Module 4 of 10 ~30 minutes

Emergency Response Systems & Coordination

Hospital Incident Command, Federal/State Agencies, and Strategic National Stockpile

HICS Agencies SNS

Learning Objectives

1

Describe the structure and purpose of the Hospital Incident Command System (HICS)

2

Identify key HICS positions and their responsibilities

3

Explain the nurse's role within interprofessional emergency operations

4

Identify federal and state agencies involved in bioterrorism response

5

Understand Strategic National Stockpile deployment process

6

Describe Point of Dispensing (POD) operations and nurse roles

Incident Command System (ICS) & NIMS

Standardized Emergency Management

The Incident Command System (ICS) is a standardized, on-scene, all-hazards approach to incident management. It provides a common organizational structure enabling effective coordination among multiple agencies and jurisdictions.

The National Incident Management System (NIMS) integrates ICS into a national framework, ensuring all responders - from local to federal - use the same terminology and structure.

Five Key ICS Principles

1. Unity of Command

Each person reports to only ONE supervisor. This prevents confusion from conflicting orders.

2. Chain of Command

Clear line of authority from top to bottom. Everyone knows who they report to and who reports to them.

3. Span of Control

Each supervisor manages 3-7 people (ideal is 5). More than 7 requires additional supervisory layers.

4. Common Terminology

Standardized terms across all responders. No agency-specific jargon that others won't understand.

5. Modular Organization

Structure expands or contracts based on incident needs. Start small, add positions as needed.

Why This Matters for Nurses

When a bioterrorism event occurs, you may be working alongside EMS, fire, police, public health, and federal agencies. ICS ensures everyone speaks the same language and knows the command structure - preventing chaos.

Hospital Incident Command System (HICS)

HICS Adapts ICS for Healthcare

HICS provides a standardized command structure specifically designed for healthcare facilities during emergencies. It maintains ICS principles while addressing unique hospital needs like patient care continuity and infection control.

HICS Organizational Structure

INCIDENT COMMANDER

Overall authority & responsibility

(CEO or designee)

Public Info Officer

Media & communications

Safety Officer

Can STOP unsafe acts

Liaison Officer

External agencies

General Staff (Section Chiefs)

OPERATIONS

"The Doers"

  • • Patient care
  • • Triage
  • • Decontamination
  • • Security
PLANNING

"The Thinkers"

  • • Situation status
  • • Documentation
  • • Resource tracking
  • • Action plans
LOGISTICS

"The Getters"

  • • Supplies
  • • Equipment
  • • Food/shelter
  • • Communications
FINANCE/ADMIN

"The Payers"

  • • Cost tracking
  • • Procurement
  • • Time keeping
  • • Claims

Safety Officer - Special Authority

The Safety Officer has unique authority to STOP unsafe operations without going through chain of command. If there's imminent danger, they can halt activities immediately.

Where Most Nurses Work

Most nurses work in the Operations Section - delivering patient care, performing triage, staffing treatment areas. But nurses can serve in ANY section based on training and experience.

Nurse Roles in HICS

Nurses Throughout the Command Structure

Nurses serve in multiple critical roles throughout HICS - not just bedside care. With appropriate training, nurses can lead units, serve as officers, and coordinate complex operations.

Clinical Roles

  • 1
    Medical Care Branch Director

    Experienced RN leader overseeing all patient care

  • 2
    Inpatient Unit Leader

    Manages nursing units during emergency

  • 3
    Emergency Department Unit Leader

    Coordinates ED surge operations

  • 4
    Triage Unit Leader

    Oversees mass casualty triage operations

Support Roles

  • 1
    Infection Control Officer

    Reports to Safety Officer - critical for bioterrorism

  • 2
    Employee Health Unit Leader

    Monitors staff health, exposures, prophylaxis

  • 3
    Labor Pool Coordinator

    Manages staffing assignments and deployment

  • 4
    Public Health Liaison

    Coordinates with health department

Federal Response Agencies

National Response Framework (NRF)

The NRF guides how the nation responds to all types of disasters and emergencies. It establishes Emergency Support Functions (ESFs) that coordinate federal assistance to state and local governments.

