Over on the Mortar Attack thread, Matt (Polak187) was getting feedback from an accident:

"I know that it is easier said than done but there must be someone in control of the situation. And some people are leaders and some are followers but the follower must be ready to pick up the ball when leader fails. They told me that there were many different agencies on scene and everyone wanted a piece. Now since it wasnt a crime scene or a fire scene, medical services are in charge of the patient. So they should have been in charge and get their point accross."

So this is mostly a question for Matt, plus anyone else that is in the EMT/fire/police business:

Don't you use the Incident Command System that was (I think) created in the 1970's? It seems an incredibly useful system, but from what I hear, there are still a lot of screwups because it isn't followed. I don't know if it's due to ego trips, showboating, posing for the media, or what.

The following is from a website that describes the system (heavily edited):

"ICS allows multiple agencies over multiple jurisdictions to work together and actually accomplish something useful.
Notice that the word “Command” is part of the name of the system. You have to take command early. How the first five minutes go can determine how the next five hours will go, and how those five hours go can determine how the next five days go.

"The ICS is based on three principles: First, somebody has to be in charge. One person.

"Second, No one can keep everything in their head. In fact, experimental evidence (confirmed by years of experience) is that one person can direct three to seven others with five people being optimum.

"Third, no man can serve two masters. You only get orders from one person, and you know who that person is.

"Smallest incident, at a minimum, there’s always an Incident Commander. There’s always an Incident Command Post, and there’s always a Staging Area. Largest incident: There’s still one Incident Commander, in one command post. His or her identity is known to everyone, and that person is only getting reports from, and giving orders to, a bare handful of subordinates. Each of those subordinates is getting information from, and giving orders to, three to seven subordinates.

"Everyone reports to just one person (and knows explicitly who that person is) and commands just a few subordinates. And so on, down the line.

"Who’s the incident commander? The first responder on scene. As other responders arrive, the Incident Commander may change, but everyone still knows who it is.

"Authority can be delegated. Responsibility cannot.

"Information and orders move up and down the chain, not side-to-side. The folks who are providing treatment don’t go off freelancing scrounging the supplies they need—they ask up the chain, supplies are provided, as available and in order of priority.

"The idea is to maximize efficiency and minimize confusion in a chaotic, fast-moving situation."

The whole thing can be found at
http://www.nifc.gov/fireinfo/ics_disc.html

Sue

Susan,
I don?t usually drop into ?Around the Campfire? but I was giving a heads up on your questions? and I just happened to be spending the day updating a PowerPoint Presentation on this very topic.

I work for a fire department that is part of the Phoenix Metro Automatic Aide System. This system is very uncommon, where the closest appropriate unit goes regardless of jurisdiction? period! My Paramedic/Engine Company answers over 70% of our calls in other cities than our own. On a simple house fire we can have battalion chiefs from two different cities, three engine companies each from a different city and a ladder from a forth city! Add PD, utilities, and an ambulance from private ambulance company and we have a cornucopia of agencies on scene! And it all works seamlessly more often than not. An effective ICS is only one hurdle in making this happen, but it is an important one.

Organizing numerous resources at an incident doesn?t begin with the ICS, it ends with it. Before ICS can work on a call some other issues have to be address before it can be implemented effectively. First, all the agencies have to be on the same page? all of them. This is often easier said than done. Each involved agency must have common communications, common policies and procedures (where appropriate), common terminology and radio codes, and joint training on the ICS. In addition, every member from the most senior officer to the newest boot needs to buy into the system completely! If everyone is on the same radio system using the same policies that they have trained on together ICS works? but it can still fail if not done properly.

I have seen the ICS fail, I have caused the ICS to fail <img src="/images/graemlins/blush.gif" alt="" />? Where I have seen it fail the most is with departments and communities where the agencies can?t get along well enough to make things work. And departments with young members with inadequate supervision and low call volume.

Here are links to my Presentation in
PPT format and PDF Format

San Mateo County, California has done away with jurisdictional boundries for fire and medical response. The closest units go. ICS (now called NIMS--National Incident Management System) is practiced on every call. Even a simple medical aid call, the engine goes "on scene" on the radio and initiates the "Main Street Command, Captain Jones is the Incident Commander". Police have caught on to this too, and like it, especially at a fire or rescue call. BTW, NIMS is required for Federal Disaster reimbursement. FEMA's web site even has on-line courses for all levels. If you are interested in listening to San Mateo County's fire radio traffic, point your browser to www.firedispatch.com.

