It is recommended that the risk manager distribute this guidance article to members of the EOC, any subcommittees, individuals with specific responsibility within the HICS, and top management. Through the use of HSEEP, the whole community can develop, execute, and evaluate exercises that address the preparedness priorities. management: preparation, mitigation, response, and recovery. Oakbrook Terrace (IL): Joint Commission Resources; 2018 Jan 1. FEMA, like other government agencies and educational institutions, has maps and statistics that can help emergency planners identify the probability of many natural hazards. https://asprtracie.s3.amazonaws.com/documents/cms-ep-rule-resources-at-your-fingertips.pdf, Considerations for the use of temporary surge sites for managing seasonal patient surge. NFPA adds one additional phase between response and recovery (NFPA "1600" 1.1.2): continuity. In light of these trends, the nation's health security and its readiness for public health emergencies are high priorities (ASPR TRACIE "Hospital Preparedness Program"). The building includes ambulance bays that can be converted to large decontamination rooms; pillars in the lobby equipped with hidden panels for oxygen and other gases (thus permitting the lobby to be used for more beds and treatment); and the ability to switch airflows to exhaust airborne agents high above street level so that entire quadrants can be isolated. Disasters are often dynamic or chaotic situations, and effective training helps prepare staff to take on unexpected responsibilities and adjust to changes in patient volume or acuity, work procedures, or conditions without having to make ad hoc decisions. ACSs may be either fixed or mobile. Report to Congressional requesters. "Disasters" are a subset of "emergencies." Often, hospitals do not act alone when responding to an emergency; therefore, regional and state coordination in developing and exercising the EOP is essential. (8) Evaluate the residual hazard and risk exposures (those that remain hazardous after prevention and mitigation activities). The cycle involves the following five stages: 1. Evaluate the findings of both the facility-based and community-based HVAs. https://www.cnn.com/2018/08/28/health/puerto-rico-gw-report-excess-deaths/index.html, Toner E, Hansen MB. Action Recommendation: Confirm that the EOP is reviewed and updated, if necessary, at least annually. Mobile medical facilities are either tractor-trailer-based specialized units with surgical and intensive care capabilities or fully equipped hospitals stored in container systems. Risk managers often play a direct role in developing policies and procedures that relate to disaster-related standards of care, modification of the privileging and credentialing process, and negotiation of mutual-aid agreements with other hospitals. HCCs are one of the cornerstones of national healthcare emergency preparedness. A business impact analysis will allow you to see . While the general public sometimes uses the words interchangeably, the terms have different meanings in the emergency preparedness field. Evacuation. Risk managers often play a direct role in the development of policies and procedures related to emergency managementsuch as those addressing disaster-related standards of care, modification of the privileging and credentialing process, and negotiation of mutual-aid agreements with other hospitals. http://www.upmchealthsecurity.org/our-work/pubs_archive/pubs-pdfs/2009/2009-04-16-hppreport.pdf, U.S. Department of Health and Human Services (HHS). The types of emergency events and disasters for which healthcare organizations must be prepared are quite broad. National Hurricane Center, National Oceanic Atmospheric Administration. In preparation for mass-casualty events, planning for this type of support should be a priority at the regional or state level, and activation and operational policies should be established prior to an incident. Resource List). Ensure that both a facility-based and a community-based hazard vulnerability assessment (HVA) are conducted at least annually. Hospitals in the United States have faced a wide variety of large-scale emergencies and disasters resulting from natural, technological, and terrorist-related and other human-made causes. To ensure office safety, space heater should? Doctors and nurses b. Firemen Medications, precautions, date of next appointment. ABA Health eSource. Hospitals should be working with these groups, because catastrophic events will require a coordinated response by all emergency responders and healthcare providers, not just by hospitals but also by nursing homes, clinics, doctors' offices, and more. This phase of emergency management also proceeds based on the hospital's ICS. U.S. billion-dollar weather and climate disasters. The required items include food, water, and medical and pharmaceutical supplies. Solve your "Large-scale disaster" crossword puzzle fast & easy with the-crossword-solver.com Risk managers should consider several issues when reviewing their facilities' identified ACSs, including the level and scope of medical care to be delivered, the physical infrastructure required, staffing requirements for the delivery of such care, the medical equipment and supplies needed, and the management systems required to integrate such facilities with the overall delivery of healthcare (GAO). It also aims to minimize the need for supplemental state and federal resources during emergencies and to enable rapid recovery in the wake of emergencies and disasters. Then ask whether the organization will be ready. CMS's
