Augmentation of a Hospital Incident Command System to Support Continued Waves of the COVID-19 Pandemic.

Stamford Hospital (SH) is a 305 bed Level II Trauma center located in Fairfield County, the epicenter of the coronavirus disease 2019 (COVID-19) pandemic in Connecticut. The COVID-19 pandemic was a fast paced, rapidly evolving crisis, presenting our leadership team with unique challenges related to resource availability, patient care, and staff safety. The existing Hospital Incident Command System (HICS) was activated in March 2020 to coordinate our operational emergency management planning, response, and recovery capability for this unplanned event. Although HICS lays the groundwork for hospital preparations and protocol implementation, it is not designed to withstand prolonged crisis circumstances. Given the conditions that the COVID-19 pandemic presented, the possibility for future waves became an impending reality, prompting the need for a long-term solution. To establish guidelines that promoted balance between necessary preparations in the case of additional surges of the pandemic and concurrent resumption then maintenance of routine hospital operations, the SH COVID-19 Playbook was created. The Playbook, presented here, is arranged in accordance with the evidence-based 4 S's (Space, Staff, Systems, and Stuff) strategic critical care planning framework, to address surge capacity management within our hospital's four main patient care areas and additional supportive services. Through feedback from frontline caregivers and leaders within SH, the Playbook captures our experience, best practices, and insight acquired during the first wave of the pandemic. Established with the intentions of equipping leadership and staff globally, guidelines are presented to aid in the navigation of future pandemic surges and successfully care for COVID-19 patients, ensure staff safety, allow for normal services to operate, and provide optimal communication and support for the community, patients, and staff.

Opportunity Among Disaster: Reflecting on 2 Disaster Scenarios During the COVID-19 Pandemic.

Maintaining a public health emergency response for a sustained period of time requires availability of resources, physical and information technology infrastructure, and human capital. What perhaps is unprecedented is a medical center experiencing multiple disasters simultaneously. In this case study, the authors describe 2 separate disaster events experienced during the ongoing COVID-19 pandemic: (1) a cyberattack at Nebraska Medicine in Omaha, Nebraska, and (2) civil unrest following the murder of George Floyd in Minneapolis, Minnesota. Although these settings were very different, the following common themes can inform future disaster planning: the benefit of an already active incident command system, the prescient need for continuity of operations, and the anticipation of workforce fatigue. These dual-disaster experiences provide an opportunity to identify lessons learned that will drive improvements in emergency management through preparedness and mitigation measures and response innovations for future simultaneous disasters.

Implementation of the Hospital Incident Command System during COVID-19 Pandemic; Experience from an Iranian Reference Hospital.

Introduction: There is growing popularity of the Hospital Incident Command System (HICS) as an organizational tool for hospital management in the COVID-19 pandemic. We specifically describe implementation of HICS at the Isfahan province reference hospital (Isabn-e-Maryam) during the COVID-19 pandemic and try to explore performance of it. Methods: To document the actions taken during the COVID-19 pandemic, standard, open-ended interviews were conducted with individuals occupying activated HICS leadership positions during the event. A checklist based on the job action sheets of the HICS was used for performance assessment. Results: With the onset of the pandemic, hospital director revised ICS structure that adheres to span of better control of COVID-19. Methods of expanding hospital inpatient capacity to enable surge capacity were considered. The highest performance score was in the field of planning. Performance was intermediate in Financial/Administration section and good in other fields. Discussion: In the current COVID-19 pandemic, establishing HICS with some consideration about long-standing events can help improve communication, resource use, staff and patient protection, and maintenance of roles.

Collaborative public service provision archetypes in healthcare emergencies: a case of COVID-19 administration in Sri Lanka

Purpose>This paper examines how the properties and patterns of a collaborative “networked hierarchy” incident command system (ICS) archetype can provide incident command centres with extra capabilities to manage public service delivery during COVID-19.Design/methodology/approach>The paper illustrates the case of Sri Lanka's COVID-19 administration during its “first wave” (from 15 February to 1 September 2020). Primary data were collected through in-depth interviews with government officials who were directly involved in the administration of the COVID-19 outbreak. Secondary data sources were government publications and web sources. The data were analysed and interpreted by using narrative analysis and archetype theory respectively.Findings>The findings highlight how Sri Lanka's public sector responses to COVID-19 have followed a collaborative “networked hierarchy” ICS archetype. More specifically, the government changed its normative ICS “properties” by incorporating a diverse group of intergovernmental agencies such as the police, the military, the health service and administrative services by articulating new patterns of collaborative working, namely, organisational values, beliefs and ideas that fit with the Sri Lankan public service context.Originality/value>In responding to high magnitude healthcare emergencies, the flexibility of a collaborative networked ICS hierarchy enables different balances of organisational properties to be incorporated, such as hierarchy and horizontal networking and “patterns” in public service provision.

