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OPRW 2018: HICS - The Insider's Perspective · The SHEA Podcast

• 0:12
  SPEAKER_00: The Society for Healthcare Epidemiology of America, SHAY, is pleased to present the podcast, HICS, The Insider's Perspective, part of SHAY's podcast series at httplearningce.shay-online dot org.
• 0:29
  SPEAKER_00: This podcast is moderated by Dr.
• 0:31
  SPEAKER_00: Judy Guzman Cottrill, professor of pediatrics at Oregon Health and Science University.
• 0:37
  unknown: Dr.
• 0:38
  SPEAKER_00: Guzman Cotrill also serves as an infection prevention and healthcare epidemiology consultant for the Oregon Health Authority's HAI program and as its medical director for Ebola and Emerging Pathogen Preparedness.
• 0:50
  SPEAKER_00: She was appointed chair of the SHA CDC Outbreak Response Training Program, ORTP, which provides U.S.
• 0:58
  SPEAKER_00: hospital epidemiologists and others with the tools and training needed to effectively handle facility level to pandemic infectious diseases emergencies.
• 1:16
  SPEAKER_02: Today I am joined by Christina Spurgeon and Pratish Tosh, two experts in healthcare emergency management.
• 1:24
  SPEAKER_02: Both will be sharing their expertise about emergency management and the application of HIRS or HIRS, which stands for the Hospital Incident Command System.
• 1:34
  SPEAKER_02: Christina Spurgeon has been in healthcare emergency management for nearly 15 years.
• 1:40
  SPEAKER_02: She is the emergency manager for UC Davis Medical Center in Sacramento, California, which is a level one trauma and pediatric care specialty center.
• 1:51
  SPEAKER_02: Her primary focus is on overall system readiness.
• 1:55
  SPEAKER_02: Specifically to getting people trained up with their tools that they need or to walk into any command center or for any event or ready to go.
• 2:04
  SPEAKER_02: Dr.
• 2:04
  SPEAKER_02: Pratima Taj is an infectious disease physician and the medical director of emergency management at Mayo Clinic in Rochester, Minnesota.
• 2:13
  SPEAKER_02: His prior training includes the EIS or Academic Intelligence Service at the CDC and a fellowship with the Center for Infectious Diseases Research and Policy or SIDRAP at the University of Minnesota.
• 2:27
  SPEAKER_02: He is involved in preparedness activities on a local, regional, and national level, including serving on the J C D C Outbreak Response Training Program Expert Writing Panel.
• 2:40
  SPEAKER_02: So Christina and Pratesh, let's begin with the basics.
• 2:43
  SPEAKER_02: What exactly is Hicks and why was it developed?
• 2:48
  SPEAKER_03: The hospital incident command system was developed early on in around the 70s by the California fire group that was worried about making sure that they had the right information and the right terminology to respond effectively and quickly to overwhelming disasters.
• 3:05
  SPEAKER_03: And specifically, it started with resource typing, and they were trying to figure out how to make sure that when you ordered a fire truck, everybody was talking about the same thing.
• 3:13
  SPEAKER_03: And so they developed the incident command system for themselves, which is a military-style system that has plain language coded into it so that when you say incident commander, everybody knows what you're talking about.
• 3:24
  SPEAKER_03: And so they developed this very simple system that has five branches to it.
• 3:28
  SPEAKER_03: And from that flowed the different various types of incident command systems that different groups have tailored to themselves, including healthcare.
• 3:36
  SPEAKER_03: And so it's based on what Calfire did several decades ago.
• 3:40
  SPEAKER_03: And it has the different ways to bring together different groups in a hospital so that you can flex up, flex down, add, subtract, whatever it is that you're trying to respond to.
• 3:50
  SPEAKER_03: You design your system according to the incident that you're faced with.
• 3:53
  SPEAKER_03: And the whole point of it is so that you have some training in advance and you understand this very simple system so that you can walk into any incident command center, whether it's a small hospital, a large hospital, part of the medical health operations branch in a county, or even a essential services function for a larger piece of the government.
• 4:14
  SPEAKER_03: And operations means operations, and the liaison officer is doing something similar.