Provider and Supplier Types Affected by CMS's Emergency Preparedness Rule, CMS emergency preparedness rule: resources at your fingertips, Disasters and Emergencies: Definitions from Governmental and Accrediting Bodies, Potential Emergency Operations Committee Members, Emergency System for Advance Registration of Volunteer Health Professionals (ESAR-VHP), Types of External Emergencies and Disasters, https://www.phe.gov/Preparedness/planning/hpp/reports/Documents/2017-2022-healthcare-pr-capablities.pdf, https://asprtracie.s3.amazonaws.com/documents/cms-ep-rule-resources-at-your-fingertips.pdf, https://asprtracie.s3.amazonaws.com/documents/aspr-tracie-considerations-for-the-use-of-temporary-care-locations-for-managing-seasonal-patient-surge.pdf, http://www.phe.gov/Preparedness/planning/hpp/reports/Documents/capabilities.pdf, https://www.phe.gov/Preparedness/planning/hpp/Documents/HPP-15-anniversary.pdf, http://www.phe.gov/Preparedness/planning/mscc/handbook/chapter2/Pages/default.aspx, https://mrc.hhs.gov/CMS/File/MRC_Quarterly_Report_FY17Q4.pdf, https://www.phe.gov/Preparedness/planning/hpp/reports/Documents/nims-implementation-guide-jan2015.pdf, https://www.sciencedirect.com/science/article/pii/S0140673606698966?via%3Dihub, https://www.ncbi.nlm.nih.gov/pubmed/17189033, https://weather.com/storms/hurricane/news/2017-10-11-hollywood-florida-retirement-home-deaths-hurricane-irma#/, https://www.cdc.gov/phpr/readiness/00_docs/PHEP-Funding-CDC-RFA-TP17-1701.pdf, https://www.cdc.gov/flu/pandemic-resources/pdf/pan-flu-report-2017v2.pdf, https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/SurveyCertEmergPrep/Downloads/Advanced-Copy-SOM-Appendix-Z-EP-IGs.pdf, https://www.fema.gov/media-library-data/20130726-1828-25045-0014/cpg_101_comprehensive_preparedness_guide_developing_and_maintaining_emergency_operations_plans_2010.pdf, https://www.fema.gov/media-library-data/20130726-1609-20490-1678/fema577.pdf, https://www.fema.gov/national-incident-management-system, https://www.fema.gov/national-preparedness-goal, https://www.fema.gov/national-preparedness-system, https://www.fema.gov/nims-frequently-asked-questions#item1, https://emedicine.medscape.com/article/765495-overview, https://www.jointcommission.org/assets/1/18/emergency_preparedness.pdf, https://www.calhospitalprepare.org/hazard-vulnerability-analysis, http://www.sacbee.com/news/state/california/fires/article188377854.html, http://www.er-emergency.com/preparedness-12-step-disaster-plan, https://www.ncbi.nlm.nih.gov/pubmed/16773881, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3038369/, https://www.ncbi.nlm.nih.gov/pubmed/21251426, http://time.com/4917743/la-vita-bella-nursing-home-dickinson-texas-photo/, https://web.mhanet.com/2012_Lessons_Learned.pdf, http://nationalacademies.org/hmd/Activities/PublicHealth/LocalTerrorResponse.aspx, https://www.nfpa.org/Assets/files/AboutTheCodes/99/99_A2011_HEA-HES_ROP_ballot.pdf, https://www.nhc.noaa.gov/news/UpdatedCostliest.pdf, https://www.ncbi.nlm.nih.gov/pubmed/17400163, http://www.chicagotribune.com/lifestyles/health/ct-x-1130-rush-tour-20111130-story.html, https://www.cnn.com/2018/08/28/health/puerto-rico-gw-report-excess-deaths/index.html, http://www.upmc-cbn.org/report_archive/2010/cbnreport_03052010.html, http://www.upmchealthsecurity.org/our-work/pubs_archive/pubs-pdfs/2009/2009-04-16-hppreport.pdf, https://wayback.archive-it.org/3926/20140108162209/http://www.hhs.gov/news/press/2011pres/05/20110505a.html, https://www.cnn.com/2017/10/10/weather/hurricane-nate-maria-irma-harvey-impact-look-back-trnd/index.html, Guidance: The Hospital Incident Command System, Guidance: Medical Staff Credentialing and Privileging, Guidance: OSHA Inspections, Citations, and Penalties, Disaster Medical Services DivisionHospital Incident Command System, Emergency preparedness requirements for Medicare and Medicaid participating providers and suppliers, Kaiser Permanente hazard vulnerability analysis, Standard for an Active Shooter/Hostile Event Response (ASHER) program, OSHA best practices for hospital-based first receivers of victims from mass casualty incidents involving the release of hazardous substances, Yale New Haven Health System Center for Emergency Preparedness and Disaster Response, https://www.ecri.org/components/HRC/Pages/SafSec6.aspx, Clinics, rehabilitation agencies, and public health agencies as providers of outpatient physical therapy and speech-language pathology services, Intermediate care facilities for individuals with intellectual disabilities, Comprehensive outpatient rehabilitation facilities, Psychiatric residential treatment facilities, Religious nonmedical healthcare institutions, Programs