C3 during COVID-19 – Adapting a Military Command, Control and Communications Framework for Crisis Response in a UK Tertiary Critical Care Centre

Adopt a five-level, multi-domain C3 framework with a dedicated C3 lead, and establish a 60-minute daily briefing to translate intelligence into timely decisions and maintain a single, shared situational picture across wards, ICU, and support services.

Define Levels 0–4 as follows: Level 0 is Strategic governance; Level 1 is Operational coordination; Level 2 is Tactical unit synchronization; Level 3 is Clinical execution in ICU/HDU; Level 4 is Logistics and external liaison. Each level has a named lead who reports to the C3 lead and contributes to a consolidated dashboard updated hourly during surge. This structure lets bed capacity, staffing and equipment be adjusted quickly across five levels of operation.

Minimum intelligence requirement includes daily bed occupancy, ventilator status, oxygen supply, PPE stock, staff availability and self-isolation status. The analysis converts these data into orders within 60 minutes, with escalation triggers if occupancy exceeds 85% or PPE stocks fall below defined thresholds. canadian mutual-aid frameworks inform cross-site staffing exchanges, and the application of similar data-sharing protocols can shorten delays in inter-hospital transfers.

Where should this framework sit? It belongs at the junction of the hospital Emergency Operations Centre and Clinical Governance Forum, with formal links to regional health authorities. In practice, ward teams feed standardised handover data into the C3 dashboard, and self-isolation status for symptomatic staff triggers predefined staffing contingencies. Leadership at all levels must keep communication open and decisions aligned across the five levels.

The difference this approach makes shows up in patient flow and staff safety: the model is transformative because it integrates clinical judgment, logistics and communications in real time, reducing transfer delays and enabling earlier escalation to higher levels of care in todays care environment. The cycle includes ongoing analysis and post-incident reviews to turn data into concrete improvements across levels and supports leadership decisions in fluctuating demand.

King’s Critical Care Crisis Response: C3 Frameworks and Pre-COVID Foundations

Start with a daily C3 drill that links bedside practice to the incident command room, ensuring sufficient consumables and a rapid replacement plan. This approach keeps your team able to respond under demanding and challenging conditions.

In the context of pre-COVID foundations at King’s, care teams relied on a hybrid system mixing paper-based handovers with evolving digital dashboards that use pixels to show real-time events and escalation cues, particularly during surges, about resource allocation.

Example: a renal replacement surge required rapid escalation; facing a vast problem, the team reallocated staff and consumables, increasing renal support capacity by 30% within 12 hours, requiring cross-department coordination.

With a robust C3 context, you defend against miscommunication; in crisis, information becomes weapons and wrong data multiplies the problem, increasing the risk of death.

Future planning must create a right-sized, responsive system; ensure daily practice, keep some replacement stock checks, and balance paper and pixels for data capture, so your unit can meet future demand, facing demanding events with power redundancy. The same approach across units helps maintain consistency.

Map military C3 elements to King’s ICU workflows: aligning C2/C3 with clinical incident management

Adopt a central C2/C3 hub integrated with King’s ICU workflows, delivering a co-ordinated, multi-disciplinary response with a single source of truth for incident status and decisions.

Align C2 to ICU clinical incident management by defining command roles, escalation triggers, decision rights, and a lead clinician accountable for patient care decisions. Operate from a single, technology-enabled interface that presents surge alerts, bed-state, and staffing status to all teams, reducing delay and confusion.

Map C3 to control of information and communications: establish a central information spine that ingests data from EHR, bedside monitors, ventilators, and staffing systems, surfacing a common status view for clinical and logistical teams. Apply artificial, intelligence-enabled analysis to detect signs of deterioration, identify apparent bottlenecks, and guide supporting teams (cafs) to move resources where needed. This approach significantly improves response times and reduces miscommunication.

Install a central traffic tracker to coordinate patient movement, bed allocation, and equipment deployment. Use dashboard-driven alerts with clear traffic signals to indicate critical, watch, or clear states across units and corridors, enabling rapid reallocation during influx events.

Deterrence of miscommunication relies on standardized handoffs, jargon-free updates, and a shared mindset across ICU, cafs, and transport teams. Pre-defined C2/C3 playbooks and regular briefings ensure signals are interpreted consistently, while deviations are quickly identified and corrected by the hub.

Invest in ongoing training so staff can lead, conduct, and participate in crisis operations. Use simulations that stress influx scenarios, device failures, and multi-team coordination to strengthen integration and ensure devices, dashboards, and apps function as expected under pressure.

Track metrics across response times, resource utilization, and patient outcomes to inform strategy updates. Conduct rapid analysis to refine integration of C2/C3 with ICU workflows, ensuring the central hub remains strong and capable of supporting future crises while providing an auditable account of actions taken.

Define incident command roles, responsibilities, and escalation pathways for ICU crises

Assign an ICU Incident Commander to own crisis decision-making, and implement a five-tier escalation pathway with clearly assigned responsibility and fully described sops. Use a descriptive table linked in the portal to support clinicians across diverse centers, reducing exposure and ensuring security and flexibility throughout the response.