Community-based response to the COVID-19 pandemic: case study of a home isolation centre using flexible surge capacity.

OBJECTIVES: Coronavirus disease 2019 (COVID-19) has consumed many available resources within contingency plans, necessitating new capacity surges and novel approaches. This study aimed to explore the possibility of implementing the concept of flexible surge capacity to reduce the burden on hospitals by focussing on community resources to develop home isolation centres in Bangkok, Thailand. STUDY DESIGN: A qualitative study consisted of observational and semi-structured interview data. METHODS: The development and activities of home isolation centres were observed, and interviews were conducted with leaders and operational workforces. Data were deductively analysed and categorised based on the practical elements necessary in disaster and emergency management. RESULTS: Data were categorised into the seven collaborative elements of the major incident medical management and support model. The command-and-control category demonstrated four subcategories: (1) coordination and collaboration; (2) staff engagement; (3) responsibility clarification; and (4) sustainability. Safety presented two subcategories: (1) patients' information privacy and treatment; and (2) personnel safety and privacy. Communication showed internal and external communications subcategories. Assessment, triage, treatment and transport followed the processes of the COVID-19 treatment protocols according to the World Health Organisation (WHO) guidelines and hospital operations. Several supply- and patient-related challenges were identified and managed during centre development. CONCLUSIONS: The use of community resources, based on the flexible surge capacity concept, is feasible under restricted circumstances and reduced the burden on hospitals during the COVID-19 pandemic. Continuous education among multidisciplinary volunteer teams facilitated their full participation and engagement. The concept of flexible surge capacity may promote an alternative community-based care opportunity, irrespective of emergencies' aetiology.

The Community Assessment to Inform Rapid Response (CAIRR): A Novel Qualitative Data Collection and Analytic Process to Facilitate Hyperlocal COVID-19 Emergency Response Operations in New York City.

All disasters are local but implementing a hyperlocal response in the midst of a public health emergency is challenging. The availability of neighborhood-level qualitative data that are both timely and relevant to evolving objectives and operations is a limiting factor. In 2020, the New York City Department of Health and Mental Hygiene (NYC DOHMH) responded to the COVID-19 emergency using a novel, hyperlocal approach. Key to the implementation of this approach was the creation of the Community Assessment to Inform Rapid Response (CAIRR), a process for rapid collection and analysis of neighborhood-specific, objective-focused, qualitative data to inform tailored response operations. This paper describes the process of developing the CAIRR and its contribution to the NYC DOHMH's hyperlocal response in order to guide other jurisdictions seeking to employ a hyperlocal approach in future disaster responses.

Laboratory Surge Response to the COVID-19 Pandemic: An Incident Command System Approach.

The COVID-19 pandemic has reaffirmed the critical significance of effective diagnostics in outbreak response. In Taiwan, the COVID-19 wave in May 2021 led to a rapidly growing demand for SARS-CoV-2 diagnostic tests. To meet the challenge, an extensive system-wide emergency preparedness plan, hospital emergency incident command system (HEICS), was developed to deal with emergencies involving healthcare systems. During the wave of the COVID-19 outbreak, a 19.4-fold increase in SARS-CoV-2 PCR (polymerase chain reaction) diagnostic tests occurred in the hospital. The incident commander of TCVGH reviewed COVID-19 related events daily and purchased a high-throughput PCR machine for SARS-CoV-2 PCR diagnostic tests. In addition, the Department of Operations was responsible for staff scheduling and educational training. The turn-around times of SARS-CoV-2 diagnostic tests were shortened from 21.2 hours to 5.8 hours in the second week of the COVID-19 wave. Implementation of HEICS integrated resources could be helpful for expanding surge capacity during future outbreaks.

Healthcare Leadership in the COVID-19 Pandemic: From Innovative Preparation to Evolutionary Transformation.

