Читать книгу Emergency Incident Management Systems - Mark Warnick S., Louis N. Molino Sr - Страница 89

Fire and Rescue Service have been utilizing a modified version of the US ICS method since approximately 1999. While most countries around the world have based their modifications on the FIRESCOPE version of ICS, the United Kingdom chose to utilize and modify the ICS method developed by Chief Alan “Bruno” Brunacini. In fact, Brunacini generously donated his time to assist in creating the IMS method used in the United Kingdom (Arbuthnot, 2015).

According to Arbuthnot (2015), the need for an IMS method to manage operations in the United Kingdom was realized after several fire responses went horribly wrong. While numerous fires may have played a role, the Gillender Street fire in London during July 1991, and the Sun Valley poultry factory fire in Hereford, England, during September 1993 seemed to be the impetus. In both aforementioned fires, two firefighters died (in each one). Additionally, there had been questions about command and control issues in a government report, which also helped the push for solutions. Initially, the two main focuses for the UK ICS method were dynamic risk assessment and organizational structure on the operational (fire) ground. As the system started to develop, a third focus was added which revolved around command competency. After much debate and inquiry, a final IMS method was decided on, and in 1999, the UK Fire Service released the Incident Command manual. Since then, there have been revisions, updating, and additions in 2002 and 2008 (Arbuthnot, 2015).

In the United Kingdom, the Metropolitan Police Service determined that an IMS method was needed after a police constable was killed in the Broadwater Farm riot that occurred in October of 1985. This event caused the Metropolitan Police to realize that a rank‐based command system was not appropriate for rapidly changing events. This was (primarily) based on the premise that there was no specific individual definitively managing operations during the response to the riot, thereby causing chaos, confusion, and uncertainty (Future Learn, n.d.).

After reviewing this riot (and other incidents), it was determined that three essential roles were important in managing an incident. To mitigate problems with incident management, a few members from the Metropolitan Police created and implemented a new IMS framework called Gold–Silver–Bronze. This framework was also found to be useful in preplanned operations. Soon after its inception, it began to be utilized or integrated by other emergency services/public safety agencies (Future Learn, n.d.).

In this system, the Gold Commander is in complete control of organizational resources for an incident. The Gold Commander will be located somewhere other than the actual incident (usually in a control room) and will be in contact with their resources so they can receive regular updates. The specified control room is known as Gold Command, and this is where they will formulate the strategy. This remote command post was devised so that the person creating strategy has less of a chance of getting tunnel vision caused by being physically at an incident. Multiple Gold Commanders from different organizations (fire, police, EMS) will work together on a multiagency response in Gold Command and, if by chance they are not in the same geographical location, they will remain in continuous contact with each other by videoconference or telephone. This is not to insinuate that they will usually be in the same room, but rather they will typically be in the same geographical location, usually within walking distance of each other. Designated Gold Commanders from different agencies will periodically meet so that they can deliberate and articulate policies and improve working practices between their organizations. In these meetings, they will often preplan coordination for various types of incidents (Future Learn, n.d.).

The Silver Commander is responsible for managing tactics, and they are at, or near, the incident. It should be noted that the Silver Commander is not physically involved in dealing with the incident; they are strictly used for tactical planning. On larger incidents, they will typically be in a command vehicle or at an improvised command center with their counterparts from other disciplines. This command center will be identified as the Joint Emergency Services Control Centre (JESCC). After being given strategic direction by the Gold Commander, they will begin to formulate the tactics needed to meet the overall strategy for an incident. The tactical actions they develop will keep in mind the overarching strategy's that should be met, and plan accordingly. Once they develop these tactical plans, they then provide tactical direction to the Bronze Commander, or in cases where multiple commanders are used, the appropriate Bronze Commander (Future Learn, n.d.).

A Bronze Commander is in direct command of resources at the incident, and they ensure that their on‐scene staff carries out the tactics and orders provided by the Silver Commander. In a multiagency response, a Commander or some other representative (from each required discipline) will take direction from their organization. If the incident covers a large geographical area, then multiple Bronze Commanders might be based on the geography of the incident. If an incident is extremely complex, each Bronze Commander can be given their own task (or responsibility) within the response to the overall incident. As an example, in a mass casualty incident, one Bronze Commander might oversee the taking statements, while another manages crime scene security, and yet another oversees survivor management (Future Learn, n.d.).

