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March 12
Lessons from Fukushima: New guide provides answers to save lives and improve emergency medical response

Quick questions: A nuclear incident has occurred in your community and people are going to come to you for help. Do you know which medical issues you should focus on first? Or which steps need to be taken immediately after an incident to best protect the public? Or what resources might be available to help?

Before you answer “no” to any of those questions, download a copy of the newly released Decision Maker’s Guide: Medical Planning and Response for a Nuclear Detonation.

An effective medical response and an infrastructure prepared to protect itself from fallout could save tens of thousands of lives following device nuclear incident. During the response to the Fukushima Daiichi nuclear power plant disaster in Japan over seven years ago, integration of large amounts of complex information and evidence-based guidance into real-time decision making and response was shown to be nearly impossible without direct contact between leaders and subject matter experts.

Fortunately, not many people were exposed to radiation following the Fukushima disaster in 2011. However, the response to that incident identified the need for a “to-the-point” guide for upper-level decisions makers, including government officials, emergency managers and planners. That guide is now available. Let’s learn from the challenges during the Fukushima response seven years ago, and not place ourselves in a similar situation.

The Guide (or the DMG) is meant for senior operational responders, emergency managers, public health advisors, healthcare officials, government officials, and other policy and decision-makers to assist preparedness and response decision making by providing readily accessible information that quickly describes what to do. The DMG is based on critical scientific and medical aspects of a nuclear incident as well as the response organization and resources anticipated to be required or available during a response.

The DMG is released in collaboration with Radiation Emergency Medical Management (REMM). REMM is a resource for medical practitioners who may not typically treat radiation injuries to provide guidance about clinical diagnosis and treatment of radiation injury during radiological and nuclear emergencies. The platform provides just-in-time, evidence-based, usable information with sufficient background and context to make complex issues understandable to help them administer the most appropriate care during a disaster.

As an informational resource and practical tool, the DMG presents essential background information that provides the “why” behind critical issues and decisions that must be made in the complex response to a nuclear detonation. To ensure that vital information is quickly accessible when needed, the DMG outlines key issues and explains why those issues are critical to best protecting people exposed during large-scale radiation incidents. This approach allows responders to focus on what’s actually important – saving lives.

To do this, the DMG introduces the innovative “Dynamic Navigation” feature that takes complex scientific and operational information and translates it into a question-based, time-phased structure so that decision-makers can know what to do and what to anticipate during each phase of an incident. With this innovation, medical response decision-makers, planners, and leaders do not require expertise in radiation response and the DMG points them to the questions they need to ask and provides answers in the timeframes required for success. This helps ensure that the most impactful decisions can be made during each critical time interval to save lives after a radiological or nuclear disaster.

The “Dynamic Navigation” feature is also structured to layer information so that the first sections are 1 and 2 page summaries of specific topics or action items highlighting decision making considerations, key information, and “need to know” facts. Each summary provides links to in-depth guides where details and background information can be found in addition to links to additional details and references if readers want to dive deeper into a topic.

The DMG is an updated and more usable version of existing guidance found in Medical Planning and Response for a Nuclear Detonation: A Practical Guide. The DMG can be downloaded as a fully functional PDF for desktop, handheld, and mobile use, used on-line, or printed. A future DMG Version 3 will feature additional updated information as well a full web-based version.

Even if you think that as a medical response planner, responder, or leader you wouldn’t need to use the DMG, downloading it now ensures you will have it in case you need it. You can also download Mobile REMM, which provides a dose estimator, triaging tools, and more. Having critical resources at your fingertips in the event of a radiological or nuclear disaster can help you make better decisions that save the lives when seconds count.

February 21
Aging and Disability Task Force: An Access and Functional Needs Approach to Addressing the Unmet Disaster Needs Following Hurricanes Irma and Maria

The recent impacts of Hurricanes Irma and Maria left Puerto Rico and the U.S. Virgin Islands (USVI) in complete devastation. Buildings and homes were destroyed. Hospitals, dialysis centers, and pharmacies that weren’t destroyed were closed due to water and wind damage or a lack of electricity. Transportation services were lacking or, in some areas, non-existent. These issues affected everyone; however, people with access and functional needs – including older adults and people with disabilities – were particularly vulnerable in the hurricanes’ aftermath.

In response, the Office of the Assistant Secretary for Preparedness and Response (ASPR) created the Aging and Disability Taskforce to assess and address unmet social service needs for these at-risk populations. Members of the Taskforce included subject matter experts from the Administration for Community Living (ACL), the Office for Civil Rights, and ASPR’s Division for At-Risk Individuals, Behavioral Health and Community Resilience (ABC).

