Hospital incident command system (HICS) performance in Iran; decision making during disasters

This observational study was conducted between May 1st 2008 and August 31st 2009. Twenty three Iranian hospitals were included. A tabletop exercise was developed for each hospital which in turn was based on the highest probable risk. The job action sheets of the HICS were used as measurements of performance. Each indicator was considered as 1, 2 or 3 in accordance with the HICS. Fair performance was determined as < 40%; intermediate as 41-70%; high as 71-100% of the maximum score of 192. Descriptive statistics, T-test, and Univariate Analysis of Variance were used.None of the participating hospitals had a hospital disaster management plan. The performance according to HICS was intermediate for 83% (n = 19) of the participating hospitals. No hospital had a high level of performance. The performance level for the individual sections was intermediate or fair, except for the logistic and finance sections which demonstrated a higher level of performance. The public hospitals had overall higher performances than university hospitals (P = 0.04).The decision making performance in the Iranian hospitals, as measured during table top exercises and using the indicators proposed by HICS was intermediate to poor. In addition, this study demonstrates that the HICS job action sheets can be used as a template for measuring the hospital response. Simulations can be used to assess preparedness, but the correlation with outcome remains to be studied.Disasters, both natural and man-made, and the number of people affected by them have increased over the past decades [1,2]. The impact is illustrated by 46 million people being affected by earthquakes and tsunamis, between 1991 and 2005, worldwide [2]. Hospitals are cornerstones for health care in a community, and must continue to function in the face of a disaster [3,4]. An effective hospital command system is therefore crucial.The Incident Command System (ICS) is a standardized on-scene, all-hazards incident management approach designed s