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Similar to individual HCOs, the coalition (Tier 2) has an EOP that guides actions during response. The management organization of Tier 2 is less structured when compared with individual HCOs (Tier 1) and the jurisdiction (Tier 3) because decision authority is based primarily at the management level of each coalition member. Depending on incident circumstances, the Tier 2 coalition may elect to write a comprehensive incident action plan (IAP) that summarizes each participant's HCO IAP (Figure 3-1).[7] This is most likely to occur when the response will be drawn out over an extended period of time (days or weeks).
The Tier 2 coalition IAP developed for each operational period requires approval by each coalition member. The Tier 2 coalition clearinghouse function ensures that HCOs have the information they need at a level of detail that enables them to provide adequate MSCC in situations where jurisdictional incident management (Tier 3) may not yet be involved.
The Tier 2 coalition must have adequate systems in place to collect data from HCOs and rapidly return aggregated information to coalition members. Pre-identify the type of information that might be important to collect and share across the coalition.
Establish preferred methods of communication, such as radio, telephone, Internet, and facsimile. Mutual aid is assistance between HCOs through the provision of facilities, equipment, personnel, or supplies when individual resources cannot meet the surge demands generated by a specific incident. The term mutual aid refers to the establishment of a formalized compact between response entities from neighboring jurisdictions.
The HCO mutual aid memorandum of understanding (MOU) is commonly a voluntary commitment (not a legal agreement) by each participating HCO to share information and provide available assistance in a major emergency or disaster. Donor HCOs should pay staff members who volunteer to assist other facilities; the requesting HCO then reimburses this cost within a specified period of time. Liability coverage is carried by the donor HCO, but any expenses associated with the liability coverage are guaranteed by the receiving HCO. Requesting HCOs agree to rehabilitate equipment before it is returned, to replace donated supplies, and to reimburse all associated costs.
Requesting HCOs designate staff to receive, brief, assign, and supervise donated healthcare personnel. When patients must be moved between facilities, the HCO requesting assistance is responsible for arranging transport (including transmitting the patient's chart and other information): The transfer of responsibility for a patient occurs once the patient reaches the new facility. The accepting HCO has full authority to assign one of its physicians as the primary medical provider for the patient, but grants temporary courtesy staff privileges to the patient's usual physician. Additional issues are addressed in the American Hospital Association's template, Model Hospital Memorandum of Understanding. Additional information on the key components of an incident action plan is provided in Appendix C. In most cases, HCOs will first go through their normal supply chain to address surge demands. During a visit to HMS Queen Elizabeth in March, Vice Admiral Nora Tyson and her team of US personnel discussed how the UK and US carriers would work together on combined carrier tasks.
The US and the UK signed a Statement of Intent in 2012, which set out their commitment to combined carrier strike once HMS Queen Elizabeth becomes operational.
Vice Admiral Tyson and her team are assessing how that commitment might be exploited including opportunities to benefit jointly from the F35B Joint Strike Fighter capability, which is shared by the Royal Navy and the US Marine Corps. HMS Queen Elizabeth is due to start sea trials next year while HMS Prince of Wales is currently being assembled at Rosyth shipyard. Posted on May 12, 2015 with tags Carrier, europe, future, Joint, Navy, News by topic, Operations, UK, US. Sailors from the Arleigh Burke-class guided-missile destroyers USS Mustin (DDG 89) and USS John S. The conference aims to bring together key decision makers in the industry to discuss modern methods of port security and provide effective learning experiences for all delegates through the carefully selected expert speaker line up. Interacting with delegates from across the globe and hearing from industry leading experts will ensure delegates are up-to-date with high priority information that enables you to best secure your seaports, civilians and means of trade.


