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Apr 12
New Training to Enhance Disaster Health Outcomes for Your Whole Community

Free online training focuses on helping people with access and functional needs

In planning for the whole community’s needs during a disaster, consider that on any given day, approximately half of the U.S. population has a temporary or permanent condition that limits their ability to take action in an emergency. Simply put – they have access and functional needs (AFN).

Addressing access and functional needs is a crucial part of comprehensive disaster planning for the whole community and is mandated for inclusion in federal, state, local, tribal, and territorial public health emergency plans. ASPR has developed the HHS/ASPR Access and Functional Needs (AFN) Web-Based Training to help public health officials, emergency managers, and social/human service providers learn how to address access and functional needs in disaster preparedness, response, and recovery.

The concept of access and functional needs provides an inclusive approach to describing the wide array of populations who may have additional needs before, during, or after an emergency. Populations with access and functional needs may include but are not limited to:

children, people who live in institutional settings, older adults, pregnant women, people with disabilities, people with chronic conditions, people with pharmacological dependency, people with limited access to transportation, limited English proficiency/non-English speakers,people of low socioeconomic status, and homeless indivduals

Public health officials, emergency managers, and social/human service providers need to be aware of and comply with a legal requirements that were designed to protect individuals with access and functional needs from discrimination. The training highlights information from federal guidance, laws and executive orders that require non-discrimination for addressing access and functional needs—both specific and non-specific to a disaster context.

Within the training, participants will learn how to operationalize the Communication, Maintaining Health, Independence, Support and Safety, and Transportation (CMIST) framework so that they may address a broad set of common access and functional needs irrespective of specific diagnoses, status, or labels.

CMIST Framework is comprised of communication, maintaining health, independence, support & safety, and transportation.

Additionally, the training provides a number of tools and resources for addressing access and functional needs during disaster preparedness, response, and recovery activities. Participants will find relevant data, recommended partners, and links to tools and information so that they may immediately apply what they have learned and successfully address access and functional needs in their communities.

Ensuring that you are taking the necessary steps to provide people with access and functional needs with the assistance they need to stay healthy in a disaster requires strong partnerships, a solid understanding of the legal requirements, and advance planning. The new HHS/ASPR Access and Functional Needs (AFN) Web-Based Training can help you better understand and operationalize these requirements so you can promote better health outcomes for the whole community.

Mar 15
Preparing for a Potential Domestic Ebola Outbreak

Enhancing U.S. Healthcare System Preparedness and Public Health Emergency Response Capabilities

Blog Series:  Battling the Ebola Epidemic

An Ebola outbreak that began more than seven months ago continues to claim lives in the Democratic Republic of the Congo (DRC). Although international response efforts are underway to contain the outbreak at its source and prevent the spread of the disease to other countries, we must always be prepared for the possibility of an Ebola case in the United States.

The U.S. Department of Health and Human Services (HHS) is working with its partners to prepare healthcare systems and enhance response capabilities so we are ready to protect American communities. To prepare the nation to face rapidly evolving and complex health threats, the HHS Office of the Assistant Secretary for Preparedness and Response (ASPR) is enhancing regional preparedness, developing response plans, conducting exercises to ensure those plans can be implemented effectively, and training medical responders from the National Disaster Medical System (NDMS). 

Enhancing Regional Preparedness in the United States

To strengthen regional highly infectious disease response capabilities in the U.S., HHS/ASPR and the Centers for Disease Control and Prevention (CDC) have worked with state health departments and the private sector to develop a tiered approach to prepare U.S. healthcare facilities to safely and rapidly identify, isolate, evaluate, and manage travelers or patients with possible or confirmed cases of Ebola.

ASPR provided hospitals with approximately $214 million from the 2014 Ebola emergency supplemental funds to establish a nationwide, regional treatment network for Ebola and other highly infectious diseases. The funding established the foundation required for the nation’s healthcare system to safely and successfully identify, isolate, assess, transport, and treat patients with suspected cases of Ebola virus disease or other highly infectious disease.

