1.1 Mass Casualty and Mass Effect Incidents: Implications for Healthcare Organizations
1.2 Systems-Based Approach to Healthcare Incident Management
1.3 The MSCC Healthcare Coalition (Tier 2)
1.4 Relevant NIMS Principles for the Healthcare Coalition
1.5 The MSCC Healthcare Coalition as a MAC System
2.1 The Healthcare Coalition Overview
2.2 The Healthcare Coalition Baseline Operations
2.3 The Healthcare Coalition Response Team
2.4 The Healthcare Coalition Senior Policy Group
3.1 Establishing Procedures for the Progressive Stages of Response and Recovery
3.2 Incident Recognition
3.3 Initial Notification/Activation
3.4 Mobilization
3.5 Incident Operations
3.6 Demobilization
3.7 Transition to Recovery and Return to Readiness
4.1 Healthcare Coalition Strategies for Integrating with Coalition Member Organizations (Tier 1)
4.2 Healthcare Coalition Integration with Jurisdictional Command (Tier 3)
4.3 Healthcare Coalition Regional Roles
5.1 Developing the Healthcare Coalition
5.2 Establishing the Healthcare Coalition Emergency Management Program (EMP)
5.3 Programmatic Issues for the Healthcare Coalition
5.4 Hazards Vulnerability Analysis
6.1 Implementation of the Healthcare Coalition Response Organization
6.2 Other Healthcare Coalition Preparedness Activities
6.3 Healthcare Coalition Mitigation Activities
7.1 The Need for Healthcare Coalition Operational Documents
7.2 Written Instrument Options
7.3 Resource Assistance Issues in Healthcare Coalition Instruments
7.4 Procedural Guidance for Healthcare Coalition Written Agreements
7.5 Relevant Healthcare Standards and Guidance for the Healthcare Coalition
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MSCC Handbook
Chapter 1: Healthcare Emergency Response and the Need for a Healthcare Coalition
Chapter 2: The Healthcare Coalition as a Response Organization: System Description
Chapter 3: The Healthcare Coalition during Emergency Response and Recovery: Concept of Operations
Chapter 4: Integration of the Healthcare Coalition into Overall Emergency Response and Recovery
Chapter 5: The Healthcare Coalition Emergency Management Program: Implementing Sustainable Solutions
Chapter 6: The Healthcare Coalition Emergency Management Program: Mitigation and Preparedness Activities
Chapter 7: Healthcare Coalition Administrative and Documentation Guidance
Appendix A: Acronyms
Appendix B: Glossary
Adequate: Denotes the quality or quantity of a system, process, procedure, or resource that will achieve the relevant incident response objective.
Administrative body: As used in this handbook, the organization that provides preparedness support to the Healthcare Coalition. This can include, but is not limited to, activities such as arranging meeting space, providing financial accounting, and/or supporting document archiving and control.
Area Command: An organization established to oversee the management of multiple incidents that are each being handled by a separate Incident Command System organization or to oversee the management of a very large or evolving incident that has multiple Incident Management Teams engaged. An Agency Administrator/Executive or other public official with jurisdictional responsibility for the incident usually makes the decision to establish an Area Command. An Area Command is activated only if necessary, depending on the complexity of the incident and incident management span-of-control considerations. (NIMS)
Badging: The process of providing outside personnel with identification that gives them access (usually limited) to the designated facilities of the organization requesting assistance.
Chief: The Incident Command System title for individuals responsible for management of functional Sections: Operations, Planning, Logistics, Finance/Administration, and Intelligence/ Investigations (if established as a separate Section). (NIMS)
Command Staff: The staff who report directly to the Incident Commander, including the Public Information Officer, Safety Officer, Liaison Officer, and other positions as required. They may have an assistant or assistants, as needed. (NIMS)
Common Operating Picture: An overview of an incident by all relevant parties that provides incident information enabling the Incident Commander/Unified Command and any supporting agencies and organizations to make effective, consistent, and timely decisions. (NIMS)
Communications/Dispatch Center: Agency or interagency dispatch centers, 911 call centers, emergency control or command dispatch centers, or any naming convention given to the facility and staff that handles emergency calls from the public and communication with emergency management/response personnel. The center can serve as a primary coordination and support element of the Multiagency Coordination System(s) (MAC System) for an incident until other elements of the MAC System are formally established.
