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Appendix D: Glossary

Medical Surge Capacity and Capabilities (MSCC) Handbook

Adequate: Denotes the quality or quantity of a system, process, procedure, or resource that will achieve the relevant incident response objective.

Area Command (Unified Area Command): An organization established (1) to oversee the management of multiple incidents that are each being handled by an ICS organization, or (2) to oversee the management of large or multiple incidents to which several Incident Management Teams have been assigned. Area Command has the responsibility to set overall strategy and priorities, allocate critical resources according to priorities, ensure that incidents are properly managed, and ensure that objectives are met and strategies followed. Area Command becomes Unified Area Command when incidents are multijurisdictional. (adapted from NIMS)

Assignments: Tasks given to resources to perform within a given operational period that are based on operational objectives defined in the IAP. (adapted from NIMS)

Chief: The Incident Command System (ICS) title for individuals responsible for command of the functional ICS Sections: Operations, Planning, Logistics, and Finance/Administration. This group is collectively referred to as the General Staff.

Command Staff: In an incident management organization, the Command Staff consists of the Incident Command and the special staff positions of Public Information Officer, Safety Officer, Liaison Officer, and other positions as required (such as Senior Advisors). Special staff positions report directly to the Incident Commander and may have an assistant or assistants. (adapted from NIMS)

Complex Medical Incidents: Events where the victims have unusual medical needs or require medical care that is not readily available. These medical needs may be very difficult to adequately define or address without specialized expertise, even with only a few casualties.

Contingency Plan: Proposed strategy and tactics (often documented) to be used when a specific issue arises or event occurs during the course of emergency or disaster operations.

Disaster ("Major"): As defined in the Robert T. Stafford Act, a "major disaster" is any natural catastrophe (including any hurricane, tornado, storm, high water, wind-driven water, tidal wave, tsunami, earthquake, volcanic eruption, landslide, mudslide, snowstorm, or drought), or, regardless of cause, any fire, flood, or explosion, in any part of the United States, which in the determination of the President causes damage of sufficient severity and magnitude to warrant major disaster assistance under this Act to supplement the efforts and available resources of States, local governments, and disaster relief organizations in alleviating the damage, loss, hardship, or suffering caused thereby.

Emergency (Federal): As defined in the Robert T. Stafford Act, any occasion or instance for which, in the determination of the President, Federal assistance is needed to supplement State and local efforts and capabilities to save lives and to protect property and public health and safety, or to lessen or avert the threat of a catastrophe in any part of the United States.

Emergency Management: Describes the science of managing complex systems and multidisciplinary personnel to address emergencies or disasters, across all hazards, and through the phases of mitigation, preparedness, response, and recovery.

Emergency Management Program (EMP): A program that implements the organization's mission, vision, management framework, and strategic goals and objectives related to emergencies and disasters. It uses a comprehensive approach to emergency management as a conceptual framework, combining mitigation, preparedness, response, and recovery into a fully integrated set of activities. The "program" applies to all departments and organizational units within the organization that have roles in responding to a potential emergency. (adapted from NFPA 1600 and the VHA Guidebook, 2004)

Emergency Operations Center (EOC): The physical location from which the coordination of information and resources to support domestic incident management activities normally takes place. The use of EOCs is a standard practice in emergency management and is one type of Multiagency Coordination Center (MACC). The EOC is used in varying ways at all levels of government and within private industry to provide coordination, direction, control or support during emergencies.

Emergency Operations Plan (EOP): The "response" plan that an entity (organization, jurisdiction, State, etc.) maintains for responding to any hazard event. It provides action guidance for management and emergency response personnel, during the response phase of Comprehensive Emergency Management.

Emergency Support Function (ESF): As defined in the National Response Plan, an ESF refers to a group of capabilities of Federal departments and agencies to provide the support, resources, program implementation, and services that are most likely to be needed to save lives, protect property, restore essential services and critical infrastructure, and help victims return to normal following a national incident. An ESF represents the primary operational level mechanism to orchestrate activities to provide assistance to State, Tribal, or local governments, or to Federal departments or agencies conducting missions of primary Federal responsibility.

Exceptional: Refers to unusual numbers or types of victims, impacted medical care systems, or other very adverse conditions.