• 4:18
  SPEAKER_03: So those titles are broad and they are similar across any group that's going to be using it.
• 4:25
  SPEAKER_02: Pratish, from the lens of an infectious disease physician and the medical director of emergency management, what are the key components and the overall structure from your standpoint for the type of work that you do?
• 4:38
  SPEAKER_01: I think the most important thing, most important component of the structure is actually the structure itself, in that this is a way to organize the chaos.
• 4:49
  SPEAKER_01: So in any emergent situation, you have a lot of information and a lot of things that need to be done.
• 4:56
  SPEAKER_01: And the HICS or HICS structure is a way to organize that information flow and also the operational things that need to be done in order to handle that.
• 5:07
  SPEAKER_01: And what this does is it leverages the expertise of the experts you already have.
• 5:11
  SPEAKER_01: So people who are experts in logistics are doing logistic things, and uh people who are experts in medical care are doing the things that they're really good at.
• 5:23
  SPEAKER_01: And so this is a structure that allows people to work closely together in an organized fashion to meet the overall goals of whatever is facing them.
• 5:34
  SPEAKER_01: What's nice about the structure itself is that people have been using this somewhat universally across the United States and elsewhere, so that when your hospital is interacting with, for example, the police department or public health, or really anybody else who's involved in this response, the structures are similar.
• 5:53
  SPEAKER_01: So somebody who is the logistics chief within the fire department is using the same terminology, the same structure as your own hospital.
• 6:01
  SPEAKER_01: And so I think the most important aspect of the structure is the structure itself.
• 6:07
  SPEAKER_02: Yes, that is a really great point.
• 6:09
  SPEAKER_02: I think early on in my role as the director of infection prevention at my own hospital, I didn't understand what that role was.
• 6:17
  SPEAKER_02: And I still remember very clearly the first time I was called into my hospital's incident command center for an infectious disease-related emergency.
• 6:26
  SPEAKER_02: I walked into the room and I didn't know what the structure was.
• 6:30
  SPEAKER_02: So I didn't really understand initially what my role was.
• 6:34
  SPEAKER_02: Because it was never really clearly explained to me.
• 6:37
  SPEAKER_02: So, Christina, could you explain what actually does happen in the hospital command center?
• 6:43
  SPEAKER_03: Sure.
• 6:44
  SPEAKER_03: So it's interesting that you bring up that walking into a command center and not understanding your role because it can be very confusing at first.
• 6:52
  SPEAKER_03: It's not the same structure that you use for your day-to-day operations.
• 6:55
  SPEAKER_03: And that is very purposeful because the reason why we're opening a command center is because some part or even large parts of your daily operations don't work anymore.
• 7:04
  SPEAKER_03: And that's part of the first assessment that you know groups are making when they're looking at any kind of incident.
• 7:10
  SPEAKER_03: And that's the biggest question to me.
• 7:12
  SPEAKER_03: Can we use daily operations or part of daily operations?
• 7:14
  SPEAKER_03: And if you can't, or if you're not sure, a command center is set up so that you can, first of all, assess what it is that's going on.
• 7:22
  SPEAKER_03: And so generally when you walk into a command center, there's a large group of people there, um, you know, maybe halfway digging through some finders and maybe some buckets of supplies and trying to figure out how they need to organize.
• 7:35
  SPEAKER_03: And what they're really doing is they're trying to get a handle on what is this incident, what's happened, and how has it impacted our operations?
• 7:44
  SPEAKER_03: And how long is it going to last?
• 7:45
  SPEAKER_03: And they're asking all of these questions.
• 7:47
  SPEAKER_03: How long is it going to last?
• 7:49
  SPEAKER_03: You know, who's involved?
• 7:50
  SPEAKER_03: Who do we need to communicate with?
• 7:52
  SPEAKER_03: How are our patients and our members and their families being affected?
• 7:56
  SPEAKER_03: Do we have structural damage and or is this some kind of you know, IT outage where we've lost our medical health record?
• 8:02
  SPEAKER_03: So, how do we look at all of these things and try to get all of these answers?