To prepare clinicians to provide safe and supportive care for patients with Ebola or other highly infectious diseases, HHS awarded funding to establish the National Ebola Training and Education Center (NETEC). NETEC is a consortium of three U.S. healthcare facilities – Emory University in Atlanta, Georgia; University of Nebraska Medical Center/Nebraska Medicine (UNMC) in Omaha, Nebraska; and the New York City Health and Hospitals Corporation/HHC Bellevue Hospital Center in New York, New York. All three of these hospitals have treated Ebola patients successfully. NETEC offers training, resources, readiness assessments, and expertise to help prepare for emerging threats related to infectious disease outbreaks, including Ebola.

By leveraging the best practices established from investments made with the Ebola supplemental appropriations, ASPR is developing innovative, tiered, regional demonstration projects that can serve as models for building a Regional Disaster Health Response System across the country.

Developing Protocols and Exercises to Save Lives

Immediately after the Ebola outbreak in 2014, ASPR collaborated with the Department of State and other federal departments and agencies to develop protocols and capabilities to address potential U.S. cases of Ebola, including transport systems and a network of domestic hospitals that could activate biocontainment units on short notice.

In order for the protocols to be useful, healthcare providers need to understand how to use them. Saving lives requires preparation and training. Partners across the healthcare system need to work together to ensure that patients are safely transported and treated in an emergency – and that requires practice and tremendous coordination.  

In 2018, ASPR led an exercise called Tranquil Terminus, the largest bio-containment patient movement exercise in HHS history. The exercise focused on moving seven people acting as patients with Ebola symptoms within different regions of the country.  During the event, partners exercised notification processes, worked together to make critical decisions, and used resources to move highly infectious disease patients by ground and by air transport. 

Training NDMS Responders

To ensure our responders are able to support future infectious disease outbreaks, ASPR is utilizing Ebola supplemental funding to provide enhanced training to NDMS personnel. These medical professionals come primarily from private sector and are called into action by HHS as intermittent federal employees to respond to public health emergencies and disasters. 

NDMS has partnered with the University of Nebraska Medical Center to support two specific training courses for personnel:

  • Isolation, Simulation and Quarantine Training provides situational awareness, preparedness and planning, infection prevention and control, and crisis and risk communications
  • Highly Infectious Disease Patient Transport Training trains personnel to transport highly infectious patients to appropriate facilities, use personal protective equipment, and implement infection control practices while avoiding excessive delays in care

Both of these training courses provide NDMS personnel with the appropriate skills and general awareness to treat highly infectious disease patients without becoming infected or spreading infection within the impacted area. 

The Path Forward

Ebola is just one of many potential national health security threats our nation faces. We are working with our partners across government and industry to accomplish a single, critical goal:  saving lives in an emergency. By making smart investments, establishing strong partnerships, and creating comprehensive plans, we will be better prepared to fight Ebola or other highly infectious diseases and save lives.   

This is the second blog in a two-part series on battling the Ebola epidemic.  This series is designed to highlight the actions that ASPR is taking to protect health and save lives during current Ebola outbreak.  To stay up to date as new blog posts are published, follow us on TwitterFacebook or LinkedIn.

Mar 14
Combating and Containing the Ebola Outbreak

ASPR’s Strategic Approach to Ebola Medical Countermeasure Development and Utilization in the 2018 Ebola Outbreak

Blog Series:  Battling the Ebola Epidemic

Ebola reemerged as a health threat in 2018, in the Democratic Republic of the Congo (DRC), where two outbreaks of Ebola virus disease have occurred since May 2018. The first of these two outbreaks, in western DRC, was quickly contained. However, the second outbreak, in eastern DRC, has yet to be contained due in large part to the volatile security situation in that region. This second outbreak has now become the second largest Ebola outbreak since the virus was discovered in 1976, surpassed only by the 2014-2016 outbreak in West Africa. It is unlikely to be the world’s last.

Ebola and other highly infectious diseases can cross borders.  In order to protect the American people from this deadly disease, we must fight the outbreak at its source.  As a critical part of the global response, the U.S. Department of Health and Human Services (HHS) is developing and deploying medical countermeasures, which may help save lives by protecting individuals in DRC from infection and may reduce the severity of disease.  Within HHS, the Office of the Assistant Secretary for Preparedness and Response (ASPR) plays a critical role in medical countermeasure development and use.

Developing New Medical Countermeasures

During the 2014 Ebola outbreak in West Africa, HHS/ASPR’s Biomedical Advanced Research and Development Authority (BARDA) started working closely with partners in industry and throughout government to accelerate the development of potential vaccines, therapeutics, and diagnostics. 

