Critical Incident Management

The Incident Action Planning Process

Every emergency incident requires some form of planning to control each aspect of response.  The planning process was designed to expand and shrink as needed.

Initial tasks are accomplished intuitively by the Incident Commander, followed by a more formal and systematic planning process called Management-by-Objectives (Irwin, 1989).

As with all bureaucracies, the planning process includes the filling out of forms.   The two types of forms are 1) “action,” which sets objectives, assigns the organization, and outlines the tasks to be done, and 2) the “support and recording” forms, which assist incident management by providing worksheets for systematic plan development, assuring that data and records are available and that resources are accounted for, integrating communications capabilities, and documenting decisions.

Unified Command

Of those emergencies serious enough to require the response of several agencies, each has its own legal obligation to perform some type of action.  These critical, multiple-agency emergencies call for a Unified Command structure, and are those incidents that affect more than one geographical jurisdiction, incidents that affect more than one functional jurisdiction, and incidents that affect geographical and functional jurisdictions.  The use of Unified Command at terrorist incidents is a must to achieve a successful outcome of the incident with the fewest complications.

Unified Command, comprising eight individuals, is a consistent, systematic means of organizing a variety of autonomous civilian agencies into one concerted emergency response effort (Irwin, 1989).  Uniform procedures enable all involved agencies to perform their roles effectively by overcoming inefficiencies and duplications of effort.

The practical goals of Unified Command are to (Irwin, 1989):

• Improve the information flow between the agencies involved and maintain logs pertinent to the incident response (actions taken and significant decisions made),
• Develop a single collective approach to the management of the incident, including forecasting the direction of the response and flexing to meet those determinations in conjunction with Planning,
• Reduce or eliminate functional and geographical complexities,
• Optimize the efforts of all agencies, and
• Reduce or eliminate duplications of effort.

The Incident Command System causes differing response agencies to come together in a major emergency and become “one” organization, with overarching management by Unified Command.  The planning process for Unified Command is the same as it is for the Incident Commander, starting with stated objectives, but from a team perspective of the individual Commanders who have approved their portion of the plan that affects their agencies.

Agencies who assign Commanders must have the authority to order, transport, and maintain the resources necessary to meet Command objectives, which is not based on size or budget level of the agency but dependent upon the legitimate capability of fiscal authority.

Two alternatives to participation in the Unified Command group are having Deputy Incident Commanders or by placing a senior officer of an agency in charge.  Agencies with limited involvement may choose to fill their commitment to the incident with a Deputy, rather than a “full” Commander (Irwin, 1989).  For smaller jurisdictions involved in a major emergency, it may be appropriate to designate that agency’s area or function as a Branch, Division, or Group, and place a senior office of the agency in charge.  That office will be an integral part of the unified effort and take part in the planning process, while at the same time fulfilling “at home” responsibilities and serving its own jurisdiction.

Medical Resources

The Medical Unit’s role is to take care of incident personnel only.  A public health officer or other M.D. can be the Incident Commander under some circumstances, or might be a member of a Unified Command Group.  Groups of ambulance and paramedic personnel can be designated as Teams or Task Forces for just about any incident involving injuries.  During a major medical emergency, a Medical Communications Leader position is assigned to coordinate scene-to-hospital(s) communications.

Integrating Volunteer Efforts

Volunteer efforts can both help and hinder emergency response agencies, with their immediate energies and work accomplishments being a valuable help.  The hindrance comes from unmanageable numbers of volunteers, poorly directed work, and a general lack of control. Lack of control can be reduced or eliminated by appropriate use of ICS.

The supervision and integration of these resources into disaster response requires Command attention to recognize the situation, set reasonable objectives for volunteers, and provide supervision and clear direction from Planning, Logistics, and Finance (where approved and appropriate).

A real world situation where techniques were used to manage this effectively was in the aftermath to the 2010 Haitian earthquake.  It was well known that people with medical skills were interested in volunteering to assist the victims so the American Medical Association and National Disaster Life Support Foundation quickly established an online registry where physicians could volunteer. In addition to the registry that captured information including specialty, availability, language skills, and previous disaster medicine experience, they also posted a webinar to prepare volunteers for working in Haiti (Kerr, 2010).

The World Health Organization also enacted measures to mitigate the unregulated flow of donations to the earthquake site, as they outlined medical supplies most needed in the response. This list, which included things such as “bandaging and adhesive tape, intravenous equipment, plaster of Paris for casting, suction tubing, suture silk, X-ray film, Foley catheters, aminophylline, atenolol, ibuprofen, paracetamol, bupivacaine, and ketamine” (Kerr, 2010) was accompanied by specific instructions about how to donate these supplies.

The Incident Command System (ICS)

The Incident Command System (ICS) was developed after a series of wildland fires that caused death, damage, and destruction in southern California in 1970 (Irwin, 1989).  Hundreds of problems with the response and coordination effort spurred the development of the ICS.  There are five functions in the ICS, designed to improve effectiveness, accountability, and communications.  ICS uses an incident action planning process that is systematic and comprehensive; multiple agencies and emergency response disciplines can be integrated into a common organization using the process (Irwin, 1989).  It is “a set of personnel, policies, procedures, facilities, and equipment, integrated into a common organizational structure designed to improve emergency response operations of all types and complexities” (Irwin, 1989).  The Incident Command System process has gained national acceptance to the point that any form of planning may be thought of as being an “ICS” process, which can be dangerous as the planning may be incomplete or ineffective.  The interrelationship between vulnerabilities and critical functions must be understood and addressed during risk assessment.  The United States Government Accountability Office (GAO) is the investigative arm of Congress and they review and provide reports on risk assessments funded by the federal government on their website. See http://www.gao.gov

In 1970, most of the radios in use were of single-frequency capability; scanners were rare; and federal, state, and local forces were operating in different frequency bands (Irwin, 1989).  Agency dispatch centers could not communicate with each other.  Major strategic events were not reported or logged from agency to agency.

