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The Hospital Emergency Incident Command System— Is the Army Medical Department on Board?

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The Hospital Emergency Incident Command System— Is the Army Medical Department on Board? JEM The Hospital Emergency Incident Command System— is the Army Medical Department on board? Major John J. Casey III, USA, MSSI, MHS AbstrAct challenge hospitals already running at seemingly Catastrophic scenarios that once seemed merely the- maximum capacity and struggling to remedy inpa- oretical have become a stark reality. Horrific natural tient and emergency room overcrowding. In addition to disasters, the emergence of state-sponsored terrorism, these challenges, hospitals must prepare for the possi- pro liferation of chemical and biological agents, availabil- bility of being the victim or site of a disaster. ity of materials and scientific weapons expertise, and The Joint Commission on the Accreditation of recent increases in less discriminate attacks all point Healthcare Organizations (JCAHO) mandates that toward a growing threat of mass casualty (MASCAL) hospitals develop emergency response plans to miti- events. Hospitals across America are upgrading their gate the devastating effects associated with emergen- ability to respond to disasters and emergencies of all cies and disasters.1 One such emergency manage- kinds as the nation wages its war on terror. To respond ment model that has been modified for use in hospi- to these challenges, many civilian hospitals are relying tals is the Hospital Emergency Incident Command on the Hospital Emergency Incident Command System System (HEICS). (HEICS), an emergency management model that employs The number of hospitals using HEICS in the civil- a logical management structure, detailed responsibili- ian sector continues to grow, perhaps due to its stat- ties, clear reporting channels, and a common nomen- ed advantages, or perhaps due to JCAHO regulatory clature to help unify responders. Modeled after the compliance issues.2 Although there has been no man- FIRESCOPE (FIrefighting RESources of California date by the Army Medical Department (AMEDD) to Organized for Potential Emergencies) management sys- implement HEICS in Army medical facilities, some tem, HEICS is fast becoming a key resource in health- have elected to do so. By surveying all 29 US Army care emergency management. Over the past couple of hospitals around the world, this article illustrates the years, military hospitals have begun embracing the effectiveness of HEICS in responding to emergencies HEICS model as well. This article discusses the preva- and disasters within these military hospitals. lence of HEICS and provides an analysis of its effective- ness within the Army Medical Department (AMEDD). Methods The research conducted for this article consisted of IntroductIon an online survey to measure the effectiveness of HEICS in Army hospitals around the world. There have been a “Crisis consists of danger and opportunity.” few similar studies conducted in civilian hospitals but —Chinese proverb none in military treatment facilities. The purpose of this survey was to collect information on the utilization of the Emergencies and disasters often cause crises, HEICS model in Army health care facilities and the suc- confusion, and inefficiency in hospitals. They can cesses or challenges these facilities may be experiencing. overwhelm a hospital’s resources, including staff, The survey was de signed to determine the percentage of space, and supplies. Mass casualty (MASCAL) events Army facilities using the HEICS model, examine why Journal of Emergency Management 61 Vol. 4, No. 3, May/June 2006 table 1: List of Army hospitals surveyed 1 US Army Medical Department Activity, Camp Zama, Japan 2 Brooke Army Medical Center, Fort Sam Houston, Texas 3 Landstuhl Regional Medical Center, Landstuhl, Germany 4 Moncrief Army Community Hospital, Fort Jackson, South Carolina 5 DeWitt Army Community Hospital, Fort Belvoir, Virginia 6 121st General Hospital, Seoul, South Korea 7 Tripler Army Medical Center, Honolulu, Hawaii 8 Womack Army Medical Center, Fort Bragg, North Carolina 9 Irwin Army Community Hospital, Fort Riley, Kansas 10 Blanchfield Army Community Hospital, Fort Campbell, Kentucky 11 Reynolds Army Community Hospital, Fort Sill, Oklahoma 12 US Army Hospital, Heidelberg, Germany 13 William Beaumont Army Medical Center, Fort Bliss, Texas 14 Walter Reed Army Medical Center, Washington, DC 15 Evans Army Community Hospital, Fort Carson, Colorado 16 Bayne-Jones Army Community Hospital, Fort Polk, Louisiana 17 Keller Army Hospital, West Point, New York 18 General Leonard Wood Army Community Hospital, Fort Leonard Wood, Missouri 19 Martin Army Community Hospital, Fort Benning, Georgia 20 Ireland Army Community Hospital, Fort Knox, Kentucky 21 Madigan Army Medical Center, Fort Lewis, Washington 22 Dwight David Eisenhower Army Medical Center, Fort Gordon, Georgia 23 Darnall Army Community Hospital, Fort Hood, Texas 24 Lyster Army Aeromedical Center, Fort Rucker, Alabama 25 Weed Army Hospital, Fort Irwin, California 26 Bassett Army Community Hospital, Fort Wainwright, Alaska 27 Winn Army Hospital, Fort Stewart, Georgia 28 US Army Medical