of all-inclusive care for the elderly, Rural health clinics and federally qualified health centers. refreshed NIMS, are available on the NIMS page at the FEMA website. According to the National Oceanic and Atmospheric Administration (NOAA) National Hurricane Center estimates, in just six weeks in late August and September 2017, damage estimates from Hurricane Harvey reached $125 billion; Hurricane Irma, $50 billion; and Hurricane Maria, $90 billion. An emergency, conversely, is an unexpected event that disrupts a hospital's ability to provide care but does not require outside assistance beyond, perhaps, a hazmat team or the local fire department (see Disasters and Emergencies: Definitions from Governmental and Accrediting Bodies). ASPR-TRACIEAssistant Secretary for Preparedness and Response, Technical Resources, Assistance Center, and Information Exchange, U.S. Department of Health and Human Services, CMSCenters for Medicare and Medicaid Services, CoPs(Medicare) conditions of participation, DRCDisaster Resource Center (Los Angeles), EMemergency management (in reference to Joint Commission standards), ESAR-VHPEmergency System for Advance Registration of Volunteer Health Professionals, HEICShospital emergency incident command system, HHSU.S. FEMA outlines a process for the
https://emedicine.medscape.com/article/765495-overview, Government Accountability Office (GAO). This means identifying potential hazards and devising safeguards to mitigate their impact. . (Roccaforte and Cushman) For more information, see
A variety of federal and state resources are available to assist hospitals. The Hospital Incident Command System. NIMS can help organizations successfully exchange information with external stakeholders to facilitate more efficient response and recovery efforts. different criteria can result in . In every recent disaster, the number one lesson learned seems to center on communications, not just the well-reported instances of communication system failures but also the need for strategic information: Who needs to know what? The force of the earthquake sent a tsunami rushing towards the Tohoku coastline, a black wall of water which wiped away entire towns and villages. HPP promotes, through regional collaboration, sustained national focus on improved healthcare preparedness and response and improved patient outcomes. The process of preparing a disaster recovery plan begins by identifying these causes and effects, analyzing their likelihood and severity, and ranking them in terms of their business priority. Interviewing the patients over the telephone. EOP interventions that include the broader community should be practiced. Policies and procedures must address the use of volunteers in an emergency and other emergency staffing strategies, including the process for integration of state or federally designated healthcare professionals to address surge needs during an emergency (42 CFR 482.15[b][6]). 42 CFR 482.1- 482.66. The coalition has also developed regional disaster plans and a software system for resource and bed tracking; facilitated increased interhospital communication; and provided funding for staff and disaster coordinators at participating hospitals. Ensure that a process is in place for granting temporary privileges to medical staff. The EOC may wish to create subcommittees representing Joint Commission's seven critical areas to ensure that all important aspects of advance planning and preparation have been addressed. Additionally, 72 or more major urban areas have federally funded metropolitan medical response systems that help the community prepare for mass-casualty events. In this role, the designee will evaluate the following: Based on this monitoring, hospitals must use a multidisciplinary process (which includes LIPs to document and communicate deficiencies and opportunities for improvement to the improvement team responsible for monitoring environment-of-care issues). 2017 Aug 28 [cited 2018 Feb 20]. CMS believes that working together with coalition partners reduces the administrative burden on an individual organization. However, not all hazards are equally likely; nor will all hazards have the same impact on a hospital. Drills and exercises: the way to disaster preparedness. 2008 Jun [cited 2018 Mar 1]. According to FEMA, NIMS "provides stakeholders across the whole community with the shared vocabulary, systems, and processes to successfully deliver the capabilities described in the National Preparedness System." In catastrophic situations, who are the front line defenders for American citizens? Hazard vulnerability analysis. Health insurance for aged and disabled. An effective mitigation effort should begin with, and be based on, the HVA, as this will help the disaster coordinator and EOC prioritize issues during follow-up mitigation and preparedness planning (ASPR TRACIE "Management"). Finan S. Disaster preparedness: legal issues faced by hospitals in the post-Katrina environment. 2017 Oct 17 [cited 2018 Feb 14]. 