EIIP Virtual Forum Presentation — December 13, 2006
NIMS National Credentialing System
The Emergency Medical Services Working Group
Frank Disimino
Program Specialist, Standards and Compliance Branch
FEMA NIMS Integration Center
Avagene Moore
EIIP Moderator
The following version of the transcript has been edited for easier reading and comprehension. A raw, unedited transcript is available from our archives. See our home page at http://www.emforum.org
[Welcome / Introduction]
Avagene Moore: Welcome to the EIIP Virtual Forum! We are pleased to see each of you here today! Our topic today is the "NIMS National Emergency Responder Credentialing System."
It is my pleasure to introduce our guest speaker today. Frank Disimino is a Program Specialist in the Standards & Compliance Branch with the FEMA NIMS Integration Center. Frank formerly served with the Department of Justice's Office for Domestic Preparedness (ODP), and has extensive previous experience in international relief. He is a certified EMT-Paramedic, RN, and holds a master's degree in Health Care Administration.
If you have not read the background page, I urge you to do so after our session today to learn more about our speaker's expertise and experience.
We welcome you to the EIIP Virtual Forum, Frank.
[Presentation]
Frank Disimino: Good Afternoon for everyone on the East Coast and a Good Morning (hopefully without too much snow!) for those joining from the Midwest and Western states. On behalf of the NIMS Integration Center (NIC), I want to thank EIIP and Ms. Avagene Moore, in particular, for the opportunity to explain the National Incident Management System (NIMS) as it relates to credentialing with a focus on the nineteen Emergency Management System (EMS) positions that were posted for initial comments and review in September 2006.
The NIMS-oriented resource management and mutual aid enhance incident readiness and response at all levels of government through a comprehensive and integrated system that allows jurisdictions to share resources among mutual aid partners. On Oct. 20, 2004, FEMA and the NIMS Integration Center (NIC) released the National Mutual Aid Glossary of Terms and Definitions, and Resource Typing Definitions for 120 different kinds of resources. The resource typing definitions were prepared by subject matter experts and federal, state and local responders who would be using the definitions to inventory assets and support mutual aid requests.
In addition to the persons directly involved in the groups, there were over 300 corresponding members who reviewed working drafts and participated in the formation of the definitions. The Glossary and Resource Typed Definitions can be accessed at http://www.fema.gov/nims/mutual_aid.shtm.
Resource typing and mutual aid are key components of the National Incident Management System. And, since the release of NIMS and the National Response Plan (NRP), there has been an increased interest in the definitions. In some cases, this has led to a few states and localities developing new ones after concluding that the definitions don’t fit their needs. The whole idea of NIMS is based on the need for standard definitions and practices; differing definitions will in effect negate the fundamental idea that all responders should be using common definitions when ordering or receiving assets though mutual aid. Systems that do not conform to these common definitions are not compliant with NIMS.
The NIMS Integration Center recognizes that in some instances changes need to be made to the definitions and in other instances entirely new ones created. The Center will facilitate this process to ensure that we maintain a consistent nationwide approach to resource typing and consistency across the nation.
RESOURCE MANAGEMENT
Resource management under NIMS defines standardized mechanisms and establishes requirements for processes to describe, inventory, mobilize, dispatch, track, and recover resources over the cycle of the incident. This may sound more difficult than it really is. A resource typing system allows responders to keep track of all resources required and used for response. This is especially important when receiving or providing mutual aid. Typed resources are easy to identify for replacement, upgrading, or exchange.
Resources are organized in these ways:
• Category: function for which the resource is most useful (firefighting, law enforcement & security, transportation, communications, public works & engineering, information & planning, mass care, etc.)
• Kind: broad class of characterization, such as teams, personnel, equipment, supplies, vehicles, and aircraft.
• Components: what composes the resource (e.g., hose, pump, ladder, truck, personnel, cots, blankets, water storage containers, syringes, etc.)
