EMS Consequence Management: The ICS Elephant in the Room

Whatever model of EMS service delivery your community utilizes, the day will come when you will interact on a large scale with multi-jurisdictional agencies


As I was looking for ideas for this new EMS Consequence Management column, I ran across an article written by EMS Chief Skip Kirkwood in the February 2008 issue of EMS Magazine entitled: "NIMS and ICS: From Compliance to Competence." In the article, the author challenges us to not only be compliant, but to also be up to speed on how EMS fits into the incident command system (ICS).

Many in EMS feel this ICS animal is only for the fire service. And many are not competent in using this incident organizational method that is not only a presidential directive, but also a proven approach for the tackling domestic all-hazard incidents, both manmade and natural.

Released in 2003, Presidential Directives 5 and 8 address first responders, governmental and private sectors and preparedness as they relate to better management of all-hazard incidents. We have all taken required ICS and NIMS (National Incident Management System) courses via classroom instruction or the Internet, but I wonder how competent we are three years after Chief Kirkwood's article.

Elements to Refresh Your Memory

It's a huge task to understand and utilize the ICS, which was developed in the 1970s to improve scene organization and accountability of wildland fires. To be truthful, the simplicity of ICS is knowing your role in it.

Following are some ICS elements that may refresh your understanding:

  • ICS is a standardized on-scene all-hazard management concept.
  • ICS is flexible. It can change its size to accommodate the incident.
  • ICS has a top-down organizational structure which begins when the first responder on the scene becomes the incident commander. It expands as necessary.
  • ICS involves the designation and coordination of elements such as extrication, triage, treatment, transport and staging, which are all EMS-intensive.

Incident command can be singular or unified depending on the incident. With singular command, one person coordinates the incident. It is most useful in smaller, single-jurisdictional incidents. With unified command, officers from different jurisdictions share command. It is used for very large events.

Responsibilities of the incident commander are resource intensive and strategic in nature. Some important aspects related to a successful command and positive patient outcome include:

  • Establish communications and request additional resources.
  • Stabilize the incident and provide for life safety, accountability and welfare of all personnel, including EMS.
  • Ensure all patients are extricated, triaged/treated and transported to medical facilities.

Good incident commanders know that at the end of every successful rescue or operation there are patients. If they don't understand that concept, it's just a body recovery operation.

Break It Down

The ICS management tool breaks things down into pieces. For many EMS systems, ICS will only be utilized during multi-agency responses to mass casualty incidents or mass gatherings and special events. These are huge resource-intensive operations that need to be broken down into manageable bites. We might ask, so how do you eat an elephant? The answer: one bite at a time.

Let's look at the EMS role in a successful ICS operation and our piece of the elephant.

Medical Branch

As Figure 1 depicts, the basic function of the medical branch is to improve medical management of the incident and to properly carry out triage, treatment and transport of patients at the scene. As mentioned previously, these scenes are all-hazard in nature. You may be required to medically monitor other rescuers during hazmat operations in addition to monitoring patients involved in the incident. Your involvement could also include medical expertise in prehospital care with direct patient contact during extrication in a structural collapse or confined-space operation.

The medical branch of ICS falls under the responsibility of operations. Given the top-down organizational structure, the medical branch director is the person responsible to operations. According to ICS, the initial EMS person assigned to the incident is the medical branch director.

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