Today, BARDA is supporting the late-stage development of two vaccine candidates one by Merck (V920) and one by Janssen and  Bavarian Nordic (Ad26.ZEBOV/MVA-BN®-Filo). BARDA is working with these vaccine developers to support potential licensure of the vaccines.

In addition, BARDA is using Project BioShield funds to support the advanced development of two therapeutic candidates, by Regeneron (REGN3470-3471-3479) and by Mapp Bio (ZMapp).  These products are being made available in the DRC in collaboration with the National Institute of Allergy and Infectious Diseases (NIAID), within the National Institutes of Health, as part of the NIAID-sponsored randomized clinical trial to evaluate the safety and efficacy of these products.  The randomized clinical trial also includes mAb114, which is being supported by NIAID Vaccine Research Center, and Remdesivir by Gilead.  BARDA continues to support pre-clinical testing of Remdesivir.

Voluntary Ring Vaccination

Although a licensed vaccine is not yet available, more than 86,000 people have been given the single-dose investigational recombinant rVSV-ZEBOV vaccine developed by Merck under a Compassionate Use protocol to prevent the spread of Ebola in DRC.  

This vaccination campaign uses a voluntary “ring vaccination” strategy, which focuses on individuals at an increased risk of infection because of their contact with a patient who has a confirmed case of Ebola virus disease. The strategy seeks to vaccinate contacts and contacts-of-contacts — the network of people who may have been exposed to the patient while he or she was symptomatic, and who may be protected by the vaccine.  In some cases, people in targeted geographic zones near the Ebola patient are getting vaccinated. As of February 4, 2019, 695 rings and two geographic zones were targeted for vaccination. In addition, healthcare workers and frontline workers are being vaccinated. 

Neighboring countries have started vaccinating healthcare workers and front line workers as well. Uganda has vaccinated healthcare workers and front line workers in 101 health facilities.  Vaccination started in South Sudan on January 28, 2019 and plans for vaccination of healthcare workers and front line workers are advanced in Rwanda and Burundi.

In addition, Janssen and Bavarian Nordic have developed a two-dose vaccine and are working with the WHO and other organizations to potentially evaluate the vaccine in the region.

Using Point-of-care Diagnostics to Help Contain the Disease

When investigating a recent death in an area where the Ebola virus may be circulating, it is essential to determine quickly if the person died from Ebola. After a person has died from Ebola, their body can continue to transmit the virus to anyone who is exposed to the body without wearing appropriate personal protective equipment, so appropriate steps, such as a safe and dignified burial, must be taken to keep the disease from spreading.

To protect the community, bodies of people who have died in areas where the Ebola virus may be circulating are being checked for Ebola virus using a rapid point-of-care test developed by OraSure with support from BARDA, and authorized for emergency use by the U.S. Food and Drug Administration (FDA). These rapid diagnostic tests provide results in minutes, giving responders the information they need to make more effective decisions.

Emerging disease outbreaks, particularly those with the potential to become epidemics, are but an international flight away and are significant global health threats.  ASPR will continue to support the medical countermeasures needed to protect health and save lives in the face of Ebola and other 21st century health threats.

This is the first blog in a two-part series on battling the Ebola epidemic.  This series is designed to highlight the actions that ASPR is taking to protect health and save lives during current Ebola outbreak.  The next post in this series will detail the ways that we are working with partners to enhance U.S. healthcare capabilities and enhance domestic response capacity. To stay up to date as new blog posts are published, follow us on TwitterFacebook or LinkedIn.

Feb 19
Exhaustion in the ED and Beyond: Managing Supply Shortages and Staff Fatigue in Healthcare Facilities

Blog Series: Anticipating and Managing the Challenges Associated with Supply Shortages

The next time you face a supply shortage – from saline to syringes – brace yourself. Another shortage may be on the way:  staffing. As we discussed in the first blog in this series, hospitals and healthcare facilities face supply shortages every day, and these shortages require staff to dedicate more time and resources so they can continue providing patient care.

These extra demands can be hard enough to meet during normal operations, but they are especially common and difficult to handle during a disaster.  Long after Hurricane Maria struck Puerto Rico, saline IV bags, cancer drugs, and other critical pharmaceuticals and medical supplies remained in short supply.  When the added stress of a disaster meets increased demands caused by a prolonged supply shortage, your staff may not be able to cope if you don’t have a plan in place. 