2018 May 2 [cited 2018 Jul 22]. government receives warning that an emergency could be imminent, its first priority is to alert and warn citizens and take whatever actions are needed to minimize damage and protect life and property. This guidance article touches on operations of the emergency operations committee (EOC) and on the planning and mitigation elements of a comprehensive EOP and includes links to resources that can assist organizations in complying with CMS's emergency preparedness final rule. 42 USC 1395x. 104-191 (1996). Since CMS issued the final rule on emergency preparedness, many of the strategies that were previously optional are now mandatory. States also have the ability to declare states of emergency or disaster, and such declarations affect the manner of response and availability of resources. (Santiago et al. paper recommends that vulnerable countries develop comprehensive disaster resilience strategies (DRS) in consultation with development partners and other stakeholders. Information concerning the various dangers in other properties of chemicals and regions in medical facility is documented? 2010 Mar 2 [cited 2018 Feb 6]. Large medical systems should have a plan in place for notifying satellite sites as needed of the activation of the EOP. 2009 Mar [cited 2018 Feb 6]. (CMS "Final Rule"), CMS contends that the emergency preparedness regulations were needed because prior federal, state, and local regulations and accreditation standards established a patchwork of inconsistent expectations. Tabletop exercises can be used to assess plans, policies, and procedures without deploying resources. https://www.fema.gov/whole-community. The transferring entity must, however, retain documentation of the specific name of the receiving facility. Memorandum. Joint Commission requires hospitals to communicate to community emergency response agencies about identified needs and vulnerabilities. [cited 2018 Feb 20]. (CMS "State Operations Manual") Once the HVA is completed, the organization must then compare the HVA findings to the scope, objectives, and planned interventions of the EOP. The DRC coordinates surge capacity planning, facilitates drills and exercises, stockpiles pharmaceutical caches, procures supplies, coordinates staff sharing, conducts personal protective equipment and decontamination training, and facilitates communications planning. External incidents may affect the structural and nonstructural integrity of the hospital itself, damage or destroy an entire community, or have no structural effect on the hospital at all, such as in the event of a school shooting. Erickson J. Quakes, eruptions, and other geological cataclysms. Once the EOP has been activated, the public information officer and communications officer, both specific positions within the ICS, typically serve as conduits for information to internal and external stakeholders, including staff, visitors, families, and news media. 2017 Nov 21 [cited 21018 Feb 8]. 2.0. Which of the following is inappropriate in a patient waiting room? (MHA). Action Recommendation: Ensure that the training and testing plan is reviewed and revised, if needed, on an annual basis. The patient may be expected to pay at the time of service. How many prescription pads should each doctor have to ensure office security? Finally, organizations need to analyze the response to and maintain documentation of all drills, tabletop exercises, and emergency events. The new regulations require an enhanced communication plan that outlines how healthcare providers and suppliers will communicate during an emergency or disaster. Introduction: The Triple Disaster, Response and Recovery. The current browser does not support Web pages that contain the IFRAME element. First created in 1917 when the U.S. was entering World War I, the debt ceiling has been raised by Congress (and occasionally the president, when authorized to do so by Congress) dozens of times since then. Organizations had been developing more links to the broader community and switching to an "all-hazards" planning process, which shifts the emphasis from planning for a particular type of emergency to delineating the common features of and common strategies to be used when responding to all types of emergencies. d. all of the above. c. working to alleviate harmful conditions. (CMS "Final Rule") The rule is enforced through Medicare and Medicaid service provider conditions of participation (CoPs). The critical task in preparedness planning is to define the system (how assets are organized) and processes (actions and interactions that must occur) that will guide emergency response and recovery. The integrated EOP must "demonstrate that each separately certified healthcare facility within the system actively participated in the development of the program" (CMS "Final Rule" 482.15[f][1]). Unless otherwise authorized by the incident commander, the designated public information officer should be the only person permitted to communicate with the broader community and the media on behalf of the organization. Community-based exercises allow organizations to test incident command and control procedures, including communication plans that are critical when an emergency creates patient surge beyond