• 8:07
  SPEAKER_03: Because we can't act on anything until we fully understand what's going on.
• 8:10
  SPEAKER_03: And so the biggest piece of the command center is the assessment and understanding what exactly it is that's happened, because the biggest part of that is one or two people can't really fully understand that.
• 8:22
  SPEAKER_03: You need to have a bigger group discussion with as many people as are impacted as possible, especially if they're the department managers or the leadership group, so that they can make a very quick and sometimes terse assessment of what it is that's happened and how it's impacted your organization.
• 8:36
  SPEAKER_03: And once that has become clear and that you've asked why, what, how, who, when, and the W questions enough times, what it is that you're supposed to be doing about it can be pretty easily illuminated.
• 8:49
  SPEAKER_02: That's a great overview.
• 8:50
  SPEAKER_02: Pratesh, can you share maybe one or two examples of being that person on call or that person who gets the first page that there may be a potential outbreak or exposure?
• 9:01
  SPEAKER_02: How do you decide who comes together to make that assessment?
• 9:05
  SPEAKER_02: And how do you decide that it is time to open your hospital command center?
• 9:10
  SPEAKER_01: That comes up a lot.
• 9:12
  SPEAKER_01: And our organization is fairly large.
• 9:15
  SPEAKER_01: And so one of the things that we've done to make it a little bit more nimble is that we have called a hikes assessment team call.
• 9:22
  SPEAKER_01: Basically, everyone who is a leader in a box can be called into a conference call.
• 9:26
  SPEAKER_01: And so when somebody is suspecting that there's an incident that could affect an area beyond just one small area, basically affecting multiple areas, it would not resolve within just an hour.
• 9:38
  SPEAKER_01: We will often call the call a hikes assessment team call so that everybody who is ahead of a box can weigh in on the call.
• 9:45
  SPEAKER_01: And sometimes we're able to just with that call itself, say, well, this may be easily dealt with with just a few people, and then those groups really take off with it.
• 9:55
  SPEAKER_01: Uh, but others are much more in-depth.
• 9:58
  SPEAKER_01: I think of an example within the last couple of months where uh we ran into some water issues, uh, and it was an issue with a well as it turned out.
• 10:07
  SPEAKER_01: But you know, the initial findings of of some dark water coming out of faucets, well, then we start thinking, well, this is this going to affect patient care areas.
• 10:17
  SPEAKER_01: And then you start thinking, well, how do we do dialysis without uh making sure it's it's clean water?
• 10:22
  SPEAKER_01: These sorts of things.
• 10:23
  SPEAKER_01: And it became obvious actually fairly quickly that we needed a very robust, system-wide response.
• 10:31
  SPEAKER_01: And at that point, we not only had the hikes assessment team call, but at that point we said, you know, we actually need to convene as hikes and have the big group meeting so that we can address all the issues, but also get our hands on what all the information is.
• 10:47
  SPEAKER_01: And so that incident turned out to be a three, three and a half day issue where we ended up, you know, shipping in actually all this bottled water and figuring out all kinds of logistic things, but also seeing how do we take care of patients, especially with thinking about dialyzing patients.
• 11:03
  SPEAKER_01: So this was these turned out uh to be a big deal that may not have initially alarmed, let's say, somebody in facilities, just they just see sediment, but that can be a much bigger deal, which is why you get a lot of people involved, and at least in the initial discussion, of how could this uh impact your institution?
• 11:20
  SPEAKER_02: When I think back to my own institution and my own situations where the incident command system had been activated, initially I would always assume it would be something major like that.
• 11:31
  SPEAKER_02: A huge uh pandemic or a flood or an exposure to measles or pulmonary tuberculosis.
• 11:38
  SPEAKER_02: But can the incident command system also be activated for less emergent outbreaks?
• 11:43
  SPEAKER_02: And if so, what would be the benefits in a situation like that?
• 11:47
  SPEAKER_02: Christina, could you speak to that?
• 11:50
  SPEAKER_03: Sure.
• 11:51
  SPEAKER_03: So one of the things that can be most confusing about the hospital incident command system is that because it's different from your daily structure, we don't get a lot of time to practice with it.