Compact: An agreement or contract between persons, nations, or States. (Black's Law Dictionary, Sixth Ed.)
Contract: An agreement between two or more persons to create an obligation to do or not to do a particular thing. (Black's Law Dictionary, Sixth Ed.)
Corrective Actions: The implementation of procedures that are based on lessons learned from actual incidents or from training and exercises. (NIMS)
Credentialing: The authentication and verification of the certification and identity of designated incident managers and emergency responders. The credentialing process entails the objective evaluation and documentation of an individual's current certification, license, or degree; training and experience; and competence or proficiency to meet nationally accepted standards, provide particular services and/or functions, or perform specific tasks under specific conditions during an incident. (NIMS)
Department Operating Center (DOC): An Emergency Operations Center (EOC) specific to a single department or agency. The focus of a DOC is on internal agency incident management and response. DOCs are often linked to and, in most cases, are physically represented in a combined agency EOC by authorized agent(s) for the department or agency. (NIMS)
Disaster ("Major"): As defined in the Robert T. Stafford Act, a "major disaster" is any natural catastrophe (including any hurricane, tornado, storm, high water, wind-driven water, tidal wave, tsunami, earthquake, volcanic eruption, landslide, mudslide, snowstorm, or drought), or, regardless of cause, any fire, flood, or explosion, in any part of the United States, which in the determination of the President causes damage of sufficient severity and magnitude to warrant major disaster assistance under this Act to supplement the efforts and available resources of States, local governments, and disaster relief organizations in alleviating the damage, loss, hardship, or suffering caused thereby.
Duty Officer: As used in this handbook, an individual position that is available 24/7 to respond to questions and determine initial actions for a response organization, including whether the organizations should be activated. Duty Officers also may seek out additional initial incident information, decide upon the need for activation, and determine initial actions. Upon activation of the response organization, the Duty Officer position is suspended and the individual transitioned to staffing a position in the response organization.
Emergency (Federal): Any incident, whether natural or manmade, that requires responsive action to protect life or property. Under the Robert T. Stafford Disaster Relief and Emergency Assistance Act, an emergency means any occasion or instance for which, in the determination of the President, Federal assistance is needed to supplement State and local efforts and capabilities to save lives and to protect property and public health and safety, or to lessen or avert the threat of a catastrophe in any part of the United States. (NIMS)
Emergency Management: Describes the science of managing complex systems and multidisciplinary personnel to address emergencies or disasters, across all hazards, and through the phases of mitigation, preparedness, response, and recovery.
Emergency Management Assistance Compact (EMAC): A congressionally ratified organization that provides form and structure to interstate mutual aid. Through EMAC, a disasteraffected State can request and receive assistance from other member States quickly and efficiently, resolving two key issues up front: liability and reimbursement. (NIMS)
Emergency Management Committee: A preparedness entity established by an organization that has the responsibility for emergency management program (EMP) oversight within the organization. As such, the committee would normally have the responsibility to ensure the overall preparation, implementation, evaluation and currency of the EMP. (adapted from the VHA Emergency Management Guidebook, 2005)
Emergency Management Program (EMP): A program that implements the organization's mission, vision, management framework, and strategic goals and objectives related to emergencies and disasters. It uses a comprehensive approach to emergency management as a conceptual framework, combining mitigation, preparedness, response, and recovery into a fully integrated set of activities. The "program" applies to all departments and organizational units within the organization that have roles in responding to a potential emergency. (adapted from NFPA 1600 and the VHA Emergency Management Guidebook, 2004)
Emergency Operations Center (EOC): The physical location at which the coordination of information and resources to support incident management (on-scene operations) activities normally takes place. An EOC may be a temporary facility or may be located in a more central or permanently established facility, perhaps at a higher level of organization within a jurisdiction. EOCs may be organized by major functional disciplines (e.g., Fire, Law Enforcement, Medical Services), by jurisdiction (e.g., Federal, State, regional, Tribal, city, county), or by some combination thereof. (NIMS)
Emergency Operations Plan (EOP): The "response" plan that an entity (organization, jurisdiction, State, etc.) maintains for responding to any hazard event. It provides action guidance for management and emergency response personnel, during the response phase of Comprehensive Emergency Management.
