Hospital Incident Command System (HICS) is a standardized incident management system designed specifically for hospitals and healthcare organizations in the United States. It is based on the principles of the Incident Command System (ICS) component of the National Incident Management System (NIMS) and is adapted for the healthcare environment. HICS provides an organizational structure and a process for planning, building, and adapting that structure to manage threats, planned events, or emergency incidents of any size or complexity.
History
HICS originated in the late 1980s as the Hospital Emergency Incident Command System (HEICS), developed to provide hospitals with an incident management foundation. The original HEICS was developed in 1991 by the Orange County Emergency Medical Services (EMS) Agency under sponsorship from the California Emergency Medical Services Authority (EMSA). It was based on the FIRESCOPE ICS structure and adaptations made by Orange County EMS and the Hospital Council of Northern California. Revisions followed in 1993 (HEICS II) and 1998 (HEICS III).
In the fourth edition (2006), the system evolved from HEICS to HICS—the Hospital Incident Command System—reflecting recognition that an incident management system is valuable not only for emergencies but also for daily operations, preplanned events, and non-emergent situations. The fifth edition of HICS was released in May 2014, incorporating lessons learned from real-world emergencies, the 2009–2010 National HICS Survey, the 2011 HICS National Stakeholders' Summit, and input from a national work group of hospital subject-matter experts.
Governance and Oversight
The California Emergency Medical Services Authority (EMSA) leads the ongoing effort to maintain and promote HICS. The California Health and Safety Code (Division 2.5, Chapter 3, State Administration Section 1797.151) requires EMSA to coordinate medical and hospital disaster preparedness. EMSA has established a HICS National Advisory Committee composed of representatives from hospitals, healthcare organizations, associations, government and regulatory agencies, and ex officio members to assist with the development, implementation, and maintenance of HICS guidance and activities.
Relationship to NIMS and ICS
HICS is consistent with the National Incident Management System (NIMS) and the Incident Command System (ICS). It addresses the NIMS requirement that hospitals "manage all emergency incidents, preplanned exercises and preplanned (recurring/special) events in accordance with ICS organizational structures, doctrine, and procedures, as defined in NIMS." HICS is a flexible, scalable, and adaptable system that can be used by all hospitals regardless of size, location, patient acuity, patient volume, or hazard type. It expands or contracts relative to the needs of the situation.
Key Characteristics
HICS is a comprehensive all-hazards incident management strategy that:
- Is a model for hospital emergency management systems used both nationally and internationally
- Can be used in both emergent and non-emergent incidents and events (e.g., moving patients within the facility, dispensing medication to staff, hosting large events)
- Assigns positions only as determined by the scope and magnitude of the incident (scalability)
- Provides a predictable chain of command with a suggested span of control
- Ensures accountability of position and team function through prioritized action checklists
- Uses common language to promote interagency communication
- Employs Management by Objectives (MBO), in which the problem is evaluated, a plan to remedy it is identified and implemented, and necessary resources are assigned
Hospital Incident Management Team (HIMT)
The HICS organizational structure is called the Hospital Incident Management Team (HIMT). The term was changed from "Incident Management Team" in the 2014 edition to eliminate confusion with other response teams. The HIMT identifies five primary management components:
Command:
- Incident Commander (IC): The only position always activated. Responsible for overall management of the incident, setting operational periods, and devising strategies and priorities.
- Public Information Officer (PIO): Coordinates information sharing inside and outside the hospital.
- Liaison Officer: Primary contact for external agencies supporting the hospital.
- Safety Officer: Monitors operations to identify and correct unsafe practices.
- Medical-Technical Specialists: Persons with specialized expertise (e.g., infectious disease, legal affairs, risk management, medical ethics).
General Staff (Sections):
- Operations Section: Manages all tactical activities and implements the Incident Action Plan (IAP). Includes branches for Medical Care, Infrastructure, Security, Hazardous Materials (HazMat), Business Continuity, and Patient Family Assistance.
- Planning Section: Collects, evaluates, and disseminates situational information; conducts planning meetings; and prepares the IAP. Includes Resources, Situation, Documentation, and Demobilization Units.
- Logistics Section: Provides all support needs, including communications, IT/IS equipment, food services, supply, transportation, labor pool and credentialing, employee health and well-being, and employee family care.
- Finance/Administration Section: Coordinates personnel time, procurement, compensation/claims, and cost tracking.
Hospital Command Center (HCC)
The HCC is a designated location in the hospital prepared to convene and coordinate response activities, resources, and information during an emergency or disaster. Key design features include accessibility, flexibility, sustainability, security, survivability, and interoperability. An alternate HCC site should be pre-established in case the primary location becomes non-functional.
Incident Action Planning (IAP)
Incident action planning is a core concept of HICS. The IAP is a written document that provides the hospital's incident objectives, anticipated obstacles, and needed resources during an operational period. The planning process follows the Planning "P" model developed by FEMA, which includes: initial response and assessment, establishing incident objectives, developing strategies and tactics, determining needed resources, issuing assignments, implementing actions, evaluating and revising plans, and demobilization.
HICS Toolkit
The HICS Toolkit includes:
- Hospital Incident Management Team (HIMT) Chart: Identifies HIMT positions and their relationships.
- Incident Planning Guides (IPGs): Outline strategic considerations for hospitals when writing response plans.
- Incident Response Guides (IRGs): Develop incident-specific response actions organized by time periods (Immediate, Intermediate, Extended, and Demobilization/System Recovery).
- Job Action Sheets (JAS): Provide specific position guidance for each HIMT member, including responsibilities, reporting relationships, and action steps.
- HICS Forms: Modified ICS forms for hospital use, including forms for incident documentation, resource tracking, safety information, and cost collection.
Benefits
Benefits of using HICS include: efficient and coordinated response to emergencies; seamless integration with the Multi-Agency Coordination System (MACS) and community response partners; NIMS consistency; federal preparedness and response grant consistency; and accreditation consistency (e.g., The Joint Commission).
Adaptations
HICS has been adapted for other healthcare settings, including the Nursing Home Incident Command System (NHICS), mobile field hospitals, alternate care sites, and use in austere conditions. The system is designed to be customized by individual hospitals to fit their mission, size, and resources while maintaining core ICS principles.