PURPOSE: In pandemics, centralized healthcare leadership is a critical requirement. The objective of this study was to analyze the early development, operation, and effectiveness of a COVID-19 organizational leadership team and transformation of healthcare services at West Virginia University Hospitals and Health System (WVUHS). The analysis focused on how Kotter's Leading Change eight-stage paradigm could contribute to an understanding of the determinants of successful organizational change in response to the COVID-19 pandemic. METHODS: The fifteen core leaders of WVUHS COVID-19 strategic system were interviewed. A qualitative thematic analysis of the interviews was used to evaluate key aspects of leadership dynamics and system-wide changes in healthcare policies and protocols to contain the pandemic. Outcome measures included the degree to which WVUHS could handle and contain COVID-19 cases as well as COVID-19 death and vaccination rates in West Virginia compared with other states. RESULTS: The leadership team radically and rapidly revamped nearly all healthcare policies, procedures, and protocols for WVUHS hospitals and clinics, and launched a Hospital Incident Command System. As a result of this effective leadership team and strategic plan, WVUHS surge capacity was adequate for COVID-19 cases. In addition, West Virginia was an early frontrunner in COVID-19 vaccination rates as well as lower death rates. CONCLUSION: WVUHS's leadership response to the COVID-19 pandemic followed Kotter's eight-stage paradigm for Leading Change in organizations, including the establishment of a sense of urgency, formation of a powerful guiding coalition, creation of a vision, communication of the vision, empowerment of others to act on the vision, plan for and creation of short-term wins, consolidation of improvements and production of more changes, and institutionalization of new approaches. This approach was effective in limiting the spread and impact of COVID-19 within the hospital network and across the state, with many lessons learned along the way.

Mass Critical Care Surge Response During COVID-19: Implementation of Contingency Strategies - A Preliminary Report of Findings From the Task Force for Mass Critical Care.

BACKGROUND: After the publication of a 2014 consensus statement regarding mass critical care during public health emergencies, much has been learned about surge responses and the care of overwhelming numbers of patients during the COVID-19 pandemic. Gaps in prior pandemic planning were identified and require modification in the midst of severe ongoing surges throughout the world. RESEARCH QUESTION: A subcommittee from The Task Force for Mass Critical Care (TFMCC) investigated the most recent COVID-19 publications coupled with TFMCC members anecdotal experience in order to formulate operational strategies to optimize contingency level care, and prevent crisis care circumstances associated with increased mortality. STUDY DESIGN AND METHODS: TFMCC adopted a modified version of established rapid guideline methodologies from the World Health Organization and the Guidelines International Network-McMaster Guideline Development Checklist. With a consensus development process incorporating expert opinion to define important questions and extract evidence, the TFMCC developed relevant pandemic surge suggestions in a structured manner, incorporating peer-reviewed literature, "gray" evidence from lay media sources, and anecdotal experiential evidence. RESULTS: Ten suggestions were identified regarding staffing, load-balancing, communication, and technology. Staffing models are suggested with resilience strategies to support critical care staff. ICU surge strategies and strain indicators are suggested to enhance ICU prioritization tactics to maintain contingency level care and to avoid crisis triage, with early transfer strategies to further load-balance care. We suggest that intensivists and hospitalists be engaged with the incident command structure to ensure two-way communication, situational awareness, and the use of technology to support critical care delivery and families of patients in ICUs. INTERPRETATION: A subcommittee from the TFMCC offers interim evidence-informed operational strategies to assist hospitals and communities to plan for and respond to surge capacity demands resulting from COVID-19.

Implementation of incident command system to deal with SARS-CoV-2 pandemic in Clínica Las Condes, Chile / Sistema hospitalario en situación de crisis: implementación de sistema de comando de incidentes para enfrentar pandemia SARS-CoV-2 en Clínica Las Condes, Chile

La pandemia en Chile generó un desafío de modernización y gestión de los Cuidados Intensivos, haciendo necesario que las unidades de pacientes críticos realizaran un aumento de su capacidad hospitalaria, lo que requiere preparar una infraestructura, un equipamiento mínimo, protocolos y un equipo humano preparado y alineado, para garantizar la seguridad y calidad de atención a los pacientes. Una forma de lograrlo es la incorporación de la estrategia militar de Sistema de Comando de Incidentes, utilizado para enfrentar distintos tipos de desastres, con una estructura modular de comando y sus seccionales de trabajo, con diferentes equipos y líderes para hacer frentes a los variados desafíos. El objetivo de este artículo es describir la instauración del sistema de comando de incidentes en un hospital privado, detallando su conformación y los resultados logrados.