• 12:00
  SPEAKER_03: And so it's a good idea to open your command center even just to make that initial assessment and ask those questions, but you can use it to do contact tracing for even a small outbreak because it it serves the function well because it allows you to reorganize and you can have a very small command structure opened up with just an incident commander, maybe an operations chief and a planning chief, and then a couple of people who are working on uh the contact tracing to get all the information together so that you can work with your county or other local officials to quickly contain an outbreak that started out small that could end up being a lot bigger if if you aren't on top of it right away.
• 12:36
  SPEAKER_03: And so using that command structure allows you to first of all uh recognize that daily operations is not necessarily your best bet right now.
• 12:45
  SPEAKER_03: And it also allows the people that are involved to kind of reorganize and reorient uh how they're doing their work so that they can say, and they can reprioritize this is important because we are, we need to work quickly, we need to work succinctly, and we need to work in a slightly different organizational factor.
• 13:02
  SPEAKER_03: And so using a small command structure to do those things can delineate the fact that you're doing something different from your daily operations.
• 13:10
  SPEAKER_03: And it also allows you to say things like, tell your boss, hey guys, I can't do this meeting today because we're working on an important issue that should be over quickly, but we want to take the time away from our other functions that we're that we've been committed to in the hospital so that we can complete this work and work through our incident action plan, which is a part of what the planning section does, get the job done, turn it off, and go back to daily operations.
• 13:35
  SPEAKER_01: I can give a couple of examples.
• 13:38
  SPEAKER_01: Uh, in 2014, during the height of the Ebola outbreak in West Africa, healthcare systems across the country really were preparing for uh how what do you do if you see a patient, or how do you even know whether you're seeing a patient?
• 13:53
  SPEAKER_01: And for that, it was just such a major overhaul of our systems and sensing well what are the gaps and how do we communicate across a very large structure.
• 14:06
  SPEAKER_01: And so we actually activated our hospital incident command system during a, if you will, a non-event.
• 14:12
  SPEAKER_01: So as we were preparing to take care of a potential Ebola patient, and we activated hikes just because there was so much that needed to be done.
• 14:22
  SPEAKER_01: And as we finally got all the policies, procedures in line, we were able to deactivate.
• 14:28
  SPEAKER_01: And eventually we never actually saw a case, but it helped us to gear up for what we needed to do.
• 14:36
  SPEAKER_01: Now, there are incidents where we have had to actually activate hikes or in a smaller way fashion, our hikes assessment team, you know, if we are ruling out a patient for a high-consequence infectious disease, such as, for example, Middle East respiratory syndrome or something like measles, just because those sort of things not only require some special care, but can involve public affairs and other aspects.
• 15:02
  SPEAKER_01: And so for those situations, even when we're just ruling it out, often we'll activate hikes in some way, just so we can make sure that all the people who are involved know who else is involved and how do we interact and we can move quickly.
• 15:16
  SPEAKER_01: So it can range from a large event that you were just preparing for to a single patient and responding to that.
• 15:27
  SPEAKER_02: So, Prateesh, in those situations, who is the person in charge?
• 15:31
  SPEAKER_02: Who is the commander and how is that determined?
• 15:33
  SPEAKER_02: Does it depend on the specific situation?
• 15:37
  SPEAKER_01: So the question of who's in charge and who needs to be there are two different ones.
• 15:41
  SPEAKER_01: There's several different, if you will, boxes, different areas that are uh operationally important, each within the different groups, planning, logistics, etc.
• 15:50
  SPEAKER_01: And based on what the incident is, we have templates of if this is an information technology outage versus if this is a utility outage versus a high-consequence infectious disease or a trauma, these sort of things.
• 16:05
  SPEAKER_01: We have a template on really who needs to be there, which boxes need to be filled based on the type of incident.
• 16:11
  SPEAKER_01: So, of course, we can add or subtract as information comes in.
• 16:16
  SPEAKER_01: But the question about who is leading it, that's more about the incident commander.
• 16:20
  SPEAKER_01: And this is the incident commander is usually not somebody who knows the most about the situation itself, but knows uh the most about how hikes work.
