The ICS template was adapted for use in the early 1990s by hospitals in California during multiple earthquake incidents that directly affected their services. The model known as the Hospital Emergency Incident Command System (HEICS) has been deemed a best practice and has been required by The Joint Commission for several years. Now federalized and replicated across the country, ICS has been expanded and integrated into the National Incident Management System (NIMS) and is increasingly being required by regulatory agencies for funding and minimum standards. Using a systematic approach, NIMS integrates the best of existing processes and methods into a unified national framework for incident management. This creates optimal interoperability across multiple disciplines. ICS has even spanned the globe with versions in New Zealand, Australia and Canada and recently the United Nations recommended ICS use as the international standard.

ICS basics

The foundational principles of ICS—dependable chain of command, common terminology, focused objectives, prioritized actions, flexibility, integrated communications and manageable spans of control have been shown to improve outcomes, regardless of the size or scope of the incident. This is accomplished by focusing priorities in 5 functional sections—Command, Operations, Planning, Logistics and Finance. In the HEICS model, this is further broken down into 2 main components—the organizational chart and specific job action sheets for every position with immediate, intermediate and extended actions. In both systems, checklists and templates have been created to further improve accuracy and efficiency in an almost any setting from an all-hazards perspective.

AMEICS

While very useful to date, there are clearly nuances in the air medical realm that ICS and HEICS do not specifically account for, particularly when the incident involves an air medical program in crisis, such as in the case of an overdue aircraft. The Commission on Accreditation of Medical Transport Services (CAMTS) requires very specific plans and actions for such occurrences; however, these are generally program specific and can be cumbersome to integrate into the non-ICS world of aviation, especially in programs that cover large territories with varying jurisdictions and air space or even international considerations. Many of the reasons ICS become the gold standard, exist in air medical with regards to MCI and post accident/incident plans (PAIP) response. Opportunities exist to improve accountability, communications, terminology, systematic planning and inter-agency adaptation. The Air Medical Emergency Incident Command System (AMEICS; pronounced “AM-icks” for short) has taken the best of ICS and HEICS and tailored it for air medical use. The pearl of AMEICS is in its flexibility—that it can be used to dove-tail into existing ICS formats for MCI and disaster or can stand alone to augment a PAIP situation. Similar to HEICS, AMEICS has a standardized organizational chart and job action sheets that can be replicated and customized for any program.
In AMEICS there are five functional color-coded sections—Command (black), Operations (red), Planning (blue), Logistics (yellow), and Finance (green). Like ICS, AMEICS is a framework; a tool. It is not a ready made PAIP plan or step-by-step process. (See figures 1 and 2 for organizational chart and sample job action sheet).

East meets West

The combined efforts of two teams were optimized in the creation of and final versions of AMEICS. Program representatives from Carilion Clinic Patient Transportation and AIRLIFE Denver shared draft versions of their AMEICS plans over the past year. The plans were modified on both ends before settling on the current adaptation. Carilion and AIRLIFE Denver deployed AMEICS at about the same time. Implementation included training for program leaders and general team orientation. Both programs chose to augment their system with “AMEICS kits.” Boxes are stored in the “command centers” (not necessarily the communications center) of each program that contain color-coded folders with pre-printed job action sheets, paper, pens, maps, name badges with AMEICS titles, and other items that may be needed in a PAIP or large scale incident situation. Comparing kit composition proved helpful in that each program added additional items based on review of the others contents. AIRLIFE Denver leaders carry electronic editions of the AMEICS and PAIP plans on their PDAs and have pre-printed “brief case” versions in their private vehicles and in the company response vehicle. At Carilion Clinic, leaders carry pre-printed PAIP/AMEICS plans and all documents are electronically available.

Last year, representatives from AIRLIFE Denver traveled to Carilion to watch an unannounced PAIP drill take place. While Carilion Clinic leaders and team demonstrated their PAIP plan and use of AMEICS in a full-scale fashion, AIRLIFE Denver representatives observed, evaluated and interjected variables. Once the drill concluded and was debriefed, representatives from both programs discussed further opportunities and modified the AMEICS model. Earlier this year, Carilion Clinic leaders returned the favor by evaluating a full-scale PAIP activation at AIRLIFE Denver. The interactive sessions at both programs proved valuable for all participants. Again the documents were modified and finalized into the format that stands today.

Testing AMEICS in the real world

Since implementing AMEICS, both programs have had the opportunity to use their AMEICS plans in real situations. While it is difficult to measure its impact, the proven ICS backbone of AMEICS delivers clear command, consistent terminology, improved communication and prioritized objectives and actions. Pre-determined roles and notification trees improved communication. Pre-printed forms and standardization improved documentation and ensured accuracy. In every case, incident debriefings identified further program enhancements and continued customization of the AMEICS model such as the implementation of the PDA versions and AMEICS kit additions.

Available Resources

The Carilion and AIRLIFE Denver teams are proud of AMEICS and of the cooperative relationship that continues to improve processes at both programs. Our purpose in sharing AMEICS with the larger air medical and critical care transport community is to augment existing initiatives regarding safety and preparedness and to foster regional planning. We offer the AMEICS documents and templates in the spirit of continuous improvement while seeking best practice reaction. All materials are available on their websites and future updates will be on this website.