June 21, 2002

For many urban hospitals and emergency response agencies, the issue of disaster preparedness has taken on heightened significance since the Sept. 11 terrorist attacks. While the shock and anxiety of that tragedy have subsided somewhat, many health care organizations have been re-evaluating their emergency response plans.

Leadership at the MGH and throughout Partners HealthCare are no different: They have been reassessing and revitalizing current plans to prepare for the worst possible emergency. As a result of their work, all Partners hospitals, including the MGH, are instituting a new emergency command structure called the Hospital Emergency Incident Command System (HEICS).

"We had a good plan in place before Sept. 11," says Ann Prestipino, senior vice president for MGH Surgery, Anesthesia and Cardiac Program and chair of the MGH Emergency Planning Committee. "Since that tragic event, however, we have been making important decisions to enhance and improve our emergency plans to respond to any type of disaster."

The most significant improvement was to revamp the hospital's command structure used during a crisis, so that it paralleled other emergency response agencies such as local fire and police departments and emergency medical services. HEICS is an emergency management system that engages a management structure with defined responsibilities of key personnel, clear reporting channels and the use of common terminology to help unify hospital staff with other emergency responders. This system was first used by hospitals in California in the 1980s and is being incorporated by many health care facilities across the country. Partners is the first hospital network on the East Coast to adopt the system.

According to Julia Sinclair, administrative director for MGH Emergency Medicine and coordinator of HEICS implementation at the MGH, the new management system is based on an organizational structure with four sections – logistics, planning, finance and operations – that ultimately report to the emergency incident commander. Each section has an appointed chief who designates directors and unit leaders to fill certain job responsibilities with supervisors and officers filling in other crucial roles. This structure limits the span of control for each manager to distribute the workload more effectively.

"An important aspect of this plan is that it is flexible," says Sinclair. "Only the positions or functions that are needed are activated depending on the size and scope of the specific emergency situation." For example, the HEICS plan can address small-scale incidents such as a local fire or subway crash. It can address natural disasters such as a snowstorm or hurricane. For internal accidents such as a fire on hospital property or an electrical shutdown, it offers an internal response mechanism to continue hospital operations. Or HEICS can be activated to respond to major incidents such as an act of terrorism or biological warfare.

"We can't possibly think of every contingency for every conceivable emergency," says Prestipino. "By implementing this system, we have oriented and trained key staff members in critical roles generic to any type of disaster. This coupled with good judgment and ongoing work with outside agencies, positions us well to deal with any situation."

The HEICS plan now is being integrated into the hospital's current emergency response plan. Since April, a core group of MGH and Partners employees have been trained using the HEICS plan. A table-top disaster drill and a full-scale mock disaster drill using the HEICS structure are planned for the fall.

For more information about HEICS and the MGH emergency response plan, call Sinclair at (617) 726-3387.