The New York Yankees are one of the greatest teams in professional baseball, and until recently, also had a legendary manager: Joe Torre. But even Torre didn't go it alone - he had a batting coach, a pitching coach and trainers, among other helpers.

In baseball, you'd never even think of leaving the manager on the bench without assistance. But we do that in hospital incident management, expecting our leader to manage the World Series, so to speak, at a moment's notice - with only a few sandlot games and a job action sheet under his or her belt.

Hospitals don't run like fire departments, and hospital leadership doesn't use the Incident Command System (ICS).

Fire departments utilize the ICS on every call; it's their standard operating procedure, just as it is for emergency medical services (EMS). Hospitals, however, only use it during a disaster, which is a federal standard. But using it only during disaster scenarios leads to inconsistent and potentially weak command centers. Those in charge of hospital preparedness agree that an atmosphere of confusion surrounds hospital command centers in terms of job descriptions and position-specific roles of incident command, such as planning section chief and operations section chief.

When a facility looks at its response assets, it usually only looks internally. Being part of an overall health system, however, one facility has access to more assets than just its own inventory - but may not realize it. This leads us to the hospital incident management team concept: What if, like wild land firefighters, we could develop an incident management team that could deploy to an affected facility and assist in command center operations?

At Sanford Health in Sioux Falls, S.D., we've done just that.

Developing the Team

Sanford Health is a large health-care system that covers South Dakota, Minnesota, Iowa and Nebraska, and serves 24 hospitals, and more than 100 clinics and long-term care facilities. Most hospital facilities under our flag are Critical Access Hospitals, which are hospitals certified to receive cost-based reimbursement from Medicare. Most of them would suffer immediate staffing issues during a major incident.

About three years ago, the Center for Prehospital Care and Emergency Preparedness at Sanford Health began rolling out National Incident Management System (NIMS)-compliant incident command training. I traveled to each of the aforementioned Critical Access Hospital facilities to assess their capability to expand during an incident and maintain care over several days. The findings were simple: Although each facility could generate an adequate number of staff members to meet the initial needs of an incident, most couldn't maintain complex operations over numerous operational periods. This becomes even more challenging when you add an incident requiring decontamination, and is still more challenging when you look at incidents requiring a lot of resource management like a pandemic.

Every hospital has a few people who are active in regional committees regarding NIMS compliance issues, infection control, pandemic planning and local exercises. Many of these people have been active in these roles for several years and know the standards and requirements to meet each year's competencies for federal funding. At Sanford Health, it was these people who began the focus and led the hospital incident management team to what it is today. We brought training in for them in higher levels of incident command, hazardous material operations, chemical hazard recognition, etc.

We began developing, almost innocently, what we see today: a deployable team of emergency operations center managers and incident management specialists who can respond to any affected facility in our health system, and assist the incident commander and the incident management team to achieve its objectives. The team has 24 members, and there isn't a second string. Team members are trained to a particular level. We eventually plan to have at

Greg Santa Maria  |  Contributing Writer