Emergency Support Function (ESF): As defined in the National Response Framework, an ESF refers to a group of capabilities of Federal departments and agencies to provide the support, resources, program implementation, and services that are most likely to be needed to save lives, protect property, restore essential services and critical infrastructure, and help victims return to normal following a national incident. An ESF represents the primary operational level mechanism to orchestrate activities to provide assistance to State, Tribal, or local governments, or to Federal departments or agencies conducting missions of primary Federal responsibility.
Event: A scheduled non-emergency activity (e.g., sporting event, concert, parade, etc.). (NIMS)
Federal: Of or pertaining to the Federal Government of the United States of America.
Finance/Administration Section: The ICS functional area that addresses the financial, administrative, and legal/regulatory issues for the incident management system. It monitors costs related to the incident and provides accounting, procurement, time recording, cost analyses, and overall fiscal guidance.
Functional Area: A major grouping of the similar tasks that agencies perform in carrying out incident management activities. These are usually all or part of one of the five ICS sections (Command, Operations, Logistics, Planning, Finance/ Administration).
Function: The five major activities in the Incident Command System: Command, Operations, Planning, Logistics, and Finance/Administration. Intelligence is not considered a separate function under traditional ICS but has been added for consideration as a possible separate function under NIMS. The term function is also used when describing the activity involved (e.g., the Planning function). (adapted from NIMS)
General Staff: A group of incident management personnel organized according to function and reporting to the Incident Commander. The General Staff normally consists of the Operations Section Chief, Planning Section Chief, Logistics Section Chief, and Finance/Administration Section Chief. An Intelligence/Investigations Chief may be established, if required, to meet incident management needs. (NIMS)
Hazard: A potential or actual force, physical condition, or agent with the ability to cause human injury, illness, and/or death, and significant damage to property, the environment, critical infrastructure, agriculture and business operations, and other types of harm or loss.
Hazard Vulnerability Analysis (HVA): A systematic approach to identifying all hazards that may affect an organization, assessing the risk (probability of hazard occurrence and the consequence for the organization) associated with each hazard and analyzing findings to create a prioritized comparison of hazard vulnerabilities. The consequence, or vulnerability, is related to both the impact on organizational function and the likely service demands created by hazard impact.
Healthcare Coalition: As used in this handbook, a group of individual healthcare organizations in a specified geographic area that agree to work together to enhance their response to emergencies or disasters. The Healthcare Coalition, being composed of relatively independent organizations that voluntarily coordinate their response, does not conduct command or control. Instead, the Coalition operates consistent with Multiagency Coordination System (MAC System) principles to support and facilitate the response of its participating organizations.
Healthcare Coalition Notification Center (or Coalition Notification Center): As used in this handbook, the entity that provides notification services for the Coalition. Requirements include 24/7 staffing and appropriate technologies to support the notification activities. The Coalition Notification Center remains operational during incident operations and is folded under the Operations Section. Establishing independent notification center capabilities can be expensive and existing capabilities (usually private sector) are often the best option for adopting this responsibility.
Incident: An actual or impending hazard impact, either human caused or by natural phenomena, that requires action by emergency personnel to prevent or minimize loss of life or damage to property and/or natural resources. An incident is an unplanned occurrence.
