The EMSI IMT is available for COVID-19 support. Contact EMSI if your organization requires incident management assistance.
Emergency management, medical, and public health professionals in the United States and around the world have shifted their attention to the evolving Coronavirus (COVID-19) pandemic. While the complete clinical picture with regard to COVID-19 is not fully known yet, COVID-19 has been declared a pandemic by the U.S. Centers for Disease Control (CDC). Based upon a myriad of factors such as population density and age of the population, different parts of the United States are seeing varying levels of COVID-19 activity. More cases of COVID-19 are likely to be identified in the United States in the coming days and weeks, including more instances of community spread. The CDC expects that widespread transmission of COVID-19 in the United States will occur. In the coming months, most of the U.S. population will be exposed to this virus.
While the U.S. nationally is currently in the initiation phases, states, where community spread is occurring, are in the acceleration phase. Widespread transmission of COVID-19 could translate into large numbers of people needing medical care at the same time, with healthcare providers and hospitals quickly becoming overwhelmed. Schools, childcare centers, and workplaces may experience more absenteeism. Mass gatherings may be sparsely attended or postponed. Public health and healthcare systems may become overloaded, with elevated rates of hospitalizations and deaths. Other critical infrastructure, such as law enforcement, emergency medical services, and sectors of the transportation industry may also be affected. This has resulted in a large-scale mobilization of emergency management personnel to support COVID-19 response efforts, including Incident Management Teams (IMTs).
As IMTs prepare for COVID-19 support deployments, EMSI IMT members are offering advice and best practices for managing and coordinating the response to a pandemic.
Size Up and Incident Potential
As with all incident response, a thorough incident size-up and assessment of incident potential is paramount. IMTs must recognize that they are responding to a non-standard “incident”, not limited to a specific incident-site, that will likely continue for months. As such, IMTs must immediately consider long-term response needs including sustainable staffing approaches and rotations. IMTs must also recognize that members of their own teams may become affected and plan for additional resources to backfill positions.
Effective COVID-19 response requires a unified effort between emergency managers, public health officials, and medical professionals. As these disciplines work together to manage the response, they must understand their respective authorities and areas of expertise, including decision making authorities in specific jurisdictions. It must be clear which decisions need to be made and who is the responsible authority for making the decision. Mapping out decision-making lines of authority, in advance of having to make the decision, can facilitate timely and informed decision-making. And take it a step further by determining what information will be required to make an informed decision.
Short-Term Incident Action Planning Coupled with Long-Term Planning
IMTs are well-versed in implementing the operational planning process to develop an Incident Action Plan (IAP) for an operational period. IAP planning and implementation will certainly be required in response to COVID-19 to effectively and efficiently allocate limited resources towards achieving incident objectives. But given the expected duration of the COVID-19 response, IMTs must also think about long-term planning. This includes, but is not limited to, long-term IMT staffing, resource requirements, logistics needs, and contingency planning. To ensure a sustainable response and prepare for the subsequent weeks and months of the nationwide and worldwide COVID-19 pandemic, IMTs must implement long-term planning processes from the outset.
Public health and medical, as well and emergency management resources, are going to be required for a long time. Sustainable resource management processes must be implemented early on, identifying critical resources and ensuring they are used effectively. Critical resources can’t be burned out in the initial weeks of this response and then unable to respond for the following months of the pandemic. Plans for sustainable resource allocation must be developed and implemented. Furthermore, resources must be protected from contracting COVID-19, thus rendering them out of service, or worse, spreading the disease to other responders.
A pandemic can represent a non-standard deployment for an IMT. Therefore, IMTs must identify and integrate appropriate Technical Specialists into their response organization, including, but not limited to, medical specialists such as doctors and nurses, infectious disease and epidemiology specialists, public health professionals, crisis communicators, long-term and strategic planners, and continuity planners and specialists.
Common Operating Picture
Information about COVID-19 is evolving rapidly. IMTs must maintain a Common Operating Picture (COP) that is not only specific to their area of responsibility (AOR) but consistent with the larger COP and current information available on the pandemic. Furthermore, IMTs should refer to the state and local health departments in their jurisdiction, who may provide supplemental guidance specific to the IMTs AOR.
IMT Information Reporting
Internal to the IMT, Incident Commanders and the Situation Unit should work to establish information reporting thresholds and requirements, including critical and routine information reporting requirements. These should be communicated to all team members to ensure information exchange internal to the IMT and can be used to feed the Common Operating Picture. Given the rapidly evolving pandemic, information reporting requirements should be revisited and updated on a routine basis.