• 16:33
  SPEAKER_01: And so we have a group of four incident commanders who are basically take turns being on call at any one time so that if there's an incident that comes up, they can help lead hikes in the information gathering and the operational elements.
• 16:52
  SPEAKER_01: I've seen this uh where institutions will you know pick their CEO or something to be the incident commander.
• 16:59
  SPEAKER_01: That's really not the right person.
• 17:01
  SPEAKER_01: You want somebody who's well versed in the structure, not somebody who is whose main function is to make the big institutional decisions or be involved with the policy discussions.
• 17:15
  SPEAKER_01: You really want your experts doing their expert thing.
• 17:18
  SPEAKER_01: And so the incident commander should be somebody who is expert in how hikes works, not necessarily a leader within your institution.
• 17:27
  SPEAKER_03: And the incident commander job can change, that it may start out that you have something that seems really big that turns out to be uh not so big, or maybe something that's not as impactful, but might be going on for a while.
• 17:39
  SPEAKER_03: And so you might want to have somebody who is more knowledgeable about the structure or the incident or both, who takes on that role rather than one of your leaders uh or one of the um other people that, you know, like the house supervisor who might need to be running the rest of the hospital.
• 17:55
  SPEAKER_03: And so you can scale it down and have somebody else take over that role so that you can be more targeted and more focused on solving the problem that you're faced with.
• 18:05
  SPEAKER_02: So, Christina, when you say that you scale down or in a situation that is more of a long-term incident command situation, such as the Ebola outbreak or a pandemic influenza season, what does that look like in terms of scaling down and having just those core people huddled?
• 18:23
  SPEAKER_02: Is it a daily huddle or is it a room that's going 24 hours a day?
• 18:28
  SPEAKER_02: Can you describe a little bit more how you scale up and down and are still able to strategize and solve the problem at hand?
• 18:36
  SPEAKER_03: So it depends on where you are, because if you're in a situation like you mentioned, that might be going on for you know several days, several weeks, several months, where you need to have somebody monitoring.
• 18:47
  SPEAKER_03: The biggest point about that is that you have an identified person or group who is on point to receive and uh deliver, develop communications around that event.
• 18:58
  SPEAKER_03: And so it's not that you want to have necessarily, depending on what it is, an entire room full of people that is sitting there working on this particular incident.
• 19:07
  SPEAKER_03: You may need a couple of people who have been designated as being incident commander and they're changing over shifts, or you've got a small group of people within the structure that are focused on that incident and they may meet once a day.
• 19:21
  SPEAKER_03: They may meet once a day on a bridge line, on a conference call or online so that they can look through their incident action plan, work through their objectives that day, you know, update each other and develop the communications that would go out to the rest of the organization.
• 19:35
  SPEAKER_03: And so I was involved in an incident with the California experienced a measles outbreak in 2015, and we had already had part of our command center structure activated to deal with Ebola.
• 19:48
  SPEAKER_03: We took a subgroup of the infectious disease experts and others, logistics and planning and operations, that were focused on Ebola, and we pivoted to face the measles outbreak.
• 20:00
  SPEAKER_03: And it was in several different counties in Northern California, as well as Southern California.
• 20:05
  SPEAKER_03: And the the difference between how the counties wanted contact tracing and communications to flow was significant.
• 20:10
  SPEAKER_03: And so our organization had to make sure that we had somebody on point for each one of those counties, but also somebody on point for the overall structure of the organization to collate, collect, and then redisseminate that information through the rest of the organization so that we could keep our policies and procedures constant and standard across the different groups and different geographic areas that were experiencing that measles outbreak.
• 20:36
  SPEAKER_03: And so we it was about, I think, six people total that worked for about six weeks, and the people traded in and out, and it was a daily phone call in the morning to discuss any updates, and then emails would be traded throughout the day.
• 20:50
  SPEAKER_03: And that may sound non-traditional for an incident command structure, but it was still using the basic principles.
• 20:56
  SPEAKER_03: There was an incident commander, we had a planning chief, we had an operations chief, and we had three different people who had various infectious disease, infection control, infection prevention expertise levels.