• Metrics: measurement standards that identify capability or capacity. Metrics will differ depending on the kind of resource being typed.
• Type: refers to the level of resource capability, and provides managers with additional information to aid the selection and best use of resources. A type is based on a minimum level of capability described by the identified metrics for that resource or component. Type I implies a higher capability than Type II.
States and local jurisdictions should use resource typing definitions to describe or inventory their resources. A description of the typing definitions and approach can be found at: http://www.fema.gov/pdf/nims/NIMS_basic_resource_typing_system.pdf.
NIMS-oriented resource management and mutual aid enhance incident readiness and response at all levels of government through a comprehensive and integrated system that allows jurisdictions to share resources among mutual aid partners.
The NIMS Integration Center is developing a national credentialing system that will help verify, quickly and accurately, the identity and qualifications of emergency personnel responding to an incident. The National Emergency Responder Credentialing System will document minimum professional qualifications, certifications, training and education requirements that define the standards required for specific emergency response functional positions.
The NIC is using working groups to identify job titles to be credentialed and the qualifications and training required. Working groups are focusing on the following: Incident Management, Emergency Medical Services, Fire/Hazardous Materials/ Law Enforcement, Medical and Public Health, Public Works and Search and Rescue.
CRITERIA FOR CREDENTIALING EMERGENCY MEDICAL SERVICES (EMS) PERSONNEL
For ease of ordering and tracking, response assets need to be categorized via resource typing. Resource typing is the categorization and description of resources that are commonly exchanged in disasters via mutual aid, by capacity and/or capability. Through resource typing, disciplines examine resources and identify the capabilities of a resource’s components (i.e., personnel, equipment, training).
During a disaster, an emergency manager knows what capability a resource needs to have to respond efficiently and effectively. Resource typing definitions will help define resource capabilities for ease of ordering and mobilization during a disaster. As a result of the resource typing process, a resource’s capability is readily defined and an emergency manager is able to effectively and efficiently request and receive resources through mutual aid during times of disaster.
NIMS define credentialing as referring to the National Resource Typing Definitions that involves personnel and teams (i.e. as equipment would need credentialing). As part of our nation’s efforts to strengthen catastrophic response capabilities in line with the National Incident Management System (NIMS), FEMA’s NIMS Integration Center has released the proposed initial minimum criteria for EMS Personnel to be deployed using a national credentialing system.
The purpose of a subject matter working group is to identify additional resource definitions typing (where applicable, for the specific disciplines (i.e. EMS, Medical/Public Health) to be added to the current 120 NIMS National Resource Typing Definitions.
The NIMS requires that states and territories need to identify, inventory and manage these resources (i.e. the current 120 NIMS National Resource Typing Definitions) to promote more effective interstate mutual aid through common interoperability and integration. This is also a requirement by DHS and other Federal agencies, as a condition for Federal preparedness funding.
The development of a national credentialing system is a fundamental component of the National Incident Management System (NIMS). According to the NIMS, "credentialing involves providing documentation that can authenticate and verify the certification and identity of designated incident managers and emergency responders."
Credentialing ensures that response personnel "possess a minimum common level of training, currency, experience, physical and medical fitness, and capability" for the roles they are tasked to fill. The NIMS Integration Center initiated the development of a national credentialing system in FY 2005 to enhance the ability of federal, state, tribal and local jurisdictions to identify and dispatch appropriately qualified emergency responders from other jurisdictions when needed. A national credentialing system ensures that personnel resources requested from another jurisdiction to assist in a response operation are adequately trained and skilled. A national system to verify the identity and qualifications of emergency responders will not provide automatic access to an incident site. This system can serve to prevent unauthorized (self-dispatched or unqualified personnel) access to an incident site.
