I came across an article yesterday posted on EMS1/AMU’s blog about EMS adopting an incident command system. It’s an article that leaves me with a lot of questions.
I want to examine some individual statements within the article.
- “Many EMS providers lack training and awareness about implementing an incident command structure.”
This is 100% true, but I’ll also expand this statement across much of public safety and emergency management. Aside from well-experienced practitioners of ICS, which there are relatively few compared to the greater public safety/EM community, most simply aren’t equipped to implement a significant incident management system. The biggest reason is that ICS training sucks.
- “EMS organizations have only recently recognized the value and need for such a command structure as part of their response strategy.”
I would suggest that this is partly true, but in many parts of the nation, requirements and standards have been established by way of executive order, state and regional EMS protocols, and other means for EMS to use ICS. Many of these have been in place since the 90s, before HSPD-5 and NIMS requirements, but certainly with the emergence of NIMS in 2003, this has largely been a standard of practice for EMS, if not a requirement in many places (and under specific circumstances, such as required through OSHA 1910.120). While I understand that ‘standards’ and ‘requirements’ don’t necessary define value, they essentially dictate a need.
- There was a recognition that “EMS providers were having difficulty applying fireground incident command practices to EMS calls.”
While I agree with what I think is the spirit and intent of this statement and bring this back to my comments on item 1 above, I’m still cringing at the ‘fireground incident command’ phrase in this statement. ICS isn’t just for the fireground. While it may have been born in wildfires, that was decades ago. We are now officially in 2019 and should be well past this concept that ICS is only for the fireground. Even if we disregard, for the sake of discussion, the requirements for all responders to use ICS, such as those in OSHA 1910.120, which predate NIMS, HSPD-5 was signed almost 17 years ago! Nothing in HSPD-5 or the original NIMS document elude to the current implementations of ICS being a fireground system. It was to be applied to all responders.
- “During a response, providers did not establish a formal command structure”
Totally true. This applies, however, not just to EMS, but to most of public safety. See my comment for item 1.
- “In 2012… they began to research various fire and EMS command models that were scalable and practical for all types of critical EMS calls.”
I’m not sure why there is a need to look past NIMS ICS. Perhaps we are stepping back to my comment on item 1 again, but if you understand the system, you can make it work for you.
It is absolutely not my intent to throw negativity on the author or the people who spearheaded the implementation of an EMS-specific ICS as cited in this article. They clearly identified what they perceived to be a need and tried to address it. I give them credit for that. It should be seen, though, that they identified many of the same needs that ICS was developed to address in the first place. They then created a system (which has many of the same qualities of ICS) that is focused on EMS needs during an incident. The issue here is bigger than this article, and certainly more endemic. Unfortunately, the article doesn’t really provide much detail on their ‘provider in command’ model, but what they describe can all be accomplished through NIMS ICS if properly utilized. They even identify objectives of their model, which are really just pre-identified incident objectives. They certainly don’t require a different model. I think, however, what they largely accomplished was an audience-specific training program to show how elements of ICS can be implemented. I just don’t think they needed to change the model, which is what the article seems to indicate.
Sadly, trying to make customized adaptations of ICS is nothing new. For years, some elements of the fire service have dug in with certain models which are fire-ground centric. Other disciplines have dome similar things. It’s worth mentioning that FEMA had developed a number of discipline-specific ICS courses, such as ICS for Public Works or ICS for Healthcare. While the intent of these courses is to provide context and examples which are discipline-specific (which is a good practice) rather than new models specific to these disciplines, I think that has inadvertently given some the impression that there are different systems for different disciplines. ICS is ICS.
Once again, I put the blame on poor training curriculum. When a system is developed and proven to work under a wide variety of circumstances and for a wide variety of users, yet users keep feeling a need to develop adaptations for themselves, this is not a failure of the system or even the users, it’s a failure of the training.
There are facets of public safety and emergency management that are generally not using ICS as well or as often as they should. EMS is one of them. As an active EMT for over a decade (including time as a chief officer), I can attest that (in general) ICS training for EMTs is abysmal. The text books tend to skim over the pillars of ICS and focus on the operational functions of triage, treatment, and transport. While these are important (for a mass casualty incident… not really for anything else), they fail not only in adequately TEACHING the fundamental principles of ICS (which can and should be used on a regular basis), but they fall well short of actually conveying how to IMPLEMENT ICS. Further, much of the training provided includes a concept of ‘EMS Command’, which is opposed to what is in ICS doctrine. We shouldn’t be encouraging separate commands and ICS structures at the tactical level of the same incident.
A few years ago I had started a crusade of sorts to get a better ICS curriculum developed. There was a lot of support for this concept across the public safety and EM community, not only in the US but other nations as well. Perhaps with the coming of the new year that effort needs to be reinvigorated?
© 2019 – Timothy Riecker, CEDP