• 21:07
  SPEAKER_03: And so they were working together to make sure that we had all the bases covered with the contact tracing and any kind of response protocols.
• 21:15
  SPEAKER_03: And more importantly, what they were doing was that they were preparing to flex up if needed, that the if the measles outbreak had gotten bigger, we would have been able to take that structure, add more people to it, and continue on with an already established group.
• 21:31
  SPEAKER_02: That makes great sense.
• 21:33
  SPEAKER_02: I think it really highlights how the incident command system is there to help you.
• 21:38
  SPEAKER_02: It's a structure where at the top level in this type of a situation, you will have assistance and someone in the hospital system will find assistance for you.
• 21:49
  SPEAKER_02: As things change throughout the outbreak or the pandemic, the structure will also change.
• 21:56
  SPEAKER_02: How can clinicians and other infectious disease physicians Who work in infection prevention or infection prevention teams learn more about HICS and how it can help them.
• 22:09
  SPEAKER_01: Sure.
• 22:09
  SPEAKER_01: And in some facilities, the role of organizing incident command comes onto the infection prevention team.
• 22:20
  SPEAKER_01: If you will, because of outbreaks and things like that, in many hospitals across the United States, it is the infection prevention group that's sort of tasked with putting this together.
• 22:30
  SPEAKER_01: We recently, as part of the SHA CDC group, have an outbreak response training program that's available, as well as a guidance document on what it means, what all these terms are, why it was developed, and how it can help you.
• 22:49
  SPEAKER_01: There's training programs that are available, SHA and CDC putting these together and lots of information.
• 22:55
  SPEAKER_01: If you people are at a facility where it's done by emergency management, then infection prevention and control still forms a very important part, especially because many of the things that a hospital will need to respond to may involve infections.
• 23:10
  SPEAKER_01: And so whether faction prevention control is leading the emergency management efforts or are an important piece of it, it is important that people involved in the faction prevention control are familiar with their institutional responsibilities with regard to emergency management.
• 23:33
  SPEAKER_02: Christina, from the eyes of an emergency manager, are there any other helpful resources that clinicians or others involved in infection prevention and outbreak management learn more about the incident command system?
• 23:48
  SPEAKER_03: I think the best way to do it is to contact whoever is, first of all, contact whoever it is that's in your organization that's responsible for it.
• 23:56
  SPEAKER_03: So whether you have an emergency manager or not, you have probably have somebody who is tasked with emergency management in your hospital or in your organization and reach out to that person and find out when their next HICS training, hikes training, um, incident command structure training is, and more importantly, when the next exercise is.
• 24:16
  SPEAKER_03: And sometimes, you know, hospitals are required to exercise multiple times during the year.
• 24:22
  SPEAKER_03: And so it's uh, and it's never fun, honestly, to have to walk into a real incident and try to learn on the fly.
• 24:28
  SPEAKER_03: So even if it's a drill that has nothing to do with infectious disease, you can learn the structure and understand how incident command works at its basic level through any kind of scenario through an exercise.
• 24:40
  SPEAKER_03: So certainly contact your local emergency manager, and then there's a number of online sources.
• 24:45
  SPEAKER_03: The outrage response training program has an incident command module with it.
• 24:50
  SPEAKER_03: And then the other place that I like to go is the California Emergency Medical Services Authority's website where they have all of the hospital incident command system materials archived and downloadable in word form so that you can get right to it and start, you know, looking through those different materials.
• 25:08
  SPEAKER_03: There is the job action sheet, which is the primary tool.
• 25:11
  SPEAKER_03: Each box in the incident command system has a job action sheet that describes that role would want to fill.
• 25:18
  SPEAKER_03: And there is one for infection control, infection prevention.
• 25:21
  SPEAKER_03: And I think there's actually also a separate one for infectious disease.
• 25:24
  SPEAKER_03: And so you can bring in those expert people and have them look over those job action sheets before they get into a command center situation.
• 25:33
  SPEAKER_03: And so they can preview those online or um from your local emergency manager because they're ultimately meant to be tailored according to what your organization's needs are.