Incident Action Plan (IAP): The document in ICS that guides the response for that operational period. It contains the overall incident objectives and strategy, general tactical actions, and supporting information to enable successful completion of objectives. The IAP may be oral or written. When written, the IAP may have a number of supportive plans and information as attachments (e.g., traffic plan, safety plan, communications plan, and maps). There is only one IAP at an incident. All other "action plans" are subsets of the IAP and their titles should be qualified accordingly. For example, the jurisdiction primarily impacted usually develops the IAP. Action plans developed below the level of the jurisdiction may be referred to as "Operations Plans". (e.g., individual Hospital Operations Plans)
Incident Commander (IC): The individual responsible for all incident activities, including the development of strategies and tactics and the ordering and the release of resources. The IC has overall authority and responsibility for conducting incident operations and is responsible for the management of all incident operations at the incident site. (adapted from NIMS)
Incident Command System (ICS): The combination of facilities, equipment, personnel, procedures, and communications operating within a common organizational structure, designed to aid in the management of resources for emergency incidents. It may be used for all emergencies and has been successfully employed by multiple response disciplines. ICS is used at all levels of government (local, State, Tribal, and Federal) to organize field level operations. (adapted from NIMS)
Incident Command Post (ICP): The physical location close to the incident site (or elsewhere for a diffuse incident or one with multiple sites), which serves as a base location for managing tactical or "field operations." Located within the ICP are designated representatives of the major response agencies for the incident, who fill positions in the incident command team. The ICP location is designated by the Incident Commander.
Incident Management Team (IMT): The Incident Commander and appropriate Command and General Staff personnel assigned to an incident.
Incident Objectives: Statements of guidance and direction necessary for selecting appropriate strategy(s) and the tactical direction of resources. Incident objectives are based on realistic expectations of what can be accomplished when allocated resources have been effectively deployed. Incident objectives must be achievable and measurable, yet flexible to allow for strategic and tactical alternatives. (adapted from NIMS)
Joint Information Center (JIC): A center established to coordinate the public information activities for a large incident. It is the central point of contact for all news media at the scene of the incident. Public information officials from all participating Federal agencies collaborate at the JIC, as well as public information officials from participating State and local agencies. (adapted from NIMS)
Jurisdictional Agency: The agency having jurisdiction and responsibility for a specific geographical area or a mandated function. Usually, this is a public agency representing a local, State, or Federal government that has direct authority for emergency response and recovery. (adapted from NIMS)
Jurisdiction: A political subdivision (Federal, State, county, parish, and/or municipality) with the responsibility for ensuring public safety, health, and welfare within its legal authorities and geographic boundaries. In the context of this handbook, it refers to a geographic area's local government, which commonly has the primary role in emergency response.
Liaison: In ICS, it is a position(s) assigned to establish and maintain direct coordination and information exchange with agencies and organizations outside of the specific incident's ICS structure. (adapted from NIMS)
Liaison Officer: A member of the Command Staff responsible for filling the senior liaison function with representatives from cooperating and assisting agencies or organizations (NIMS)
Logistics Section: The ICS functional section that provides resources and other support services to incident management, operations, and the other ICS sections. (adapted from NIMS)
Management by Objectives: In the ICS, this is a proactive management activity that involves a four-step process to achieve the incident goal. The steps are: establishing the overarching incident objectives; developing and issuing assignments, plans, procedures, and protocols; establishing specific, measurable objectives for various incident command functional activities and directing efforts to fulfill them, in support of defined strategic objectives; and documenting results to measure performance and facilitate corrective action. (adapted from NIMS)
Management Meeting: In the incident management process, the meeting that establishes (or revises) the incident goals and objectives and the makeup of the ICS structure. NIMS does not separate this meeting from the Planning meeting, although they are commonly separated in wildland fire and Urban Search and Rescue incident management.
Mass Casualty Incident: An incident that generates a sufficiently large number of casualties whereby the available healthcare resources, or their management systems, are severely challenged or unable to meet the healthcare needs of the affected population.
Mass Effect Incident: An incident that primarily affects the ability of an organization to continue its normal operations. For healthcare organizations, this can disrupt the delivery of routine healthcare services and hinder their ability to provide needed surge capacity. For example, a hospital's ability to provide medical care to the victims of an earthquake is compromised if it must focus on relocating current patients because a section of the facility was destroyed.
Measures of Effectiveness: Defined criteria for determining whether satisfactory progress is being accomplished toward achieving the incident objectives. Similarly, defined criteria can also be utilized to establish the effectiveness of the overall Emergency Management Program in meeting its defined goals across the four phases.
