How to Implement NIMS into Daily Operations Planning

How many EMS agencies utilize the National Incident Management System (NIMS) to its fullest? Do we as agencies say all of our employees have the proper qualifications, capability and emergency checklists just in case the unthinkable happens? Or are we complacent enough to think we have checked that box and we need to move on to more pressing issues? What if we were to adopt principles of NIMS and utilize the concepts on a daily basis—would this improve our overall organization as a whole?

Just like any public service agency, the Richmond Ambulance Authority (RAA) is bound by national standards to comply with NIMS. As an organization that focuses on continuous improvement processes, we sought to ensure we’re not only compliant but constantly capable, credible and current in NIMS processes and procedures. By incorporating NIMS practice, language and publications into everyday activities, the transition to a major incident is seamless, immediate and second nature.

This article outlines five ways we are now deploying NIMS practices and procedures at RAA.

Plan to Share Information

Failure to share information is a common pitfall for organizations. Coordinated efforts are not only encouraged within the incident command system (ICS), but also required due to standardized meeting schedules. Each day Rob Lawrence, our chief operating officer, holds a 15 minute operations coordination conference to ensure all directors and supervisors are operating with a common goal. Utilizing principles of the Planning “P,” each discipline is expected to report on the previous day’s performance, current status and potential concerns. This information is then transposed to the ICS 202 Incident Objectives Form identifying strategies, objectives, command priorities and safety considerations. Information is then disseminated to all management staff, including Chief Executive Officer Chip Decker and administrative managers, as well as operations managers, directors, supervisors and field training officers.

At the end of each 12 hour shift—RAA’s operational period—the field operations supervisor and the communications officer complete an ICS 201 Incident Briefing Form, which is then distributed by e-mail to all management staff. Our 201 form outlines the previous 12 hours, while giving an outlook for the next 24–36 hours. Each department within RAA has a section allowing for any major or unresolved issues to be addressed. This form has become a central point for information sharing, providing all departments with the ability to quickly identify and resolve any concerns.

Engage in Interagency Operations

Five years ago a group from Richmond’s public service agencies, specifically RAA, the Richmond Fire Department, the Richmond Police Department and the Richmond Office of Emergency Management, came together to create single incident action plan templates for all large planned events. Richmond hosts events such as the Monument Ave 10K, with 45,000 participants; the Richmond Marathon, with 20,000 participants; and off-road bicycling events that have the potential to turn into lengthy patient extrications. In 2015, Richmond is hosting the UCI World Road Cycling Championships, which is going to be an event of Olympic-sized organizational proportions. Having a coordinated effort with all agencies allows for an accurate response and decreased confusion. Within the last two years, surrounding jurisdictions have been added to this planning process. The multi-jurisdictional coordination has improved response times, decreased communication gaps and improved agency relations.

Incorporate Training

Training has played a large role in RAA becoming NIMS competent. New employees start their first week preparing for a mass-casualty incident. They are initiated with an ICS overview, which includes a tabletop exercise, using our self created “NIMS City” street scape—known locally as TICS (Table Top Incident Command Simulator)—for a practical hands-on application of ICS principles. Additionally, a number of RAAs managers and supervisors are members of the Central Virginia All Hazards Incident Management Team (CVAHIMT). CVAHIMT has taught over 23,000 man-hours of advanced incident management to central Virginia public safety agencies. RAA personnel have taken advantage of training offered by CVAHIMT primarily in incident command, operations section, planning section and unit leader-specific classes. This level of training has improved our organization’s disaster planning, while improving relationships with surrounding jurisdictions.

Develop Operational Templates

RAA’s planning mantra is to “plan for the worst, hope for the best” and it is exactly what we do. Being capable, safe and effective has been crucial to our success during disasters and incident action plans have helped to standardize our organization’s preparedness. RAA has taken this a step further and has created templates so when an event occurs we are able to deploy swiftly and efficiently.

RAA has developed an “all hazards” template that can be deployed at a moments notice. For pre-planned or forecasted events, such as hurricanes or winter storms, we have developed incident specific plans to ensure operational readiness. These plans allow RAA to begin its first operation period five days before the event occurs, with each period lasting 24 hours. During the tactics meetings, the need for extra staffing is evaluated and employees are contacted to prepare their families for extended work periods. If deemed necessary, equipment is relocated to the north and south of the river that divides our city in case bridges become impassable. Fleet status, building and grounds, generators, and facilities are evaluated to ensure functional status in case of an extended event. RAA enjoys good inter-departmental communication, which has streamlined information sharing and allowed for strengthened coordination throughout events.

Following each event, the templates are updated with improvements from lessons learned. An organizational focus has been placed on the recovery period because many organizations focus their planning and response efforts on the actual event and ignore the demobilization and recovery, which are just as important from a continuity of operations perspective. During our after action reviews RAA noticed increased call volume following the significant event. With civilians not having food, power, medications—including oxygen—or their normal comforts, we recognized the needed to plan for increased call volume until all comforts have been restored. Identifying this trend, we now plan for this higher call volume by increasing our staffing, which has allowed for limited system impact.

Involve Administrative Personnel

Incident Action Plans should not be limited to just operations staff. The administrative team is a key component in the success of any IAP and is a real untapped resource. RAA trains administrative staff to fill vital roles in ICS. These individuals became an essential part in making sure field staff is fed, housing is supplied and travel needs are met. One example of this administrative dedication to ICS is that recently our director of finance, who functions as the ICS finance/admin chief, took a finance section chiefs course.

Conclusion

Maintaining knowledge of ICS principles, capability and skill set is a critical component of effective EMS operations. Competency doesn’t happen overnight but the benefit of using ICS, even in non-traditional ways, are clear when developing and implementing an effective coordinated response to any call.

Lieutenant Todd Sheridan has been with the Richmond Ambulance Authority since 2002. During his career at RAA, he has held the positions of paramedic, ALS field training officer and is currently an assistant field operations supervisor. Todd specializes in event planning for both planned and unplanned events, including hurricanes, sporting events and presidential visits. Todd is also an active member of the Central Virginia All Hazards Incident Management Team, where he operates in the Planning and Operations Sections.