• 25:42
  SPEAKER_03: Because as I think it's been brought up a couple of times, most people wear different hats and multiple hats at the same time.
• 25:48
  SPEAKER_03: That it's very rare that you get to have people working in their single one completely focused area of expertise.
• 25:55
  SPEAKER_03: That's the ideal situation.
• 25:56
  SPEAKER_03: But if you're in, you know, if it's two in the morning and you're at a small hospital, uh, you're probably gonna be doing multiple things in the command center if you need to activate it.
• 26:05
  SPEAKER_03: And so looking through those job action sheets and just kind of understanding, especially the mission statement that's at the top of each one of those gives you a very clear direction on what that particular position is going to be doing.
• 26:15
  SPEAKER_03: And so if you have to combine them or wear several hats and do multiple positions within a command center, then you have an idea of what why those things are separated out into their different functions and what the primary uh goals and tasks of each one of those positions are.
• 26:30
  SPEAKER_03: But certainly getting involved in any exercise is a great way to meet the people that are doing this work locally and then get involved so that you can understand or have a beginning of an understanding of what it is that the command system does and how it functions for your hospital.
• 26:46
  SPEAKER_03: And then once you've got a bit of a handle on that, take it back to your colleagues, to your department, to your manager, to your reportees, and throw an exercise.
• 26:57
  SPEAKER_03: Have a really quick scenario of, you know, five minutes.
• 27:00
  SPEAKER_03: Hey guys, we just had a huge flood in the basement.
• 27:02
  SPEAKER_03: How would that impact our department?
• 27:04
  SPEAKER_03: What would we need to do next?
• 27:06
  SPEAKER_03: Let's just play what if for five minutes at a department meeting and just get everybody thinking about it.
• 27:10
  SPEAKER_03: And then at the end of that, you can come up or go back to them and say, if you're curious, here's when our next exercise is.
• 27:16
  SPEAKER_03: If you'd like to be involved, you know, shadow the planning chief so that you have the opportunity to follow up and to continue practicing because it's all about the experience that you have and the opportunities that you have to be in a command center, whether it's an exercise or an event, and so that you can walk into the command center when it's real and when something serious is going on, and you have at least a basic idea of what it is that's going on in that room.
• 27:41
  SPEAKER_02: That is such great advice to be part of an exercise before you're part of a true activation of incident command system.
• 27:49
  SPEAKER_02: I also wanted to make sure that all of the listeners were aware of the ORTP resources, which both Christina and Pratesh have mentioned.
• 27:58
  SPEAKER_02: That's the Outbreak Response Training Program where all of the resources can be found at ortp.org.
• 28:08
  SPEAKER_02: At the ORTP website, you can find all sorts of resources, including the webinar that Christina mentioned.
• 28:15
  SPEAKER_02: There are three archived webinars by experts in the field.
• 28:19
  SPEAKER_02: There's also online interactive simulation models, which focus specifically on hospital incident command systems.
• 28:27
  SPEAKER_02: You'll also find an extensive journey expert guidance document, which provides an overview and details of outbreak management.
• 28:35
  SPEAKER_02: And last but certainly not least, the website also includes an expert guidance toolkit.
• 28:41
  SPEAKER_02: And the toolkit has downloadable, fillable checklists, direct reference links, and other useful tools for hospital epidemiologists to manage outbreaks and other hospital emergencies.
• 28:53
  SPEAKER_02: So everyone should be sure to check that out.
• 28:56
  SPEAKER_02: And of course, all of these references are available open access and free of charge.
• 29:02
  SPEAKER_02: Christina and Pratesh, thank you both so much for a really great conversation.
• 29:07
  SPEAKER_02: I've learned so much about the usefulness of the hospital incident command system.
• 29:11
  SPEAKER_02: And you both have highlighted so many scenarios where it can be applied.
• 29:16
  SPEAKER_02: Thank you so much for talking about this today.
• 29:19
  SPEAKER_01: Thanks for the invitation.
• 29:20
  SPEAKER_03: Thank you very much.
• 29:34
  SPEAKER_00: To learn more about Shay's work in outbreak preparedness and response, visit www.shay-online.org.