During the initial stages of an incident, the highest‐ranking member of each discipline temporarily assumes the role of Silver or Bronze Commander. They will remain in that position until a more senior member or someone with specialized knowledge from their organization arrives on scene, then they will transfer command (Future Learn, n.d.). In personal communication, it was found out that police and medics do not utilize a formal ICS method, but these entities have created documents which mirror the fire service's architecture to a large extent. This became more of a priority since Joint Emergency Services Interoperability Principles (JESIP) (K. Arbuthnot, personal communication, 23 November 2018).

The Joint Emergency Services Interoperability Principles (JESIP) was a two‐year coordinated research program that looked at improving integration of resources and improving coordination during a multiagency response. The primary focus was to improve response and recovery whenever a major multiagency incident occurred. This two‐year shared effort, undertaken from 2012 to 2014, produced a joint doctrine that provides a framework that improves multiagency response by providing training and basic guidance. The program initiated one of the largest and most effective joint training initiatives, one that helped to integrate emergency services during a disaster in the United Kingdom (JESIP, n.d.).

A common misconception of the Gold–Silver–Bronze is that the organization in charge of an incident is dependent on the type of incident. Most people believe that the police are in charge of a criminal or terrorist incident, and that fire crews are in charge of fires and rescue type situations. This assumption is a misconception of the framework. Under the Civil Contingencies Act, these varying disciplines would coordinate the response to provide a seamless multiagency response, by utilizing Joint Emergency Services Interoperability Principles (JESIP) procedures and protocols. Each agency participating in the response has its own command structure. Representatives from each discipline will work together to provide a comprehensive and coordinated response (Future Learn, n.d.).

Comparing the UK system of IMS to the US counterpart, it is somewhat similar to the ICS method, however, multiple unnamed sources reported that the Gold–Silver–Bronze method has some issues. According to individuals who have worked in the field under this program, the issue arises when Gold Team members assert their authority to the boots on the ground, but the commands are contradictory to what responders on the ground think needs to happen in order to control the incident properly. While this view is subjective to the person, it also raises the question if a command staff that may be 30 miles away can make a better call than those that are right in front of the incident. In the United States, it is not uncommon for the Incident Commander (IC) to be off site; however, they receive detailed feedback from operations, and there are often joint planning meetings and daily evaluations. It is unclear if this occurs, these types of face‐to‐face meetings in the Gold–Silver–Bronze method. It is clear that Joint Emergency Services Interoperability Principles (JESIP) is similar to an Emergency Operations Center (EOC) that is used to supply resources to those in command of an incident.

When looking at the hospital IMS method used in the United Kingdom, hospitals integrate with public safety as part of the Gold–Silver–Bronze method, and they also have an internal IMS method for hospitals. The National Health System (NHS) in member countries of the United Kingdom (e.g. Wales, Scotland, England) provide the very specific Emergency Preparedness, Resilience and Response Framework that guides the hospital into a complete integration with public safety agencies. This framework appears to have been initially implemented in 2004, and it has undergone several modifications since then. In this framework, there are four levels of disaster. They are the following:

 Level 1: An incident that can be handled internally with the resources on hand.

 Level 2: Requires outside resources within the NHS region and liaison with local NHS office.

 Level 3: Requires outside resources within the NHS region and the regional NHS office will coordinate with commissioners at the tactical level.

 Level 4: An incident that requires NHS National Command and Control to support the response. Outside resources need from outside the region, and NHS is required to coordinate the NHS Response in collaboration with local commissioners at the tactical level (NHS England, 2015; NHS Scotland, 2015; NHS Tameside Hospital, 2016).

When a potential major incident is reported outside of the hospital, the facility will be notified. There are two levels of notification they may receive. The first is called a Major Incident Standby. In this notification, those activating the hospitals are unsure of the scope of the incident, or they do know the scope, and there is a potential that it may escalate to a larger incident. The standby classification allows hospitals more time to prepare staff and workers for receiving large quantities of patients or prepare for specialized procedures that may be needed such as decontamination, burn care, respiratory care for poison gases (NHS England, 2015; NHS Tameside Hospital, 2016).