Federal: Of or pertaining to the Federal Government of the United States of America.

Finance/Administration: The ICS functional area that addresses the financial, administrative, and legal/regulatory issues for the incident management system. It monitors costs related to the incident, and provides accounting, procurement, time recording, cost analyses, and overall fiscal guidance.

First Responder: Refers to individuals who in the early stages of an incident are responsible for the protection and preservation of life, property, evidence, and the environment, including emergency response providers as defined in Section 2 of the Homeland Security Act of 2002 (6 U.S.C. 101). It includes emergency management, public health, clinical care, public works, and other skilled support personnel (e.g., equipment operators) that provide immediate support services during prevention, response, and recovery operations.

Functional Area: A major grouping of the similar tasks that agencies perform in carrying out incident management activities. These are usually all or part of one of the five ICS sections (Command, Operations, Logistics, Planning, Administrative/Finance).

Function: In the Incident Command System, refers to the five major activities (i.e., Command, Operations, Planning, Logistics, and Finance/Administration). Intelligence is not considered a separate function under traditional ICS but has been added for consideration as a possible separate function under NIMS. The term function is also used when describing the activity involved (e.g., the Planning function).

Hazard: A potential or actual force, physical condition, or agent with the ability to cause human injury, illness, and/or death, and significant damage to property, the environment, critical infrastructure, agriculture and business operations, and other types of harm or loss.

Hazard Vulnerability Analysis (HVA): A systematic approach to identifying all hazards that may affect an organization, assessing the risk (probability of hazard occurrence and the consequence for the organization) associated with each hazard and analyzing findings to create a prioritized comparison of hazard vulnerabilities. The consequence, or vulnerability, is related to both the impact on organizational function and the likely service demands created by hazard impact.

Homeland Security Presidential Directive-5 (HSPD-5): A Presidential directive issued on February 28, 2003, and intended to enhance the ability of the United States to manage domestic incidents by establishing a single, comprehensive National Incident Management System.

Incident: An actual or impending hazard impact, either human caused or by natural phenomena, that requires action by emergency personnel to prevent or minimize loss of life or damage to property and/or natural resources.

Incident Action Plan (IAP): The document in ICS that guides the response for that operational period. It contains the overall incident objectives and strategy, general tactical actions and supporting information to enable successful completion of objectives. The IAP may be oral or written. When written, the IAP may have a number of supportive plans and information as attachments (e.g., traffic plan, safety plan, communications plan, and maps). There is only one IAP at an incident. All other "action plans" are subsets of the IAP and their titles should be qualified accordingly. For example, the jurisdiction primarily impacted usually develops the IAP. Action plans developed below the level of the jurisdiction could be referred to as "Operations Plans" (e.g., Summary Hospital Operations Plans or Individual Hospital Operations Plans).

Incident Commander (IC): The individual responsible for all incident activities, including the development of strategies and tactics and the ordering and the release of resources. The IC has overall authority and responsibility for conducting incident operations and is responsible for the management of all incident operations at the incident site. (adapted from NIMS)

Incident Command System (ICS): The combination of facilities, equipment, personnel, procedures, and communications operating within a common organizational structure, designed to aid in the management of resources for emergency incidents. It may be used for all emergencies, and has been successfully employed by multiple response disciplines. ICS is used at all levels of government (local, State, Tribal, and Federal) to organize field level operations. (adapted from NIMS)

Incident Command Post (ICP): The physical location close to the incident site (or elsewhere for a diffuse incident or one with multiple sites), which serves as a base location for managing tactical or "field operations." Located within the ICP are designated representatives of the major response agencies for the incident, who fill positions in the incident command team. The ICP location is designated by the Incident Commander.

Incident Management Team (IMT): The Incident Commander, and appropriate Command and General Staff personnel assigned to an incident.