CDC

Centers for Disease Control and Prevention

  • • Disease surveillance and investigation
  • • Laboratory confirmation (LRN)
  • • Manages Strategic National Stockpile
  • • Treatment guidelines and protocols
  • • Health Alert Network (HAN)

DHS

Department of Homeland Security

  • • Overall coordination of national response
  • • BioWatch environmental monitoring
  • • Coordinates NIMS/NRF
  • • Border and transportation security
  • • Intelligence and threat assessment

FBI

Federal Bureau of Investigation

  • • Lead federal agency for criminal investigation
  • • Evidence collection and chain of custody
  • • Attribution and prosecution
  • • Joint Terrorism Task Force coordination
  • • Works with LRN for forensic analysis

FEMA

Federal Emergency Management Agency

  • • Emergency management coordination
  • • Disaster declarations and funding
  • • ICS/NIMS training
  • • Logistics support
  • • Recovery assistance

Unified Command in Bioterrorism

For a biological incident, "Unified Command" includes representatives from: Public Health (lead for medical response), Law Enforcement (lead for criminal investigation), and Emergency Management. This ensures medical care and criminal investigation proceed simultaneously.

Nevada State Response Agencies

State-Level Coordination

Nevada has a coordinated public health and emergency management structure that works with federal agencies and local health departments during bioterrorism events.

Nevada DPBH

Division of Public and Behavioral Health

  • • State Epidemiologist (disease surveillance)
  • • Public Health Emergency Preparedness
  • • Coordinates with CDC
  • • State Health Officer authority
  • • State laboratory services

24/7 Line: (775) 684-5911

Nevada DEM

Division of Emergency Management

  • • State Emergency Operations Center
  • • Coordinates multi-agency response
  • • Emergency declarations
  • • Resource coordination
  • • FEMA liaison

Local Health Districts

Southern Nevada Health District

Clark County (Las Vegas area)

24/7: (702) 759-1000

Washoe County Health District

Reno/Sparks area

Phone: (775) 328-2447

Carson City Health

Carson City area

Phone: (775) 887-2190

Strategic National Stockpile (SNS)

Nation's Emergency Medical Reserve

The SNS is a national repository of antibiotics, antitoxins, vaccines, and medical supplies managed by CDC. It can supplement state and local resources during large-scale emergencies when normal supply chains are inadequate.

SNS Contents

Pharmaceuticals
  • • Antibiotics (ciprofloxacin, doxycycline)
  • • Antitoxins (botulinum)
  • • Antivirals
  • • Nerve agent antidotes
Vaccines & Biologics
  • • Smallpox vaccine
  • • Anthrax vaccine
  • • Immunoglobulins
  • • Potassium iodide (KI)
Medical Supplies
  • • Ventilators
  • • IV supplies
  • • PPE
  • • Bandages and wound care

SNS Deployment Process

1
Governor Requests

Governor requests SNS through State Health Officer to CDC

2
CDC Authorizes

CDC reviews request and authorizes deployment

3
12-Hour Push Packages

Pre-configured containers with broad-spectrum supplies arrive within 12 HOURS anywhere in US

4
Vendor Managed Inventory (VMI)

Agent-specific supplies follow within 24-36 hours once threat is identified

5
State Distribution

State distributes through Points of Dispensing (PODs) for mass prophylaxis

12 Hours - Anywhere in the US

The 12-Hour Push Packages can reach ANY location in the United States within 12 hours. They contain broad-spectrum supplies because the specific agent may not yet be identified. This buys time while labs confirm the threat.

Point of Dispensing (POD) Operations

Mass Prophylaxis Clinics

PODs are temporary clinics established to rapidly distribute medications or vaccines to large numbers of people during a public health emergency. A single POD can process thousands of people per day.

POD Workflow Stations

1
Greeting

Welcome, forms distribution

2
Screening

Medical history, contraindications

3
Dispensing

Medication/vaccine administration

4
Education

Instructions, side effects

5
Observation

Monitor for reactions

Nurse Roles in POD Operations

  • Screen recipients for contraindications
  • Administer vaccines or medications
  • Provide education on medication regimens
  • Document administration accurately
  • Monitor for adverse reactions
  • Supervise non-licensed staff

Key Takeaways

ICS/HICS provides standardized emergency command structure

Unity of Command: Each person reports to ONE supervisor

Span of Control: 3-7 people per supervisor (ideal = 5)

Safety Officer can STOP unsafe operations immediately

CDC manages SNS; Governor initiates request

12-Hour Push Packages reach anywhere in US in 12 hours

Nurses serve throughout HICS - not just clinical roles

PODs enable rapid mass prophylaxis distribution

Module 3 Module 5