The Medical Surge Capacity and Capability (MSCC) Management System describes a management methodology based on valid principles of emergency management and the Incident Management System (IMS). Medical and health disciplines may apply these principles to coordinate effectively with one another, and to integrate with other response organizations that have established IMS and emergency management systems (fire service, law enforcement, etc This promotes a common management system for all response entities-public and private-that may be brought to bear in an emergency. In addition, the MSCC Management System guides the development of health and medical response that is consistent with the new National Incident Management System (NIMS). The MSCC Management System emphasizes responsibility rather than authority alone for assigning key response functions and advocates a management-byobjectives approach. In this way, the MSCC Management System describes a framework of coordination and integration across six tiers of response: (1) Management of Individual Healthcare Assets (Tier 1): A well-defined IMS to collect and process information, to develop incident plans, and to manage decisions is essential to maximize MSCC. Robust processes must be applicable both to traditional hospital participants and to other healthcare facilities (HCFs) that may provide hands on patient care in an emergency. Thus, each healthcare asset must have information management processes to enable integration among HCFs (at Tier 2) and with higher management tiers. (2) Management of a Healthcare Coalition (Tier 2): Coordination among local healthcare assets is critical to provide adequate and consistent care across an affected jurisdiction. The healthcare coalition provides a central integration mechanism for information sharing and management coordination among healthcare assets, and also establishes an effective and balanced approach to integrating medical assets into the jurisdiction's IMS. (3) Jurisdiction Incident Management (Tier 3): A jurisdiction's IMS integrates healthcare assets with other response disciplines to provide the structure and support needed to maximize MSCC. In certain events, the jurisdictional IMS promotes a unified incident management approach that allows multiple response entities, including health and medicine, to assume significant management responsibility. (4) Management of State Response (Tier 4): State Government participates in medical incident response across a range of capacities, depending on the specific event. The State may be the lead incident management authority, it may primarily provide support to incidents managed at the jurisdictional (Tier 3) level, or it may coordinate multijurisdictional incident response. Important concepts are delineated to accomplish all of these missions, ensuring that the full range of State health and medical resources is brought to bear to maximize MSCC. (5) Interstate Regional Management Coordination (Tier 5): Effective mechanisms must be implemented to promote incident management coordination between affected States. This ensures consistency in regional response through coordinated incident planning, enhances information exchange between interstate jurisdictions, and maximizes MSCC through interstate mutual aid and other support. Tier 5 incorporates existing instruments, such as the Emergency Management Assistance Compact (EMAC), and describes established incident management and mutual aid concepts to address these critical needs. (6) Federal Support to State and Jurisdiction Management (Tier 6): Effective management processes at the State (Tier 4) and jurisdiction (Tier 3) levels facilitate the request, receipt, and integration of Federal health and medical resources to maximize MSCC. The current status of the Federal health and medical response is described, emphasizing the management aspects that are important for State and local managers to understand. (HHS, Medical Surge Capacity and Capability Handbook, August 2004, pp. vii-viii) Medical Unit: The unit within the Service Branch of the Logistics Section responsible for providing emergency medical services to incident personnel and for the development of the Medical Emergency Plan. (Capital Health Region, Edmonton Ca, ICS Training SM, 2007, 55)