Incident Objectives: Statements of guidance and direction necessary for selecting appropriate strategy(s) and the tactical direction of resources. Incident objectives are based on realistic expectations of what can be accomplished when allocated resources have been effectively deployed. Incident objectives must be achievable and measurable, yet flexible to allow for strategic and tactical alternatives. (adapted from NIMS)

Joint Information Center (JIC): A center established to coordinate the public information activities for a large incident. It is the central point of contact for all news media at the scene of the incident. Public information officials from all participating Federal agencies collaborate at the JIC, as well as public information officials from participating State and local agencies. (adapted from NIMS)

Jurisdiction: A political subdivision (Federal, State, county, parish, and/or municipality) with the responsibility for ensuring public safety, health, and welfare within its legal authorities and geographic boundaries. In the context of this handbook, it refers to a geographic area's local government, which commonly has the primary role in emergency response.

Liaison: In ICS, it is a position(s) assigned to establish and maintain direct coordination and information exchange with agencies and organizations outside of the specific incident's ICS structure. (adapted from NIMS)

Liaison Officer: A member of the Command Staff responsible for filling the senior liaison function with representatives from cooperating and assisting agencies.

Local Government: (HSPD-5 definition) A county, municipality, city, town, township, local public authority, school district, special district, intrastate district, council of governments (regardless of whether the council of governments is incorporated as a nonprofit corporation under State law), regional or interstate government entity, or agency or instrumentality of a local government; an Indian Tribe or authorized tribal organization, or in Alaska a Native Village or Alaska Regional Native Corporation; a rural community, unincorporated town or village, or other public entity. (As defined in Section 2 (10) of the Homeland Security Act of 2002, Pub. L. 107-296, 116 Stat. 2135, et seq. (2002).)

Logistics: The ICS functional section that provides resources and other support services to incident management, operations, and the other ICS sections. (adapted from NIMS)

Management by Objectives: In the ICS, this is a proactive management activity that involves a four-step process to achieve the incident goal. The steps are: establishing the overarching incident objectives; developing and issuing assignments, plans, procedures, and protocols; establishing specific, measurable objectives for various incident command functional activities and directing efforts to fulfill them, in support of defined strategic objectives; and documenting results to measure performance and facilitate corrective action. (adapted from NIMS)

Management Meeting: In the incident management process, the meeting that establishes (or revises) the incident goals and objectives and the makeup of the ICS structure. NIMS does not separate this meeting from the Planning meeting, although they are commonly separated in wildland fire and Urban Search and Rescue incident management.

Measures of Effectiveness: Defined criteria for determining whether satisfactory progress is being accomplished toward achieving the incident objectives. Similarly, defined criteria can also be utilized to establish the effectiveness of the overall Emergency Management Program in meeting its defined goals across the four phases.

Medical Surge: Describes the ability to provide adequate medical evaluation and care in events that severely challenge or exceed the normal medical infrastructure of an affected community (through numbers or types of patients).

Mission Assignment: The vehicle used by DHS/FEMA to support Federal operations in a Robert T. Stafford Act major disaster or emergency declaration. It orders immediate, short-term emergency response assistance when an applicable State or local government is overwhelmed by the event and lacks the capability to perform, or contract for, the necessary work. (NRP definition)

Mitigation: Activities designed to reduce or eliminate risks to persons or property or to lessen the actual or potential effects or consequences of a hazard. Mitigation involves ongoing actions to reduce exposure to, probability of, or potential loss from hazards. Examples include zoning and building codes, floodplain buyouts, and analysis of hazard-related data to determine where it is safe to build or locate temporary facilities. Mitigation can include efforts to educate governments, businesses and the public on measures they can take to reduce loss and injury. (adapted from NIMS)

Mobilization: Activities and procedures carried out that ready an asset to perform incident operations according to the Emergency Operations Plan. During the response phase of Comprehensive Emergency Management, it is the stage that transitions functional elements from a state of inactivity or normal operations to their designated response state. This activity may occur well into the response phase, as additional assets are brought on line or as surge processes are instituted to meet demands.

Multijurisdiction Incident: An incident that extends across political boundaries and/or response disciplines, requiring action from multiple governments and agencies to manage certain aspects of an incident. These incidents may best be managed under Unified Command. (adapted from NIMS)

Mutual Aid Agreement: Written instrument between agencies and/or jurisdictions in which they agree to assist one another upon request, by furnishing personnel, equipment, supplies, and/or expertise in a specified manner. An "agreement" is generally more legally binding than an "understanding."

