Adapting ICS in a Knowledge-Based Response

Learning from the 2003 SARS pandemic to inform pandemic response

In a prior post, I made reference to a study completed by the IBM Centre for the Business of Government, Adapting the Incident Command Model for Knowledge-Based Crises. That report drew on lessons learned during prior pandemic responses, including the 2002 outbreak of West Nile Virus and the 2003 outbreak of Severe Acute Respiratory Syndrome (SARS).

The 2003 outbreak of SARS saw the U.S. Center for Disease Control and Prevention (CDCP) rely on a team-based approach composed of subject matter experts in nine areas, with additional teams added on an ad hoc basis. Notably, this structure did not incorporate the ICS principle of “span of control” (the number of personnel to be supervised by a manager), and the scope of the leadership team increased to 15 teams, plus several ad hoc groups. In essence, “the CDCP viewed its emergency operations staff as filling an advisory role rather than a leadership role during the [2003 SARS outbreak] crisis.” (Ansell and Keller, 2014).

During the SARS response, the average staffing level (span of control) was 18. Learning from the challenges experienced as a result of the scale of the outbreak led the CDCP to incorporate ICS during its response to Hurricane Katrina in 2005. However, the lack of training throughout all parts of the CDCP led to organizational confusion. My colleague Timothy Riecker has written extensively on how the current ICS training curriculum can be improved, with a focus on application as opposed to rote theory-based learning. 

Fast forward to the 2009 H1N1 pandemic response. In the second phase of the 2009 H1N1 pandemic response, the CDCP incorporated a number of key changes to the traditional ICS model:

  • The role of the Incident Commander has been relegated to a supporting role to the CDCP Director, a position appointed by the U.S. President
  • Two roles, the Chief of Staff and the Deputy Incident Manager were created – reporting to the Incident Manager.
  • The operations, planning, logistics and finance/administration functions reported to a Chief of Staff rather than to the Incident Manager (IM).
  • The technical specialty unit, (traditionally a part of the planning section), formed the core of the incident management structure, reporting to the IM. These five “task forces” were Epidemiology/Lab, Community mitigation, Medical care and countermeasures, Vaccine and State coordination.
  • A plans decision unit was created, under the direction of a Deputy Incident Manager in order to “vet” incoming information. A “B” team was also added to provide a second set of eyes in vetting CDCP decisions.
  • A joint information center was elevated. Managed by the Deputy IM, the role of information center was expanded.
  • The policy unit was created 

As I have written previously, in my view ICS does not require adaptation, and can scale to any scenario. Having said that, I believe it is worth examining alternate approaches to continually refine and perfect our field. 

While I have a number of critiques of the changes incorporated by the CDCP, I am particularly interested to hear your thoughts. What changes would you keep (if any?) 

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Learning from the 2009 H1N1 Pandemic Response


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The ICS model remains a universal command and control standard for crisis response. In contrast to traditional operations-based response, the COVID-19 pandemic has required a ‘knowledge based’ framework. 

A fundamental element of ICS is the rapid establishment of a single chain of command. Once established, a basic organization is put in place including the core functions of operations, planning, logistics and finance/administration. In the face of a major incident, there is potential for people and institutions to work at cross purposes. The ICS model avoids this by rapidly integrating people and institutions into a single, integrated response organization preserving the unity of command and span of control. Support to the Incident Commander (the Command Staff) includes a Public Information Officer (PIO), a Liaison Officer and a Safety Officer.

In a study done by Chris Ansell and Ann Keller for the IBM Center for the Business of Government in 2014, the response of the U.S. Center for Disease Control and Prevention (CDCP) to the 2009 H1N1 Pandemic was examined in depth. In examining the response, a number of prior outbreak responses were reviewed. Prior to the widespread adoption of ICS, “the CDCP viewed its emergency operations staff as filling an advisory role rather than a leadership role during the crisis” (Ansell and Keller, 2014). This advisory function was the operating principle of the 2003 SARS outbreak response.

ICS was created to coordinate responses that often extend beyond the boundaries of any individual organizations’ capacity to respond. Considering the 2009 H1N1 pandemic response, the authors outline three features complicated the use of the traditional ICS paradigm:

  • The overall mission in a pandemic response is to create authoritative knowledge rather than the delivery of an operational response;
  • The use of specialized knowledge from a wide and dispersed range of sources; and 
  • The use of resources to manage external perceptions of the CDCP’s response.

In response to these unique features, the authors of the study have advocated seven adaptations to the ‘traditional’ ICS structure. These adaptations will be examined in depth in a future post.

Notwithstanding the unique challenges of a ‘knowledge-based’ response, the ‘traditional’ ICS structure is well-equipped to adapt and scale to the needs of any incident. While it is true that a ‘knowledge-based’ response differs from an operational one, this is not inconsistent with the two top priorities of the ICS model: #1: Life Safety and #2: Incident (Pandemic) Stabilization. The objectives of the incident will determine the size of the organization. Secondly, the modular ICS organization is able to rapidly incorporate specialized knowledge and expand/contract as the demands of the incident evolve. Finally, assigning resources to monitor external communications will remain the purview of the PIO as a member of Command Staff.

When the studies are written on the use of ICS in the COVID-19 pandemic, what do you think will be the key take-aways? As always, I’m interested to hear your thoughts and ideas for future topics.

version of this post was previously featured on the Exploring Emergency Management & Homeland Security Blog by Timothy Riecker, CEDP.

What Literature can teach us about the Response to Coronavirus

While the history books have yet to be written on the worldwide response to COVID-19, a recent article by Anne Applebaum, Senior Fellow at Johns Hopkins University has provided an interesting take on the response to the coronavirus. 