Obtaining situational analysis was critically important to highlighting programmatic impacts to older adults and people with disabilities. As a first step, the Taskforce facilitated effective communication and information sharing with the American Red Cross, federal civil rights attorneys, FEMA’s Office of Disability and Integration Coordination, and local networks that improve the lives of older adults and people with disabilities. The Taskforce also assessed impacts to ACL programs in Puerto Rico and USVI that provide essential support services to older adults and people with disabilities. These assessments focused on the status of building structures and the availability of accessible transportation, as well as access to clean water, food and medication, electricity, and personnel.

With this information in hand, the Taskforce was able to:

  • Provide technical assistance to further incorporate civil rights laws into emergency response and recovery activities for at-risk individuals;
  • Recommend response and recovery activities for programs severely impacted by the hurricanes; and
  • Develop an Evacuee Transition Plan for dialysis patients that were evacuated from USVI and stationed in Atlanta, GA.

The implementation of the Evacuee Transition Plan provides a breadth of information as the Incident Response Coordination Team transitions out of fulltime care coordination. The plan is intended to address the current needs of evacuees and ensure that their essential support services are maintained, including transportation, logistics, case management, food, and lodging.

This was the first time that ASPR convened a short-term taskforce with ACL colleagues, as well as the first activity requiring ACL to work across both its aging and disability programs to assess access and functional needs simultaneously.

Having a fulltime, onsite taskforce highlighted the need to address the access and functional needs of older adults and people with disabilities in order to maintain their health during a federal emergency response, and serves as a model for future disasters and public health emergencies.

February 15
ASPR’s New Vision for a Regional Disaster Health Response System Will Help Prepare Nation for 21st Century Health Security Threats

Early this week, I had the opportunity to discuss with colleagues at the University of Maryland Medical Center-Shock Trauma the concept of a regional disaster health response system that is capable of responding more effectively and efficiently to the ever-increasing array of 21st century health security threats.

ASPR Robert Kadlec touring UMD Medical Center's Shock Trauma Unit 

As the last several years have shown, the threat environment is more complex than ever – from infectious diseases with the potential to cause a pandemic, such as the H7N9 influenza virus, to state and non-state actors that have shown an interest in and willingness to use chemical, biological, radiological, or nuclear (CBRN) weapons, to cyber threats and severe weather. Building readiness and response capacity for these threats is my main priority and the catalyst for creating a regional disaster health response system.

The new framework would be built on a tiered regional system that emphasizes the use of local healthcare coalitions and trauma centers that integrate their medical response capabilities with federal facilities and local emergency medical services. This system would expand specialty care expertise in trauma and CBRN casualty management and coordinate medical response through mutual aid. A regional disaster health response  system also would incentivize the healthcare system to integrate measures of preparedness into daily standards of care.

Coalitions are the foundation of our disaster health response system. The regional healthcare coalitions created through ASPR’s Hospital Preparedness Program (HPP) are maturing (read Responding to Harvey: How a Houston-area Healthcare Coalition Modeled Success). Their work must not only continue but expand to include additional public and private sector partners (i.e., trauma centers, burn centers, pediatric hospitals, public health labs, and outpatient services).

Coalition partners help to ensure states are better prepared for an emergency by having in place the necessary guidelines and agreements for identifying who is doing what, when, and with what resources (equipment and personnel). But being prepared is only part of the disaster response equation. States and territories also need to be ready to respond quickly and efficiently. Real-time, real-world training is needed for all types of disasters, including CBRN tragedies. A standardized list of indicators must be identified and utilized to determine readiness for each disaster type.

Being ready for a disaster also entails the ability to handle medical surge capacity within a healthcare system. Currently, on any given day, our medical systems perform at near capacity. Mutual aid agreements need to be in place to quickly mobilize physicians and health practitioners from other states when needed without the bureaucratic frustrations and legal risks associated with medical licensing and liability issues.

ASPR is also looking at innovative approaches to incentivize healthcare preparedness. We look forward to continuing the dialogue with our state and local health system partners to explore various avenues to fund this system.

A regional disaster health response system will not happen overnight. Funding to support our nation’s healthcare readiness has declined steadily since 2005. Our healthcare system is largely privately run making it more difficult to get key players to agree to share resources for the benefit of the greater good. Part of my responsibility is to find ways to maximize the use of the available funds and to identify how to use them most effectively. My staff is also committed to developing a business case for readiness that will help competing organizations to work cooperatively. Coalitions are one way to bring together diverse and often competitive healthcare organizations with differing priorities and objectives.

Another step we are taking to help ASPR realize its new vision is to encourage every state and territory to adopt legislation, such as the Uniform Emergency Volunteer Health Practitioners Act Exit Icon, which allows any medical licensed volunteer to easily cross jurisdictional boundaries in an emergency.

