MSCC Project Scope Figure

Graphic shows the Public health and medical response management across the intergovernmental and public-private divides. The graphic shows a vertical relationship linking the individual healthcare organization to the federal response. The relationship, from the ground up, shows these levels: individual healthcare organization response, healthcare coalition response, local jurisdiction response, state response, interstate regional response, and finally federal response.

Figure 1-1: Management System for Reaching MSCC Objectives

Figure 1-1 shows the management system for reaching MSCC objectives. During a medical surge event, an HCO must be able to transition from a baseline medical capacity and capability using the MSCC management system to an incident medical surge capacity and capability. Once the medical surge event is complete, the HCO can then utilize the same MSCC management system to transition back to its baseline capacity and capability.

Figure 1-2: MSCC Management Organization Strategy

Figure 1-2 shows the six-tier construct depicting the various levels of public health and medical asset management during response to mass casualty and/or mass effect incidents. Tier 1 is the healthcare asset management (emergency management program and emergency operations plan using incident command). Tier 2 is the healthcare coalition in which multiple HCOs cooperate in information sharing, cooperative planning, and mutual aide).

Figure 1-3: Incident Command System

Figure 1-3 shows the Five functional areas of the ICS: Command, operations, logistics, planning, and admin/finance. The following are the primary responsibilities of each function area. Command defines the incident goals and operational period objectives and includes incident commander, safety officer, public information officer, senior liaison, and senior advisors. Operations establishes strategy or methodology and specific tactics or actions to accomplish the goals and objectives. Operations also coordinates and executes strategy and tactics to achieve response objectives. Logistics supports command and operation sin their use of personnel, supplies, and equipment and performs technical activities required to maintain the function of operational facilities and processes. Planning coordinates support activities for incident planning as well as contingency, long-range, and demobilization planning. Planning also supports command and operations in processing incident information and coordinates the information activities across the response system. Finally, admin/finance supports command and operations with administrative issues as well as tracking and processing incident expenses. Admin/finance also covers such issues as licensure requirements, regulatory compliance, and financial accounting.

Figure 1-4: Types of Demands Encountered in Incident Response

Figure 1-4 shows the two sets of simultaneous demands that are encountered during an incident response: "hazard-generated demands" and "response-generated demands". Hazard-generated demands are: warning, pre-impact preparations, search and rescue, care of injured and dead, welfare needs, restoration of essential services, protection against continuing threat, and community order. Response-generated demands are: communications, continuing assessment of situation, mobilization and utilization of resources, coordination, and exercise of authority.

Figure 1-5: Basic Presentation of a Planning Cycle

Figure 1-5 shows the basic presentation of a planning cycle. The graphic moves clockwise starting from the upper-right. First stage is to hold a planning meeting to develop strategy, tactics, and assignments to accomplish the objectives. During this stage, information processing and supportive plans are developed. Next stage is to prepare and approve an Incident Action Plan (IAP). Upon approval, this begins the operational period. Next stage is to hold an operational briefing to operations leaders about the IAP. Next stage is to execute the IAP and initiate planning for the next operational period. Next stage is to assess progress using measures of effectiveness. Final stage is to hold a management meeting to evaluate and revise incident objectives. The management meeting denotes the start point for subsequent incident planning cycles. The management meeting also includes information processing and supportive plans development.

Figure 1-6: Relationship of UC and the MACS that provide emergency management operations support to the UC.

Figure 1-6 shows the basic presentation of a planning cycle. The graphic moves clockwise starting from the upper-right. First stage is to hold a planning meeting to develop strategy, tactics, and assignments to accomplish the objectives. During this stage, information processing and supportive plans are developed. Next stage is to prepare and approve an Incident Action Plan (IAP). Upon approval, this begins the operational period. Next stage is to hold an operational briefing to operations leaders about the IAP. Next stage is to execute the IAP and initiate planning for the next operational period. Next stage is to assess progress using measures of effectiveness. Final stage is to hold a management meeting to evaluate and revise incident objectives. The management meeting denotes the start point for subsequent incident planning cycles. The management meeting also includes information processing and supportive plans development.

Figure 1-7: Common types of Multiagency Coordination Groups and Centers

Figure 1-7 shows the common types of multiagency coordination groups and centers. The common types of coordination groups are: Crisis action teams, policy committees, MAC group, joint field office coordination group and incident management planning team. The Common types of coordination centers are: emergency operations centers, joint operations center, joint filed office, joint information center, regional response coordination center, national response coordination center and national operations center.

Figure 1-8: Stages of Incident Response

Figure 1-8 shows the different stages of incident response: incident recognition, notification/activation, mobilization, incident operations, demobilization, and transition to recovery. Proactive management through the Planning cycle occurs during the final three stages.

Figure 1-9: Coordination of Planning Activities

Figure 1-9 shows the coordination of planning activities between the state and jurisdiction and that of the federal government. State and jurisdiction have concurrent planning cycles and operational periods across the stages of defining goals and objectives, defining strategy, priorities and major tactics and completing the incident action plan prior to the beginning of a new operational period. The federal government support is slightly staggered from the state and jurisdictions so that they start slightly after and end after state and jurisdictions to allow for information exchange between stages. After all stages, a formal media briefing is coordinated to release incident details in a way that ensures responders are informed first and that there is a consistent message.