Hospital and healthcare facility administrators can keep their facilities operational, continue caring for patients, and better meet the needs of their staff by watching for signs of staff fatigue, taking steps to mitigate or alleviate stress, and partnering with volunteer organizations.

Monitor Staff Fatigue

It is normal for any shortage or disaster response to increase a staff’s workload. Have a plan in place to account for staff fatigue.  It is no surprise that fatigue often sets in when work hours become longer and more intense. When your staff is fatigued, they are less likely to provide effective patient care, more prone to mistakes, solve problems more slowly, and are more likely to get injured on the job.  Fatigue can be a serious threat to both your staff and your patients.

Foster an open environment where staff members can feel comfortable expressing difficulties in managing a shortage response. If additional training is needed or if your staff is overworked, they should be able to freely communicate these concerns with hospital or healthcare facility administrators.

However, don’t expect that your staff will always knock on your door and tell you what is wrong.  Get to know your staff before a disaster strikes and learn to recognize early signs of stress before they become a major problem.  To find out how you can better recognize signs of stress in your workforce and steps you can take to help your staff cope, check out Building Workforce Resilience through the Practice of Psychological First Aid – A Course for Supervisors and Leaders.

Plan to Mitigate Staff Fatigue

In 2018, FEMA issued 124 disaster declarations and, right now, there are more than 100 FDA-recognized drug shortages.  With so many disasters and drug shortages, one or both are likely to impact your facility.  Make sure you have a system in place to identify health and safety risks, and be ready to help.  Have a plan to implement rotating, flexible schedules during an escalating response to help staff remain at peak performance.  Wherever possible, cross-train staff members on multiple roles to minimize the probability of an improper supply application.

To learn more, check out the ASPR TRACIE topic collection on responder safety and health, which includes materials on managing staff fatigue.

Reach Out to Volunteers

Facilities should also coordinate with their state and local health departments to identify qualified volunteers to assist when they suffer staff shortages due to fatigue.

Before a disaster strikes, consider reaching out to your local Medical Reserve Corps (MRC) unit. The MRC is a community-based program that organizes and utilizes local volunteers to promote community health and enhance emergency preparedness and response. Across the country, nearly 200,000 MRC volunteers among almost 1,000 units dedicate their time and expertise to helping their communities.  MRC volunteers include registered nurses, EMTs, physicians and other medical and non-medical personnel who can help your hospital or healthcare facility during a crisis. 

MRC volunteers can help hospitals keep meeting patient needs by augmenting hospital staff, staffing mobile hospitals, providing telephone and administrative support, and more.  If you plan to incorporate MRC into your hospital operations, it is always a good idea to plan ahead.  Encourage MRC units to participate in exercises and trainings so you are ready to respond together.

To start a conversation on incorporating MRC units into your hospital’s emergency plans and to see if your local MRC unit could help provide surge capacity, contact an MRC unit in your area.

The Anticipating and Managing the Challenges Associated with Supply Shortages blog series is designed to highlight actions that healthcare organizations can take to protect patient health in the event of a supply shortage.  The first post in this series detailed Four Ways to Plan to Protect Patient Health in a Medical Supply Shortage. The next post in this series will look at recommendations and resources for building partnerships.   To stay up to date as new blog posts are published, follow us on TwitterFacebook or LinkedIn.


Feb 13
National Disaster Medical System: Bringing More Than Teams of Professional Medical Providers

The National Disaster Medical System (NDMS) has a heroic, yet complex, mission to save lives and protect Americans. When disaster strikes, it’s potentially the worst day in the lives of hundreds – if not thousands – of people. Therefore, our mobilization, implementation, and execution need to be streamlined and seamless.

However, we never rest on our laurels. We are constantly training and identifying gaps within the preparedness and response framework to better mobilize when the inevitable ultimately occurs. NDMS has identified three pillars to expand the service’s capabilities and provide a robust response anytime, anywhere.