The regional disaster health response system I propose will not replace the assistance HHS now provides through the National Response Framework and the National Disaster Recovery Framework. As HHS’ lead federal agency for Emergency Support Function #8, ASPR will continue to provide medical surge capacity and capability to support state, tribal, and jurisdictional response and recovery efforts. In fact, we have already begun the process of modernizing our Disaster Medical Assistance Teams, redefining their missions, who is part of their teams, how they do patient transport, and how they integrate with hospitals in providing definitive care.

Our regional staff will continue to work closely with state health and emergency management offices. In addition to managing HPP and providing grantees technical assistance through ASPR TRACIE, ASPR will continue to seek better ways to engage public and private partners in developing innovative solutions to the emerging threats of the 21st century.​

February 13
“One Team. One Mission. A Lot of Perseverance and Ingenuity” Keeps One HHS Hurricane Recovery Specialist Focused and Motivated to Serve

Greetings from Puerto Rico! I arrived on the island more than two months ago – my first deployment as part of the Department of Health and Human Services (HHS), Office of the Assistant Secretary for Preparedness and Response (ASPR) Health and Social Services (HSS) Recovery Support Function (RSF) team. The team consists of experts from different agencies within HHS working together for a common purpose: to restore and improve Puerto Rico’s health and social services. Being here is inspiring, and I am glad I have the opportunity to serve on this mission.

Working Together As One Team. I’ve been amazed at the breadth of the team’s expertise and experience. We have employees from the National Institutes of Health, the Centers for Disease Control and Prevention, the Administration for Children and Families, the Food and Drug Administration, the Health Resources and Services Administration, the Department of Education, and ASPR. Working together, bringing perspectives from different disciplines—including public health, environmental health, behavioral health, health care services, HIV/AIDs, elder care, school-based health care, social services, and cultural competency—is a win-win situation for everyone. Where one person may not have the necessary background, someone else on the team jumps in to support. We deploy as a team, and we work as a team to ensure every place we go has face-to-face access to HHS personnel who can problem solve their issues.

Fulfilling One Mission. Our team conducts a needs assessment during site visits to health and educational facilities and tailored conversations with key stakeholders. So far the team has visited more than 75 health care facilities, social service facilities, schools, and other key locations in Bayamon, Caguas, Fajardo, San Juan, Arecibo, and Ponce. We speak with health care professionals, teachers, and administrators to hear their stories, learn about their concerns, understand their barriers to recovery, and identify current and emerging needs. For example, one health center needed a second generator and access to ambulance services to transport patients to the nearest hospital. One teacher mentioned that her elementary school was not operating on a full-day schedule because they lacked consistent electricity and water.

Our team discovered that while emergency management planning might have varied at the municipality, community, and individual/family levels, no plans accounted for the scope of two, back-to-back hurricanes cutting off communications and electricity for a sustained period. During the immediate days following Hurricane Maria, family members living in the continental United States could not communicate easily with their loved ones on the island due to the lack of electricity and telephone service. This lack of communication has been stressful for people here. Behavioral health has emerged as another concern: understandably, many residents have had a difficult time handling the stress, anxiety, and fear following Hurricane Maria.

The information our team is gathering will give us a 360-degree view of the health and social services landscape in Puerto Rico. Ultimately, this information helps us, the central government of Puerto Rico, and municipalities to target short-term and long-term actions to help the island rebuild and prepare better for the next disaster.

Working with a Community that Perseveres. One of the most striking things I observed was the hopeful resilience of health care providers, teachers, administrators, and people in the communities eager to work together and with HHS to rebuild Puerto Rico.

During one of my visits, I met a local pediatrician nicknamed “Singer,” not because he could sing, but because he could “sew” (like the sewing machine) as in suturing wounds. Immediately after the hurricane hit, some residents began removing debris and clearing the streets. As a result, many people suffered cuts, and most needed stitches. The pediatrician leveraged his skills to meet the needs of his community. Witnessing this kind of ingenuity and fortitude has inspired me to be flexible, to think on my feet, and to help others in whatever capacity I can.

In the people of Puerto Rico, I see one mission, one team, and a lot of perseverance and ingenuity, and that sentiment keeps me focused and motivates me to give my utmost each day to the recovery mission in Puerto Rico.

If you are interested in serving as a Disaster Recovery Volunteer, contact Josh Barnes, HSS RSF National Coordinator, at

The U.S. Department of Health and Human Services, through the Health and Social Services Recovery Support Function, leads a coalition of 17 federal departments and agencies, each of whom manages programs, authorities, and capabilities that can support post-disaster health and social services recovery in Puerto Rico, or wherever the next major disaster happens. To learn more, visit ASPR Recovery.

