3. PHICS Chain of Command
Figure 4: Organizational Structure & Chain of Command
The chain of command within a public health agency ICS mirrors the jurisdiction-wide chain of command. (The color-coding also mirrors that which is routinely used in a range of emergency preparedness documents, facilitating cross-agency and cross-jurisdictional coordination.) For large scale emergencies, this approach increases the assurance that those managing the incident within the public health agency are familiar with and are effective partners in inter-agency response activities. ICS can also be activated solely within the public health agency for events that do not require jurisdiction-wide response, but do require unusual deployment of resources within the public health agency in order to respond to a public health event. This might be the case in a large food-borne or water-borne disease outbreak for which extensive environmental and case investigations are needed, or for an outbreak requiring large scale treatment or prophylaxis.
Example
During a measles outbreak, school health nurses would most likely be kept in place in the schools so as to continue ongoing school surveillance, while the DOH may decrease restaurant inspections and direct that staff to case investigation duties.
This chain of command structure also recognizes the need to keep some essential public health programs running even while responding to the emergency. In figure 4, this is reflected within the Operations Section above the two boxes representing Emergency Response Operations and Essential Public Health Services. The relative size of these two units will vary depending on the scope and nature of the emergency. The relative size may also vary over time within a single emergency response, as it is likely that the same pool of staff will be drawn on for both units. During a public health emergency, it is essential that an individual be appointed to evaluate which of the day-to-day services need to continue and which can be temporarily suspended.
The number and type of units that are opened will be determined by the nature and the extent of the event.