scholarly journals Use of a Multidisciplinary Incident Command System in Response to Measles Outbreak in Maryland

2020 ◽  
Vol 41 (S1) ◽  
pp. s502-s504
Author(s):  
Taylor McIlquham ◽  
Anna Sick-Samuels ◽  
Carrie Billman ◽  
Jennifer Andonian ◽  
Melissa Dudley ◽  
...  
Keyword(s):  
The United States ◽  
Johns Hopkins Hospital ◽  
Occupational Health Services ◽  
Becton Dickinson ◽  
Distributed Resources ◽  
Incident Command System ◽  
Secondary Transmission ◽  
Incident Command ◽  
Measles Outbreak ◽  
Triage Algorithm

Background: Measles is a highly contagious virus that reemerged in 2019 with the highest number of reported cases in the United States since 1992. Beginning in March 2019, The Johns Hopkins Hospital (JHH) responded to an influx of patients with concern for measles as a result of outbreaks in Maryland and the surrounding states. We report the JHH Department of Infection Control and Hospital Epidemiology (HEIC) response to this measles outbreak using a multidisciplinary measles incident command system (ICS). Methods: The JHH HEIC and the Johns Hopkins Office of Emergency Management established the HEIC Clinical Incident Command Center and coordinated a multipronged response to the measles outbreak with partners from occupational health services, microbiology, the adult and pediatric emergency departments, marketing and communication and local and state public health departments. The multidisciplinary structure rapidly developed, approved, and disseminated tools to improve the ability of frontline providers to quickly identify, isolate, and determine testing needs for patients suspected to have measles infection and reduce the risk of secondary transmission. The tools included a triage algorithm, visitor signage, staff and patient vaccination guidance and clinics, and standard operating procedures for measles evaluation and testing. The triage algorithms were developed for phone or in-person and assessed measles exposure history, immune status, and symptoms, and provided guidance regarding isolation and the need for testing. The algorithms were distributed to frontline providers in clinics and emergency rooms across the Johns Hopkins Health System. The incident command team also distributed resources to community providers to reduce patient influx to JHH and staged an outdoor measles evaluation and testing site in the event of a case influx that would exceed emergency department resources. Results: From March 2019 through June 2019, 37 patients presented with symptoms or concern for measles. Using the ICS tools and algorithms, JHH rapidly identified, isolated, and tested 11 patients with high suspicion for measles, 4 of whom were confirmed positive. Of the other 26 patients not tested, none developed measles infection. Exposures were minimized, and there were no secondary measles transmissions among patients. Conclusions: Using the ICS and development of tools and resources to prevent measles transmission, including a patient triage algorithm, the JHH team successfully identified, isolated, and evaluated patients with high suspicion for measles while minimizing exposures and secondary transmission. These strategies may be useful to other institutions and locales in the event of an emerging or reemerging infectious disease outbreak.Funding: NoneDisclosures: Aaron Milstone reports consulting for Becton Dickinson.

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 Use of the Incident Command System Across Three Sectors of the Healthcare System in the United States

2005 ◽  
Vol 20 (S1) ◽  
pp. 9-9
Author(s):  
Kristine Qureshi ◽  
Kristien Gebbie ◽  
Kimberly Shoaf ◽  
James Soto ◽  
Eric N. Gebbie ◽  
...  
Keyword(s):  
United States ◽  
Healthcare System ◽  
The United States ◽  
Incident Command System ◽  
Incident Command

Implementation and effectiveness of the National Incident Management System’s Incident Command System in law enforcement since 2003

2021 ◽  
Vol 19 (4) ◽  
pp. 387-417
Author(s):  
John K. Nichols, MS, LCC ◽  
Magdalena Denham, EdD
Keyword(s):  
Law Enforcement ◽  
Homeland Security ◽  
Initial Phase ◽  
The United States ◽  
Incident Management ◽  
Incident Command System ◽  
National Incident Management System ◽  
Incident Command ◽  
Relevant Case ◽  
Open Question

This paper investigates the use of the National Incident Management System (NIMS)’s Incident Command System (ICS) in law enforcement since Homeland Security Presidential Directive 5 was issued in 2003. It attempts to answer the following questions: (a) To what degree has law enforcement adopted the NIMS style ICS?; (b) To what degree has the NIMS/ICS framework been applicable to law enforcement?; and (c) Is the NIMS style ICS effective in the law enforcement response environment? The research includes a review of relevant case studies and literature and also includes the analysis of a survey instrument sent to 1,220 current and former law enforcement practitioners across the United States. The survey includes both open- and closed-ended questions. The data from closed-ended questions were compiled and displayed. Data from open-ended questions were grouped thematically. Responses were then assessed and compared with information gleaned from the literature review. Results indicate the system has been widely adopted by law enforcement, and its use is applicable and effective in some law enforcement responses. Its use in the highly chaotic initial phase of incidents, however, remains an open question.