  • A Pediatric Disaster Care Program: In fiscal year 2019, NDMS will help create a Pediatric Disaster Care Program, an important first step needed to establish a National Disaster Pediatric Network. This program  will assist in identifying current capacity gaps throughout the country and what NDMS may be able to support through its enhanced infrastructure, which will include two Pediatric Centers of Excellence. The Pediatric Centers of Excellence will be placed strategically around the country to ensure the most vulnerable population receives the best care during public health emergencies, increased equipment capacity to support the specific pediatric requirements during a disaster, and enhanced training and exercises for NDMS responders. In fiscal year 2020, NDMS will review recommendations from this pediatric network and engage its stakeholders and federal partners to further increase capacity of pediatric support.
  • Medical Care for Infectious Disease Patients: Through innovative concepts and collaborative efforts with the National Ebola Training and Education Center including the University of Nebraska Medical Center, NDMS has established two additional components of its infectious disease treatment capabilities:  isolation and quarantine services, and infectious disease patient transport that will provide medical care for those diagnosed with a severe infectious disease while they are transported to medical facilities.
  • Aeromedical Patient Transport: Adding to the NDMS patient movement mission capabilities, NDMS has trained more than 200 doctor, nurses, respiratory therapists, and some other types of clinicians for air medical evacuation to operate alongside Defense Department counterparts on military aircraft.  NDMS is also building its own air transport capability so it can autonomously move patient using civilian aircraft as needed. By working side-by-side with the Defense Department, NDMS and the Military Health System can network, develop best practices, and serve as force multipliers in disasters.

Aside from these new initiatives, we have a few more novel concepts, plans, and service lines underway that are designed to create efficiencies and close gaps. We expect to rollout details of those projects over the next few months and years.

At NDMS, we’re not just bringing teams, we’re bringing capabilities.

The challenge is integration and sustainment. When it comes to medical care, a “good enough” response isn’t good enough. We strive for a seamless, strategic, and coordinated response with local, state and private sector personnel and assets so that, together, we are providing the care and services the American people expect and deserve. We’re there to save lives.

Emergency managers can contact an ASPR regional emergency coordinator to learn more about how to incorporate our new and our tried-and-true NDMS capabilities into response plans.

Feb 13
Protecting the Nation from Emerging and Pandemic Infectious Diseases and CBRN Threats

National Health Security Strategy:  Blog 3

As we scan the threat landscape as a new year begins, we find that we face a range of evolving threats to national health security. Among these risk are emerging infectious diseases that could lead to pandemic and the potential for chemical, biological, radiological, and nuclear (CBRN) emergencies.

An increasing number of immunocompromised and/or unvaccinated people (especially children), global mobility, population density acceleration, urbanization, and a growing resistence to antibiotics are all powerful trends of the 21st century that could threaten national health security.  These trends may increase the frequency, diversity, and complexity of disease outbreaks—such as Ebola, MERS, and Zika. Additionally, new strains of viruses, especially influenza viruses, and previously unseen routes of transmission, continue to emerge globally, increasing the chances of a disease outbreak evolving into a pandemic.

These natural threats join the host of serious, human-caused risks to national and global health security posed by CBRN threats.  These risks include the potential for a pathogen to be used for bioterrorism or as a biological warfare agent. According to the 2018 Worldwide Threat Assessment, these trends could lead to major economic and societal disruptions, straining governmental and international resources and increasing calls on the United States for support.

To help protect the nation from emerging and pandemic infectious diseases and CBRN threats, the Department of Health and Human Services (HHS) published the 2019-2022 National Health Security Strategy (NHSS) this week, its quadrennial strategy to prepare and safeguard the nation’s health in times of crisis.

A premise behind the 2019-2022 NHSS is that all levels of government and private sector partners have important roles to play to improve the nation’s ability to respond to and recover from 21st century threats.  To protect the nation more effectively from these emerging threats, HHS will use this whole of government/nation approach to:

Deepen interoperability by combining the strengths of our federal capabilities (including intelligence, law enforcement, and homeland security, military and veteran stakeholders) and our private sector capabilities (including hospitals, the research community, academia, and disaster response agencies).  Greater interoperability can improve our ability to quickly and effectively gather, assess, and share information and surveillance data on disease outbreaks and CBRN threats.

Support and sustain a robust and reliable public health security capacity by modernizing key public health capabilities both domestically and abroad to help with disease situational awareness, containment, and treatment; risk communication and public preparedness; and public health policy and planning.

Accelerate the development and availability of new medical countermeasures to mitigate the health consequences of CBRN and emerging infectious threats by collaborating with federal and private partners to conduct research and development, accelerate licensures, and prioritize rapid production and dissemination of medical countermeasures.

