out the tactics and orders provided by the Silver Commander. In a multiagency response, a Commander or some other representative (from each required discipline) will take direction from their organization. If the incident covers a large geographical area, then multiple Bronze Commanders might be based on the geography of the incident. If an incident is extremely complex, each Bronze Commander can be given their own task (or responsibility) within the response to the overall incident. As an example, in a mass casualty incident, one Bronze Commander might oversee the taking statements, while another manages crime scene security, and yet another oversees survivor management (Future Learn, n.d.).
During the initial stages of an incident, the highest‐ranking member of each discipline temporarily assumes the role of Silver or Bronze Commander. They will remain in that position until a more senior member or someone with specialized knowledge from their organization arrives on scene, then they will transfer command (Future Learn, n.d.). In personal communication, it was found out that police and medics do not utilize a formal ICS method, but these entities have created documents which mirror the fire service's architecture to a large extent. This became more of a priority since Joint Emergency Services Interoperability Principles (JESIP) (K. Arbuthnot, personal communication, 23 November 2018).
The Joint Emergency Services Interoperability Principles (JESIP) was a two‐year coordinated research program that looked at improving integration of resources and improving coordination during a multiagency response. The primary focus was to improve response and recovery whenever a major multiagency incident occurred. This two‐year shared effort, undertaken from 2012 to 2014, produced a joint doctrine that provides a framework that improves multiagency response by providing training and basic guidance. The program initiated one of the largest and most effective joint training initiatives, one that helped to integrate emergency services during a disaster in the United Kingdom (JESIP, n.d.).
A common misconception of the Gold–Silver–Bronze is that the organization in charge of an incident is dependent on the type of incident. Most people believe that the police are in charge of a criminal or terrorist incident, and that fire crews are in charge of fires and rescue type situations. This assumption is a misconception of the framework. Under the Civil Contingencies Act, these varying disciplines would coordinate the response to provide a seamless multiagency response, by utilizing Joint Emergency Services Interoperability Principles (JESIP) procedures and protocols. Each agency participating in the response has its own command structure. Representatives from each discipline will work together to provide a comprehensive and coordinated response (Future Learn, n.d.).
Comparing the UK system of IMS to the US counterpart, it is somewhat similar to the ICS method, however, multiple unnamed sources reported that the Gold–Silver–Bronze method has some issues. According to individuals who have worked in the field under this program, the issue arises when Gold Team members assert their authority to the boots on the ground, but the commands are contradictory to what responders on the ground think needs to happen in order to control the incident properly. While this view is subjective to the person, it also raises the question if a command staff that may be 30 miles away can make a better call than those that are right in front of the incident. In the United States, it is not uncommon for the Incident Commander (IC) to be off site; however, they receive detailed feedback from operations, and there are often joint planning meetings and daily evaluations. It is unclear if this occurs, these types of face‐to‐face meetings in the Gold–Silver–Bronze method. It is clear that Joint Emergency Services Interoperability Principles (JESIP) is similar to an Emergency Operations Center (EOC) that is used to supply resources to those in command of an incident.
When looking at the hospital IMS method used in the United Kingdom, hospitals integrate with public safety as part of the Gold–Silver–Bronze method, and they also have an internal IMS method for hospitals. The National Health System (NHS) in member countries of the United Kingdom (e.g. Wales, Scotland, England) provide the very specific Emergency Preparedness, Resilience and Response Framework that guides the hospital into a complete integration with public safety agencies. This framework appears to have been initially implemented in 2004, and it has undergone several modifications since then. In this framework, there are four levels of disaster. They are the following:
Level 1: An incident that can be handled internally with the resources on hand.
Level 2: Requires outside resources within the NHS region and liaison with local NHS office.
Level 3: Requires outside resources within the NHS region and the regional NHS office will coordinate with commissioners at the tactical level.
Level 4: An incident that requires NHS National Command and Control to support the response. Outside resources need from outside the region, and NHS is required to coordinate the NHS Response in collaboration with local commissioners at the tactical level (NHS England, 2015; NHS Scotland, 2015; NHS Tameside Hospital, 2016).
When a potential major incident is reported outside of the hospital, the facility will be notified. There are two levels of notification they may receive. The first is called a Major Incident Standby. In this notification, those activating the hospitals are unsure of the scope of the incident, or they do know the scope, and there is a potential that it may escalate to a larger incident. The standby classification allows hospitals more time to prepare staff and workers for receiving large quantities of patients or prepare for specialized procedures that may be needed such as decontamination, burn care, respiratory care for poison gases (NHS England, 2015; NHS Tameside Hospital, 2016).
The second level of notification is Major Incident Declared. This is an instance where it has been confirmed that a Major Incident has occurred, and the circumstances require the hospital to ready themselves for incoming patients. It is important to note that a Major Incident can be called without first having the hospital be on standby. The preparedness level of these hospitals also has redundant systems, which the Hospital Response Team are required to have (NHS England, 2015; NHS Tameside Hospital, 2016). As an example, the hospital is required to have the hardware, software, and the abilities to switch to a different means of communications, should their normal communications methods be damaged or knocked out.
Internally, the hospitals response to the incident is managed by the Hospital Control Team (HCT). Action Cards have a myriad of information that helps direct the Hospital Control Team (HCT) in what functions will be needed during a major incident based on the type of incident it is. Typically, a full set of Action Cards will be kept as a hard copy in the Major Incident Resource Pack and a full set of the Action Cards will be kept as a hard copy along with a copy of the Major Incident Policy in the office of the Director of Nursing as well as the Fire Safety/Emergency Planning Advisor, in an offsite location. Additionally, hard copies of these Action Plans are placed in each area that might be affected (e.g. Emergency Department, Burn Unit, Pediatrics) by a major incident and will be held available in all Departments and Wards that might be required to provide a response in the event of a major incident (NHS Scotland, 2015; NHS Tameside Hospital, 2016).
Action Cards are considered controlled documents, and changes to those cards usually require the approval by the Emergency Planning Resilience and Response Group. In most instances, the personnel identified in the Action Card as the lead of a given area is responsible for updating them and presenting the changes to the Emergency Planning Resilience and Response Group with any material changes (NHS Scotland, 2015; NHS Tameside Hospital, 2016).
The Actions Cards spell out who should be notified and in what order. Whenever a Major Incident alert is received, the Action Card identifies the notification process needed. Usually, the telephone switchboard operators and first on‐call managers will be notified, and they will initiate staff call‐out procedures. The Action Cards will suggest what actions the Hospital Control Team and Mobile Medical Team will need to take for that particular type of incident. After receiving notifications, the Action Cards will identify actions that will need to be taken in various areas and by various personnel, automatically. These actions may