Consistent Public Messaging
As our understanding of the COVID-19 pandemic evolves, so will our public messaging. Health and emergency management officials at all levels of government are providing sound, medical and scientifically based, guidance to the public. Public Information Officers (PIOs) and Joint Information Centers (JIC) must coordinate with the larger nationwide Joint Information System (JIS) to ensure public messaging in the IMTs AOR remains consistent with the overall public message and not in conflict. This may include guidance on travel restrictions, public gatherings, social distancing, and what to do if someone thinks they contracted COVID-19. Public messaging must also consider local nuances as directed by local and state health officials.
Continuity of Operations
Hopefully, organizations established sound and implementable continuity plans prior to the pandemic. Now is the time to implement them. As the world faces a sustained response to COVID-19, with restrictions in place on our everyday lives, continuity of operations is critical to sustaining an effective response and ensuring essential business and government functions continue with minimal disruption.
With the COVID-19 pandemic not limited to a specific incident site, we’re seeing much of the response efforts being managed and coordinated from Emergency Operations Centers (EOCs), which traditionally serve as coordination and support entities, not Incident Command Posts (ICPs). If assigned to an EOC, IMTs must be prepared to adapt traditional ICS structure and process to fit the needs of the EOC they are working in. Consistent with the most current version of NIMS, EOCs can organize in a variety of manners including ICS-based, Incident Support Model, departmental or functional, and/or following Emergency Support Functions (ESFs), to include others. Regardless of the EOC organization structure, if IMTs remain flexible they can assist in establishing process and structure in an EOC.
Safety of Responders
The sustained, long-term response to the pandemic cannot continue if the response force is not healthy. Vigilant measures must be put in place to protect the health of responders, including isolating and quarantining responders when prudent, following relevant personal protective equipment (PPE) recommendations when coming in contact with potential patients, washing hands and cleaning workspaces on a more frequent basis, and monitoring responders for potential symptoms.
As part of ensuring the safety and health of responders, particularly those in an enclosed environment, organizations should only activate those positions necessary to reduce the number of people within a restricted space. Station layout should be spaced to allow for six feet between members to reduce the spread of disease and work areas should be cleaned frequently to prevent the latent spread of germs on surfaces.
Additionally, response organizations should establish procedures for active monitoring, self-monitoring, and self-monitoring with delegated supervision as defined by the CDC:
- Active monitoring means that the state or local public health authority assumes responsibility for establishing regular communication with potentially exposed people to assess for the presence of fever or respiratory symptoms (e.g., cough, shortness of breath, sore throat). For personnel with high- or medium-risk exposures, CDC recommends this communication occurs at least once each day.
- Self-monitoring means personnel should monitor themselves for fever by taking their temperature twice a day and remain alert for respiratory symptoms (e.g., cough, shortness of breath, sore throat). Anyone on self-monitoring should be provided a plan for whom to contact if they develop fever or respiratory symptoms during the self-monitoring period to determine whether a medical evaluation is needed.
- Self-Monitoring with delegated supervision (in a healthcare setting) means personnel performs self-monitoring with oversight by their healthcare facility’s occupational health or infection control program in coordination with the health department of jurisdiction if both the health department and the facility are in agreement. On days HCP is scheduled to work, healthcare facilities could consider measuring temperature and assessing symptoms prior to starting work. Alternatively, a facility may consider having HCP report temperature and the absence of symptoms to occupational health prior to starting work.
Furthermore, we must manage stress among responders. The following information is provided by the CDC:
Responding to COVID-19 can take an emotional toll on you. There are things you can do to reduce secondary traumatic stress (STS) reactions:
- Acknowledge that STS can impact anyone helping families after a traumatic event.
- Learn the symptoms including physical (fatigue, illness) and mental (fear, withdrawal, guilt).
- Allow time for you and your family to recover from responding to the pandemic.
- Create a menu of personal self-care activities that you enjoy, such as spending time with friends and family, exercising, or reading a book.
- Take a break from media coverage of COVID-19.
- Ask for help if you feel overwhelmed or concerned that COVID-19 is affecting your ability to care for your family and patients as you did before the outbreak.
A great source of information in the U.S. is the CDC website, specifically their Coronavirus Diseases 2019 (COVID-19) website. EMSI encourages emergency managers, public health and medical officials, and IMTs to routinely visit this page for updated information and guidance as the COVID-19 pandemic evolves.
Additional Sources of Information Include:
As the COVID-19 response continues, resources from the EMSI IMT remain available to support efforts to manage the pandemic by either deploying personnel to a command post or EOC, or through remote and reach-back capabilities. Furthermore, EMSI IMT trainers are available for just-in-time training of IMTs assigned to provide COVID-19 support, including remote or web-based training, and can deploy with an IMT to advise, mentor, or coach in any capacity. Contact EMSI for more information on COVID-19 IMT support.