Topics to be discussed include terrorism, cyber terrorism, emergency intervention procedures, optimising technology use in security checks and case studies featuring some of the largest ports across the world. It should always be considered that the overwhelming majority of sport organisations are staffed by volunteers. Have the strategic objectives on your Balanced Scorecard been converted into an operating plan? Our process improvement plans and high-level strategic objectives have been converted into an operating plan.
Our process improvement plans and high-level strategic objectives have been converted into an aligned rolling operating plan. When you compare your actual results against the budget forecast, it provides you with valuable information about your performance. In all cases you need to determine the underlying reasons and examine the implications for the future of your business. A flexible budget is a budget with figures that are based on actual sales achieved.  The motivation for the flexible budget is to compare “apples with apples” – in other words, if I achieve 60% of projected turnover then my variable cost should also be 60% of projected, and other costs should be in line with the sales levels achieved.
The United States relied on net imports (imports minus exports) for about 45% of the petroleum (crude oil and petroleum products) that we consumed in 2011. Incorporating sustainability initiatives into warehouse and distribution center (DC) design is proving to be a win-win proposition.
Today’s global supply chains are increasingly complex and disruptions are a common occurrence. Comprehensive connectivity – from 802.11 wireless LAN technologies, cellular networks, Bluetooth. The benefits of effective S&OP are compelling - lower operating costs, reduced inventory requirements, and top-line growth, and top-performing S&OP companies are realizing these benefits and in the process gaining competitive advantage. Wholesale Distributors are faced with growing costs, shrinking margins, new competitors and demanding customers. Long advocated by expert observers of the supply chain scene, the Sales and Operations Planning process (S&OP) has reached a point of broad adoption. This article outlines study findings, provides key insights on challenges and opportunities, and offers a path forward for those seeking to join the ranks of S&OP top performers. First emerging well over 30 years ago, S&OP has moved from business buzzword status to mainstream adoption among the world’s large supply chain-focused organizations.
The appeal of S&OP lies in its ability to drive dramatic improvements in key business performance metrics. Intelligrated displayed, and continues to innovate with its full range of automation solutions. However, the Tier 2 EOP emphasizes coordination among coalition members (via the MACC) rather than direct management of individual assets. For example, an HCO may grant or deny a request for mutual aid based on perceived ability to adequately maintain its own operations.
In other cases, the coalition IAP may simply aggregate action plans from individual HCOs into a pre-designated format.
This type of unifying document, which describes common response goals and strategies, the situation at individual HCOs, the resources available, and other parameters, could facilitate integration with incident management at the jurisdictional level (Tier 3). Its primary function is to gather, collate, and disseminate aggregate information; it is not intended to analyze or filter information to make independent jurisdiction-level decisions (which is the purview of Tier 3).
Options include a hospital-based communications center for medical transport services, a private EMS service, or other entity. Examples could include personnel from the organizing body of the coalition or representatives designated on a rotating basis from individual HCOs.
Examples could include HCO action plans, initial and updated bed counts, patient volumes, and status of personnel, supplies, and equipment.
Historically, this agreement allowed for the provision of emergency services, on a reciprocal basis, when individual resources were inadequate to deal with a specific incident.


The MOU describes a systematized approach to HCO response for disaster events, whether external or internal to an institution(s). This includes knowing the proper procedures to follow, which personnel should make a request, whom to notify, and how to receive and financially account for donated resources—the latter being important for reimbursement after response. Industry leaders will also showcase their experiences and capability development achievements, through detailed presentations focusing on the delivery of systems and modernisation programmes for Frigates, Corvettes and OPV’s.
Our diverse range of topics will allow delegates to learn best practices for port security and understand further how other ports are resolving core challenges. As such, the provision of training, free of charge or very low cost, is an important means to reward volunteers. As a result, top performing organizations find that S&OP is 68 percent more effective at driving benefits than it is for other organizations. We define Sales & Operations Planning as a collaborative decision-making process used to develop and align time-phased demand, supply, and financial plans in support of the overall business plan. A current Google search turns up over 860,000 entries and a search on professional networking site, LinkedIn, finds more than 16,000 individuals who list the term “S&OP” in their profiles. Our experience indicates that effective use of S&OP can help grow the top line of the business while reducing operating costs and reducing inventory required (see Exhibit 2). This reflects the fact that HCOs retain their management autonomy during a response, while they collaborate with other medical assets to strengthen overall MSCC in the jurisdiction or region. Decisions that affect all coalition members are made by consensus through moderated meetings or teleconferences. At the Tier 2 level, this is typically accomplished through a clearinghouse function that receives data from HCOs, collates them, and returns the aggregate data to HCOs.
For example, it may be beneficial to develop spreadsheets that allow data to be electronically collated and the aggregate data quickly returned to the HCOs. For example, the Emergency Medical Services System Act passed by Congress in 1973 identified mutual aid as one of fifteen essential components in the formation of EMS systems in the United States.
It addresses the exchange of medical personnel, supplies, pharmaceuticals, and equipment, and the evacuation or admission of patients to or from any member facility in the event of a disaster. A short briefing should be prepared for staff members who volunteer to deploy to other facilities.
Few business improvement initiatives match the economic return that implementing an effective S&OP process can generate. In addition, the EOP should guide members on how to incorporate Tier 2 tenets into their respective HCO EOP.
Major strategic or policy-level decisions necessary during incident response may be relegated to meetings or teleconferences between the senior executives of the participating coalition HCOs. The mutual aid system is not a replacement for any individual hospital's emergency preparedness plan; rather, it is meant as a supplement that will augment an institution's capabilities. For example, the coalition EOP might provide instructions on such issues as how to request and integrate mutual aid assets into an HCO's incident operations, and what designated communication methods to use between HCOs during response. This forum may be designated as a MAC Group function to distinguish it from the MACC coordination function accomplished by the other Tier 2 activities. The MOU assumes that the HCO has implemented its own EOP prior to activating the mutual aid system, and that the adequacy of the affected organization's response has been exceeded. Any event requiring activation of the mutual aid system is expected to be of a magnitude that it also involves municipal emergency services and the jurisdiction's department of public health. An example of the MAC Group function may be a decision by all HCOs to buy an expensive technology necessary to address a newly recognized illness in the community.
Despite the diffuse decision authority at Tier 2, each HCO should recognize the importance of its response actions and public message being consistent with those of other HCOs in the coalition.



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