Participation of Insurers in the Unified Command System in the United States

1999 ◽  
Vol 1999 (1) ◽  
pp. 81-86
Author(s):  
Andrew J. Garger ◽  
Richard H. Hobbie
Keyword(s):  
Oil Pollution ◽  
The United States ◽  
Public Law ◽  
Incident Command System ◽  
Incident Command ◽  
Stakeholder Interests ◽  
Ongoing Training ◽  
Unified Command ◽  
Marine Safety

ABSTRACT The introduction and adoption of the Unified Command System (UCS) /Incident Command System (ICS) under the Oil Pollution Act of 1990 (Public Law 101–380, as amended) (OPA 90) has been largely effective, the ongoing training of Federal On-Scene Coordinators (FOSC) by the Coast Guard's Marine Safety School has raised the quality of spill response management, and the development of Spill Management Teams (SMT) by the private sector has also significantly improved the effectiveness of spill response. However, the role that a Responsible Party's (RP) insurance plays in an event is an aspect of marine casualty response that is not adequately addressed in the ICS or by the FOSC. More often than not, the true financial stakeholder during a casualty is not the RP under OPA 90 but rather its multiple insurers. The failure to consider multiple stakeholder interests in the ICS/UCS may result in a delayed, inefficient response or even paralysis on the part of the RP Many RP's do not have the financial resources to fund the potentially high cost of a spill response and it is only through the cooperation and prompt funding by the insurer that the RP is able to respond at all. Yet the system and organization of the response recognizes the RP, but it does not properly involve the insurers as the true stakeholders. It also fails to recognize the complexities and implications of multiple insurers. Creating a mechanism within the framework of the ICS/UCS that recognizes the insurance stakeholder interests, and requires some level of participation by insurers, would improve casualty and spill response. This paper will examine the foregoing issues and discuss why the insurer stakeholder should be included in the ICS/UCS decision making process.

Standardizing Incident Command System Training Internationally in the Public and Private Sector

2014 ◽  
Vol 2014 (1) ◽  
pp. 300322
Author(s):  
CDR Gabrielle McGrath ◽  
Christopher J. Hall
Keyword(s):  
Private Sector ◽  
The United States ◽  
Federal State ◽  
Incident Management ◽  
Private Industry ◽  
Public And Private ◽  
Incident Command System ◽  
Incident Command ◽  
The World ◽  
Public And Private Sector

During the wildfires in California in the 1970s, the Incident Command System (ICS) was developed to create a standardized approach for firefighters to use in order to conduct an efficient response effort. Over the last 44 years, this system evolved into an all-hazards system used all over the world to mitigate a myriad of incidents from hurricanes to terrorist attacks to oil spills. Although ICS was developed as a standard system, both internationally and within the United States, this system and the training on this system were not always implemented or conducted in the same manner. The size and scope of the response which followed the 2010 Macondo Well Blowout (Deepwater Horizon) reinforced the need for continual, standardized training in ICS. Public and private sector response organizations have all become engaged in this effort to standardize the training used to prepare responders to participate as members of an Incident Management Team. The National Incident Management System (NIMS) model for ICS is now recognized as this standard internationally. Changes in the regulatory landscape since the implementation of the Oil Pollution Act of 1990 have served to increase NIMS ICS acceptance and utilization among federal, state and local government agencies, as well as U.S.-based private industry. Recently, response organizations from around the world have begun training in NIMS ICS. This global standardization will enhance the response posture of the entire response community. Examples of training and exercises conducted all over the world will illustrate the initialization of international standardization of ICS.

Considerations for the vertical evacuation of hospitalized patients under emergency conditions

2010 ◽  
Vol 5 (4) ◽  
pp. 237-246 ◽  
Author(s):  
Paul P. Rega, MD, FACEP ◽  
Gregory Locher, EMT-P ◽  
Heidi Shank, RN, BSN ◽  
Kendra Contreras, RN, BSN ◽  
Christopher E. Bork, PhD, EMT-B, FASAHP
Keyword(s):  
United States ◽  
Medical Literature ◽  
The United States ◽  
First Century ◽  
System Framework ◽  
Incident Command System ◽  
Incident Command ◽  
Vertical Evacuation ◽  
Many Sources ◽  
Multiple Patients

Hospitals and other healthcare institutions in the twenty-first century face myriad challenges to their survival against a number of threats from many sources. A number of those threats, eg, internal, external, accidental, or intentional, may require the prompt evacuation of both patients and staff. Although rare, this possibility is becoming more frequent in the United States. Unfortunately, despite accrediting agencies’ mandates, there is a profound paucity of strategic and tactical guidelines in the medical literature. The purpose of this article is to present a strategic methodology for evacuation, particularly emergent evacuation, within the National Incident Command System/Hospital Incident Command System framework and to explore the tactics that should be considered when relocating multiple patients in various degrees of medical compromise.

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