HHS works with other federal and state partners to determine community needs and develop recovery strategies. These recovery strategies seek sustainable, actionable solutions to ensure public health safety, improve access to high-quality health care services, strengthen the health workforce, build healthy communities, and improve health equity by developing strategic partnerships and training and technical assistance resources.

February 09
Recovering from a Major Disaster is a Marathon, Not a Sprint: Lessons Learned from One Texas Family

Disasters upend the lives of countless families – they not only destroy homes, businesses, schools, and roads, but they also can throw disaster survivor’s lives into chaos. Local leaders are suddenly confronted with decisions on a scale they’ve never encountered before and families must quickly learn how to support themselves and those who rely on them.

When homes are destroyed and the systems that people depend on every day – from water and sewer to roads and schools – are not functioning, it can be difficult if not impossible for some people to recover. When community and government organizations reach out to help people navigate complex processes, they are playing an important role in protecting health.

The Story of Mary and Her Family

Take for instance Mary* a single mother of four. When Hurricane Harvey hit in late August, her family evacuated to a shelter in Shreveport, Louisiana. She stayed in Shreveport until the family shelter closed a few weeks later. She then roomed with extended family until that was no longer an option.

FEMA’s Individuals and Households Program was available to help Mary recover. Although she applied for assistance before being evacuated, Mary was unaware of the requirement to have her home inspected.

When Mary went back to her home in Texas, she found a notice on her door that said she had been denied housing assistance through FEMA’s program. This assistance would have provided help in repairing her current home and temporary housing assistance.

Unaware of how to explain the extenuating circumstances and appeal the decision, Mary and her four children began living out of the family van. Within a week, the van caught fire due to an electrical shortage. For several days, Mary and her family bounced between shelters and hotels, never staying at one location for more than a night.

Feeding her family also became an issue. Shelters provide food, but when Mary couldn’t find a shelter for her family they also went without food. Although her children qualified for the free breakfast and lunch program at their school, all schools in her community closed, first due to extensive damage, and then for winter break. Unfortunately, the schools that were open were miles and miles away, and gas is expensive when you can’t put food on the table.

HHS Steps In to Help

On January 1, Mary’s plight reached the Immediate Disaster Case Management program. Administered by the Department of Health and Human Services’ (HHS) Administration for Children and Families, the program supports states, tribes, and territories by providing disaster case management services to individuals and families impacted by a disaster. Texas Governor Greg Abbott activated the program when he requested federal assistance through the National Disaster Recovery Framework.

The program’s Incident Management Team immediately began working with Health and Social Services Recovery Support Function (RSF) experts from HHS’ Office of the Assistant Secretary for Preparedness and Response (ASPR) to help problem resolve Mary’s situation. ASPR’s long-standing relationship with the Texas Health and Human Services Commission proved invaluable in that process. The commission helped expedite the various forms of disaster assistance available through FEMA, the state, the U.S. Department of Housing and Urban Development, and several non-profit organizations. Within a few days, Mary received temporary HUD housing, help in repairing her existing home, and assistance with other unmet family needs.

Communities Need Information about Recovery before Disaster Strikes

Before storms strike, emergency management and health officials provide life-saving information about taking shelter or preparing homes to withstand the storm. Health and social services agencies, advocates, and faith-based and community organizations need to work with those officials to provide additional information to residents so they’re ready to recover from the storm as well.

For example, all households applying for federal disaster assistance must have their homes inspected for damage. The homeowner, or someone 18 years of age or older who lived in the household prior to the disaster, must be present for the schedule appointment to provide the inspector with proof of ownership/occupancy, insurance documents, and a list of damages, among other items.

That means people need to have copies of those essential documents in a waterproof bag in a safe place they can access after the storm. Those documents could be part of an emergency kit. Residents who leave their homes should tape their contact information to their door.

In Mary’s case, she and her family were in Shreveport and didn’t know to return home for a scheduled FEMA inspection. When Mary didn’t show for the inspection, the request for assistance was denied. Because she did not notify FEMA of how to contact her, she never received notification of the denial.

The U.S. federal government has approved nearly 370,000 Individual Assistance applications submitted by Texas residents, and approved payment of more than $1.5 billion. The government is there for the long term, and wants to help all eligible citizens. At the same time, however, it must implement procedures, such as verifying an applicant’s identity, to prevent fraud and ensure that applicants receive the disaster assistance intended for them.