Although ICS is part of NIMS, they are not one in the same. The goal of NIMS is to allow responders from all jurisdictions and agencies to interact with each other effectively and efficiently. Checkout FEMA's
NIMS Website for more information... Funnily enough NIMS is what I have been adding to my Presentation <img src="/images/graemlins/smile.gif" alt="" />

"...the closest appropriate unit goes regardless of jurisdiction? period!"

As opposed to the local system here... <img src="/images/graemlins/mad.gif" alt="" /> A few miles away from me, there is a firehouse. It's jurisdiction ends at their property line on the north side, so if the building next door catches fire, all they can do is stand there and watch. Is that stupid or what?

But I'm glad some other places are getting their respective acts together. Maybe someday they will all be working like that. <img src="/images/graemlins/smile.gif" alt="" />

Sue

That, unfortunately happens all over the country. It comes down to politics interfering with public safety <img src="/images/graemlins/mad.gif" alt="" />!

TECHNICALLY, all agencies that get Federal Funds (read - all of them) are supposed to use the ICS - and it was one of the failures pointed out by the 9/11 commisiion

NYC has a fairly complex set of rules RE ICS - the rules of which agency supplies the Incident Commander run about 1/2 page last I saw them - it can be summed up as Crime Scene = Police, Fire Scene = Fire, Medical = EMS, Some of the others become Highway Dept, or OEM, or DEP (water main breaks)

The REAL fun is when you have a fire scene that might be arson, or a crime scene that has a fire - Let me put it this way, there is a TAD of anomosity between the NYPD and FDNY (and the other way around) - There have been fisticuffs, Firemen arrested, etc

Incident Command System is used in NYC and it doesn't make anyone happy. But the way it works is as follows...

ICS is used during Multi Casualty Incident (MCI). Whatever MCI is can vary from time to time but usually for our purposes it is more than 5 patients. If the scene is fire related than things are pretty simple since only two agencies have to work together (medical and fire branch). Things get complicated when crime is involved and now you have another agency comming on scene that is totally ignorant of the other two. This is where arguments begin: since this is a crime scene than police should be in charge but there is also fire involved so fire dept should take over. In theory ICS works like a charm but in practice it is a big headache. Dont get me wrong it works better than nothing but before all the gears start turning you have this initial time when chaos rages. Every agency is on different frequencies and everyone wants to be a hero.

So in theory:
Four alarm fire happens. Fire company gets dispatched and few ambulances. Firemen fight fires and their Lt. is in charge until Capt arrives and sets up Incident Command Post. First on scene Lt usually will stick with the Capt since by now he is the most informed person on scene. First ambulance becomes medical traige and determines priority of transport for pts and supervises proper transfers. Ambulances that arrive later provide treatment. Police secures the scene. Guy in charge delegates Lts who take care of transport, communication, supplies and other important stuff. This should be set up asap but it may take few hours and until than everyone is running around like chickens with their heads cut off.

Now this is for the city. Probably the best ICS I've ever seen is at JFK airport where I moonlight. Why? Because Police, Fire Dept and Medical Agency belong to Port Authority Police Dept and they train and work together.

In conclusion: system works but it has a slow onset and that's what causes the biggest toll on patients, bystanders and rescue personel. If all people working together were willing to put their egos on the sidelines than everything would be fine. Press doesn't help either when they single out one agency to get a credit omiting others.

I am involved with EMS/Fire and SAR. In my area (cornfield county Illinois) I have seen ICS both work and fail. I have also seen NIMS starting to get used more. In my area there are always jurisdictional battles it seems. One of the big problems is that is no one administrator over police, fire, ems, SAR (too many bosses) We have all trained on it numerous times. I believe it has to originate from the top.

One of our local fire chiefs, when there is a major incident, does not go to the command post. He lets the BC remain the IC. Instead, he establishes an "observation post", where he and the mayor and the press and others who want to be in on the action, but would only be in the way are allowed to gather. He will listen to the radio traffic, translate it for the elected officials and the media, explain why things are being done in a certain way, etc. Privately, he will admit that his BC's are better trained and equipped to handle incidents than he is, and he feels that his role is to keep people out of the way of his people who are actually doing the work.

Also, at least in California, the press is allowed inside any emergency scene (provided they are advised of possible dangers) except for a crime scene. So, fire will usually request police to respond and declare a "possible crime scene" to keep the media back. After all, one never really knows if that school bus accident was a crime or not until long after everyone is transported and the bus is towed away. <img src="/images/graemlins/cool.gif" alt="" />