Each agency did its own planning and training without cross-communication.  Knowledge of the capabilities of other agencies was limited.  There was no intelligence gathering, so follow-up was impossible for situational analysis.  Resources were poorly managed.  As a result, responders to a fire looked as if they were responding to a Chinese fire drill.  Crews, engines, bulldozers, and other resources were lost, sometimes for days (Irwin, 1989).  Lack of basic tracking capabilities hindered predicting impending conditions.  There was no way to warn homeowners to evacuate or where they might go once they did leave.  Clearly, this was a case of waiting for the technology to advance to resolve these issues.  Design criteria for critical incident management were stated well before the technology was in place to implement the needed changes.

There are 36 basic positions in the complete ICS organization.  It is unlikely that all 36 positions would be filled during a normal response.  ICS can manage up to 5,200 people and is scalable based on the size/complexity of the incident. This is one of the advantageous features of ICS: regardless of the magnitude of the incident, the same familiar framework can be employed.  The 36 positions are arranged to perform the following five functions:

• Command
• Operations
• Planning
• Logistics
• Finance

ICS - Command Function

Command responsibilities are executive in nature.  This position has been designed to develop, direct, and maintain a viable organization and to keep that organization coordinated with other agencies (i.e., FEMA, FBI, ATF, EPA, etc.), elected officials, and the public (Irwin, 1989). Unified Command is a unified team effort that allows all agencies with responsibility for the incident to manage it by establishing a common set of incident objectives and strategies without losing or abdicating agency authority, responsibility, or accountability. Responsibilities include (Irwin, 1989):

• Organizing to meet the needs of the incident
• Establishing incident control objectives
• Setting priorities for work accomplishment
• Assuring development of Command-approved Action Plans
• Approval of resource orders and releases
• Approval of public information outputs, and
• Coordination with public officials and other agencies

Command executive responsibilities cannot be ignored as much attention is required to organizing and managing.  The Incident Commander (IC) is supported by a Public Information Officer (PIO), a Safety Officer (SO), and a Liaison Officer (LO).  These Officers assist the IC in fulfilling the duties of coordination with others and the overall safety of the organization’s members.  Part of this assurance of the safety of responders and command staff can be supplied from the U.S. Army in the form of personal protective equipment (detection equipment, respirators, gloves, hoods, suits) depending on the type of response required.

In addition to focusing on safety, careful attention must be paid to communications with the media covering the incident.  Pertinent and correct information is vital.  Rescinding or correcting false information released to the media can be a difficult process and can erode the public’s confidence in the response effort.  The PIO oversees execution of the plan to deal with the media, defines rules for media personnel, provides protective clothing if necessary, and may help to designate the location for satellite trucks.

When determining the location for the Command Post, careful attention must be paid not only to the location specifically (i.e., the IC posts in the lobbies of the World Trade Centers), but to secondary devices whose purpose is to harm responders.

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ICS - Operations Function

The Operations Section is usually headed by a person from the agency with the greatest jurisdictional involvement and must be agreed upon by all agencies involved in the unified command by utilizing the specific and/or special talents of all individuals involved. Therefore, Operations is the “doer” in the organization where tasks are accomplished as this person has been charged with executing the IC’s directions.  This “doing” of the work can be exhaustive and failure is frequent.  Responsibilities include (Irwin, 1989):

• Achieving command objective
• Directing tactical operations
• Participating in the planning process
• Modifying Action Plans to meet contingencies
• Providing intelligence to Planning and Command
• Maintaining discipline and accountability

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ICS - Planning Function

Planning Section responsibilities are of a staff nature.  They are support of Command and Operations and designed to provide past, present, and future information about the incident.  This information includes both resource and situation status on a real-time basis.  Responsibilities include (Irwin, 1989):

• Maintaining accurate resource status
• Gathering and analyzing situation data
• Providing displays of situation status
• Estimating future probabilities
• Preparing alternative strategies
• Conducting planning meetings, and
• Compiling and distributing approved Action Plans

The Planning Section includes a position for “Technical Specialists.”  This position requires qualified advisors to provide Planning with technical data that are critical to incident management. 

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ICS - Logistics Function

The Logistics Section responsibilities are also of a staff nature and are divided into two sub functions: Service and Support.  Logistics provides all of the personnel, equipment, and services required to manage the incident. 

The Service Branch is responsible for tasks that “keep the organization going” (Irwin, 1989), such as communications and medical care for the incident personnel.  The Support Branch assures that all parts of the organization can function by providing adequate facilities, supplies, resources, and service equipment.  Once the human, technical, and mechanical resources are obtained by Logistics, the management of those resources are turned over to Planning and Operations.

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ICS - Finance Function

Finance is a staff function.  This Section is responsible for financial management and accountability on the incident (Irwin, 1989).  Finance authorizes expenditures in accordance with agency policies but does not actually purchase or order anything; the Logistics Section obtains identified needs after approval by Finance.

Finance uses the Incident Action Planning process, the resource-status tracking, and the Logistics acquisition records to accomplish its accounting objectives as well as four other critical functions (Irwin, 1989).

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