Balancing the need for responsible government oversight with the needs of the people you serve can be a challenge. Before a disaster occurs, help the communities you serve learn more about the state and federal disaster assistance process. For more information about the forms of federal assistance available, including IHP, the requirements of the home inspection process, how to check your application’s status, and what to do if your application is denied, visit or call 800-621-3362. In most cases, the federal government will also establish Disaster Recovery Centers (DRC) in the local area. A DRC is a readily accessible facility or mobile office where survivors may go for information about recovery programs or other disaster assistance programs, and to ask questions related to their case.

Disaster recovery can be challenging for anyone, but it is especially difficult for people who were economically disadvantaged or faced other challenges before the disaster struck. By working with at-risk members of your community and helping them navigate the disaster recovery process, you can help protect health, promote wellness, and save lives.

*To protect the identity of the family portrayed in this blog, we did not use the mom’s real name.

January 31
Inside the Texas Catastrophic Medical Operations Center: An Interview with Lori Upton

During Hurricane Harvey, SETRAC’s Catastrophic Medical Operations Center, or CMOC, acted as a clearinghouse – overseeing information management, brokering requests for assistance and supplies, coordinating patient movement, and providing situational awareness across emergency response disciplines. We spoke with Upton to learn more about the CMOC’s structure and day-to-day functions.

Q: How many members are in the Catastrophic Medical Operations Center?
A: A fully staffed CMOC has 13 members. During Harvey we expanded the CMOC to include two air medical coordinators. We also had field personnel in staging areas.

Q: What are the lead roles in the CMOC? What disciplines do they come from?
A: The four lead roles are Chief, Clinical Director, Transportation Coordinator, and Logistics Supervisor. They come from our staff, hospital, or EMS personnel that have been trained to that leadership level. The "back row" coordinators are staffed by hospital partners on a rotating basis. Each hospital facility is assigned a day of the month they are responsible for providing two trained personnel to staff a 24-hour shift.

Q: Are these full-time roles?
A: None of the members are full time, but our staff maintains a 24/7 Duty Officer daily.

Q: How are the varied roles assigned?
A: When people are assigned to the CMOC, they are coming as a regional asset – not as a representative of their respective facilities or agencies – and they lose their normal identities while they staff the CMOC. An EMS partner, for example, may assume the role of Transportation Sector or Ambulance Staging Manager. A nurse from a hospital may assume the regional role of Corridor Coordinator or Clinical Director.

Q: Are the members of the CMOC co-located during the emergency?
A: Yes, the CMOC is housed in the City of Houston Emergency Operations Center. We have secondary and tertiary backup locations in Harris County and Fort Bend County.

Q: How do you ensure that the CMOC maintains essential services like electricity and communications during a disaster?
A: The hosting jurisdiction takes care of this, but in the event we should lose essential services, we have a mobile command vehicle we can utilize for CMOC operations. We have also outfitted the City of Houston Emergency Operations Center and the Harris County Emergency Operations Center with a satellite dish to ensure connectivity.

Q: What advice do you have for other coalitions to help them during a future disaster?
A: Build relationships, demonstrate your worth incrementally, and deliver what you promise because you will only get one chance.

To learn more about SETRAC’s response during Hurricane Harvey, check out Responding to Harvey: How a Houston-area healthcare coalition modeled success.

January 31
Responding to Harvey: How a Houston-area Healthcare Coalition Modeled Success

On Aug. 27, 2017, at the height of Hurricane Harvey’s catastrophic winds and rain, a 54-year-old man with a serious head injury arrived at the Harris Health System’s Lyndon B. Johnson (LBJ) Hospital Emergency Department in Houston, Texas. As a Level III trauma center, the hospital needed additional personnel and resources to treat the man; he needed to be transported to a Level I trauma center for neurosurgery.

Hospital officials asked for transport assistance, but the weather conditions were so severe that roads were impassable and helicopter transports were grounded. A colorectal surgeon at LBJ eventually performed the necessary emergency surgery to save the patient’s life, but he still needed care and monitoring in a Level I center.

Fortunately, LBJ Hospital is part of the South East Texas Regional Advisory Council, or SETRAC, a Houston-area healthcare coalition that fosters partnerships and planning between hospitals, public health agencies, emergency medical services, and community- and faith-based organizations. The coalition’s Catastrophic Medical Operations Center, or CMOC, contacted the U.S. Coast Guard to coordinate patient transport, and shortly after surgery the patient was transferred to a Level I center where he received the ongoing care he needed.

This sort of coordinated coalition response was one of many during the 17-day disaster event.