Medical Surge: Describes the ability to provide adequate medical evaluation and care in events that severely challenge or exceed the normal medical infrastructure of an affected community (through numbers or types of patients).
Memorandum of Agreement: A Memorandum of Agreement (MOA) defines the general area of conditional agreement between two or more parties, but one party's action depends on the other party's action. The MOA can be complemented with support agreements that detail reimbursement schedules and specific terms and conditions. (adapted from FEMA's National Preparedness Directorate, Memorandum of Agreement/Memorandum of Understanding Template and Guidance; March 2009)
Memorandum of Understanding: A formal document embodying the firm commitment of two or more parties to an undertaking, and setting out its general principles, but falling short of constituting a detailed contract or agreement. (Oxford Dictionary of Law, 2006)
Mitigation: Activities designed to reduce or eliminate risks to persons or property or to lessen the actual or potential effects or consequences of a hazard. Mitigation involves ongoing actions to reduce exposure to, probability of, or potential loss from hazards. Examples include zoning and building codes, floodplain buyouts, and analysis of hazard-related data to determine where it is safe to build or locate temporary facilities. Mitigation can include efforts to educate governments, businesses, and the public on measures they can take to reduce loss and injury. (adapted from NIMS)
Mobilization: Activities and procedures carried out that ready an asset to perform incident operations according to the Emergency Operations Plan. During the response phase of Comprehensive Emergency Management, it is the stage that transitions functional elements from a state of inactivity or normal operations to their designated response state. This activity may occur well into the response phase, as additional assets are brought on line or as surge processes are instituted to meet demands.
Multiagency Coordination Group (MAC Group): According to NIMS, a group of administrators or executives or their appointed representatives who are typically authorized to commit agency resources and funds. A MAC Group can provide coordinated decision-making and resource allocation among cooperating agencies and may establish the priorities among incidents, harmonize agency policies, and provide strategic guidance and direction to support incident management activities.
Multiagency Coordination System (MAC System): According to NIMS, the primary function of a MAC System is to coordinate activities above the field level and to prioritize the incident demands for critical or competing resources, thereby assisting the coordination of operations in the field. (NIMS)
Multijurisdictional Incident: An incident that extends across political boundaries and/or response disciplines, requiring action from multiple governments and agencies to manage certain aspects of an incident. These incidents may best be managed under Unified Command. (adapted from NIMS)
Mutual Aid Agreement: Written instrument between agencies and/or jurisdictions in which they agree to assist one another upon request, by furnishing personnel, equipment, supplies, and/or expertise in a specified manner. An "agreement" is generally more legally binding than an "understanding."
National Incident Management System (NIMS): A system mandated by HSPD-5 that provides a consistent nationwide approach for Federal, State, Tribal, and local governments, the private sector, and nongovernmental organizations to work effectively and efficiently together to prepare for, respond to, and recover from domestic incidents, regardless of cause, size, or complexity. To provide for interoperability and compatibility among Federal, State, and local capabilities, NIMS includes a core set of concepts, principles, and terminology. HSPD-5 identifies these as the Incident Command System; multiagency coordination systems; unified command; training; identification and management of resources (including systems for classifying types of resources); qualifications and certifications; and the collection, tracking, and reporting of incident information and incident resources. (adapted from NIMS)
Operations Section: The ICS functional area responsible for all resources and activities that directly address the incident objectives. It develops all tactical operations at the incident, and in ICS, includes branches, divisions and/or groups, Task Forces, Strike Teams, Single Resources, and Staging Areas. As an example, if a Healthcare Coalition decides that one of its response objectives is Coalition notifications, then this function would reside within the Operations Section.
Participating Organization: As used in this handbook, any healthcare organization that provides point of service care that has agreed to participate in the preparedness and response activities of a Healthcare Coalition. The minimum commitment is participation in both preparedness and response meetings and providing response information when requested.
Planning (incident response): Activities that support the incident management process, including completing the incident action plan and support plans and accomplishing incident information processing. This is in contrast to preparedness planning, which is designed to ready a system for response.