Address 21st century threats that are known while scaling up internal federal processes to promote fast, flexible decision-making and resource allocation for unknown threats. We also must train and equip our public health and medical workforce to rapidly adapt to new threats and advance our laboratory safety, security, and capacity.

To learn more about the NHSS, check out the other blogs in this series and read the full 2019-2022 National Health Security Strategy.


Feb 07
Complex, Challenging, and Rewarding: Developing Strategies to Support Health and Human Services Recovery in Puerto Rico

Almost a year and a half after Hurricane Maria struck Puerto Rico, people across the island are still haunted by the memories of the devastating storm, and communities are still recovering. During a recent deployment to Puerto Rico to support disaster health recovery, I learned that recovery is truly a marathon that can take years. I am dedicated to helping people cope, heal and recover, and I have been honored to work with a great team for the Health and Social Services Recovery Support Function, managed by ASPR.

I was greeted with a “bienvenida” (“welcome” in Spanish) from a team composed of 90 percent local hires. This local team was key in the success of health and social services recovery projects because they provided a strong local perspective. That perspective helped us develop effective strategies and strengthen collaboration among our many partners to collaborating between all sectors on the island.

As part of the team, I coordinated a new type of training called Skills for Psychological Recovery for a variety of community groups in Puerto Rico. This evidence-based training provides responders and personnel who work directly with children and families with the skills they need to manage distress, cope with post-disaster stress, and to assist others.

Communities across the island continue to overcome widespread and complex behavioral and mental health challenges. To meet the needs of survivors and responders, we worked with many of the people on whom residents already rely for help: local social services providers and faith-based communities. We led eight training workshops with 177 responders from the Puerto Rico Department of Families and Puerto Rico Chaplain Corps. The positive response to the training was tremendous, and these groups now use the skills they learned when they go out to their communities.

Under HSS RSF, ASPR also worked with the government of Puerto Rico to enhance understanding of the broader healthcare system’s capabilities through the Capacity and Capability Assessment for Healthcare Centers. I got to be part of a team that worked with local personnel to apply a tool for assessing hospitals, diagnostic and treatment centers, and health clinics including Federally Qualified Health Centers to determine their capacity to respond to future emergencies.

For these assessments, we visited each healthcare center facility in Puerto Rico. I visited eight facilities and, in all of them, I witnessed the commitment of the administrators to share information and collaborate. Based on the data collected, the team created a snapshot of all healthcare centers in Puerto Rico in one map for an at-a-glance view on data that will be critical to respond better in the future.

Being part of recovery operations in Puerto Rico was especially meaningful for me. Much of my family lives on the island, and for a long time after the storm, I didn’t know if they were okay. Even after I learned that everybody in my family was safe, I knew that many other families weren’t as fortunate and I wanted to use my skills to help people recover.

While supporting recovery efforts in the field, I saw much people rely on health and social services in disasters and every day. On a daily basis, I manage health communications for organ transplant programs. In 2018, 122 people in Puerto Rico received transplanted organs, and about 350 people are currently on the waiting list. My agency, the Health Resources and Services Administration (HRSA) also provides funding for federally qualified health centers. For the mapping project, one of the HRSA-funded centers I visited had taken extraordinary preparedness steps long before the 2017 hurricane season; that center was one of the few fully functioning after the Hurricane Maria; it was available when people relied on it most. The center clearly demonstrated how having robust systems day-to-day can save lives in disasters.

I’ve worked on a wide range of public health challenges during my time in government service, but none of them were as complex, challenging, and rewarding as being a part of the recovery efforts in Puerto Rico. I am honored to be a part of the recovery effort and more proud than ever of the work we do day in and day out at HHS.

-Melanie Deal is a health communications specialist with HRSA’s Division of Transplantation which is the primary federal entity responsible for oversight of the organ and blood stem cell transplant systems in the U.S. and for initiatives to increase organ donor registration and donation in this country.

Feb 06
Whole-of-Government Approach: What It Means and How It Translates to Improving National Health Security

National Health Security Strategy Blog Series: Part 2

The Department of Health and Human Services (HHS) has published its quadrennial strategy to safeguard the nation’s health in times of crisis. The 2019-2022 National Health Security Strategy (NHSS) provides a vision to strengthen the nation’s ability to prevent, detect, assess, prepare for, mitigate, respond to, and recover from disasters and emergencies.