The NIMS Integration Center will work with existing state, territorial or discipline-specific credentialing bodies toward national recognition for multi-jurisdictional response under mutual aid agreements. The main components of a proposed credentialing system are: eligible volunteers; certifications and qualifications standards; credentialing organizations; credentialing information that can easily identify personnel and verify certifications, training, and licenses; and a record-keeping system.
To support this credentialing initiative, the NIC is using working groups of subject matter experts to identify job titles that should be credentialed as well as the minimum qualification, certification, training, education, licensing, and physical fitness requirements for each position. Working groups will represent the following disciplines:
-Incident Management
-Emergency Medical Services
-Fire/HazMat
-Law Enforcement
-Medical and Public Health
-Public Works
-Search and Rescue
-Animal Health Emergencies Response
Currently active groups include the Incident Management, Emergency Medical Services, Fire/HazMat, Public Works, and Search and Rescue working groups.
When National Resource Typing Definitions involves personnel or teams, minimum qualifications (i.e. credentials) need to be defined to address the competency and capability of the personnel or teams. However there are no NIMS "national standards" from an operational perspective during an incident regarding how such resources should be deployed or used.
Similarly there are no NIMS "national standards" concerning professional licensing, certification and accreditation. As is the case with EMS, once the credentialing requirements are developed, they will be posted on the NIC website (along with a NIMS Alert and public notification to the interested stakeholders, professional associations, etc.) for comments and feedback.
All comments and feedback will be collected by the NIC for review by the appropriate working group for their consideration and any finial revisions. This will be followed by an official posting, with the understanding that this is a dynamic and evolving process that allows for future revisions and adaptations.
An EMS credentialing working group comprised of 35 Subject Matter Experts who have identified 19 EMS positions anticipated to be most commonly requested during an interstate mutual aid response. They are:
1. Air Medical Transport Manager
2. Air Medical Transport Mechanic
3. Air Medical Transport Medical Director
4. Air Medical Transport Paramedic
5. Air Medical Transport Pilot
6. Air Medical Transport Registered Nurse
7. Emergency Medical Responder
8. Emergency Medical Technician (EMT)
9. Emergency Vehicle Operator
10. Emergency Vehicle Operator-Heavy
11. EMS Physician
12. Medical Branch Director
13. Medical Group Supervisor
14. Medical Supply Coordinator
15. Paramedic
16. EMS Transportation Group Supervisor
17. EMS Transportation Unit Leader
18. EMS Treatment Unit Leader
19. EMS Triage Unit Leader
For each job title, the EMS Working Group identified minimum "requisite" and "recommended" baseline criteria for education, training, experience, physical/medical fitness, certification, and licensing. These criteria are intended to complement and support existing credentialing systems. Where national standards do not exist under "requisite" criteria, "recommended" criteria are listed for current and/or future consideration.
These recommendations have been submitted to the NIMS Integration Center and are available on the NIMS Web page at http://www.fema.gov/emergency/nims. The EMS Working Group is presently in the process of reviewing all responses submitted and will make any needed revisions. A final NIMS release of the Criteria for credentialing Emergency Medical Services (EMS) Personnel will then be issued.
On-line resources about NIMS are available by visiting http://www.fema.gov/emergency/nims/index.shtm
Questions may be sent by email to the NIMS Integration Center at [email protected]
Current list of federal preparedness funding: http://www.fema.gov/emergency/nims/index.shtm
Complete list of NIMS-related training: http://www.training.fema.gov/EMIWeb/IS/crslist.asp
NIMCAST: http://www.fema.gov/nimcast/index.jsp
Samples of mutual aid agreements: http://www.nimsonline.com/download_center/index.htm
Model state/county mutual aid agreements: http://www.emacweb.org
Thank you for your time and attention. I do hope this is of some help to you. The above materials were adapted from various NIMS Alerts and the NIMS Guide for County Officials was produced by the National Association of Counties Research Foundation in cooperation with the International Association of Emergency Managers under a Cooperative Agreement provided by the DHS.
Please feel free to contact me at my point of contact information.
