Connecting our world at UW Medicine

Incident Command System 101


Photo Caption: Incident Command team at one of the first meetings [before mask mandates].


As one of the first healthcare systems to treat patients with COVID-19 in the U.S., UW Medicine went from responding to emergencies on an entity level to a formal, centralized Incident Command System (ICS).

The scale and magnitude of the impact of COVID-19 is something our healthcare system has never encountered before. We have seen widespread community transmission and critically ill patients being entered into UW Medicine hospitals. UW Medicine’s Incident Command team had to figure out early and quickly how to protect employees and patients, work with government and scientific communities, disseminate information and keep employee morale up, all while everything we knew about the virus was changing day-to-day.

Let’s go back to the end of February 2020.

“We figured out very fast that no one entity could do this alone,” says Sommer Kleweno-Walley, one of UW Medicine’s incident commanders and the interim CEO at Harborview Medical Center.

On February 29, 2020, leadership representatives from each entity and supporting departments were brought in for a three-hour ICS training. That same day, the system was in full operation and started preparing the hospitals for COVID-19.

Now, a year later, UW Medicine’s Incident Command Team has a system down.

What is the Incident Command System?

The ICS is a hierarchical structure that allows for a coordinated response effort during a crisis. Public agencies, such as Homeland Security and local fire departments, use the ICS concept to organize themselves in an efficient manner for incident response.

Back in March 2020, the Incident Command team met daily at an in-person emergency operations center (EOC), a safe location for response staff to make decisions and be physically distanced, at UW Medical Center — Montlake. But after the first few weeks of meeting in person, the team decided that working remotely was the best thing to do to reduce the risk of COVID-19 transmission.

Now, the majority of their work is remote.

How Incident Command works at UW Medicine

Incident Command’s most important role was to establish a unified response to the pandemic at every level of the organization.

Many Incident Command members took on their emergency operation duties alongside their current jobs and responsibilities.

The time commitment and workload to effectively manage UW Medicine during this crisis has been immense — and this was especially true for the first 90 days of the pandemic in Seattle. But the ICS is designed to be scalable and can quickly adjust to meet organizational needs.

“Originally we had three teams rotate through every position to prevent burnout, and eventually we peeled back to two teams,” says Danica Little, director of UW Medicine Preparedness and Response and director of the Emergency Operations Center.

As the numbers improved, the team scaled back, but when numbers in the fall started to rise again, they were ready to jump back into action.

“This fall we experienced another surge of COVID-19 patients and had to ramp up our operations to support the needs of the organization,” says Kalen Privatsky, UW Medicine’s Incident Commander.

Incident Command was operating five to six days a week to keep up with the fall surge, and now operates depending on need.

“We engaged an outside consulting firm who are members of an Incident Management Team to help us maximize and organize our structure in addition to providing some back up coverage,” says Privatsky. “The supporting Incident Command positions now have two to three UW Medicine employees that are rotating through on a regular basis in addition to the consultant support.”

organization chart
One version of the Incident Command’s organization chart; there have been multiple versions of the chart to meet the needs of the changing environment and COVID-19 epidemiology.

Policy development

Having a centralized ICS has allowed UW Medicine teams to accomplish a great deal of collaborative work, especially around developing policy, operations and community outreach.

“Every type of operations that you do in a hospital is impacted or changed by COVID-19,” says Kleweno-Walley. “From how we deliver meal trays to how the lab processes things, it all has to be seen through the lens of COVID-19 being present in the environment.”

And all of those operations have a policy that needs to be created or reviewed to ensure safety for staff and patients.

The Medical Technical Specialist Incident Command branch helps determine these policy changes by keeping up with Centers for Disease Control and Prevention and World Health Organization recommendations and the latest COVID-19 research.

“We still have people calling from other healthcare organizations to ask us about our infection prevention processes,” says Little. “I am proud to be part of the team doing this work.”

Operations development

“We didn’t want to compete with ourselves,” says Little. “So, we pooled together to establish resources as a team. The ICS allows us to be efficient and have situational awareness so we don’t duplicate efforts.”

Early on in the pandemic, Incident Command put together teams like Clinical Informatics/Information Technology Business Continuity to set up remote infrastructure for employees and help develop patient care and testing websites.

Other teams like Telehealth Services expanded telemedicine programs to increase access to care while the Testing Sites branch set up testing locations for patients, the public and employees.

These types of projects require cross-departmental collaboration: planning, clinical operations, supply chain management, media, communications, finance, risk management, legal, human resources and regional coordination, to name a few.

No single entity or department could have pulled this off on their own, and that’s why this centralized command center is effective.

Innovation and community outreach

To support UW Medicine and the broader Seattle community, Incident Command deployed the Innovations team and partnered with the University of Washington to come up with resourceful ways to make our own supplies like 3D printed face shields and lab-produced hand sanitizer during the national shortage.

Incident Command also mobilized other departments to create accessible testing with Public Health – Seattle & King County using mobile testing vans, and drop teams assisted local long-term care facilities in planning and testing for COVID-19.

UW Medicine’s Advancement team secured and managed an extraordinary number of donations — over 2.5 million items, from masks to food and more — from caring individuals and companies in our community and around the world. They created an infrastructure for receiving donations centrally as well as created processes to equitably disseminate items to teams involved in every aspect of this response.

Reporting and sharing outcomes

Incident Command reports daily on over 300 metrics to the state and federal government.

“We have liaisons and embedded experts collaborating with the state that report back to Incident Command,” says Kleweno-Walley.

Collaborating interdepartmentally and with local and state entities has been fundamental in managing everything from surge capacity to PPE.

“We never ran out of PPE to protect our staff,” says Little. “Not all healthcare systems can say that.”

Where we are now and moving forward

March 1, 2021 marks one year since Incident Command was activated, and everything from how we do our jobs to going to the grocery store has changed. Incident Command has been adapting and changing too, in order to meet the needs of the UW Medicine community.

“Incident Command has been an integral aspect of UW Medicine’s success in this pandemic’s response,” says Privatsky. “Currently we are focused on the delivery of the COVID-19 vaccine.”

Looking back over the past year, what stands out the most to Kleweno-Walley and Little is how fast the ICS was put into action and how proud they are to work for UW Medicine.

“What UW Medicine is doing and how we have responded is something we should never forget,” says Kleweno-Walley. “No matter how hard it is at the time, we are helping the state, the Seattle area and our patients.”

Incident Command’s activation milestones

Here’s a look back at the moments and milestones that UW Medicine (via the structure and support of the Incident Command System) has stepped up to meet.

Year in Review Timeline

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