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US hospitals are required by Joint Commission to utilize a command structure that is compliant with the National Incident Management System (NIMS). Most utilized is the Hospital Incident Command System (HICS) which guides any disaster response. Further, hospitals are required to NIMS guidelines when responding to events that predicate the implementation of disaster plans or protocols - especially when hospital leaders will interact with local, state or federal authorities. These mandates have grown in depth and breadth since all first responder disciplines began to update their local policies, procedures, and education requirements in the post-9/11 preparedness environment.  This new environment includes ongoing federal grants designed to increase hospital preparedness and capacity, but with the fund are mandates requiring hospitals to educate staff members in NIMS education and its use. As a result, many hospitals have adopted HICS and NIMS as the general frameworks on which they build disaster plans, education sessions, and disaster drills. While federal and state officials continue to track compliance with federal requirements, there seems to be a gap in tracking use and effectiveness of HICS and NIMS in real-life incidents, whether planned or emergent. This article examines the real-life experiences of one 1,000+ bed Michigan hospital system that used HICS and NIMS during responses to a state funeral, a credible bomb threat, and a helicopter crash

An Independent Review of Several Successful Hospital Incident Command System (HICS) Implementations and Lessons Learned