Frank Disimino, Program Specialist
NIMS Integration Center (NIC) - Room 205
FEMA Headquarters
500 C Street, S.W.
Washington, DC 20472
Office (202) 646-2578
e-mail: [email protected]
Avagene Moore: Thanks for your overview of the NIMS National Credentialing System, Frank. We will now turn to questions from our audience.
[Audience Questions & Answers]
Question:
Larry Heidenberg: You stated there are groups for both EMS and a group for Medical/Public Health. Although the EMS one is active, the PH/Medical was not listed as active. Under the 19 positions, you listed a Medical Branch Director. How will these two areas interact (especially the Public Health Component) when both systems are finally in place so that they will have a "unified" structure?
Frank Disimino: Though both working groups are separate, each is aware of the minimum baseline criteria for credentialing. The difference between EMS and Medical/Public Health is that they require more development with the NIMS creating resource typing definitions at the national level. We certainly are aware of the need to coordinate within similar disciplines credentialing requirements. But our primary focus is to be able to identify the required resource capabilities as defined under each the National Resource Typing definitions.
Question:
Fred Rion: Although two separate things (accountability and credentialing), locally we have begun to look at developing a system (possible ID linked to Web based or other database) that would identify an individual, their level of NIMS training, their discipline specific skill set and other information. Before getting too far ahead of what the Federal government has in mind, should we focus on (in the case of EMS) these 19 positions (kind of prototype it, along with other disciplines identified by the NIC already) and go from there? Obviously we don't want to invest too many resources if in a year or so, there is a different Federal mandate than we envision.
Frank Disimino: Thank you for your question. Identifying national standards that would incorporate qualifications, identity verification, and permission for access to an incident scene are still ongoing. The NIC would appreciate any feedback and thought that you may have.
Question:
Mike Boyle: A few years ago ODP had developed 10 disciplines for emergency response, (i.e., Fire Service, Hazmat, EMS, Public Health). Are those discipline categories now replaced with the NIMS categories? If so what was the reasoning behind the change? The ODP disciplines seemed to capture what was needed. In the NIMS categories there appears to be quite a few overlaps, e.g. Search and Rescue includes EMTs and paramedics from the EMS discipline.
Frank Disimino: Mr. Boyle, I am not certain under what context ODP defined these disciplines, but for NIMS purposes, the resource typing are outlined by discipline as already described: Incident Management, EMS, Fire/HazMAt, Law Enforcement, Medical and Public Health, Public Works, and Search and Rescue. There is no attempt on the NIC's part to define the entire first responder disciplines, just within those categories. We understand that this is an evolving process. For this purpose, our resource management initiatives should not be considered over-riding of other initiatives or directives of other federal agencies. That is not our intent.
Question:
Debra Robinson: Many seem bogged down in details of compliance for various issues already. Where is compliance for this going to be regulated on a local basis?
Frank Disimino: Thank you for your question, Debra. As indicated, the NIC has no authority when it comes to licensing, accreditation, or certification. These tasks will be handled by the appropriate regulatory bodies. The NIC is simply trying to determine what are the prerequisite requirements by such certification bodies to ensure resource capabilities in a mutual aid environment involving interstate requests.
Question:
Amy Sebring: Following up on your previous reply regarding Health & Medical resources, is the NIC currently engaged in defining Health & Medical resources beyond EMS, and if so, do you know when they will be available?
Frank Disimino: Currently, the Medical/Public health effort is being spearheaded under the direction of HHS through coordination by the NIC. We have two working groups: one for Medical, one for Public Health. We are hoping to have the resource typing definitions completed by late winter and then, based on what has been defined, the working groups will outline the credentialing requirements to ensure those resource typing definition capabilities can be delivered via mutual aid requests, as well as being inventoried and tracked for availability.
Question:
Debra Robinson: I understand the need to standardize positions, qualifications, descriptions, etc. I see the greatest value in the larger metro areas, but how is this going to affect the "little people" in EMACS who may question their appropriate classifications?