SETRAC serves as a model for building and maintaining a successful healthcare coalition and using it in disaster response. Crucial to its success were resources provided by the Hospital Preparedness Program, or HPP. HPP provides federal funding, guidance, and technical assistance to promote healthcare system preparedness and response. The program is managed by the Office of the Assistant Secretary for Preparedness and Response (ASPR) and brings together key players in healthcare and emergency response disciplines to prepare for, respond to, and recover from large-scale disasters. The program also provides healthcare coalitions with technical assistance through ASPR TRACIE and regionally-based field project officers, and supports trainings and exercises that help prepare coalition members to handle real emergencies.

HPP promotes the development and maturation of healthcare coalitions and drives discussion around response capabilities. Response is the yardstick by which a healthcare coalition’s success is measured.

According to SETRAC’s Director of Preparedness Lori Upton, RN, BSN, MS, CEM, the coalition’s Catastrophic Medical Operations Center mediated the coalition’s successful response. CMOC operated as a single coordinating entity during the disaster – an important function of effective healthcare coalitions – by overseeing information management, brokering requests for assistance and supplies, coordinating patient movement, and providing situational awareness across emergency response disciplines.

Although the CMOC had been activated previously during localized flooding and for major public events such as the Super Bowl, Hurricane Harvey was different: the storm delivered more than five feet of rain in just two days and caused epic flooding in the region.

Regular communication between the CMOC, the coalition’s partners, the U.S. Department of Health and Human Services, and the military provided a means to share crucial information about coalition status, weather reports, partner needs, and patient movements. During the disaster, the CMOC coordinated a wide range of activities, including:

1544 Patient movements, 24 hospital evacuations, 20 nursing home evacuations and 773 helathcare missions 

The coalition also participated in efforts to ensure that dialysis patients who were trapped in their homes or relocated to evacuation centers could continue to receive treatment.

When measured in terms of saved lives and reduced suffering, SETRAC’s response to Hurricane Harvey was a clear success. Fundamental to that success was the coalition’s relationship with HPP. “We use HPP as a foundation to identify gaps in preparedness and determine funding priorities,” says Upton. “HPP has allowed us to move concepts into realities.”

For more information about how SETRAC’s Catastrophic Medical Operations Center works, check out this Q & A with Lori Upton.

If HPP has helped your community respond to a disaster, share your story!

December 26
What Happens Next? Federal, State & Local Partners Work Together to Identify and Address Public Health and Social Services Needs in Texas following Hurricane Harvey

The response to Hurricane Harvey was rapid and robust. In the days and weeks after the storm, over 1,000 public health and medical responders deployed to protect residents’ health and save lives. HHS worked alongside state agencies, disaster relief organizations and other federal partners as part of the response.

But what happens now?  How can communities across Texas recover?

To answer these questions, state and local health and human services officials needed more information and a better understanding of the health and social services needs created in the wake of the storm. In general terms, state and federal government staffs knew that the damage had been extensive, impacting about 60 counties and damaging more than 200,000 homes, plus businesses and schools. Yet they didn’t have enough information to focus recovery efforts, prioritize recovery activities, or target resources so they could be used effectively.

In Texas, recovery experts from the Department of Health and Human Services (HHS) Office of the Assistant Secretary for Preparedness and Response (ASPR) offered state officials a new approach: assistance with a health and social services landscape assessment. The assessment is used to help state and local officials better understand the impact the storm had on health and social services; identify the recovery resources that are available at the local, state and federal levels; and outline long-term recovery actions.

Texas Governor Greg Abbott understood that recovery is more than repairing roads and transportation services, more than rebuilding homes and businesses and removing debris. Beyond the “sticks and bricks” of recovery, you need to look at the health, social services, and environment needs of communities. He quickly requested federal assistance, activating the National Disaster Recovery Framework that includes the Health and Social Services Recovery Support Function (HSS RSF).

Between October 24-27, six multi-disciplinary HSS RSF teams – each including environmental, public health, social services, behavioral health, and health care system representatives from HHS, the U.S. Public Health Service Commissioned Corps, as well as the Texas Health and Human Services Commission and the Texas Department of State Health Services – visited 13 counties and 112 health and social services programs and schools. These counties and facilities were selected based on triaging information from 20 existing de-identified datasets, including FEMA’s Individual Assistance applications, private insurance claims, social vulnerability indices, floodplain and storm path maps and programmatic data from hospitals, nursing homes, community health clinics, schools, child care facilities, mental health authorities and FEMA Disaster Recovery Centers.

Each site received a recovery needs assessment. During the assessments, team members held informal, recovery-focused discussions with facility staff on disaster recovery challenges and successes. The sites provided a status update on their damages; discussed issues related to their staffing, patients and communities; environmental and safety concerns; and any other primary needs. During the visits, state and federal team members also had an opportunity to distribute important information to help facilities with their recovery efforts, including the quickest way to apply for federal assistance.