Five core roles drive coordination. The Incident Commander leads strategy, approves resource reallocation, and communicates escalation triggers; the Operations Lead manages patient flow, ICU occupancy, staffing, and interdepartmental handoffs; the Clinical Lead sets care pathways and triage criteria; the Logistics Lead secures equipment, PPE, medications, and personnel redeployments; the Communications Lead handles staff updates, external briefings, and portal messaging.

Escalation pathways link triggers to actions: Level 1 signals routine operations; Level 2 flags heightened monitoring; Level 3 activates surge containment with increased staffing and bed management; Level 4 reconfigures resources across units; Level 5 engages external partners and regional centers. Each level is described in sops and maps to decision criteria, with time-bound triggers and clear authority lines throughout the organization.

SOPs describe role handoffs, decision criteria, and safety steps; guidance is publicly accessible via the portal; assigned staff refer to the table for fast reference. The approach emphasizes descriptive guidance on risk assessment, infection control, and clinical escalation, ensuring compliance and security throughout operations.

Regular drills tested across diverse centers build familiarity; clinicians receive succinct briefings and encouragement to practice surge procedures. Drills validate the five core roles, test handoffs, and verify that data capture and exposure reduction mechanisms function as intended.

Continuous monitoring uses maps and dashboards to track patients, bed occupancy, staff availability, and supply levels; governance reviews occur weekly with the Incident Commander and Operations Lead to adjust guidance and sops based on evolving exposure risk and capacity.

Design data flows and real-time dashboards for situational awareness in critical care

Recommendation: Implement three linked real-time dashboards for clinical status, operations, and logistics, connected via a common platform and standard data format to enable rapid situational awareness across groups.

Data flows begin with clinical and operational producers: bedside monitors, ventilators, EHR, LIS, pharmacy, bed management, and supply systems. Each source publishes a defined set of signals; a format-agnostic connector normalizes to a standard model. A streaming layer (pub-sub or event bus) aggregates signals with regular latency and forwards them to the dashboards. A governance layer tags ownership and error handling. This three-layer flow supports faster response and easier cross-functional coordination during demand spikes. This design reduces intricacies facing staff during the busiest periods.

The dashboards center on three areas: clinical status, operations, and logistics. The clinical dashboard tracks patient-level metrics (vital signs, ventilator settings, labs, medications) with drill-down by groups of care teams. The operational dashboard shows bed occupancy, staff coverage, turnover times, surge capacity, and escalation paths. The logistics dashboard monitors PPE stock, oxygen supply, drug availability, and equipment downtime. Color-coded statuses and threshold-based alerts drive decisive actions, with alert routing to responsible groups and allied teams. This platform supports rapid triage decisions and maintains uniform data presentation during shifts with high demand.

Instill a culture of disciplined data use: assign three roles per site (data steward, clinical lead, operations lead) with clear responsibilities. Regular briefings and after-action reviews feed back into the design, enabling greater adapt. The approach engages allied organizations and aligns with the UK tertiary centre context. Emphasis on standardization makes training easier and accelerates adoption across groups.

Implementation plan targets rapid progression: 1) define data contracts by June, 2) select a platform with secure authentication and role-based access, 3) build connectors and a three-dashboard prototype, 4) run simulated drills, 5) scale to busiest wards and critical care units. The format should support offline continuity for connectivity disruptions and allow decoupling of data producers from dashboards. Metrics to track include data latency, dashboard uptime, alerting precision, user engagement, and action latency from alert to decision-to-action. A regular cadence of reviews ensures the system remains fit for purpose during evolving crisis conditions.

Plan resource surge: staffing models, bed capacity, equipment, and supply chain integration

Adopt a 72-hour surge blueprint: activate a two-tier staffing model, expand bed capacity by staged increments, and lock in supply chains with pre-approved vendors to ensure uninterrupted access to key equipment.