In 1947, Albert Camus, a French philosopher and journalist published a novel called The Plague. Like other novels of its decade, including Orwell’s 1984 and Animal Farm, the novel is allegorical. That is, while it is purportedly about the occupation of France, it really seeks to illuminate the unseen. As the primary character, Dr. Bernard Rieux bears primary responsibility for treating the afflicted in his town of 200,000, while vainly exhorting authorities to take measures to address the spread before it was too late. 

In modern Italy, the virus first appeared in the northern provinces of Lombardy and Veneto, a region heavily represented by the Northern League, a far-right political party led by Matteo Salvini. As Daniel Trilling reports in The Guardian, the defining feature of populism, namely the mistrust of elites and widely circulated conspiracy theories find the most fertile ground in times of uncertainty. 

[The quarantined town] continued with business, with making arrangements for travel and holding opinions. Why should they have thought about the plague, which negates the future, negates journeys and debates?

from The Plague, by Albert Camus (1947)

In an article published in the Harvard Business Review, four lessons have been considered that may have helped to mitigate the failure to contain COVID-19 in Lombardy and Veneto:

Skepticism and cognitive bias. Despite warnings that had been weeks in the making, Italian authorities engaged in confirmation bias and viewed with skepticism any position that did not align with their preferred position. This systematic refusal to listen to subject matter experts in the early days of the outbreak (defined from February 21 to March 22) resulted in the region being impacted by an “incessant stream of deaths.” (Pisano, et. al., 2020)

Avoiding partial measures. In response to the initial wave of COVID-19 cases, the Italian government issued decrees concerning lockdown areas (‘red zones’). These red zones were then expanded until they were applied to the whole country. This partial-measure approach backfired for two major reasons. Firstly, the known facts were non-predictive of the situation, so the partial lockdown followed the virus rather than prevented its spread. Secondly, partial lockdowns may have helped to accelerate the spread of the virus as Italians relocated to ‘non-lockdown’ regions, inadvertently spreading the virus to regions it had not been before.

Rapid learning is essential. A feature of ICS is the ability for it to rapidly scale up or down in response to changes in the facts. The Italian health care system is highly decentralized, and newly acquired knowledge was not given the priority it deserved. The article looks at the policy decisions of Lombardy and Veneto officials in depth as the two regions share similar socioeconomic traits, however experienced far different outcomes. Lombardy opted for a more conservative approach, with a strong focus on symptomatic cases whereas Veneto’s strategy was proactive and varied. As of March 26, 2020, the Lombardy region suffered 5,000 deaths in a population of 10 million, whereas Veneto experienced 287 deaths (in a population of 5 million) during the same period.    

Collection and distribution of data. As a corollary to the third lesson, the lack of data dissemination and standardization of virus statistics should be a priority. Documenting both macro (state) and micro (hospital) levels would help authorities to allocate available (often limited) resources accordingly. 

In the uncertain environment in which we find ourselves, both emergency management professionals and policymakers can benefit from the ‘fast tracked’ lessons being developed in real time.

Perhaps fittingly, the heroes of Camus’ novel remain the doctors and the volunteers who use science to contain and control the disease, without indulging fear-based hysteria. According to Dr. Rieux, “[it] may seem a ridiculous idea, but the only way to fight the plague is with decency.” (Camus, 1947).

As always, I look forward to reading your thoughts and insights.

How B.C. is Acing the Pandemic Test

The decisive action taken by the B.C. PHO on COVID-19, has focused on the twin pillars of containment and contact tracing.

A version of this post was featured on the Exploring Emergency Management & Homeland Security Blog by Timothy Riecker, CEDP.

The pandemic has upended how those in the emergency management field have seen traditional response frameworks. Lessons learned from the pandemic response will be useful to governments and the private sector alike in the coming years.

The ICS framework for emergency response is well equipped to address the unique needs of any disaster, including a global pandemic. The rapid scalability of the structure allows the response to move faster than the speed of government. It provides the framework for standardized emergency response in British Columbia (B.C.).

The B.C. provincial government response to the coronavirus pandemic, led by Dr. Bonnie Henry, the Provincial Health Officer (PHO) has received international acclaim. It is useful therefore to learn from the best practises instituted early on in the pandemic to inform future events. 

In February 2020, the Province of B.C. published a comprehensive update to the British Columbia Pandemic Provincial Coordination Plan outlining the provincial strategy for cross-ministry coordination, communications and business continuity measures in place to address the pandemic. Based on ICS, the B.C. emergency response framework facilitates effective coordination by ensuring the information shared is consistent and effective. The Province of B.C. has provided a daily briefing by Dr. Henry and Adrian Dix, the B.C. Minister of Health as a way to ensure B.C. residents receive up to date information from an authoritative source.

While we may consider the COVID-19 pandemic to be a unique event, a number of studies have provided guidance to emergency response practitioners of today. The decisive action taken by the B.C. PHO on COVID-19, has focused on the twin pillars of containment and contact tracing. Early studies regarding the effect of contract tracing on transmission rates have seen promising results, however the tracing remains a logistical burden. As studies indicate, these logistical challenges have the potential to overwhelm the healthcare system should travel restrictions be relaxed, leading to the possible ‘importation’ of new infections. 

B.C. has instituted robust contract tracing mechanisms to reduce the spread of COVID-19 in alignment with best practises in other jurisdictions. When instituted methodically, contact tracing, consistent communication, and Dr. Henry’s mantra to “Be calm. Be kind. Be safe.” remain critical tools to ensure limited spread, a well-informed and socially cohesive population.

How has your organization helped to slow the spread of COVID-19?  As always, I welcome your feedback and suggestions for how to improve the blog.