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The incident command system (ICS) is a management tool for organizing and coordinating response operations during disasters and emergency responses (see Image. Incident Command System). The system allows multiple agencies to integrate crisis response efforts. The ICS is easily scalable to any size event and ensures common terminology, efficient resource use, and personnel and patient safety. Decades of experience responding to disasters gave rise to the ICS. The current ICS developed from the work of a collaborative task force, the Firefighting Resources of Southern California Organized for Potential Emergencies (FIRESCOPE), in response to significant casualties and complications that arose from California wildfire control efforts in the 1970s.[1] The FIRESCOPE review identified major issues with coordinating and organizing incidents. Many incident failures were due to coordination and organizational problems and resource and personnel insufficiency. Command hierarchy and accountability were lacking. Communication systems were used inefficiently and with conflicting radio codes. Freelancing—when individuals or specialized groups self-dispatched or became involved without coordinating with other responders—was a source of confusion and safety issues. The ICS intends to alleviate these problems by providing a replicable framework that responders from different regions and backgrounds can utilize.[2] Understanding the system and its components helps responding agencies coordinate their efforts.[3] The Homeland Security Presidential Directive-5 (HSPD-5), signed by President Bush in 2003, called for the Department of Homeland Security to create a unified national ICS for coordinated response to diverse incidents at local, state, and federal levels. The result of this directive was the National Incident Management System (NIMS), a collection of best incident management practices, principles, and terminology. One NIMS principle is standardized ICS use, which HSPD-5 requires in response to incidents.[4] Prehospital and hospital-based providers should thus be familiar with ICS terminology, basic principles, and applications.