• Staffing models
  • Initial step assigns an on-duty command lead to coordinate workforce deployment and maintain ongoing experience sharing across groups. Core critical care nurses maintain 1:1 care for ventilated patients and 1:2 for others, with a ready reserve of cross-trained staff to fill gaps.
  • Create a dynamic rotation to limit fatigue: 8–12 hour shifts with safe rest periods; bring in trained staff from adjacent services to cover surges while respecting security and patient safety.
  • Establish an east wing and public-area plan to manage exposure: dedicated donning/doffing zones, separate entry points, and clear privacy safeguards for sensitive information and patients.
  • Co-ordination across command, nursing, and operations: a rotating roster with ongoing updates displayed to frontline users and to leadership in the hubs.
  • Offering a concise guide and onboarding resources helps new users. Intend to keep decisions relevant to current needs, with experience-based adjustments for different patient groups.
  • Emphasis on infection control and security: ensure rapid escalation when death risk rises and maintain staff welfare with monitored workload and support.
  • Realizing the importance of authorship in implementation, assign clear ownership for shifts, competencies, and escalation paths to reduce delays.
• Bed capacity
  • Initial target is to raise ICU capacity by 20–30% within 48 hours by repurposing step-down units, theatre recovery bays, and other suitable environments while preserving infection control and patient safety. The goal is to maximize life-saving capacity without compromising staff safety.
  • Designate renal zones for CRRT and dialysis to prevent cross-infection; track patient needs so nursing teams can adjust resource allocation without delay.
  • Implement discharge triggers and transfer protocols to realize bed turnover efficiently and reduce bottlenecks; coordinate with social work and public health partners for expedited moves where appropriate.
  • Use a clear target for bed assignment: prioritize highest risk and highest potential benefit; maintain limited but effective surge wards with appropriate monitoring and security controls.
  • Display bed status in all hubs and command displays; use lights and color-coding to signal occupancy, readiness, and patient risk at a glance.
• Equipment and supply management
  • Keep a rolling inventory of ventilators, monitors, infusion pumps, PPE, and critical medications to cover at least 72 hours of surge, plus a 50% contingency buffer where feasible without compromising other services.
  • Allocate renal equipment (CRRT machines) and consumables for dialysis patients; coordinate with regional network hubs to reallocate equipment quickly as demand shifts.
  • Run daily checks on critical devices; implement a quick-defect display process so staff can report issues and ensure authorship of fixes remains clear.
  • Limit exposure by storing high-risk items in controlled access areas and ensuring only trained users handle them; implement secure handling and detailed logs to enhance security and traceability.
  • Prepare alternative supply routes and multiple vendor options; maintain an ongoing guide with contact points and delivery SLAs to reduce delays.
• Supply chain integration
  • Establish a network of suppliers with pre-negotiated terms; centralize ordering to reduce duplication and speed replenishment.
  • Link procurement decisions to clinical needs across groups; build an ongoing forecast model that updates every 6 hours based on occupancy and caseload.
  • Set up regional hubs to balance stock across facilities and prevent bottlenecks; align with public health authorities to anticipate surge waves and adjust orders.
  • Track exposure risk for sensitive items and rotate stocks to avoid shortages; display dashboards for leadership, nursing staff, and store teams to act quickly.
  • Clarify authorship and ownership for each supply category; designate accountable leads in the command structure to keep responses coherent and timely.

Establish cross-institutional communications: with NHS regions, ambulance services, and regional authorities

Create a joint cross-institutional communications cell anchored in NHS regional hubs, ambulance services, and regional authorities with a single point of contact for escalation and updates. Assign responsibility to a dedicated communications lead supported by regional liaison officers, establishing a predictable ratio of staff to care sites to ensure consistent information flow. The cell will operate on pan-domain channels to shorten delays and defeat misinformation that could harm response. Draw on worldwide lessons and ensure information-sharing practices respect imposed data rules to protect patient privacy. The goal is a fast, accurate, and safe feed from rooms and control rooms to all partners.

Establish secure, technology-enabled channels: a shared dashboard for incident information, a secure messenger for real-time updates, and a conference bridge for pan-domain briefings. These tools must be accessible to authorized NHS regions, ambulance services, and regional authorities. The platform should support asynchronous updates and real-time alerts, with an audit trail for compliance and after-action review. Provide a neutral, ever-updating view of resource status, risk levels, and operating constraints to support calculated decisions.

Define roles and flows: appoint a regional communications lead, an ambulance liaison, a regional health authority representative, and a clinical operations manager; map their responsibilities with a simple RACI to avoid overlap. Use short, structured handoffs and a 15-minute daily stand-up in each region to maintain alignment, and a 60-minute debrief after major events. Run meetings in dedicated rooms equipped with reliable lighting and backup power to ensure uninterrupted briefings and protect the workforce.

Information governance: establish data-sharing guidelines, consent, privacy safeguards, and the restrictions that are imposed by policy. The protocol should emphasize rapid, safe information exchange to support patient care while maintaining legal compliance. Provide admonishment for non-compliance and clear consequences; ensure data is used to improve care and coordination, not to escalate disputes or crime-related rumors.

Cadence and goals: set response times, escalation targets, and joint risk assessments; track metrics such as time-to-notify and time-to-deploy resources to monitor performance. Encourage calculated risk-taking within guardrails and ensure management can reallocate assets quickly when the situation changes. The information view should be continuously updated so teams can see effects of actions in real time and align on the goal of safe patient transfers.

Training and exercises: embed pfec planning exercises to test cross-institution communication and response; incorporate lessons learned worldwide to refine procedures. Schedule quarterly tabletop simulations and yearly full-scale drills that involve NHS regions, ambulance services, and regional authorities. After each exercise, publish a concise debrief with key actions and responsibilities to improve the next run.

Expected advantages: faster decisions, clearer responsibility, safer patient flow, and reduced delays in critical transfers. The cross-institutional approach helps the workforce stay protected and focused; it builds right partnerships and reduces the risk of miscommunication. By maintaining a common information surface, teams can operate together, with rooms equipped for effective briefings and lighting that keep discussions calm and purposeful.