PHYSICIAN ROLES

AT THE HOSPITAL IN
A DISASTER

This material has been developed for training purposes. No

part of this course or its materials shall be copied or
utilized for monetary gain.
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Objectives

1. Discuss the physician role in HICS

2. Discuss the principal concepts and features

of the Hospital Incident Command System

3. Discuss how the hospital is part of the

community response

PHYSICIAN ROLES IN THE HOSPITAL IN A DISASTER

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Planning

WHAT DO WE NEED TO
PLAN FOR:

• What are the risks we

face daily?

• What is on our Hazard

Vulnerability
Assessment list?

PHYSICIAN ROLES IN THE HOSPITAL IN A DISASTER

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The Responsibility is…

WHO IS RESPONSIBLE FOR EMERGENCY

PREPAREDNESS AT (Insert Facility):

• Emergency Management Committee

• Environment of Care Committee

• (Insert specific methodology used)

• CMS requires all staff, physicians and

contractors, and volunteers be trained annually
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Emergency Response

HOW IS AN EMERGENCY
RESPONSE DIFFERENT
FROM DAY-TO-DAY?

• Emergency Operations
Plan

• Emergency Codes

• Hospital Incident
Command System
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HICS

HOSPITAL INCIDENT COMMAND SYSTEM:

Helps improve hospital response and coordination

between hospitals and other responders using:

• Defined responsibilities
• Clear reporting channels
• A common nomenclature
HICS does not replace or supplant daily hospital operations
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 BASIC INCIDENT COMMAND
STRUCTURE
Incident
Commander

Public
Safety
Information
Officer
Officer

Medical/
Liaison
Technical
Officer
Specialist(s)

Operations Planning Logistics Finance/

Section Administration
Section Chief Section Chief
Chief Section Chief

Modular Organization:
Functional Sections Activated as Needed
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HICS is Scalable

FLEXIBLE
The system is scalable so that more or fewer
positions - depending on the emergency - may
be implemented

PHYSICIAN ROLES IN THE HOSPITAL IN A DISASTER

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Activation of the
Emergency Operations Plan

ACTIVATING THE PLAN:

The hospital Emergency

Operations Plan is
activated by: (Insert
method such as;
administrator on call
authorizing the hospital’s
emergency codes)
PHYSICIAN ROLES IN THE HOSPITAL IN A DISASTER
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Activation of the
Emergency Operations Plan
HOW DO YOU KNOW THE
PLAN IS ACTIVATED?:

The hospital communicates

that the plan is activated by:
• Overhead Page
• Email/Alerts
• Pager System
PHYSICIAN ROLES IN THE HOSPITAL IN A DISASTER
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HICS - Hospital
Incident Command System

MANAGEMENT ROLES
IN AN ACTIVATION :

Command and

General Staff

PHYSICIAN ROLES IN THE HOSPITAL IN A DISASTER

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 • Chemical
COMMAND
• Clinic
Administration
Incident • Communicable
Commander Disease
• Hospital
Administration
Public • Legal Affairs
Safety
Information
Officer
Officer
• Medical Ethicist
• Medical Staff
Liaison
Medical/ • Pediatric Care
Technical
Officer
Specialist(s)
• Radiological
• Risk Management
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COMMAND STAFF:
Incident Commander: Gives overall strategic direction
for the hospital
Public Information Officer: Communicates with
internal and external stakeholders including: staff, patients,
visitors, and media
Safety Officer: Ensures safety of staff, patients and
visitors
Liaison Officer: Hospital Command Center contact for
supporting agencies and organizations
Medical Technical Specialist(s): Subject matter
experts that advise the Incident Commander and/or
assigned section
 MEDICAL/TECHNICAL
SPECIALIST

Examples Include:

• Biological • Medical Staff

• Infectious Disease
• Pediatric Care
• Chemical
• Radiological
• Medical Ethicist
• Legal Affairs • Clinical
• Risk Management Administration
• Hospital
Administration
 GENERAL STAFF: SECTIONS

Incident
Commander

Public
Safety
Information
Officer
Officer

Medical/
Liaison
Technical
Officer
Specialist(s)

Finance /
Operations Planning Logistics Administration
Section Chief Section Chief Section Chief Section Chief
 (Insert Facility Name)

HICS Sections

SECTIONS INCLUDE:

• Operations
• Planning
• Logistics
• Finance/
Administration
PHYSICIAN ROLES IN THE HOSPITAL IN A DISASTER
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Operations Section

OPERATIONS SECTION
MISSION:
• Manage tactical
operations
• Direct all tactical
resources
• Carry out the mission
and Incident Action Plan
PHYSICIAN ROLES IN THE HOSPITAL IN A DISASTER
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Operations

Some of the Operations

Section Branches you may
be assigned to:
• Medical Care Branch
• Patient Family
Assistance Branch
• HazMat Branch

PHYSICIAN ROLES IN THE HOSPITAL IN A DISASTER

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 MEDICAL CARE BRANCH DIRECTOR

Supervises:
• Inpatient Unit Leader (all inpatient units)

• Outpatient Unit Leader (all outpatient services)

• Casualty Care Unit Leader (Treatment Areas including:

Immediate, Delayed, Minor, and Expectant/Deceased)

• Behavioral/Mental Health Unit Leader

• Clinical Support Unit Leader (Lab, Diagnostic Imaging,

Pharmacy, Morgue, Blood Bank)

• Patient Registration Unit Leader

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Other Sections

Logistics: Organizes and maintains the

physical environment – providing human
resources, material, and services to
support the incident.
Planning: Collects, evaluates, and
disseminates information and develops the
Incident Action Plan

Finance/Administration: Monitors financial

assets, accounting, and claims
PHYSICIAN ROLES IN THE HOSPITAL IN A DISASTER
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How Do I Get My Assignment

• Depending on the facility’s Emergency

Operations Plan, you can respond to the Labor
Pool for assignment

• If you are not on staff and show up to help, the

Medical Staff Office may handle the credentialing
process (insert facility process for credentialing)
(consider pre-registration as a medical volunteer)

PHYSICIAN ROLES IN THE HOSPITAL IN A DISASTER

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After Action Reporting

YOUR PART IN IMPROVING THE HOSPITAL’S

RESPONSE: Hotwash and Debriefs

PHYSICIAN ROLES IN THE HOSPITAL IN A DISASTER

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Incident Response Guides

• Active Shooter
• Chemical Incident
• Earthquake
• Evacuation, Shelter-in-Place,
and Hospital Abandonment
• Explosive Incident
• Hostage or Barricade
• Infectious Disease
PHYSICIAN ROLES IN THE HOSPITAL IN A DISASTER
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Incident Response Guide

• Mass Casualty Incident

• Missing Person
• Radiation Incident
• Severe Weather
• Staff Shortage
• Utility Failure
• Wildland Fire
PHYSICIAN ROLES IN THE HOSPITAL IN A DISASTER
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Documentation

How is documentation different

in an emergency response:
• HICS Forms
• START Triage Tags
• How does the EMR Change
in a Surge or IT Failure?
• Do we still follow HIPAA?

PHYSICIAN ROLES IN THE HOSPITAL IN A DISASTER

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Community Response

We are part of the national

system:
• Individual Hospital
• Hospital System
• Community/County
• State
• Federal
• International
PHYSICIAN ROLES IN THE HOSPITAL IN A DISASTER
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What if I Don’t Get

A HICS Assignment?

How do I handle current/new patients?

• Assist in clearing the ED for new patients
• Review/evaluate inpatients for early
discharge
• Assist in transfer of appropriate patients to
other service areas or other facilities

PHYSICIAN ROLES IN THE HOSPITAL IN A DISASTER

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What if I Don’t Get

A HICS Assignment?
How do I handle current/new patients?
• Review cancelling elective surgery and
procedures if necessary
• Prepare for patients transferred from an outside
affected area such as another county or state
• Accept assignment to a treatment area
• Open up extra clinic appointments and/or staff
Alternate Care Areas to “unload” the ED
PHYSICIAN ROLES IN THE HOSPITAL IN A DISASTER
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What if I Don’t Get

A HICS Assignment?

Triage of Resources:
• Surgeons/Anesthesiologists: OR Availability
and Priorities
• Radiologists: Imaging Priorities
• Pathologists: Lab Priorities
• Intensivists: Critical Care Priorities

PHYSICIAN ROLES IN THE HOSPITAL IN A DISASTER

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Personal Plans

• Family/Pet Plans
• Department Plans

PHYSICIAN ROLES IN THE HOSPITAL IN A DISASTER

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What Can I Do Pre-Disaster

Educate Your Patients:
• Review and Evaluate DNR/POLST
• Extra Medications
• Disaster Supplies/Family and Reunification
Plans
• Home Health and Special/Functional Needs
Patients
• CERT Programs/First Aid
PHYSICIAN ROLES IN THE HOSPITAL IN A DISASTER
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What Can I Do Pre-Disaster

Personal/Departmental Preparedness:

• Office/Car Disaster Supplies

• Personal/Staff Disaster Supplies/Family, Pet
and Reunification Plans
• Develop Departmental Disaster Plans
• Educate Your Staff
• Participate/Organize Disaster Exercises
PHYSICIAN ROLES IN THE HOSPITAL IN A DISASTER
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What Can I Do Pre-Disaster

Society/Specialty Guidelines and Courses such as:
• National Disaster Life Support Foundation
• Disaster Management and Emergency
Preparedness Course (DMEP; American College
of Surgeons)
• American College of Emergency Physicians
• Society of Critical Care Medicine
• American Academy of Pediatrics
• American College of OB/GYN
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What Can I Do Pre-Disaster

• Consider Crisis
Standards of Care
• Consider
Improvisations in
Austere
Environments

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Crisis Standards of Care

A Systems Framework for Catastrophic Disaster

Response; Institute of Medicine; 2012.
http://iom.nationalacademies.org/Reports/2012/Crisis
-Standards-of-Care-A-Systems-Framework-for-
Catastrophic-Disaster-Response.aspx
California Department of Public Health Standards
and Guidelines for Healthcare Surge During
Emergencies at www.bepreparedcalifornia.ca.gov

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QUESTIONS

THANK
YOU