Frank Disimino: Debra, the NIC's viewpoint is that there are no "little people" when it comes to addressing incidents of national significance or disaster requests. The NIC appreciates and fully intends to work in partnership with disaster VOADs as we progress to developing resource typing definitions and criteria that impact on their roles and responsibilities.
Question:
Avagene Moore: Frank, what kind of response (number wise - few or many) are you getting during the comment period for the EMS credentials? How can we and our audience help?
Frank Disimino: We've gotten several hundred comments back, both from state and local, as well as federal agencies. The EMS working group is currently in the process of incorporating these suggestions into the final revision. Having said that, this will continue to be an evolving process. And it will allow for further refinement based on the feedback from the first responder community as well as new lessons learned from disasters and other events of national significance involving emergency management agencies. The audience can help by going to our Website and providing the appropriate comments and feedback. They will continue to be forwarded to the EMS working group.
Question:
Brian Carney: Are there plans to increase the vehicle typing standards for EMS? Presently we have Types 1 through 4. Here in NJ we have developed EMS centric vehicles that address Mass Care, Logistical Support, and Medical Surge.
Frank Disimino: Presently I have not received communications from the NIMS working group. If you feel that there is a requirement to do that, please send a detailed rationale to me and I will forward it to the EMS working group.
Question:
Mike Boyle: Are the NIC coordination efforts with HHS fully integrated with the HHS Emergency System for the Advanced Credentialing of Volunteer Health Professionals (ESAR-VHP) initiatives?
Frank Disimino: Yes, good question. This is why the NIC was very specific in approaching HHS to spearhead this initiative regarding Medical and Public Health. HHS is fully aware of the EMS activities regarding resource typing, as well.
Question:
Amy Sebring: There are no plans to develop credentialing for the Emergency Management discipline per se? For example, to support MAC/EOC type functions.
Frank Disimino: By emergency management discipline, if you mean state emergency management personnel, we have not resource typed these personnel. The thinking is that most states from a mutual aid perspective would not require emergency management personnel from another state to staff their state EOC, but rather, would draw upon that state's internal resources to support emergency management on the scene, if I understand your definition of emergency management personnel.
Amy Sebring: Not only state but also local as in major cities perhaps. I believe EMAC has coordinated these types of individuals in the past.
Ed Kostiuk: Frank is correct; we have addressed resource typing within the Emergency Management Field and felt we could create an IMT group that could sustain operations for a sister state if the need arose to "fill in" their EOC positions via the EMAC system.
Frank Disimino: Thank you for your comment, Ed. When addressing the need for national resource typing definition, we look towards guidance from the state and local first responder community where they perceive gaps regarding our national typing of resources. Please know that we anticipate by early winter to issue criteria for resource typing and for credentialing for additional resource typing. We will issue NIMS Alerts addressing this issue.
Question:
Mike Boyle: You mention that the NIC is looking at developing a Web-based system to facilitate credentialing. Can you give us some indication of how far along in the development cycle that system is?
Frank Disimino: Mike, I would say that the current model, of course, is the NICC (National Integration Coordinating Center), Wildland Fire. We are in current discussions with the state emergency management agencies for use of ROSS and/or WebEOC. The purpose is to find a system that the states will concur with. At this time, there is no definitive agreement. It will come to an issue of allocating dollars and personnel in developing such a system. We are not at the point like Wildland's use of the "Red Card".
Question:
Lori Wieber: Perhaps you can address this question from an associate who is not here today. It is my understanding that personnel must have a social security number in order to be credentialed. Being in a border state (Michigan) we have many Canadian volunteers active within our non-governmental response organizations such as SAR. Since they do not have SSN how will they be addressed or credentialed? Who would be a good source for follow-up on this question?