Department Activity, Wuerzburg, Germany 29 McDonald Army Community Hospital, Fort Eustis, Virginia the model was or wasn’t adopted, and determine the The survey administration took place between effectiveness of the model in these facilities. February 1 and February 28, 2006. Survey questions A pretest of the survey questionnaire was given were developed with the goal of identifying partici- to several Army officers who are familiar with the pants’ understanding of the HEICS model as well as HEICS model. Based on their responses, ambiguous the effectiveness of HEICS in their facilities. Twenty questions were identified and corrected. The survey questions were included in the survey, designed to questionnaire was kept short (20 questions) in an determine which military hospitals were using at tempt to ensure minimum inconvenience for partici- HEICS, why they were or were not using the model, pants. The Internet version of the questionnaire was de - the amount of training provided on HEICS, how often signed first, and the e-mail follow-up was adapted from it. it has been used, and its perceived effectiveness. 62 Journal of Emergency Management Vol. 4, No. 3, May/June 2006 resuLts hospitals through participation in community-wide By the end of the survey period, all 29 Army hos- disaster exercises, only 25 percent of Army hospitals pitals had responded, producing a response rate of have ever used the system in an actual disaster or 100 percent (see Table 1 for a complete list of Army emergency. Of the 25 percent who have actually had hospitals). Survey participants included commanders, to activate the system in a real emergency, most used deputy commanders for administration (DCAs), oper- it less than three times in the last 24 months. The ation officers, and emergency management plan (EMP) system has been utilized in a variety of situations, custodians. Of the 29 respondents, 3 percent were com - with the most common (30 percent) being to respond manders, 59 percent were DCAs, 21 percent were oper- to a MASCAL event, followed closely by response to a ations officers, and 17 percent were EMP custodians. natural disaster (25 percent). The participants who completed the survey were, Each of the hospitals that responded to an actual for the most part, familiar with the HEICS model. em ergency using HEICS stated that the system pro- Approximately 62 percent stated that they were very duced excellent results. Of those that have used the sys- familiar with the system, while only 3 percent claimed tem, 12.5 percent stated it worked “very well” and had no they were not at all familiar with HEICS. Most of the complaints, while the other 87.5 percent stated it worked participants (56 percent) learned about the system on “good,” with only minor adjustments needed. No partici- the job, and only half had ever received formal training pant surveyed expressed dissatisfaction with the system. on the system outside of their organizations. When looking at those facilities that do not use The AMEDD has made great strides in adopting HEICS, there are some common reasons for their choice. HEICS. According to the survey, 79 percent of the 29 As with any conversion, some resistance occurs when Army hospitals in the AMEDD reported some degree hospitals consider converting to the HEICS model. of implementation of HEICS. Some surveyed administrators believe it will be too Although most participants claimed they were difficult to change existing plans. Others feel that the very familiar with HEICS, nearly half of them (52 system is too cumbersome and convoluted. Further con- percent) were not sure which version of the system cerns deal with the expense of converting, as well as their facilities were using. The most prevalent system staff reactions to the new system. The survey deter- in place was HEICS III, which is not unusual, since it mined that 21 percent of the Army hospitals around the is the most recent version released. world have not implemented HEICS as their emer- Each participant was asked why his or her facili- gency management system. Most of these facilities (62 ty decided to implement HEICS. There were a multi- percent) felt that the system was too cumbersome, and tude of answers, but two of the most common were the remaining 18 percent thought it was too expensive. that it met the needs of the organization (20 percent) and to adhere to JCAHO regulatory requirements (23 dIscussIon percent). In fact, 96 percent of the hospitals using Effective emergency preparedness and response HEICS stated they are now using it to satisfy JCAHO requires planning, training, and exercising. A well- emergency management plan requirements. established emergency management plan can help ac - All hospitals surveyed have held training sessions to complish these objectives. The AMEDD has embraced introduce managers and staff to HEICS, have run table- the HEICS model, which is evident in the 79 percent top exercises to increase familiarity with the system, and implementation rate in Army hospitals. However, have conducted live drills in HEICS to evaluate its effec- this percentage is still lower than that seen in civilian tiveness. The frequency of training on HEICS varied healthcare facilities.
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