The second level of notification is Major Incident Declared. This is an instance where it has been confirmed that a Major Incident has occurred, and the circumstances require the hospital to ready themselves for incoming patients. It is important to note that a Major Incident can be called without first having the hospital be on standby. The preparedness level of these hospitals also has redundant systems, which the Hospital Response Team are required to have (NHS England, 2015; NHS Tameside Hospital, 2016). As an example, the hospital is required to have the hardware, software, and the abilities to switch to a different means of communications, should their normal communications methods be damaged or knocked out.

Internally, the hospitals response to the incident is managed by the Hospital Control Team (HCT). Action Cards have a myriad of information that helps direct the Hospital Control Team (HCT) in what functions will be needed during a major incident based on the type of incident it is. Typically, a full set of Action Cards will be kept as a hard copy in the Major Incident Resource Pack and a full set of the Action Cards will be kept as a hard copy along with a copy of the Major Incident Policy in the office of the Director of Nursing as well as the Fire Safety/Emergency Planning Advisor, in an offsite location. Additionally, hard copies of these Action Plans are placed in each area that might be affected (e.g. Emergency Department, Burn Unit, Pediatrics) by a major incident and will be held available in all Departments and Wards that might be required to provide a response in the event of a major incident (NHS Scotland, 2015; NHS Tameside Hospital, 2016).

Action Cards are considered controlled documents, and changes to those cards usually require the approval by the Emergency Planning Resilience and Response Group. In most instances, the personnel identified in the Action Card as the lead of a given area is responsible for updating them and presenting the changes to the Emergency Planning Resilience and Response Group with any material changes (NHS Scotland, 2015; NHS Tameside Hospital, 2016).

The Actions Cards spell out who should be notified and in what order. Whenever a Major Incident alert is received, the Action Card identifies the notification process needed. Usually, the telephone switchboard operators and first on‐call managers will be notified, and they will initiate staff call‐out procedures. The Action Cards will suggest what actions the Hospital Control Team and Mobile Medical Team will need to take for that particular type of incident. After receiving notifications, the Action Cards will identify actions that will need to be taken in various areas and by various personnel, automatically. These actions may be for the Emergency Department, clinical staff as well as nonclinical staff (NHS Scotland, 2015; NHS Tameside Hospital, 2016).

Some of the actions that may be listed is how to maintain records on each patient, where they are located (updated regularly), and how they should be identified. Additionally, the Hospital Control Team (HCT) may determine that the hospital may need to accelerate discharge procedures to provide more beds for the influx of patients coming from a major incident. The Actions Cards may spell out the need to keep families informed, so part of the requirements of the Hospital Control Team (HCT) after a disaster is to provide a specific area for the patient's family, and to provide a liaison person to keep them informed. Another consideration that will be listed on the Action Cards is when a major incident may be part of criminal activity. In these incidents, the Hospital Control Team can direct personnel to enact already established protocols to protect and preserve potentially useful forensic evidence (NHS England, 2015; NHS Tameside Hospital, 2016).

In creating the Hospital Control Team (HCT), there are typically five main positions. These positions are the HCT Manager (usually the hospital's Chief Operating Officer), the Corporate Lead (usually the Chief Executive), the Nursing Officer (usually the Director of Nursing), Hospital Control Team (HCT) Administrator, and the Hospital Control Team (HCT) Documenting Officer. These five individuals work together to manage the incident in an organized manner. It should be recognized that the IMS method that is used is similar to the ICS method that is utilized by UK fire brigades, although it appears that it is not the same (NHS Tameside Hospital, 2016).

Much more could be written on the United Kingdom. This book only touches on the continual improvements that are seen in incident managements and IMS methods. Much like the United States, the United Kingdom is always trying to improve. It appears as if the key players in IMS methods are never satisfied with status quo, or that the systems they use are “good enough.” This continual thriving to improve allows them to be one of the main leaders in the world for managing major incidents.