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NIMS Refresh 2016: Do Healthcare Coalitions Fit?

NIMS Refresh 2016: Do Healthcare Coalitions Fit?

The Federal Emergency Management Agency (FEMA) recently released a draft of the National Incident Management System refresh (NIMS 3.0), the first update since 2008. And they introduced a new term, the Center Management System (CMS). When response and recovery operations are in play, it is within the CMS that healthcare coalitions appear to plug in.

But they don't.

You see, there’s a distinct difference between a healthcare coalition and what NIMS 3.0 defines as an operations/coordination center – which is nestled into the newly coined CMS.

The Center Management System may include emergency operations/coordination centers, Incident Command Sites, and MAC Groups
FEMA NIMS 3.0 Draft: Figure 4, Example of Chain of Command and Reporting Relationships

Maybe it depends on whether a healthcare coalition has matured enough to define, communicate, and ‘operationalize’ its role in response and recovery. NIMS means very little to a healthcare coalition that has not evolved beyond a preparedness organization that meets monthly to more efficiently use grant dollars, Right?

But it means everything to those coalitions with the maturity and sophistication to activate an operations/coordination center – a Health Emergency Operations Center (HEOC), if you will.

NIMS 1.0, 2.0

On March 1, 2004, in the wake of the 911 attacks, the newly minted Department of Homeland Security (DHS) published the first National Incident Management System (NIMS 1.0). Since the Federal Government did not not have the authority to mandate NIMS implementation on the states, it was done through fiscal enticement. The same is true today. Beginning in 2005, federal preparedness grants were directly linked to NIMS 1.0 compliance.

NIMS 1.0 was described as, “a consistent nationwide template to enable Federal, State, tribal, and local governments, nongovernmental organizations (NGOs), and the private sector to work together to prevent, protect against, respond to, recover from, and mitigate the effects of incidents, regardless of cause, size, location, or complexity.”

It was the first effort by the federal government to standardize the tenets and terminology of incident command across the Nation and was readily adopted by states and municipalities nationwide.

In 2006, following what President Bush called a "less than ideal" response to Hurricane Katrina, FEMA began a review and revision process for the National Response Plan (Now the National Response Framework [NRF]) and NIMS 1.0. This led to the release of NIMS 2.0 in December of 2008. Among other changes NIMS 2.0:

  • Was reorganized to emphasize that NIMS is more than the Incident Command System (ICS);
  • Increased emphasis on planning and added guidance on mutual aid;
  • Clarified roles of private sector, NGOs, and chief elected and appointed officials, and
  • Highlighted the relationship between NIMS and the NRF

NIMS 2.0 remains in effect today – for now.

NIMS 3.0 and The Center Management System

On April 8, 2016,  FEMA opened the 30-day National Engagement Period for the yet to be released NIMS refresh (NIMS 3.0). Yes, the engagement period is now closed. If you missed it, you are not alone. Today’s musings are not intended to provide a deep dig into NIMS 3.0. I’ll do that in the next few weeks.

That said, in order to understand how a HEOC might plug into the refreshed system, we must provide a high altitude of NIMS 3.0 and its most valuable new component, the CMS.

The Center Management System includes various types of emergency operations/coordination centers

NIMS 3.0 makes a point to emphasize that it it is intended to provide stakeholders a shared vocabulary, systems, and processes to successfully deliver the capabilities described in National Preparedness System (NPS). Among other changes, the revision:

  • Reflects and incorporates lessons learned from exercises, real world incidents, and policy updates, such as the NPS, and NIMS-related guidance, including the 2013 NIMS Intelligence/Investigation Function Guidance and Field Operations Guide;
  • Reflects progress in resource typing and mutual aid and builds a foundation for the development of a national qualification system;
  • Clarifies that NIMS is more than just the Incident Command System (ICS) and that it applies to all stakeholders with roles in incident management across all five mission areas (Prevention, Protection, Mitigation, Response, and Recovery);
  • Explains the relationship among ICS, the CMS for operations centers/coordination centers, and Multiagency Coordination Groups (MAC Groups)

That fourth bullet deserves a shout-out. NIMS 3.0 “[e]xplains the relationship among ICS, the CMS for operations centers/coordination centers, and Multiagency Coordination Groups (MAC Groups).” If there’s a nirvana component to NIMS 3.0, this is it.