Frank Disimino: Thanks, Lori. The NIC has no intention of developing policies that will adversely impact the ability of other federal agencies or state responders to receive international volunteers or support in mutual aid agreements that are already in place. We are trying to determine the criteria for identity verification in compliance with HSPD-12.
Lori Wieber: As a follow up who could I contact to get further information on the international volunteers answer you gave above. It appears that there is some confusion regarding the mechanism and requirements.
Frank Disimino: Lori, presently the NIMS would defer to those first responder agencies that already have mutual aid agreements or memorandums of understanding related to the international volunteers. For the future, we will need to determine how we are going to incorporate qualifications and identity verification standards so that we can facilitate the use of international volunteers. You can contact me later offline.
Question:
Mike Boyle: I believe according to NIMS and most state law, it is a local and municipal responsibility to maintain inventories of resources. What tools, if any, does NIC envision being made available to these agencies in the future for use in this task? Or is it envisioned that they would be responsible to provide their own tools based on NIC recommendations and resource typing criteria? The same question arises concerning the FIPS-201 process (HSPD-12). What tools might be available to them in the near future to ensure compliance without placing burdens on managing the credentialing process?
Frank Disimino: Presently, NIMS only required state and locals to inventory the 120 national resource types that have been published. The NIMS has no formalized requirement as to what type of software the states and locals must use to accomplish this task. Some states use ROSS and others use WebEOC. On the national level, we would be interested in ways that ROSS and WebEOC can be interoperable. The key concern is not just what has been inventoried but what is also available for deployment from an interstate mutual aid perspective. Regarding FIPS 201, system hardware requirements are still in the process of being determined. The NIC is well aware that such requirements come with cost regarding funding (personnel, IT, etc.) and we are looking at the state and locals for their recommendations.
The National Capital Region and Denver have different systems that are not compatible. We are in the process of trying to address those concerns, understanding that response agencies are not in the position to dis-invest themselves of equipment and systems that they already implemented.
Question:
Amy Sebring: Has there been any thoughts about extending the credentialing system to a uniform national ID card system that incorporates both identity verification and type/level of credential?
Frank Disimino: Thank you for your question Amy. There are many policy issues that would need to be address prior to adopting a uniform national ID card system. These include the obvious need for national agreement regarding: IT software and hardware standards, cost, accreditation and certification control for the issuance of these ID cards, etc. The more perplexing issues involves: privacy, the need for agreement as to the extent and depth of information that would be required and updated, addressing national security clearance requirements, getting nationally consensus on what operational authority such an ID card system would convey (i.e. given the varied requirements of the various first responder disciplines), etc.
Having said that, the NIC is working with both the National Capital Region (i.e. Virginia, D.C. and Maryland) as well as with the city of Denver to identify their current ID systems to determine what might be applicable as a starting point on which to build national consensus around from a limited interstate mutual aid and ICS perspective. However the Federal government (as this issue is broader than DHS) is still a long ways off from issuing standards related to a uniform national ID card system.
[Closing]
Avagene Moore: Thank you, Frank! We greatly appreciate your effort and time on our behalf. We wish you well as you continue your work in this important NIMS effort.
Please stand by a moment while we make some quick announcements. If you are not currently on our mailing list, and would like to get program announcements and notices of transcript availability, please see the Subscribe link on our home page.
We are proud to announce a new EIIP Partner today. We welcome Warning Systems, Inc. www.warningsystems.com. Elysa Jones, Emergency Program Manager and Jim Conrad, Marketing, serve as co-Points of Contact for WSI. Jim is with us today. Welcome Jim and WSI! If you are interested in becoming an EIIP Partner, please see the "Partnership for You" link on the EIIP Virtual Forum homepage http://www.emforum.org .
Thanks to everyone for participating today. We appreciate you, the audience!
Before you go, please help me show our appreciation to Frank for a fine job. The EIIP Virtual Forum is adjourned! We wish you all Happy Holidays and invite you back on January 10, 2007!