capacity. When evaluating current operational challenges raised during emergencies and disasters, remember that the EOP should address different actions to be taken during each of the four or five phases. : Office of the Assistant Secretary for Preparedness and Response, Technical Resources, Assistance Center, and Information Exchange (ASPR-TRACIE), U.S. Department of Health and Human Services. Health Syst Risk Manage. Several key elements must be included in policies and procedures that support the EOP. Documentation of the training must be maintained by the organization (CMS "Final Rule" 482.15[d][1][iii]). FEMA 577. High-visibility disasters have led the federal government to emphasize community-wide emergency planning. HSEEP provides a set of guiding principles for exercise and evaluation programs, as well as a common approach to exercise program management, design and development, conduct, evaluation, and improvement planning. (IOM). Before the patient arrives, the receptionist should? No longer is it sufficient to manage emergencies as they arise; rather, hospitals must plan and prepare, in advance, to mitigate, respond to, and recover from natural and human-made emergencies and disasters. https://wayback.archive-it.org/3926/20140108162209/http://www.hhs.gov/news/press/2011pres/05/20110505a.html, Willingham AJ. For more information on conducting exercises, see the guidance article
Many such arrangements have evolved beyond informal discussions to formal operational HCCs. Emergency Planning and Community Right-to-Know Act. In these systems, certain principles and criteria must be considered that can be achieved with a lack of resources. A comprehensive understanding of emergency preparedness is necessary to be effective. Joint Commission standard EM.01.01.01 identifies four phases of emergency
http://www.phe.gov/Preparedness/planning/mscc/handbook/chapter2/Pages/default.aspx, Medical Reserve Corps. Clear communication. All written plan that helps illuminate the risk that employees may experience when there are dangerous contaminants in the medical office is called a? 1986. Joint Commission standard EM.02.02.07 requires that staff and LIPs know in advance what they are expected to do during an emergency. Any gaps or discrepancies should be corrected. Two hospitals had to be evacuated during these wildfires.. Mitigation consists of all activities that reduce or eliminate the probability of a hazard occurring or eliminate or reduce the hazard's impact if it does occur. Before any volunteer can provide patient care, the hospital must obtain a valid government-issued photo identification (ID), such as a driver's license; at least one proof of licensure such as a current picture ID from a healthcare organization; ID indicating that the individual is a member of a recognized state or federal response organization (e.g., ESAR-VHP or a disaster medical assistance team); or confirmation by a currently privileged hospital practitioner or by a staff member with personal knowledge of the volunteer practitioner's ability to act as an LIP volunteer practitioner during a disaster. No longer is it sufficient to manage emergencies as they arise; rather, hospitals must prepare in advance to mitigate, respond to, and recover from natural and human-made emergencies and disasters. Since then, hospitals in the United States and elsewhere have faced a wide variety of large-scale emergencies and disasters from natural, technological, and terrorist-related and other human-made causes. CMS contends these new regulations strike a balance between being specific and general that permits providers and suppliers to develop an effective emergency operations plan (EOP). Select all that apply. Mitigation elements should always be considered when constructing new buildings or rehabbing existing ones. In addition, preparedness includes all training, drills, and exercises; these are performed to stress and evaluate the EOP. The assessment should evaluate the patient population, "including but not limited to, persons at risk, the types of services that the facility would be able to provide in an emergency, continuity of operations, including delegations of authority and succession plans" (CMS "Final Rule"; 42 CFR 482.15[a][3]). The regulations require organizations to take a "comprehensive, consistent, flexible, and dynamic regulatory approach to emergency preparedness and implement a response that incorporates the lessons learned from the past, combined with the proven best practices of the present." Similarly, state and local public health departments are also involved in emergency preparedness planning for public health emergencies. Comprehensive accreditation manual for hospitals. The usual deployment lasts two weeks. Cross out each incorrect pronoun and write the correct form above it. 2018 Jun 11 [cited 2018 Feb 14]. [13] with small adjustment, the characteristics of a large-scale disaster can be categorized as: Large scale impact, severe consequences, multi-agency involvement,. Fixed sites are nonmedical buildings, such as hotels, armories, or auditoriums that are close enough to the hospital