The current Incident Command System (ICS) was developed to manage wildland fires, then was adopted by general firefighting. It has since been adapted to multiple other sectors and widely used. The Hospital Emergency Incident Command (HICS) was introduced in 1991. An ICS currently is required to be used for hospital incident management in the US.

The overarching structure of traditional HICS consists of Command Staff (Incident Commander, Public Information Officer, Safety Officer, Liaison Officer and Medical/Technical Specialist) and General Staff. The General Staff has Sections consisting of Operations, Planning, Logistics and Finance/Administration. Multiple and flexible subgroups carry out the processes in these areas.

This HICS structure does not adapt easily to hospital daily functions and alternatives have been proposed. This includes structuring around essential functions and mixed models. Over time hospital systems have become larger, and incidents more complex and sustained. New more expansive and flexible ICS structures are needed for complex responses.

We reviewed both the published and grey literature for examples of different incident management structures and evidence of their effectiveness.

There is very little scientific literature on this topic. Several different descriptive reports exist. Multiple examples of hospital incident command organization structures from the hospital level progressing to hospital (and healthcare) system level and then multistate regional models will be reviewed. This includes the standard HICS model, emergency support function models and modifications following advanced ICS principles such as area command.

Different ICS models exist that may offer individual healthcare systems improved ways to manage disasters.