Figure 2-0: Management of Individual Healthcare Assets (Tier 1)

Image shows figure 1-2: MSCC Management Organization Strategy's six-tier construct depicting the various levels of public health and medical asset management during response to mass casualty and/or mass effect incidents. Emphasis is put on the lowest level, Tier 1: Healthcare asset management (EMP and EOP using incident command).

Figure 2-1:Organization of the National Response Plan

Figure 2-1 shows the organization of the Emergency Operations Plan from Healthcare Organizations as depicted in the national response plan from the Department of Homeland Security. The organization of the plan has five steps. First, is the Base Plan, consisting of concepts of operations, coordinating structure, roles and responsibilities, definitions, etc. The next step is the emergency support function annexes consisting of groups� capabilities and resources into function that are most likely needed during an incident (e.g. transportation, firefighting, mass care, etc. Next, is Support Annexes, which describes common processes and specific administrative requirements (e.g. public affairs, financial management, worker safety and health issues, etc.). Fourth is incident annexes, which outline procedures, roles and responsibilities for specific contingencies (e.g. terrorism, catastrophic, radiological, etc). Last, is Appendices, made up of glossary, acronyms, authorities, and compendium of national interagency plans.

Figure 3-0: Management of Individual Healthcare Assets (Tier 1)

Image shows figure 1-2: MSCC Management Organization Strategy's six-tier construct depicting the various levels of public health and medical asset management during response to mass casualty and/or mass effect incidents. Emphasis is put on Tier 2: Healthcare "coalition" (info sharing, cooperative planning, mutual aid.

Figure 3-1. Tier 2 Coalition Action Plan

Figure 3-1 shows the clearinghouse process for creating a coalition incident action plan from disaggregated HCO IAPs submitted. All individual IAPs from the Healthcare Organizations are feed into the coalition clearinghouse function which receives the data from the HCOs, collates them, and returns the aggregate data to the HCOs. The output, the HCO coalition IAP, is then sent on to the Jurisdiction Incident Management.

Figure 4-0: Jurisdiction Incident Management (Tier 3)

Image shows figure 1-2: MSCC Management Organization Strategy's six-tier construct depicting the various levels of public health and medical asset management during response to mass casualty and/or mass effect incidents. Emphasis is put on the Tier 3: Jurisdiction incident management (medical ICS and emergency support - EOC).

Figure 4-1: Generic Management Structure for Jurisdictional Response

Figure 4-1 shows the generic management structure for Jurisdiction response to emergency event. The following is the hierarchical structure that reports up and feeds into the Unified Command. At the bottom, are the five sections: Operations, logistics, planning, and Administration/Finance. These sections report up to the Senior Liaison. The Senior Liaison reports up to the Safety Team which is responsible for the traditional safety role, health/prevention medicine, and security. Next is the Safety Information Officer. Following the Safety Information Officer are the Senior Advisors which may include pre-selected experts representing the private medical community. The senior advisors feed directly into the Unified Command, which consists of Fire/EMS, Law Enforcement, Public Health, Human services, and others as indicated (e.g. public works, schools, etc.). The Unified Command also coordinates Regional and State Management. Also feeding the Unified command is the Multiagency coordination Center (MACC), which is usually local EOC. The MACC's policy is guided by the Multiagency Coordination Group (MAC Group), which has the senior political authority for jurisdiction.

Figure 4-3. EOC Incident Support in Traditional Emergency Response

Figure 4-3 shows the Incident Support that the Emergency Operations Center provides during a traditional emergency response. Within the Jurisdiction area, the EOC integrates political leaders with the Unified Command. The EOC also supports the UC on needs not met through available assets or mutual aid in support of the Incident Management Post at the incident itself. The EOC also addresses incident-related issues outside the focus of the US (e.g. traffic disruptions). Finally, the EOC coordinates support with other levels of government (e.g. federal, regional, state) that fall out side the actual jurisdiction area.

Figure 5-0: Jurisdiction Incident Management

Image shows figure 1-2: MSCC Management Organization Strategy's six-tier construct depicting the various levels of public health and medical asset management during response to mass casualty and/or mass effect incidents. Emphasis is put on Tier 4: State response and coordination of intrastate jurisdictions (management coordination and support to jurisdictions).

Figure 5-1. Generic SEMS Management Structure

Figure 5-1 shows the generic Standardized Emergency Management System (SEMS) structure. The structure is a 5 level hierarchy starting from the ground up. The ground level is the "Field Response", emergency responders carrying out tactical decisions and activities in direct response to a threat. The Field Response requires the use of ICS functions. Above the Field Response is the "Local Government". Local Government includes cities, counties, and special districts and manages and coordinates overall emergency response and recovery activities in their jurisdictions. Above local government is the "Operational Area" which encompasses the county and all political subdivisions in the county, including special districts. The Operational area manages and coordinates information, resources and priorities among local governments and serves as the coordination and communications link between local and regional levels. Above the operational area is the "Regional Level" which manages and coordinates resources among operational areas. The Region Level also coordinates information sharing between operational areas and the State level and oversees State support for emergency response activates in the region. Last, at the top of the hierarchy, is the "State Level" which manages State resources to meet emergency needs of other levels and coordinates mutual aid among regions and between regional and State levels. Finally, the State Level serves as communication link between the State and the Federal response system.