The pandemic in Chile has been a real challenge in terms of modernization and management of intensive care. Critical care units have been forced to increase their hospital capacity in terms of infrastructure, equipment, protocols and human team, while guaranteeing safety and high-quality patient care.One approach to achieve this objective is to develop the army strategy called incident command system that has been used to face different types of disaster. A modular command structure is developed based on the creation of teams each lead by an expert in different areas in order to cope with a variety of upcoming challenges.The objective of this article is to describe the setting up of a successful incident command system in a private hospital, detailing its formation and results obtained.

All Hands on Deck: Local Public Health Agencies Leveraging the Incident Command System During Crises.

The COVID-19 pandemic has stretched limited public health resources beyond measures, particularly at the local level. What started as an interesting report of pneumonia of unknown etiology in late December 2019 in Wuhan, China, bloomed into an international crisis by mid-January 2020. However, it was not until late January, when the first case was reported in the United States, that a new reality took shape for US public health agencies. After all, severe acute respiratory syndrome never made it to this country, and the only 2 cases of Middle East respiratory syndrome here were imported and never spread. Local public health agencies are notoriously short-staffed and underfunded. Therefore, when a crisis looms, personnel from a multitude of areas within the agencies are called upon to help out. Under its innovative and forward-thinking leadership, the St. Louis County Department of Health internally implemented the Incident Command System, a component of the National Incident Management System. While reassignment of individuals to new responsibilities under a new and temporary reporting structure did not always go perfectly, Incident Command System kept its promise to be adaptable to a fast-evolving situation, to clearly outline needed areas of responsibility, and to provide scaffolding that kept the Department of Health functional in chaotic times. It was able to be implemented quickly within hours of the first confirmed COVID-19 case in St. Louis County and enhanced the quality and timeliness of the public health response. This experience is being shared to provide a model of how organizations with limited personnel can use the Incident Command System to reorganize and meet unexpected challenges with increased success.

Addressing the Challenge of COVID-19: One Health Care Site's Leadership Response to the Pandemic.

The coronavirus disease 2019 (COVID-19) pandemic created an extremely disruptive challenge for health care leaders that required a rapid, dynamic, and innovative response. The purpose of this manuscript is to share the leadership actions and decisions at Mayo Clinic in Florida during the first 6 months of the pandemic (February to July 2020). We note 4 strategies that contributed to an effective response: (1) leverage experience with disaster preparedness and mobilize regional and national networks; (2) use surge models to anticipate and to address supply chain issues as well as practical and financial effects of the pandemic; (3) adapt creatively to establish new safety and procedural protocols in various areas for various populations; and (4) communicate timely information effectively and be the common source of truth. Mayo Clinic in Florida was able to address the surges of patients with COVID-19, to provide ongoing tertiary care, and to restore function within the first 6 months with new, strengthened practices and protocols.

Use of Incident Command System for Disaster Preparedness: A Model for an Emergency Department COVID-19 Response.

The COVID-19 pandemic has placed unprecedented demands on health systems, where hospitals have become overwhelmed with patients amidst limited resources. Disaster response and resource allocation during such crises present multiple challenges. A breakdown in communication and organization can lead to unnecessary disruptions and adverse events. The Federal Emergency Management Agency (FEMA) promotes the use of an incident command system (ICS) model during large-scale disasters, and we hope that an institutional disaster plan and ICS will help to mitigate these lapses. In this article, we describe the alignment of an emergency department (ED) specific Forward Command structure with the hospital ICS and address the challenges specific to the ED. Key components of this ICS include a hospital-wide incident command or Joint Operations Center (JOC) and an ED Forward Command. This type of structure leads to a shared mental model with division of responsibilities that allows institutional adaptations to changing environments and maintenance of specific roles for optimal coordination and communication. We present this as a model that can be applied to other hospital EDs around the country to help structure the response to the COVID-19 pandemic while remaining generalizable to other disaster situations.

Delayed Primary and Specialty Care: The Coronavirus Disease-2019 Pandemic Second Wave.

Time is of the essence to continue the pandemic disaster cycle with a comprehensive post-COVID-19 health care delivery system RECOVERY analysis, plan and operation at the local, regional and state level.The second wave of COVID-19 pandemic response are not the ripples of acute COVID-19 patient clusters that will persist until a vaccine strategy is designed and implemented to effect herd immunity. The COVID-19 second wave are the patients that have had their primary and specialty care delayed. This exponential wave of patients requires prompt health care delivery system planning and response.