after a researcher discovered that there was a consensus among hospitals, and hospital staff, that Hospital Incident Command System (HICS) method was only moderately helpful in Iran. The vast majority of those surveyed felt that this method would be more useful in developed countries, but it did not exactly meet the needs of underdeveloped Iran. Having this information, a group of researchers began looking for modifications to make it more effective in Iran. These modifications were not done in a haphazard way. Potential changes were essentially voted on by an 11‐member group that were all considered subject matter experts. These subject matter experts were used to review potential changes to the system (made by a researcher) and to vote whether these changes would improve Hospital Incident Command System (HICS) in Iran. In this Delphi study, if 85% or more of the subject matter experts agreed with what they survey proposed, then the change was accepted. If there was less than an 85% consensus, the proposal would either modify the suggestion or discard it from the study (Djalali et al. 2015).
Among several changes, the first was the addition of a Quality Control Officer to the Command group. The purpose of this new position is to assess and improve the performance of the Hospital Incident Command System (HICS) method in Iranian Healthcare Facilities. The Quality Control Officer was also put in place to recognize possible gaps, identify the related reasons, and then report them to the Incident Commander (IC). By doing so, they should be able to facilitate solving the problem or coming up with a mitigation measure (Djalali et al. 2015).
Security is another area where there were modifications in the Iranian model. In the Hospital Incident Command System (HICS) method, security was originally a second‐level position. The security team would perform their duties under the direction of the hospital manager or general director (based on which name is used by the hospital). It was found that placing security in a third managerial level was not effectual in the Security Branch (of the Operations Section), the placement of security was changed to a new section on its own, reportable only to the Incident Commander (IC). This change was made because emergency department crowding is a major issue, especially during, and immediately following, a disaster. This new section will be charged with traffic control and crowd control. Additionally, hospital buildings are not exempt from disasters. After an event, a hospital might suffer structural and nonstructural damage. This change in security will also ensure that when there is structural damage, security can create and oversee the search and rescue teams that might be needed to rescue victims trapped in Iranian Hospitals. Adding security as a section, should result in better performance during times of chaos, confusion, and uncertainty, as well as remove a portion of the related stress from hospital administrators (Djalali et al. 2015).
To make this method more applicable to Iranian hospitals, the Infrastructure Branch was also moved to the Logistic Section. In an emergency incident, the Operations Section would need to manage both medical and nonmedical services, including what is considered technical/logistics services. By moving this function to the Logistics Section, it helps to facilitate a safe hospital strategy and frees up the Operations Section. This modification also allows the Operations Section to focus only on medical services, rather than potentially being distracted by nonmedical services as the facility manages a disaster (Djalali et al. 2015).
Another modification made to the Iranian version of Hospital Incident Command System (HICS) method was that the Business Continuity Branch was moved from the Operations Section to the Planning and Administration Sections. Business continuity is the capability of an organization to continue crucial functions during and after a disaster or emergency. Business continuity planning establishes risk management methods and procedures that will prevent or reduce interruptions to mission‐critical services. Business continuity also restores full function to the organization as quickly and effortlessly as possible. In the case of Iranian hospitals, the researchers identified that the administrative offices will typically have responsibility for planning, and conducting hospital business, during normal operations. They deduced that moving this function in a disaster or emergency could cause more difficulties, so the decision was that HICS should not change who oversees business continuity in a disaster, and this was also the consensus of the subject matter experts (Djalali et al. 2015).
While these were not the only changes, all changes were made to be specific to Iranian hospitals. The ability for an IMS method to be customized provides evidence that shows the flexibility of the ICS method and the Hospital Incident Command System (HICS) method of incident management. It also shows that true IMS methods must be flexible in order to be adapted to other countries. It should be cautioned that making changes to any IMS method (at a local level) could lead to integration problems with other agencies. For this reason, significant changes should only be made at the federal level. Looking at the changes made to the Hospital Incident Command System (HICS) method in Iran, it was done using a group of subject matter experts, researchers, and even individuals who helped create the latest version, all of which came to a consensus. By doing so, they developed and modified Hospital Incident Command System (HICS) so that it is more feasible to implement in their country.
3.15 Iraq
Since the 2003 invasion of Iraq, the United States and its allies have been working to give Iraq the tools that are needed to improve social order. In doing so, they have helped Iraq to become a self‐sufficient society that will be able to handle their own issues. Among the tools that were provided was the most up‐to‐date public safety training available in the world. Both Britain and the United States (as well as other nations and nongovernmental organizations) have provided ICS training to Iraqi public safety officials and nonprofits for many years. This initially appears to have begun in January of 2005 with law enforcement. By November of 2005, 836 law enforcement officers were trained in ICS (Center for Strategic and International Studies, 2006).
While no information could be found on any laws requiring an IMS method to be used in disasters and emergencies, it is clear that public safety agencies in Iraq have been receiving ICS for quite some time. Additionally, there were numerous advertisements hiring fire service trainers to teach ICS to the Iraqi fire service around the same time. This leads us to believe that public safety agencies in Iraq are widely using the ICS system. No additional information could be found on the use of Hospital Incident Command System (HICS) in Iraq; however, it is likely that hospitals were also trained in its use as a part of the structural rebuild and resilience building capacity of Iraq.
3.16 Japan
Japan is in a unique situation when it comes to utilizing an IMS method. Japan is similar to the United States in many ways, yet there are some stark differences as well. Much like the United States, there are three basic levels of government. In the United States there is primarily the federal level, the state level, and the local level (with a few exceptions such as tribal government). In Japan, the three levels of government are national level, the prefecture level, and the local level. A myriad of laws, most of them dating back to the late 1940s, are the basis for disaster and emergency response, including the Disaster Relief Act of 1947, the Fire Services Act of 1948, and the Flood Control Act of 1949. These three laws helped to define emergency response in the nation of Japan (Nazarov, 2011). Only a small amount of information is available on the implementation of IMS methods used in Japan.
The Japanese government employs the Incident Command System (ICS), but due to the limited role of prefecture level of government, the ICS method appears to be relegated primarily to local governments. The local agency initiates the ICS method in the same manner as is done in the United States; however, it does not integrate into an overarching national incident management method that would help to integrate resources. From the limited information available, it appears that the Japanese government realizes that all incidents begin and end locally, and that local incident management is critical to mitigating the effects of the incident. The same basic principle is employed in the United States, and much like the United States, it appears as if the Japanese model of ICS makes the prefecture available to assist the local government when their resources are overwhelmed (Nazarov, 2011).
There is some question whether the ICS method used in Japan can expand similar to its US counterpart. Because the Japanese IMS method is not mandated nationwide, integrating outside resources such as nonprofit organizations,