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The current Incident Command System developed out of difficulties faced by firefighters four decades ago. During the 1970s, a series of forest fires ravaged southern California threatening populated areas. Despite adequate resources and personnel, many people were injured or killed and significant property damage was sustained.1,2 Out of tragedy came the defined need for a better, more systematic approach.


  • Review the history of the creation of ICS.

  • Describe NIMS and its relation to ICS and disaster response.

  • Discuss the attributes and benefits of ICS.

  • Outline the structure of ICS and positions within ICS with a special focus on roles pertinent to a physician.


Reviews of the events and management of the tragic California fires of the 1970s revealed several significant problems. Multiple organizations were forced to work together during the incidents. They typically had disparate organizational structures which made establishing and maintaining leadership problematic. Too many workers were reporting to one supervisor, leading to an unwieldy span of control. Planning and resource allocation were poorly coordinated within and between organizations. Intra-agency communication was not well established, and differences in terminology used by various agencies led to misunderstandings and vague reporting.3 Incident information was unreliable and incident objectives were nonspecific.4 Overall, it was resource and personnel management and organization which contributed to failures during the incidents, and firefighter leadership worked to change these problems.


Fire Fighting Resources of Southern California Organized for Potential Emergencies (FIRESCOPE), a cooperative task force between local, state, and federal agencies, developed the seeds of the current Incident Command System.


The Incident Command System (ICS) is an organizational and management tool utilized during disaster situations and emergency response operations. FIRESCOPE recognized the need for a system to coordinate the multiple organizations responding to an incident. The system would need to be capable of incorporating agencies from diverse geographical locations with varying skills and leadership structures. It would need to use language and positions which could be universally recognized by the group. A management structure based on the division of labor emerged, and while there have been several versions of ICS, the basic principles and attributes remain essentially unchanged. As it became recognized that the characteristics of wildfire fighting paralleled many of the characteristics of other disasters, ICS began to be applied more widely. It is now considered the standard among emergency management and its utilization is strongly encouraged by the federal government. The Hospital Incident Command System has developed from the core of the original ICS retaining many of its attributes. EMS physicians may encounter ICS while responding to a major disaster or while working in their own emergency departments. EMS physicians must be aware of the properties and structure of ICS and which positions ...

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