Responding to disaster: Form and function of a pharmacy incident command structure

Abstract

In March 2020, the World Health Organization characterized coronavirus disease 2019 (COVID-19), caused by the novel SARS-CoV-2 coronavirus, as a global pandemic. At that time, Yale New Haven Health (YNHH) deployed its system incident management (SIM) structure to oversee systemwide pandemic response efforts. YNHH hospitals utilize the hospital incident command system (HICS), a comprehensive incident management system used to manage threats, planned events, or emergency incidents. The HICS is based on the same principles as the incident command system (ICS) component of the National Incident Management System (NIMS), issued by the US Department of Homeland Security. The ICS is a standardized approach to the command, control, and coordination of incident management utilized by all levels of the US government and many organizations in the private sector. The ICS provides a common hierarchy within which personnel from multiple organizations can operate effectively and specifies an organizational structure for incident management that integrates and coordinates a combination of procedures, personnel, equipment, facilities, and communications. The HICS, an adapted version of the ICS for the healthcare setting, is a versatile and scalable system that can be used by all hospitals, regardless of size, location, patient acuity, patient volume, or type of incident. The YNHH incident response system will be referred to here as the SIM-HICS, as each hospital in the system operates a local HICS with system-level oversight provided by SIM, the unified command structure for the overall healthcare organization. The YNHH pharmacy enterprise provides services to 2,475 licensed inpatient beds across 7 hospitals, ambulatory hospital clinics, and an expansive cancer care center network. These areas are operationally served by 7 traditional inpatient pharmacies, 2 service line–oriented inpatient pharmacies, and additional sterile product preparation facilities serving the cancer care center network. In addition to inpatient and clinic operations, the pharmacy enterprise also provides outpatient, specialty, and home infusion pharmacy services. The pharmacy workforce comprises approximately 800 team members and is led by the chief pharmacy officer and pharmacy directors in service line– and site-specific roles. This consultation aims to share the methods of forming a pharmacy incident command structure (PICS) and its functions, which promote integration with health-system incident response efforts while also meeting the unique needs of the pharmacy enterprise. Colleagues have recently published information about the PICS in reports describing specific processes, initiatives, and outcomes of select teams collaborating within this structure. This consultation intends to describe the formation of the PICS, the roles and responsibilities of participants, and integration with healthsystem response efforts.