The new strategy focuses on three overarching objectives: 1) prepare, mobilize, and coordinate a whole-of-government approach; 2) protect the nation from the health effects of emerging and pandemic infectious diseases and chemical, biological, radiological, and nuclear (CBRN) threats; and 3) leverage the capabilities of the private sector. For more information about the NHSS, its purpose and objectives, see part one in this blog series, which explains how the NHSS shapes the federal approach to evolving threats. In this blog, I will dig deeper in to the “whole-of-government” concept.

So what does whole-of-government mean? And, how is ASPR using the concept to help the nation prepare for, respond to, and recovery from medical emergencies and public health disasters?

The purpose of the whole-of-government approach is to create a culture that facilitates a shared vision between federal agencies both within the U.S. Department of Health and Human Services and across all federal departments. Inter and intra-agency coordination and cooperation strengthens departments’ abilities to operate as one system rather than a collection of separate components. It establishes a unified effort between government agencies to maximize all available resources—personnel, funding, and equipment and supplies—in a collaborative effort.

Within ASPR, the demand for a whole-of-government approach will continue to grow as the health security threats to our nation continue to grow and change. The use of chemical, biological, radiological, and nuclear (CBRN) weapons; cyber warfare; emerging infectious diseases that could lead to a pandemic; and the growing occurrence of catastrophic natural disasters and human-caused incidents, such as wildfires, are driving efforts to share resources.

The 2019-2022 NHSS, as well as other policies, guidelines, and strategies developed under ASPR leadership, takes the whole-of-government concept a step further by investing in strong partnerships with the private sector. Leveraging the capabilities of our nation’s hospitals and health care coalitions, public health and emergency management communities, biotech firms, academia, and voluntary organizations improve the nation’s ability to actively respond to and recover from 21st century health security threats and reduce illness, injury, and loss of life to first responders and victims. The end state being a whole-of-nation approach to health care security emphasizing:

  • more partnerships to promote enhanced situational awareness and coordination of efforts to address critical threats on the national, state, tribal, territorial, and local levels.
  • improved engagement with international partners to rapidly identify, characterize, and report international health threats that pose risks to America.
  • identification and collaboration with non-traditional health stakeholders to enhance preparedness for health threats, reduce and mitigate disaster risks, and build resilience.

To learn more about this approach, download a copy of the 2019-2022 NHSS.

The 2019-2022 National Health Security blog series is designed to highlight key aspects of this new strategy to protect the nation from a wide range of threats to national health security, including natural disasters; disease outbreaks and pandemics; chemical, biological, radiological and nuclear emergencies; and cybersecurity vulnerabilities.  To stay up to date as new blog posts are published, follow us on Twitter, Facebook or LinkedIn.

Jan 25
Four Ways to Plan to Protect Patient Health in a Medical Supply Shortage

Blog Series: Anticipating and Managing the Challenges Associated with Supply Shortages

According to FDA, there are currently 109 drugs in shortage in the U.S. Supply shortages threaten patient health even in the best circumstances, but their number and impact can be exacerbated by a prolonged disaster response. With so many shortages, one is likely to impact your hospital or healthcare facility at some point.  By planning to cope with the impacts of a supply shortage, your hospital or healthcare facility will be better prepared to continue providing patient care when one occurs.

Make sure your facility has a plan in place that is tailored to meet the needs of different kinds of shortages, as supply shortages often call for specialized practices and procedures. What is the protocol when your inventory is depleted? Do you know your federal, state, and local government contacts? How do you manage an influx of patients? 

Here are four ways you can plan to protect patient health before a critical supply shortage threatens your facility:

  • Make an Overarching Plan for Supply Chain ShortagesWhen supply counts run low, managing and tracking inventory requires careful consideration, which means having staff dedicate more time to resource management planning. Additionally, certain administration techniques take more time than others. For example, an IV “push” typically takes longer to administer than a normal IV injection. Small additions to an ever-increasing workload during a shortage can add up and overwhelm staff. This can also lead to unanticipated overtime costs, which can impact facility budgets. Drug shortages can affect all aspects of health care, but every specialty has different challenges to face and overcome.  Check out the ASPR TRACIE factsheet on drug shortages and disasters to learn about common considerations for handling supply shortages.
  • Train Staff to Handle Supply ShortagesOnce you have developed an effective plan to manage supply shortage, make sure that your facility’s staff is trained and all relevant personnel have been assigned a role in handling the shortage.  Learn more about ways that you can work with your staff to manage supply shortages in the ASHP Guidelines on Managing Drug Product Shortages.
  • Incorporate Supply Shortages into COOP: Facilities should consider supply shortages when building and updating all continuity of operations (COOP) and emergency response plans. The first step in this process is building a comprehensive emergency response plan. ASPR TRACIE has a topic collection with resources to help you build an emergency response plan. These materials provide guidance on critical components of emergency response plans as well as templates and guidelines.
  • Plan with Your Health Care Coalition: Health care coalitions can also be a valuable resource in responding to and managing supply shortages. Health care coalitions are groups of individual healthcare and response organizations in specific regions that work to prepare for and respond to disasters. To find the HCC in your state, consult ASPR’s state-by-state list or interactive map.  ASPR TRACIE also has a number of HCC resources that may be useful to you and your staff, including its Hospital Disaster Pharmacy Calculator

Many shortages can create situations in which hospital staff are faced with unique problems and challenges. By ensuring that your facility has clear plans and protocols in place to deal with supply shortages, you increase the likelihood that your staff will be able to manage the situation effectively, allocate resources appropriately, and get supplies to people who need them most.

The Anticipating and Managing the Challenges Associated with Supply Shortages blog series is designed to highlight actions that healthcare organizations can take to protect patient health in the event of a supply shortage.  The next post in this series will look at recommendations and resources for handling impacts to your staff caused by a supply shortage.   To stay up to date as new blog posts are published, follow us on Twitter, Facebook or LinkedIn.

Jan 17
The HPH RISC Toolkit: A No-Cost Risk Assessment for Your Healthcare Facility

Managing risk is one of the most complex and critical aspects of running a healthcare facility. The goal of the Healthcare and Public Health Risk Identification and Site Criticality Toolkit (HPH RISC Toolkit) is simple: make that task easier – at no cost to the facilities.

The ASPR RISC Toolkit is a cost-effective, objective, data-driven, all-hazards risk assessment tool. It allows your facility to determine its ability to withstand a variety of 21st century health security threats, including chemical, biological, radiological or nuclear attacks; pandemic influenza or other emerging infectious diseases; and other manmade or naturally occurring incidents.

From a planning perspective, using the HPH RISC Toolkit presents your facility with multiple benefits. The data from the Toolkit can help inform your facility’s emergency preparedness planning, risk management activities, and resource investments.  This allows your facility to more strategically assess risk and plan your budget.

Although the information the tool can provide you facility is very valuable, the HPH RISC Toolkit is free to use. This means you can improve your understanding of your facility’s security and resilience with minimal investment.

The HPH RISC Toolkit was developed with the input of a team of ASPR Critical Infrastructure Protection partners at the federal, state, local and private sector levels and risk management subject matter experts. It is designed to help healthcare facility owners and operators identify risks in an easy-to-follow format using objective national-level data.

The toolkit consists of three self-assessment modules allowing healthcare facilities to:

Identify threats and hazards.  Assess vulnerabilities.  Determine criticality and consequences.

Several dozen ASPR stakeholders and representatives from regional healthcare coalitions validated the HPH RISC Toolkit through pilot testing; version 1.0 incorporates the partner feedback from these versions.

Version 1.0 builds on the original focus of physical infrastructure, identifying dependencies and interdependencies including cybersecurity concerns and the healthcare supply chain. It also contains the ability to compare multiple facilities across systems, coalitions, and regions.

Simply download a copy of the HPH RISC Tool and you can complete your assessment using a local copy of the tool.  Your results can only be accessed where you save and store the information.

Simple to download and use, the HPH RISC Toolkit also has a help desk support function for any users needing guided assistance through emailing Our website features a Frequently Asked Question guide to help you or your stakeholders troubleshoot any issues that arise.

A fact sheet ASPR developed providing more information is available online.

We've also developed reference materials to give you some background on the tool's methodology and development.

If you would like to help increase your facility’s risk assessment capabilities, download the ASPR CIP RISC Toolkit online today

Have you tried the HPH RISC Toolkit? Share your feedback and success stories with us at  

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