Hospital Resources

Why Hospital Resources Matter in All-Hazards Preparedness

Hospitals occupy a unique position in any disaster or public health emergency. They are simultaneously the destination for the sick and injured, a potential source of surge demand, and — in events like infectious disease outbreaks or mass casualty incidents — a resource that can itself become overwhelmed. For preparedness coordinators, emergency managers, and public health professionals, having the right reference materials on hand is not a bureaucratic nicety; it is the difference between a coordinated response and a chaotic one.

This page collects the core hospital-focused resources that the Center for Preparedness Education recommends and maintains. It centers on the Hospital Incident Command System (HICS) — the framework that most U.S. hospitals use to organize their emergency response — along with adaptations for smaller facilities and the job aids that make the system usable in real time. Teams looking for formal instruction in the framework can compare hospital incident command system hics training options before their next exercise.

Key Takeaways

• HICS is the hospital-specific adaptation of the Incident Command System (ICS), and it is the backbone of hospital emergency management in the United States.
• The Fifth Edition of HICS was released by the California Emergency Medical Services Authority (EMSA) on May 30, 2014, and remains a widely used reference for hospital incident command.
• Small and rural hospitals often cannot staff a full ICS structure, so scaled-down job action sheets and a simplified IMT chart are essential tools.
• Job aids for command staff, general staff, and medical-technical specialists translate the framework into actionable checklists during an incident.
• The Center for Preparedness Education maintains these documents and can answer questions about how to apply them in your facility.

Understanding HICS and Its Place in Hospital Emergency Management

The Hospital Incident Command System is a standardized, all-hazards incident management framework designed specifically for the healthcare environment. It adapts the broader Incident Command System (ICS) — the management system used across fire, EMS, law enforcement, and public health — to the realities of a hospital: clinical priorities, patient care continuity, regulatory obligations, and the need to coordinate with external agencies like emergency management and public health departments.

HICS gives hospitals a common language and a common organizational chart. When a hospital activates HICS, it establishes a defined command structure with an Incident Commander, a Command Staff (Public Information Officer, Safety Officer, Liaison Officer, and often a Medical/Technical Specialist), and a General Staff organized into Operations, Planning, Logistics, and Finance/Administration sections. This structure scales up or down depending on the size and duration of the event.

The value of HICS is not the paperwork — it is the predictability. When a mass casualty incident, a hazardous materials release, or a novel infectious disease arrives at the emergency department door, staff who have trained on HICS already know who is in charge, where information flows, and how resources are requested. That familiarity reduces the cognitive load during the highest-stress moments of a response.

The framework is maintained and periodically revised. The Fifth Edition of the HICS materials was officially released by the California Emergency Medical Services Authority (EMSA) on May 30, 2014.

EMSA has historically been the steward of the HICS documents, and the Fifth Edition package includes the core guidance, the incident response guides, the job action sheets, and the associated forms. You can access the current materials through the EMSA HICS page at http://www.emsa.ca.gov/HICS — select the red “Click Here” link on that page to reach the download area.

It is worth noting that HICS is not the only framework hospitals may encounter. The National Incident Management System (NIMS), maintained by FEMA, provides the overarching doctrine that HICS aligns with, and the Joint Commission emergency management standards require hospitals to use an incident command approach.

HICS satisfies both because it is built on the same ICS principles. For a broader grounding in the national framework, see the FEMA National Incident Management System resources.

HICS for Small Hospitals

One of the most common practical problems in hospital preparedness is that the full HICS structure assumes a certain depth of staffing. A large academic medical center may have dedicated emergency management staff, a safety department, and enough administrators to fill every ICS position. A critical access hospital in rural Nebraska or Kansas may have a single emergency manager — or a nurse manager wearing that hat part-time — and cannot possibly staff a full Command and General Staff.

That is why the Center for Preparedness Education maintains a set of HICS adaptations for small hospitals. These materials recognize that in a small facility, one person may hold multiple roles, and the incident command structure must be flattened without losing the essential functions.

The small-hospital resources include:

• HICS Job Action Sheets for Small Hospitals — condensed versions of the standard job action sheets that combine or eliminate positions that a small facility cannot fill, while preserving the critical decision points.
• Small Hospital IMT Chart — a simplified Incident Management Team organizational chart that shows how a lean team can cover command, operations, planning, logistics, and finance with fewer people.
• Med-Techs Job Aids — quick-reference aids for medical-technical specialists, who in a small hospital may be the same clinicians providing patient care.
• Command Staff Job Aids — practical checklists for the Incident Commander, Public Information Officer, Safety Officer, and Liaison Officer.
• General Staff Job Aids — checklists for the Operations, Planning, Logistics, and Finance/Administration section chiefs.

The guiding principle for small hospitals is functional coverage over positional fidelity. You do not need a person titled “Planning Section Chief” if the same individual can perform the planning function under a different title. What you cannot skip is the function itself — someone must track the incident action plan, someone must manage resources, and someone must account for costs.

How to Decide Which Structure to Use

When choosing between the full HICS structure and a small-hospital adaptation, consider these criteria:

Factor	Full HICS Structure	Small-Hospital Adaptation
Staffing depth	Enough personnel to fill distinct ICS roles	Limited staff; roles must be combined
Event duration	Prolonged incidents requiring shift rotation	Short-duration or single-operational-period events
External coordination	Multiple agencies, unified command likely	Limited external partners
Documentation burden	Full IAP, situation reports, and forms	Streamlined documentation
Training level	Staff trained in specific ICS positions	Cross-trained generalists

A useful rule of thumb: if you can staff the positions and the incident will span more than one operational period, use the full structure. If you cannot, use the adaptation — but document which functions are being combined and by whom, so that accountability is preserved.

Job Aids: Turning the Framework into Action

Job action sheets and job aids are where HICS stops being an org chart and starts being a tool. A job action sheet lists, in roughly chronological order, the tasks a person in a given position should perform during an incident — from initial activation through demobilization. A job aid is a shorter, often one-page reference that distills the most critical actions and reminders.

The Center maintains job aids across three broad