By Andrew H. Shen, MD
UCLA/OVMC Emergency Medicine Resident PGYIII
Los Angeles, CA
Vol. 11, Issue 3, June 2002
The events of September 11th have brought hospital disaster response to the forefront of concerns for emergency medicine physicians. A generic, yet flexible disaster response plan has been developed in California and implemented in various hospital settings based on the incident command model. The Hospital Emergency Incident Command System (HEICS) provides the structure and flexibility to respond effectively to unique disasters and facilitate communications with non-hospital response systems.
HEICS was originally conceived in 1992 in Orange County, CA hospitals. It is based on the FIRESCOPE incident command system used by most fire departments in the United States. It was later refined by San Mateo County Emergency Medical Services into its third revision to date. The HEICS model consists of a flexible management organizational chart that designates forty-nine roles of accountability and control in a disaster response scenario. At the top of the chart is the incident commander. Serving under the incident commander are four officers that are responsible for different domains.
The bulk of the 49 HEICS roles are subdivided among the four officer domains. Each defined role member is given a worksheet that serves as a checklist for accountability and documentation. Each role can be activated or deactivated throughout the response depending on the need at that time. This flexibility allows HEICS to be used efficiently in large, and small-scale disasters, and large or small hospital settings.
Given that most hospitals already have pre-existing disaster response plans, why should you consider reworking your hospital plan within the HEICS model? One important advantage is that most prehospital and law enforcement agencies use an incident command model. In the chaos of terrorist attack or natural calamity, shared incident command models greatly facilitate communication between the hospital and prehospital providers. HEICS has already been used successfully in disaster response scenarios including the Northridge earthquake. In 1997, the HEICS study group issued a survey of California hospitals regarding the use of its system. Of the hospitals that responded, 56% reported integrating the HEICS system into their hospital. 34% of hospitals had actually used the HEICS plan in a real life disaster response, with 82% describing it as a positive experience (none stated it as a negative experience). A paramedic involved in the World Trade Center attack stressed the importance of an incident command system more recently. Additionally, the adoption of the HEICS plans by an abundance of hospitals would facilitate inter-hospital cooperation and communication during a wide-scale disaster.
As an emergency physician on the forefront of disaster related issues in your hospital, how can you facilitate the transition from a non-incident command system to HEICS. Needless to say, this transition will require dedication from the emergency physician in order to convince hospital administration of the benefits of the HEICS plan. The good news is that there is a defined program to help hospitals make this transition. An experienced instructor may come to tour the facility and help integrate the facility culture to the HEICS plan. There are numerous scenario worksheets to help staff learn the new system. An expected time of implementation for a medium sized hospital is six months to one year depending on the aggressiveness of those involved. The HEICS group can be contacted at their Web site, www.emsa.cahwnet.gov, regarding information to implement the HEICS plan.
We, as emergency physicians, can no longer be passive regarding our hospital disaster response plans. As we have unfortunately experienced recently, terrorist attacks and natural disasters are part of our new reality. The HEICS plan has proven to be a flexible disaster response plan that helps us communicate with EMS and communicate between hospitals. Emergency physicians have a unique opportunity to work with hospital administration to lead their institutions in seriously addressing the adequacy of their disaster response plans.