and the right size to be adapted to provide medical care (Joint Commission "Health Care"). . (CMS "Final Rule"). . NFPA 99: Health care facilities code. Many Joint Commission requirements for hospitals are not applicable to nursing homes, physician offices, and other settings. Media coverage of several recent natural disasters highlighted providers who demonstrated little to no advanced emergency planning and woefully inadequate responses, placing patient lives at risk and in some cases resulting in patient deaths. Preparing for a medical surge, especially at mass-casualty levels, cannot be done in isolation; rather, hospitals should work with local and state emergency agencies, existing HCCs, nearby hospitals, and other relevant response partners to assess the need for the following (ASPR TRACIE "Hospital Preparedness Capabilities"): The EOP must identify ACSs for patient carea key component in preparing for medical surge. http://www.chicagotribune.com/lifestyles/health/ct-x-1130-rush-tour-20111130-story.html, Santiago L, Shoichet CE, Kravarik J. Puerto Rico's new Hurricane Maria death toll is 46 times higher than the government's previous count. The EOC should, at minimum, include representatives with operational knowledge of and decision-making authority for
Participate in interagency mutual-aid or mutual-assistance agreements, Promote and ensure proper hospital processes, equipment, communications, and data interoperability to facilitate the collection and distribution of accurate information with local and state partners during an incident, Manage all emergency incidents, exercises, and preplanned events with consistent application of incident command system (ICS) organizational structures, doctrines, processes, and procedures, Having redundant, interoperable communications systems in place among hospitals, public health agencies, and emergency managers, Being able to report the number of beds available within 60 minutes of a request, Having plans for surge capability, hospital evacuation, as well as shelter of patients and staff, Measures for receiving an influx of patients (surge), Procedures for ensuring that medical records are adequately maintained and accompany patients during evacuation, Requirements dealing with the interruption of utilities and after-life care, Developing consistent policies and procedures, Establishing an effective communications plan, Conducting sufficient training and testing of the EOP, Maintaining ongoing programs of environmental assessment, such as regular environmental, safety, and security rounds or a building maintenance program to identify potential problems before they occurincreased frequency in environmental rounding may be necessary during an actual emergency, Establishing programs for testing, inspection, and preventive maintenance of backup systems and facility safety and security features, Reducing the use of hazardous materials (including mercury), properly training handlers to prevent spills and leaks, and optimally designing storage rooms and cabinets to ensure proper storage or disposal, Installing and monitoring facility security through access control and perimeter security systemsincreased frequency in security rounds may be necessary during an actual emergency, Describe how the permanent medical staff will be able to distinguish volunteers from hospital staff, Outline the process for supervising volunteers, Outline criteria that help staff determine, within 72 hours, whether disaster privileges or responsibilities granted to volunteers should continue (this decision is based on the observation and supervision activities), Additional medical equipment, pharmaceuticals, and other patient care supplies, Equipment that assists with the provision of specialized medical evaluation and care such as pediatrics, burn, and trauma care equipment and supplies or mobile assets to supply services such as radiology or pharmacy, Mobile teams of healthcare professionals and mobile caches of equipment and/or supplies, Mobile trailers or shelters to provide space for treatment of patients, storage of surge supplies, and resources for emergency communication, Equipment that can deliver power, heating, ventilation, air conditioning, and potable water, as well as equipment that can provide food storage and equipment to sustain essential patient services, Systems that can provide redundant communication and information management capabilities (e.g., failover and backup, remote site hosting), Sheltering in place for patients, staff, and volunteers (482.15[b][4]), Supporting medical documentation that preserves patient information, protects the confidentiality of patient information, and secures and maintains availability of records (482.15[b][5]), Assisting the organization with providing information about the general condition and location of patients under the facility's care, as permitted under shelter-in-place regulations (482.15[c][6]), Command, which establishes the incident goals and objectives, Operations, which develops the specific tactics and executes activities. 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