Demystifying the Center Management System (CMS)

The CMS describes the organization, functional responsibilities, and activation levels of operations/coordination centers, and remains scalable and flexible

  • CMS identifies common functions; describes a standard management and organizational structure; and defines standard activation levels to enhance the sharing of personnel, equipment, and teams across centers and across jurisdictional boundaries.
  • The CMS encompasses all types of operations/coordination centers from across sectors and disciplines.
  • Operations/coordination centers are locations from which staff provide centralized and coordinated support to Incident Command, on-scene personnel, and/or other operations/coordination centers.
  • Unlike the CMS, the Incident Command System (ICS) is used to manage the on-scene/tactical-level efforts aimed at stabilizing the situation, saving lives, and protecting property and the environment by directly applying resources.
  • Together, ICS and CMS describe a comprehensive approach to structuring incident management personnel— from the tactical responders on the scene to personnel providing coordination and support in an operations/coordination center.

The problems with NIMS 1.0 and 2.0 has never been with the tactical, boots-on-the-ground, folks like firefighters, police, or Urban Search and Rescue (USAR) teams. Those dudes get chain of command, vertical communications, command and control, because it is their life. The conflict has always been with a complete lack of understanding of and respect for the roles, responsibilities, authorities, and liabilities of various operations/coordination centers. Not everyone has conditional immunity.

The Healthcare Coalition

The good folks with U.S. Department of Health and Human Services (HHS), Office of the Assistant Secretary for Preparedness and Response (ASPR) has defined a healthcare coalition as, “[a] collaborative network of healthcare organizations and their public and private sector response partners that serve as a multi-agency coordinating group to assist with preparedness, response, recovery, and mitigation activities related to healthcare organization disaster operations.”


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With all due respect, ASPR’s got it wrong and has unintentionally caused heartache with many coalitions and state preparedness offices. In stating that healthcare coalition’s will “serve as a multi-agency coordinating group to assist with preparedness, response, recovery, and mitigation activities related to healthcare organization disaster operations,” they’ve put the cart ahead of the horse.

Heck, today, less than 10 percent – and I’m being generous – of the Nation’s 490+ coalitions have matured to a point that they could even consider stepping into such a role. And we’re entering year four of five in the project period. This is not a criticism. It is an acknowledgment of how difficult it is to expect healthcare and preparedness professionals to become experts in organizational development. 

Maybe a healthcare coalition could be more accurately defined as:

"An independently governed organization where healthcare providers and their public and private sector stakeholders collaborate to cross-pollinate, share cost, and unite effort in preparedness.”

And the HEOC (the NIMS 3.0 operations/coordination center) could be defined as:

"Locations from which staff provide centralized and coordinated support to hospital and other healthcare organization EOCs, Public Health Emergency Operations Centers (PHEOC), State and local EOCs, and other operations/coordination centers.”

 

Now, some would say that I'm talking semantics here. The healthcare coalition really becomes the HEOC, so it's one in the same, Right?
 

Well, is the EMA the same as the EOC, or is it an agency that activates an EOC in disasters? Is a Public Health Department a PHEOC, or does it activate its PHEOC in an emergency? Is a hospital an EOC, or is it a healthcare organization that activates its EOC when necessary?

A healthcare coalition is an independently governed organization where healthcare providers and their public and private sector stakeholders collaborate to cross-pollinate, share cost, and unite effort in preparedness. It is not an EOC. 

It must be able to function as a preparedness organization.

Only then, should it evolve to establish a HEOC that can provide centralized and coordinated support to hospital and other healthcare organization EOCs, Public Health Emergency Operations Centers (PHEOC), State and local EOCs, and other operations/coordination centers. So:

  1. Build the organization with solid, inclusive governance, engage new disciplines one at a time, create brand identity, and market yourself in the community.
  2. Demonstrate the value your coalition can provide to all stakeholders.
  3. Unite as a team to assess risk, plan for the unfathomable, identify and procure needed resources, train, exercise, evaluate, and improve.

Then figure out how to plug your healthcare coalition into NIMS 3.0, and do it in concert with state and local emergency management agencies and health departments.

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Karl Schmitt, MPA

Karl Schmitt, MPA


Karl is the Passionate Founder & CEO of bParati. He is on a mission to build a national network of effective, sustainable healthcare coalitions. More...

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Karl Schmitt, Passionate Founder & CEO, bParati

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