Hospitals are the most important base for health care in a community especially when it comes to a disaster, the function of a hospital has to be in a high quality and also the communication, transportation, and prevent distribution between hospitals have to be good as well. The Incident Command System (ICS) was created in 1970 in response to a series of wildfires in Southern California in the United States. The goal of ICS was to create a simple communication and establish lines to authority and command, also to provide more effective on-site management and the use of resources.
Hospital Emergency Incident Command System (HEICS), most common name as Hospital Incident Command System (HICS), is a method by which the hospital operates when an emergency is announced. Allow them to develop communication between the hospitals, when an emergency is happening. However, it is difficult to evaluate the outcome of health care in a disaster because of the lack of internationally accepted standards of performance. Hospitals usually are unprepared to evaluate the strengths and vulnerabilities of their own managements systems before the occurrence of an actual calamity.
Therefore the main objective of this study was to measure the decision making performance according to HICS job actions sheets using tabletop exercises. Research Statement or Research Question(s): The decision making performance in the participating Iranian hospitals, as measured during tabletop exercises and using the HICS was intermediate to poor. The performance was better in the public hospitals as compared to university hospitals and was shown to be independent of the hospital size.
The HICS job action sheets can be used as a sample for measuring the hospital’s response. The researchers believe that a comprehensive hospital disaster plan should include managerial, operational elements of hospital preparedness, and an appropriate command system suited to the specific hospital organization. Methods: This observational study was collected in Iran, between May 1st 2008 and August 31st 2009. Twenty three hospitals were picked for this study. Fourteen hospitals were public and 9 were university hospitals.
A tabletop exercise was developed for each hospital. Which is based on highest problem solving decisions emergency responses. They gave out several exercises, each exercise was based on a risk map of the area. They used 28 standardized scenarios from 2006 HICS and each scenario was run for a maximum of 2 hours. All positions of the HICS were assessed according to the 5 main sections (command, operations, planning, logistics, and finance/administration) using the job action sheets, by a groupof 3 evaluators, mainly medical doctors who has been work for at least 6 years..
The performance for each HICS position was scored based on the compatibility of the participants’ decisions with the relevant job action sheet. A compatibility below 40% was scored as 1, a compatibility between 40 and 70% as 2, and if the compatibility was above 70%, the score was 3. The score was 0 if the position was missed or no performance was achieved for the specific task………. The range for the total HICS score was 1-192 (see additional file 1), and was divided into at three categories: Fair: 1-76; Intermediate: 77-134; High: 135-192. Descriptive statistics was performed.
A t-test was used to compare means of HICS performance between hospitals with respect to their affiliation, size and training courses. A Univariate Analysis of Variance was used to evaluate the effect of independent variables on HICS performance. Primary Results The hospitals were located in 12 different cities but none of the participating hospitals had a hospital disaster plan. Also none of the hospital had high performance level. The performance according to HICS was intermediate for 19 hospitals (83%).
The performance level of the different individual sections was fair to intermediate, except for the logistics and finance/administration sections, those are the only two sections with a higher level of performance. Overall the public hospital had a higher performance level than those university hospitals (P = 0. 04) in its main sections. The size of the hospital is not interrupt by reference in this study because there was no significant different according to the size of the hospital. Evaluation: The disaster may happen in an area where only affect one city, town, or country or may be affect to several counties.
The minimal time and waste on communication, transportation, operation, and the lowest influences it can make is the highest ideal that the reason why HICS is important. I think this article has a main idea of improving the risk of the disaster by collecting the responses from the hospital by the actual scenario practice in different area, which can help as a guide line of the response in the real situations even the feedback from the research is not as good. However, the entire research was based on the limited budget. Which limited the area of the hospital had be chose.