Following the site visits, members from all six teams debriefed. Analysts from the HSS RSF Team reviewed the data and within 48 hours issued a report to the state and its recovery partners. Based on the results of the analysis, Texas is implementing five new projects: peer-to-peer recovery training for school administrators, train-the-trainer programs for first responders and a train-the-trainer program in psychological first aid for educators.  The state will also establish a health care systems recovery workgroup and a children and youth recovery task force.

Activating the Recovery Framework also helped state officials establish relationships with key federal partners from each HSS RSF team. These relationships may prove invaluable when trying to navigate and access federal assets during disaster recovery. In turn, the federal government also is utilizing the data to improve the resources and services it offers states during the recovery phase.

If you aren’t familiar with the federal government’s Health and Social Service Recovery Support Function and what it can do for your state, check it out. State, local, territorial, or tribal officials with questions can reach out to the ASPR Recovery Team.

December 14
Keeping Facilities Open: Stabilizing and Restoring Puerto Rico’s Health Sector Following the Island’s Worst Hurricane Season Ever

In the aftermath of Hurricane Maria, the Department of Health and Human Services (HHS) immediately deployed thousands of staff members and health care providers to Puerto Rico. Almost daily, the national media highlighted work HHS Disaster Medical Assistance Teams did to save lives. Less known are the activities and programs HHS put in place that went beyond direct patient care. Hundreds of personnel, from logistics experts to security personnel, worked behind the scenes to help restore Puerto Rico’s health sector. Their mission: to assist local hospitals, dialysis facilities, clinics, and medical supply manufacturers in obtaining the resources needed to continue or restore operations. These businesses are the backbone of the local economy and, even more importantly, are essential in saving lives.

Within days after Maria’s landfall, HHS and other response partners began conducting site visits to healthcare facilities across the island to identify their capabilities after the storm and determine what they needed to provide patient care. Did hospitals and dialysis centers have supplies and equipment their patients would need? Did the facilities have generators, and if so, how long could those generators run? Did laboratory equipment survive the storm? Did the facilities have diesel to run those generators? Did medical suppliers, such as oxygen manufacturers, have the resources they needed to continue production and delivery? Did pharmaceutical companies – a major employer in the territory and critical to the rest of the U.S. – have power and necessary resources, such as industrial gases to continue the production of critical healthcare products?

One of the most immediate needs across the health sector was power restoration. HHS worked with the Federal Emergency Management Agency, the Department of Energy, and the Army Corps of Engineers to communicate the importance of assisting hospitals, other healthcare facilities, and medical manufacturers and distributors with power restoration, generators, and generator fuel.

HHS identified medical and industrial gas production as another priority need for the health sector in Puerto Rico. Hospitals, home healthcare providers and pharmaceutical companies require medical oxygen as well as other gases to support patient care and healthcare product manufacturing. Due to the challenges of shipping gases long distances, Puerto Rico usually receives all its medical gases from two manufacturers on the island, Both of these manufacturers lost power in the immediate aftermath of Hurricane Maria, threatening the supply of gases for healthcare and creating the potential for a serious risk to public health. HHS quickly convened a task force composed of representatives of the two impacted manufacturers and other federal response partners in order to identify solutions to the gas supply disruption. This task force developed a system for shipping large containers of liquid oxygen and liquid nitrogen to Puerto Rico from the Continental United States. The federal members of the task force assisted the companies with regulatory and permitting issues as well as prioritization of on- and off-loading of cargo vessels.

Sodium chloride, also known as saline, also ended up in short supply due to disruptions to a critical manufacturing facility in Puerto Rico. This shortage impacted not only the healthcare system in Puerto Rico, but hospitals and other healthcare providers across the Continental United States who rely on the saline produced on the island. HHS assisted the impacted company with transportation and other needs in order to facilitate the movement of product off the island and held calls with healthcare system partners to discuss strategies they could implement to help conserve and replenish this essential medical supply.

Diesel fuel for generators became another priority to help stabilize the health infrastructure. HHS staff learned that diesel trucks were not reaching their destinations. The staff immediately reached out to the appropriate federal agencies to arrange for law enforcement escorts to ensure diesel got where it was supposed to go.

HHS also held daily teleconferences with hospitals, healthcare suppliers, and pharmaceutical companies to understand the impacts of the storm and to provide the latest federal information on response activities. In addition, we worked with the National Volunteer Organizations Active in Disasters and its partner Healthcare Ready. These organizations processed and distributed donations to help strengthen healthcare supply chains.

