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Large-scale bioevent disasters, whether from natural or deliberate causes, result in mass illness or unchecked disease transmission (epidemic or pandemic). Bioevents differ in that they are characterized by vast numbers of individuals from geographically diverse areas seeking medical assistance over periods of days or months. Triage management and surge capacity decisions are required immediately as are sustained population-based actions built on unprecedented collaboration between state, national, and international resources to maintain operational continuity.1–5
Established management schemes under the National Incident Management System and its incident command system (ICS) are used by many public safety professions in North America, the United Kingdom, New Zealand, and Australia. The National Incident Management System has shown reliability in conventional disaster conditions and the ability to structure and restructure on a moment-to-moment basis in response to unforeseen complications provoked by large, complex, and dynamic emergencies.6–12 Although ICS has been used by various emergency responders for many years, its adoption for use by health care facilities (HCFs) is relatively recent and has occurred slowly during the past decade.13
The authors question whether the existing incident command system for conventional disasters is optimally structured and prepared to meet the myriad of decisions required during public health disasters in a timely and effective manner. This article examines a potential health-related command structure and the functions required for authoritative decision making in future bioevents.
CONCEPT OF A HEALTH-SPECIFIC COMMAND STRUCTURE AND EMERGENCY OPERATIONS CENTER
During a large-scale bioevent, many jurisdictions may designate their local department of health as the lead agency with the ability to expand by incorporating ethicists, legal consultants, infectious disease, critical care, and other specialists into decision-making processes. Epidemiological outbreak control and investigation, surveillance, emergency medical services, acute medical care, containment strategies, mental health, mass fatality care, hospital management, pharmacy, self-care and assisted self-care, veterinary medicine, and palliative care may be activated during high-consequence bioevents. Although the need for a heightened level of response by numerous health care partners during complex bioevents is widely assumed, this has rarely been comprehensively explored in the peer-reviewed literature in the context of a unified health care command structure and emergency operations center (EOC).12,14–17
Major bioevents can create a surge in demand for health care services while diminishing the availability of these services. This combination...