Planning Meeting: A meeting held as needed throughout the duration of an incident to select specific strategies and general tactics for incident operations and for service and support planning. In the incident management process, the planning meeting establishes strategy and priorities based upon the goals and objectives developed in the management meeting. Remaining decisions for the action plan are achieved during this meeting. (adapted from NIMS)
Planning Section: In ICS, this functional area is responsible for the collection, evaluation, and dissemination of operational information related to the incident and for the preparation and documentation of the incident action plan and its support plans. The Planning Chief is responsible for running the management and planning meetings and the operations briefing, and the Planning Section supports these activities. The Planning Section also maintains information on the current and forecasted situation, the status of resources assigned to the incident, and other incident information. (adapted from NIMS)
Preparedness: The range of deliberate, critical tasks and activities necessary to build, sustain, and improve the capability to protect against, respond to, and recover from hazard impacts. Preparedness is a continuous process. Within NIMS, preparedness involves efforts at all levels of government and the private sector to identify threats, to determine vulnerabilities, and to identify required response plans and resources. NIMS preparedness focuses on establishing guidelines, protocols, and standards for planning, training and exercise, personnel qualifications and certification, equipment certification, and publication management. (adapted from NIMS)
Preparedness Organization: An organization that provides coordination for emergency management and incident response activities before a potential incident. These organizations range from groups of individuals to small committees to large standing organizations that represent a wide variety of committees, planning groups, and other organizations (e.g., Citizen Corps, Local Emergency Planning Committees, Critical Infrastructure Sector Coordinating Councils). (NIMS)
Prevention: Actions to avoid a hazard occurrence or to avoid or minimize the hazard impact (consequences) if it does occur. Prevention involves actions to protect lives and property. Under HSPD-5, it involves applying intelligence and other information to a range of activities that may include such countermeasures as deterrence operations; heightened inspections; improved surveillance and security operations; investigations to determine the full nature and source of the threat; public health and agricultural surveillance and testing processes; immunizations, isolation, or quarantine; and as appropriate specific law enforcement operations aimed at deterring, preempting, interdicting, or disrupting illegal activity and apprehending potential perpetrators and bringing them to justice. (adapted from NIMS)
Private Sector: Organizations and entities that are not part of any governmental structure. It includes for-profit and not-forprofit, and formal and informal structures, including commerce and industry, non-governmental organizations, and private voluntary organizations. (adapted from NIMS)
Processes: Systems of operations that incorporate standardized procedures, methodologies, and functions necessary to effectively and efficiently accomplish objectives. (adapted from NIMS)
Public Health Emergency: Defined by the Model State Emergency Health Powers Act (MSEHPA): An occurrence or imminent threat of an illness or health condition that is believed to be caused by: (1) bioterrorism; (2) the appearance of a novel or previously controlled or eradicated infectious agent or biological toxin; (3) a natural disaster; (4) a chemical attack or accidental release; or (5) a nuclear attack or accident. It must pose a high probability of a large number of deaths in the affected population, or a large number of serious or long-term disabilities in the affected population, or widespread exposure to an infectious or toxic agent that poses a significant risk of substantial future harm to a large number of people in the affected population. (The Center for Law and the Public's Health at Georgetown and Johns Hopkins Universities)
Public Information Officer: Official at headquarters or in the field responsible for preparing and coordinating the dissemination of public information in cooperation with other responding Federal, State, Tribal, and local agencies. In ICS, the term refers to a member of the Command Staff responsible for interfacing with the public and media and the Joint Information Center.
Recovery: The phase of Comprehensive Emergency Management that encompasses activities and programs implemented during and after response that are designed to return the entity to its usual state or to a "new normal." For response organizations, this includes return to readiness activities.
Resiliency: The ability of an individual or organization to quickly recover from change or misfortune.
Resources: All personnel and major items of equipment, supplies, and facilities available, or potentially available, for assignment to incident or event tasks on which status is maintained.
