans. Hospitals should familiarize themselves with the HICS IV structure, guidelines, and documents, and designate appropriate staff to participate in “train the trainer” es. The California Emergency Medical Services Authority website posts the complete HICS IV guidebook, as well as some quick learning modules. The Federal Emergency Management Agency conducts some helpful es, such as “Introduction to the Incident Command System for Healthcare/Hospitals.” Hospitals that previously created their own HEICS III plans must now incorporate the more detailed

The impact of mass-casualty events is usually not limited to a single hospital, but often affects entire communities

requirements postulated in HICS IV. One example: “Job Action Sheets” have been extensively revised to include additional action steps, broken down into four time periods – immediate, intermediate, extended, and recovery. Emergency-preparedness coordinators should carry out a “gap analysis” of their existing plans toentify the need for specific HICS IV updates. 2. Incorporate HICS IV requirements in this year’s JCAHO disaster drills. Hospitals should incorporate the HICS IV requirements in their 2007 training and drilling exercises. Because of the importance that JCAHO places on post-drill and post-incident process improvements, hospitals would be well advised to focus primarily on capturing the “lessons learned” during drills and incidents so they can improve their own plans and bring them into HICS IV compliance in advance of JCAHO visits. 3. Start (or continue) developing mutual-aid agreements. The impact of mass-casualty events is usually not limited to a single hospital, but often affect entire communities and regions. For this reason, HICS IV recommends that hospitals in close proximity to one another agree in advance, and in as much detail as possible, on how they will work together and/or share resources during an actual incident. To the extent that not enough, or not sufficiently detailed, mutual-aid agreements are already in place, hospital executives should reach out to their counterparts in neighboring hospitals to negotiate those agreements. Local and regional hospital associations also can aid in this effort. 4. Consider replacing binders with automated incident management systems. Many hospitals keep their disaster-management plans in three-ring binders, the minimum file requirement mandated by HICS IV. Binders are therefore de facto “compliant”. However, they also are notoriously hard to keep up-to-date, and they may be inaccessible if the hospital itself is damaged or if a key team member is not on site during any of the phases of the typical incident. Moreover, binders are not automatically “customized” by role and/or type of incident, a deficiency which for practical purposes means that users may have to search long and hard for relevant guidance before they can determine exactly what to do in specific circumstances. An Easy “Always On” Alternative The use of HICS IV-compliant web-based incident-management systems can be a far more effective alternative. A comprehensive all-hazards web-based system can provide interactive work-process and decision-support tools for all four stages of hospital incident management, including – to cite but one example – interactive dashboards with hazard-specific Job Action Sheets for each position in the command structure. Such systems can incorporate purpose-built communications, and would be particularly useful in tracking and reporting on beds, patients, equipment, supplies, and critical infrastructure, thereby reducing error, confusion, and inefficiency during the response and recovery stages of an incident. Another advantage is that web-based systems tend to be more robust and flexible than cell phones, landlines, pagers, and “runners” are, and also can provide far more comprehensive information and guidance than is likely to be available from other communications media. During actual incidents, disaster managers can access these “always on,” decentralized, web-based systems via their HTML browsers – anywhere and anytime – instead of having to carry the binders with them, jotting down notes, leaving cell phone messages, or waiting for runners.

Paul Dimitruk

Paul Dimitruk is the chief executive officer of the Los Angeles-based PortBlue Corporation, which specializes in the development of expert systems for business and government applications, primarily in the fields of  health care, national defense, homeland security, and law enforcement. Prior to assuming his current post he was chairman and CEO of Pareto Partners, a London-based investment management firm which is today the largest currency risk-management firm in the world. Dimitruk, an honors graduate of Denison University, also holds a Juris Doctor Degree from New York University. An associate member of the Association of Former Intelligence Officers, he also serves as a member of the Advisory Board of the Center for Strategic and International Studies in Washington, D.C., and as a member of the Department of Homeland Security’s Private-Sector Advisory Group.

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