Incident Management Systems for Outbreak Control

It seems like just yesterday I was writing my first blog post after only a week of work here at UHN. Time is going incredibly quickly, and with every week that passes, I am left with one less week in which to complete my project. Since my first post, my project has materialized into something intimidatingly nebulous and overwhelmingly interesting. Though it does not involve research, my project requires an intimate knowledge of outbreak management, basic infection control procedures, and emergency preparedness/response. I will be developing an Incident Management System (IMS) response that can be applied throughout the UHN to manage seasonal Influenza outbreaks. IMS is a Government of Ontario endorsed framework for emergency management, and allows for an efficient and coordinated response when multiple stakeholders are involved. In the context of seasonal Influenza outbreaks at UHN, 6 physical locations, countless departments (Environmental Services, Pharmacy, Occupational Health & Safety etc.), external agencies (Toronto Public Health) and Infection Control all need to work together to keep patients and the community as safe as possible while stopping the spread of Influenza virus.

IMS is based on a few core principles, including Unity of Command, Standardized Terminology, and Simplicity/Flexibility. Unity of Command refers to each outbreak responder reporting to only one supervisor. Each supervisor can only supervise 3-7 responders, as this represents the optimal span of control. Standardized terminology for the outbreak is used so that different departments and agencies can all speak the same language and understand outbreak status updates as they are received. Lastly, IMS is designed to be as simple as possible for responders (each individual has a documented list of responsibilities and reports to a single supervisor) and as flexible as possible (applicable to events of varying severity).

My first responsibility is to establish the chain of command. The typical IMS response involves an Incident Commander and three Command Staff (Liaison Officer, Safety Officer, and Outbreak Information Officer). Command then oversees four major branches of the response. Operations are the responders who will implement the Outbreak Toolkit actions and directives (the “doers”). Planning are the responders who prepare the Toolkit, maintain outbreak documentation, and plan for resources that may be required (the “preppers”). Logistics is responsible for service and support, and will order, store, maintain and distribute resources as needed (the “getters”). In my case, these resources include additional nursing staff, Tamiflu and Relenza as prophylaxis, Personal Protective Equipment (PPE), Nasopharyngeal swabs (NPs) and etc. Finally, Finance and Administration track staff hours and prophylaxis uptake, track the cost of resources used for the outbreak response, and ultimately provide compensation for them (the payers).

The difficulty with UHN is that seasonal Influenza outbreaks can occur at multiple sites, and can occur at the same time (an outbreak at Princess Margaret may be called concurrently with an outbreak at Toronto Western). This means that a multi-layered IMS must be developed, that allows for a UHN Command as well as Site Commands that can be activated and terminated as necessary throughout the season. Once this framework is developed, I must identify individuals (during the day and off-hours/weekends) that can fulfill each role. Each role requires a Job Action Sheet, which outlines that responders designated actions/responsibilities. These responsibilities must be further separated into immediate, intermediate, and recovery priority status. Lastly, I will develop a Communications Cycle which outlines the following:

  • Who needs to be aware of what (internally and externally)
  • When do they need to be aware of it (communications cycle)
  • Who will make them aware of it (defined in Job Action Sheets)
  • How will they be made aware (channel of communication)

Given that UHN has 16,000 employees, this task seems impossible at the moment. But, every day another job gets checked off of my To-Do list, and I am confident that I have the support, determination, and initiative I need to produce quality work.