National Incident Management System (NIMS): A system mandated by HSPD-5 that provides a consistent nationwide approach for Federal, State, Tribal, and local governments, the private sector, and nongovernmental organizations to work effectively and efficiently together to prepare for, respond to, and recover from domestic incidents, regardless of cause, size, or complexity. To provide for interoperability and compatibility among Federal, State, and local capabilities, NIMS includes a core set of concepts, principles, and terminology. HSPD-5 identifies these as the Incident Command System; multiagency coordination systems; unified command; training; identification and management of resources (including systems for classifying types of resources); qualifications and certifications; and the collection, tracking, and reporting of incident information and incident resources. (adapted from NIMS)

National Response Plan (NRP): The NRP establishes a comprehensive all-hazards approach to enhance the ability of the United States to manage domestic incidents. The plan incorporates best practices and procedures from incident management disciplines – homeland security, emergency management, law enforcement, firefighting, public works, public health, responder and recovery worker health and safety, emergency medical services, and the private sector – and integrates them into a unified structure. It forms the basis of how the Federal government coordinates with State, local, and Tribal governments and the private sector during incidents.

Operations Section: The ICS functional area responsible for all resources and activities that directly address the incident objectives. It develops all tactical operations at the incident, and in ICS, includes branches, divisions and/or groups, Task Forces, Strike Teams, Single Resources, and Staging Areas.

Planning (incident response): Activities that support the incident management process, including completing the incident action plan and support plans and accomplishing incident information processing. This is in contrast to preparedness planning, which is designed to ready a system for response.

Planning Meeting: A meeting held as needed throughout the duration of an incident to select specific strategies and general tactics for incident operations, and for service and support planning. In the incident management process, the planning meeting establishes strategy and priorities based upon the goals and objectives developed in the management meeting. Remaining decisions for the action plan are achieved during this meeting. (adapted from NIMS)

Planning Section: In ICS, this functional area is responsible for the collection, evaluation, and dissemination of operational information related to the incident, and for the preparation and documentation of the incident action plan and its support plans. The Planning Chief is responsible for running the management and planning meetings and the operations briefing, and the Planning Section supports these activities. The Planning Section also maintains information on the current and forecasted situation, the status of resources assigned to the incident, and other incident information. (adapted from NIMS)

Preparedness: The range of deliberate, critical tasks and activities necessary to build, sustain, and improve the capability to protect against, respond to, and recover from hazard impacts. Preparedness is a continuous process. Within NIMS, preparedness involves efforts at all levels of government and the private sector to identify threats, to determine vulnerabilities, and to identify required response plans and resources. NIMS preparedness focuses on establishing guidelines, protocols, and standards for planning, training and exercise, personnel qualifications and certification, equipment certification, and publication management. (adapted from NIMS)

Prevention: Actions to avoid a hazard occurrence, or to avoid or minimize the hazard impact (consequences) if it does occur. Prevention involves actions to protect lives and property. Under HSPD-5, it involves applying intelligence and other information to a range of activities that may include such countermeasures as deterrence operations; heightened inspections; improved surveillance and security operations; investigations to determine the full nature and source of the threat; public health and agricultural surveillance and testing processes; immunizations, isolation, or quarantine; and as appropriate specific law enforcement operations aimed at deterring, preempting, interdicting, or disrupting illegal activity, and apprehending potential perpetrators and bringing them to justice. (adapted from NIMS)

Private Sector: Organizations and entities that are not part of any governmental structure. It includes for-profit and not-for-profit, and formal and informal structures, including commerce and industry, non-governmental organizations (NGO), and private voluntary organizations (PVO). (adapted from NIMS)

Processes: Systems of operations that incorporate standardized procedures, methodologies, and functions necessary to effectively and efficiently accomplish objectives. (adapted from NIMS)

Public Health Emergency: Defined by the Model State Emergency Health Powers Act (MSEHPA): An occurrence or imminent threat of an illness or health condition that is believed to be caused by: (1) bioterrorism; (2) the appearance of a novel or previously controlled or eradicated infectious agent or biological toxin; (3) a natural disaster; (4) a chemical attack or accidental release; or (5) a nuclear attack or accident. It must pose a high probability of a large number of deaths in the affected population, or a large number of serious or long-term disabilities in the affected population, or widespread exposure to an infectious or toxic agent that poses a significant risk of substantial future harm to a large number of people in the affected population. (the Center for Law and the Public's Health at Georgetown and Johns Hopkins Universities)

Public Information Officer: Official at headquarters or in the field responsible for preparing and coordinating the dissemination of public information in cooperation with other responding Federal, State, Tribal, and local agencies. In ICS, the term refers to a member of the Command Staff responsible for interfacing with the public and media and the Joint Information Center.