While having the right size generator is a basic preparedness step for many businesses in the health sector, one of the lessons emerging from this year’s hurricane seasons is that generators typically are built to run for a week or two not long-term, and they require regular maintenance. Private physicians’ offices, too, need to talk with their building owners about whether the building has a generator maintained regularly and of suitable size to allow the offices to remain open in long-term power outages.

Recovery is a marathon, not a sprint. Immediate after the storm, our goal was to help health care organizations jumpstart the process by helping the health sector obtain the resources they needed to get or keep their facilities running. The health sector continues to work toward full recovery, and HHS will be there to help every step of the way.

December 01
Filling the Gaps: Planning for the Disaster Health Needs of Patients Taking Opioids and People Using Illicit Drugs

When a disaster strikes public health and medical responders need to be ready to treat recreational users of opioids who are suffering from withdrawal, opioid patients who are in recovery, and patients who rely on opioids for pain management. Public health and health care professionals need to include the management of issues related to opioid use and addiction as part of their overall disaster preparedness, response and recovery plans.

Amid this year’s historic hurricane season, for example, some of the health care facilities, including opioid treatment centers, in the impacted areas struggled to reestablish services. Some area residents who relied on opioids for pain management or were being treated for opioid addiction had to manage the stress of the storm and the symptoms of opioid withdrawal at the same time.

Many of those patents also relied on emergency shelters in the wake of the storm. HHS medical responders who provided support to emergency shelters saw a number of patients who did not have their medications with them or ways to get replacements. In addition, some people in the shelter were non-medical opioid users who were unexpectedly cut off from their regular supplies and were suffering from withdrawal.

The opioid epidemic is a problem that has spread to communities throughout the country. According to the Substance Abuse and Mental Health Services Administration, in 2016, there were 11.8 million people aged 12 or older who misused opioids in the past year and the majority of that use was prescription pain reliever misuse rather than heroin use; there were 11.5 million pain reliever misusers and 948,000 heroin users.

Planning for Disruptions in Treatment and Potential Increases in Illicit Drug Use

Disruptions in service are a reality in many major disasters. The disruption of steady-state systems needed for medical care, such as pharmacies, medical facilities, and treatment centers, could result in an increase in people seeking alternatives to prescribed opioids, such as illicit drugs like heroin and illegally made fentanyl,that may be more readily available. It could also lead to people suddenly having to manage the symptoms of withdrawal when other support systems may be weakened or non-existent.

Public health, healthcare and emergency management planners and responders need to consider they can minimize the adverse effects of addition withdrawal on the community, residents in emergency shelters, and protect responders. Before a disaster affects your community, plan to address the needs of people who are addicted to opioids, recovering from opioid addiction, or require opioids for pain management.

HHS agencies are available to assist states and localities in contingency planning for disasters that disrupt systems, including having important supplies such as naloxone available at shelters, having shelter staff trained to respond to addiction withdrawal or overdoses, and engaging local and regional partners to share information about the availability of medical infrastructure. To get assistance with planning, contact the HHS Substance Abuse and Mental Health Services Administration or the HHS Office of the Assistant Secretary for Preparedness and Response.

In addition, state and local health agencies and health care providers can collaborate with law enforcement agencies to monitor and deter the use of illegal substances in communities that have suffered an emergency event. Such partnerships can help protect communities that may be vulnerable after disasters.

Protecting Responders from Accidental Exposure

According to the Drug Enforcement Administration, law enforcement officers, K9 units, emergency medical service personnel, and fire rescue professionals are also being adversely affected by accidental opioid overdose and particularly by the shift in the use of prescription opioids to the more potent illicit fentanyl into many communities.

Illicit fentanyl, although similar to prescription opioids and heroin, is 50 to 100 times more potent. Exposure to even a small amount can be fatal. First responders need resources and guidance to reduce and prevent occupational exposure to this dangerous substance in the field.

The first defense to treat an opioid overdose, whether intentional, accidental or occupational, is naloxone. Naloxone can reverse opioid-related overdoses and is administered by intranasal spray, intramuscular, subcutaneous, or intravenous route. Because fentanyl is extremely potent, multiple doses of naloxone may be needed to overcome the overdose. There are other precautionary steps that can be taken to reduce exposure to fentanyl, such as personal protective equipment.

Next Steps: Planning and Response

Federal agencies created the following resources to help local and state responders and planners:

As efforts to address this epidemic unfold, federal, state, local, and community organizations will need to work together in planning for and responding to crises. Saving lives amid our nation’s opioid crisis requires a multidisciplinary approach.

Let’s get the conversation going among public health, behavioral health, law enforcement, and emergency management professionals to develop best practices in assessing risks and in planning to protect the health and safety of responders and the people they serve. Doing so can protect health and save lives not just during disasters but every day.

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