Incident management: where the EMT fits in the command system
One commander, one boss each, staging, plain language, and unified command
A two-car crash with one patient needs no organization chart. A bus rollover, an apartment fire or a tornado does. When many crews from many agencies arrive at one scene, somebody has to decide who does what, or everybody does the same thing and the rest goes undone. The incident command system (ICS) is the standard answer in the United States. It is part of the National Incident Management System.
The rules that make it work
- One incident commander. One person is in charge of the whole incident. On a small call that person may also be doing patient care. On a large one they do nothing but command.
- Unity of command. Every responder reports to one supervisor and takes assignments from that one person.
- Span of control. One supervisor can manage roughly three to seven people, with five as the usual target. Past that, the job is split.
- Plain language. No ten-codes and no agency slang on the radio. Crews from other towns do not share your codes.
- It grows and shrinks. Only the positions the incident needs are filled.
- Accountability. Command knows who is on scene, where they are and what they are doing.
If you are first on scene
The first unit to arrive is in command until someone takes it over. If that is your ambulance, do not dive into the first patient you see. Do these things instead:
- Stop where you can see the scene and are out of danger.
- Give a short size-up on the radio: what you see, about how many patients, and what hazards.
- Say that you are establishing command, and name it, for example "Main Street Command".
- Ask for the help you think you will need, and say where you want it to stage.
- Start triage, or assign your partner to it.
When a supervisor or chief officer arrives, command is transferred face to face if at all possible, with a short briefing: what happened, what has been done, who is assigned where, and what is still needed. Then it is announced on the radio so everyone knows who is in charge now.
Staging, and why you wait there
Staging is a named place, away from the scene, where arriving units park and wait for an assignment. When you are sent to a working incident, you go to staging, check in with the staging officer, and wait there for an assignment. You do not drive to the scene because you can see where the work is. That is called freelancing. A freelancing crew creates confusion and safety problems for everyone else working the scene.
The EMS side of the chart
On a large medical incident, command usually sets up a medical group or EMS branch. Under it are the jobs you are most likely to be handed: triage (sort the patients), treatment (care for them in the treatment area), and transport (load them, track them and spread them among hospitals). A safety officer watches for hazards and can stop any unsafe action on the spot. Whatever your assignment, you report to the person who gave it to you, you finish it, and you report back for the next one.
Unified command
Some incidents belong to more than one agency at once. A shooting is a police scene and an EMS scene. A chemical spill on a highway belongs to fire, police, EMS and perhaps the state. In unified command, the leaders of the agencies with responsibility stand together at one command post and agree on one set of objectives and one plan. Each still directs their own people. Crews on the ground still have one supervisor each, and they hear one plan instead of three.
Check in, take one assignment from one supervisor, do it, and report back. If you are first in, size up, name command and call for help before you touch a patient.
Position titles, vest colors, radio channels and staging procedures differ between regions. Your local incident plans, your protocols and your medical director govern real practice. FEMA's online independent study courses on ICS are the usual formal training, and your agency will tell you which ones it requires.