Recovery: The phase of Comprehensive Emergency Management that encompasses activities and programs implemented during and after response that are designed to return the entity to its usual state or to a "new normal." For response organizations, this includes return-to-readiness activities.

Resiliency: The ability of an individual or organization to quickly recover from change or misfortune.

Resources: All personnel and major items of equipment, supplies, and facilities available, or potentially available, for assignment to incident or event tasks on which status is maintained.

Response: Activities that address the direct effects of an incident. Response includes immediate actions to save lives, protect property, and meet basic human needs. Response also includes the execution of emergency operations plans as well as activities designed to limit the loss of life, personal injury, property damage, and other unfavorable outcomes. As indicated by the situation, response activities may include applying intelligence and other information to lessen the effects or consequences of an incident; increased security operations; continuing investigations into nature and source of the threat; ongoing public health and agricultural surveillance and testing processes; immunizations, isolation, or quarantine; and specific law enforcement operations aimed at preempting, interdicting, or disrupting illegal activity, and apprehending actual perpetrators and bringing them to justice. (adapted from NIMS)

Safety Officer: A member of the Command Staff responsible for monitoring and assessing safety hazards or unsafe situations, and for developing measures for ensuring personnel safety. The Safety Officer may have assistants.

Span of Control: The number of individuals a supervisor is responsible for, usually expressed as the ratio of supervisors to individuals (under NIMS, an appropriate span of control is between 1:3 and 1:7). (adapted from NIMS)

State: When capitalized, refers to any State of the United States, the District of Columbia, the Commonwealth of Puerto Rico, the Virgin Islands, Guam, American Samoa, the Commonwealth of the Northern Mariana Islands, and any possession of the United States. (As defined in section 2 (14) of them Homeland Security Act of 2002, Pub. L. 107-296, 116 Stat. 2135, et seq.(2002).)

Strategic: Strategic elements of incident management are characterized by continuous long-term, high-level planning by senior level organizations. They involve the adoption of long-range goals and objectives; the setting of priorities; the establishment of budgets and other fiscal decisions; policy development; and the application of measures of performance or effectiveness. (adapted from NIMS)

Surge Capability: The ability to manage patients requiring unusual or very specialized medical evaluation and care. Requirements span the range of specialized medical and public health services (expertise, information, procedures, equipment, or personnel) that are not normally available at the location where they are needed. It also includes patient problems that require special intervention to protect medical providers, other patients, and the integrity of the healthcare organization.

Surge Capacity: The ability to evaluate and care for a markedly increased volume of patients—one that challenges or exceeds normal operating capacity. Requirements may extend beyond direct patient care to include other medical tasks, such as extensive laboratory studies or epidemiologic investigations.

System: A clearly described functional structure, including defined processes, that coordinates otherwise diverse parts to achieve a common goal.

Tactical: Tactical elements of ICS are characterized by the execution of specific actions or plans in response to an actual incident or, prior to an incident, the implementation of individual or small unit activities, such as training or exercises.

Terrorism: Any premeditated, unlawful act dangerous to human life or public welfare that is intended to intimidate or coerce civilian populations or governments (National Strategy for Homeland Security, July 2002). It includes activity potentially destructive of critical infrastructure or key resources. It is a violation of the criminal laws of the United States or of any State or other subdivision of the United States in which it occurs. It can include activities to affect the conduct of a government by mass destruction, assassination, or kidnapping (Section 2 (15), Homeland Security Act of 2002, Pub. L. 107-296, 116 Stat. 2135, (2002)).

Threat: An indication of possible violence, harm, or danger. (adapted from NIMS)

Unified Command: An application of ICS used when there is more than one agency with incident jurisdiction. Agencies work together through their designated Incident Commanders or Managers at a single location to establish a common set of objectives and strategies, and a single incident action plan. (adapted from NIMS)

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