Response: Activities that address the direct effects of an incident. Response includes immediate actions to save lives, protect property, and meet basic human needs. Response also includes the execution of emergency operations plans as well as activities designed to limit the loss of life, personal injury, property damage, and other unfavorable outcomes. As indicated by the situation, response activities may include applying intelligence and other information to lessen the effects or consequences of an incident; increased security operations; continuing investigations into the nature and source of the threat; ongoing public health and agricultural surveillance and testing processes; immunizations, isolation, or quarantine; and specific law enforcement operations aimed at pre-empting, interdicting, or disrupting illegal activity and apprehending actual perpetrators and bringing them to justice. (adapted from NIMS)
Response Organization: A response organization provides a structure and functions to manage emergency decision-making, decision implementation, and overarching coordination of resources and actions in the emergency context. Response organizations can include entities that conduct response management for a larger organization (private and for-profit or not-for profit), an agency or department, a government jurisdiction, or a collection of like organizations such as a Healthcare Coalition or a regional response center. Most response organizations are organized under NIMS as an Incident Management Team or as a Multiagency Coordination System. (ICDRM/GWU Emergency Management Glossary of Terms, Available at: http://www.gwu.edu/~icdrm/)
Safety Officer: A member of the Command Staff responsible for monitoring and assessing safety hazards or unsafe situations and for developing measures for ensuring personnel safety. The Safety Officer may have assistants.
Span of Control: The number of individuals a supervisor is responsible for, usually expressed as the ratio of supervisors to individuals (under NIMS, an appropriate span of control is between 1:3 and 1:7). (adapted from NIMS)
Senior Policy Group: As used in this handbook, a MAC Group consisting of executives, senior administrators, or their designees from participating organizations in a Healthcare Coalition. The Senior Policy Group provides strategic guidance to the HCRT, among other things, and is convened only as needed.
State: When capitalized, refers to any State of the United States, the District of Columbia, the Commonwealth of Puerto Rico, the Virgin Islands, Guam, American Samoa, the Commonwealth of the Northern Mariana Islands, and any possession of the United States. (as defined in section 2 (14) of them Homeland Security Act of 2002, Pub. L. 107-296, 116 Stat. 2135, et seq.(2002).)
Strategic: Strategic elements of incident management are characterized by continuous long-term, high-level planning by senior level organizations. They involve the adoption of long-range goals and objectives; the setting of priorities; the establishment of budgets and other fiscal decisions; policy development; and the application of measures of performance or effectiveness. (adapted from NIMS)
Strategy: The general plan or direction selected to accomplish incident objectives. (NIMS)
Surge Capability: The ability to manage patients requiring unusual or very specialized medical evaluation and care. Requirements span the range of specialized medical and public health services (expertise, information, procedures, equipment, or personnel) that are not normally available at the location where they are needed. It also includes patient problems that require special intervention to protect medical providers, other patients, and the integrity of the healthcare organization.
Surge Capacity: The ability to evaluate and care for a markedly increased volume of patients—one that challenges or exceeds normal operating capacity. Requirements may extend beyond direct patient care to include other medical tasks, such as extensive laboratory studies or epidemiologic investigations.
System: A clearly described functional structure, including defined processes, that coordinates otherwise diverse parts to achieve a common goal.
Tactical: Tactical elements of ICS are characterized by the execution of specific actions or plans in response to an actual incident or, prior to an incident, the implementation of individual or small unit activities, such as training or exercises.
Tactics: The deployment and directing of resources on an incident to accomplish the objectives designated by strategy. (NIMS)
Terrorism: Any premeditated, unlawful act dangerous to human life or public welfare that is intended to intimidate or coerce civilian populations or governments (National Strategy for Homeland Security, July 2002). It includes activity potentially destructive of critical infrastructure or key resources. It is a violation of the criminal laws of the United States or of any State or other subdivision of the United States in which it occurs. It can include activities to affect the conduct of a government by mass destruction, assassination, or kidnapping. (Section 2 (15), Homeland Security Act of 2002, Pub. L. 107-296, 116 Stat. 2135, (2002).)
Threat: An indication of possible violence, harm, or danger. (adapted from NIMS)
Unified Command: An application of ICS used when there is more than one agency with incident jurisdiction. Agencies work together through their designated Incident Commanders or Managers at a single location to establish a common set of objectives and strategies and a single incident action plan. (adapted from NIMS)
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