Incident Command in the Time of COVID-19

The SARS-CoV-2 virus was initially contained in China but rapidly spread across the globe. The grave threat was not apparent until it was already in our midst. Our organization implemented an Incident Command System (ICS), based on previous experience, to respond to the COVID-19 pandemic in a comprehensive and effective manner. This well-known management and response framework is used by many specialties and organizations in disasters of different complexity and size. Our ICS was able to assemble the appropriate people, assess the situation, and develop and implement plans to deal with the COVID-19 crisis. The effectiveness of the ICS structure and its execution was instrumental in getting in front of the virus and managing regional activities. The ICS is an effective tool to improve safety and mitigate risk when dealing with large-scale disasters and should be implemented and practiced before the need arises.

Our organization implemented a formal Incident Command System (ICS) very early as a response to the COVID-19 pandemic. Although it recently disbanded, we are maintaining its core functionality and communication as we continue to deal with COVID-19 into the future. The author has observed the ICS being used at hospitals through hurricanes, blizzards, and riots but never saw it work as well as it did during the initial weeks of the pandemic. This group deftly navigated through uncharted waters by leveraging the spirit and structure of Incident Command.

Five Challenges When Managing Mass Casualty or Disaster Situations: A Review Study

Background: Managing mass casualty or disaster incidents is challenging to any person or organisation. Therefore, this paper identifies and describes common challenges to managing such situations, using case and lessons learned reports. It focuses on sudden onset, man-made or technologically caused mass casualty or disaster situations. Methods: A management review was conducted based on a structured search in the PubMed and Web of Science databases. Results: The review included 20 case—and lessons learned reports covering natural disasters, man-made events, and accidents across Europe, the United States of Amerika (USA), Asia and the Middle East. Five common challenges were identified: (1) to identify the situation and deal with uncertainty, (2) to balance the mismatch between the contingency plan and the reality, (3) to establish a functional crisis organization, (4) to adapt the medical response to the actual and overall situation and (5) to ensure a resilient response. Conclusions: The challenges when managing mass casualty or disaster events involved were mainly related to the ability to manage uncertainty and surprising situations, using structured processes to respond. The ability to change mind set, organization and procedures, both from an organizational- and individual perspective, was essential. Non-medical factors and internal factors influenced the medical management. In order to respond in an effective, timely and resilient way, all these factors should be taken into consideration.

Back to Basics: Mass Casualty Incidents

Terrorist attacks, mass shootings, violent crimes, and other disasters may leave those affected feeling afraid and overwhelmed with emotion. It has been more than 17 years since the attacks on the World Trade Center in New York City killed almost 3,000 people. Since that time, the world has experienced a profuse number of mass casualty events; they are becoming commonplace and a risk that everyone recognizes as part of daily life. When disasters occur, health care providers may be required to mobilize and should be prepared for anything. Regardless of the size of the facility or the trauma level designation, perioperative nurses need to be aware of how they may be affected by traumatic events. This Back to Basics article reviews some significant mass casualty incidents and explores strategies for perioperative staff members to execute a successful response.

Mass casualty disasters: who should run the show?

BACKGROUND

A clear command structure ensures quality patient care despite overwhelmed resources during a mass casualty incident (MCI). The American College of Surgeons has stated that surgeons should strive to occupy these leadership roles.

OBJECTIVE

We sought to identify whether surgeons, as compared to emergency physicians, are sufficiently prepared to assume command in the event of a mass disaster.

METHODS

We surveyed hospital-affiliated surgeons and emergency physicians to assess their knowledge of MCI response principles and to gauge opinions regarding who should be in charge during a disaster.

RESULTS

One hundred and forty-nine (58%) surveys were completed, 78 by surgeons and 71 by emergency physicians. Both groups demonstrated a critical lack of knowledge regarding fundamental principles and key logistical components of preparedness and MCI response. Surgeons as a group were even less prepared than emergency physicians. Of those surgeons who had reviewed their hospital's disaster plan, half (50%) still did not know where to report for an MCI activation. Nonetheless, both groups believed they had sufficient training and both asserted they ought to occupy command positions during a disaster scenario.

CONCLUSIONS

Errors in disaster triage have been known to increase mortality as well as the monetary cost of disaster response. Funding exists to improve hospital preparedness, but surgeons are lagging behind emergency physicians in taking advantage of these opportunities. Overall, it is imperative that physicians improve their understanding of the MCI response protocols they will be tasked to implement should disaster strike.

Lessons learned in crisis management

This paper will explore lessons learned following a series of natural and man-made disasters affecting the Massachusetts Mutual Life Insurance Company and/or its subsidiaries. The company employs a team of certified continuity professionals who are charged with overseeing resilience on behalf of the enterprise and leading recovery activities wherever and whenever necessary.

The World Trade Center attack. The paramedic response: an insider's view

The World Trade Center attack and collapse is the first time an aircraft has been used as a weapon of mass effect. The scale and magnitude of this manmade disaster can only be compared with a natural catastrophe such as the Armenian earthquake of December 1988. The importance of an incident command system and the Simple Triage and Rapid Treatment, and the need for fixed Casualty Collection Points, is explained.