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U.S. Department of Health and Human Services

Integration With Other Tiers

Requests for Federal public health and medical support should specify the need for assistance, rather than ask for specific Federal assets. Thus, a key component of preparedness planning for emergency managers is determining the precise capabilities of the State, Tribal, and jurisdictional response systems, and establishing the process for recognizing when Federal public health and medical assistance may be indicated. Some basic considerations for preparedness planning are the following:

  • What are the full public health and medical response capabilities for the State or Tribe (including such resources as community health centers, long-term care facilities, Tribal Hospitals, VA Hospitals, and intrastate/interstate mutual aid arrangements)?
  • What types of hazard-generated demands can the response system handle? What demands may exceed the State or Tribe's resources (e.g., victims requiring isolation, casualties from an uncontrolled radiation release)?
  • What criteria will be used to determine when the State or Tribal response system is severely challenged (i.e., when the need for Federal support arises)? How will the decision-making process occur, especially early in an event?
  • What information or data will be necessary to define the specific requests for Federal assistance? How will this information be collected, collated, and analyzed at the State or Tribal level under the stress and time constraints of a large-scale or very unusual incident? Identifying the types of information that are important to convey when making a request for Federal assistance is an importance step of preparedness planning for State, Tribal, and jurisdictional emergency managers.

With a Stafford Act Declaration, the defined need for Federal assistance is transmitted via an Action Request Form (ARF) from the State EOC to the Operations Section within the DHS/FEMA JFO.[14] The ARF delineates who, what, where, when, and how much assistance is needed. Staff at the JFO reviews the eligibility of the ARF under the Stafford Act (i.e., is the need beyond the response capabilities of local, State, or Tribal authorities?) and, if it is eligible, converts the ARF into a mission assignment. The mission assignment is a work order by FEMA to a Federal agency that directs completion of a specific task. Depending on the need, FEMA will issue the mission assignment to the Primary Agency of the ESF with responsibility in that functional area. As the Primary Agency for ESF #8, HHS is issued mission assignments related to the provision of public health and medical assistance.[15] Once a mission assignment is issued, the EMG then determines, based on its internal resources and those of its OPDIVs and ESF #8 partners, the most appropriate way to accomplish the mission.

As Hurricane Katrina showed, the process for requesting and mobilizing Federal assistance can be time-consuming and cumbersome to meet urgent public health and medical needs in a disaster. HHS RECs have begun working with State public health and medical planners in their region to pre-identify areas where Federal public health and medical assistance will likely be necessary in an emergency or disaster. This may allow for the pre-scripting of common mission assignments so they can be issued quickly in a disaster. State public health and medical planners should work with their respective RECs to define areas where pre-scripted mission assignments may be warranted.

In the event that public health and medical assistance is activated under ESF #8, Federal resources will be tactically integrated into the appropriate State, Tribal, or jurisdictional ICS. This is essential because Federal assets are meant to support State, Tribal, and jurisdictional response efforts, not supplant them. To facilitate integration, Federal response teams should be briefed on how an emergency response is being managed at the State, Tribal, or jurisdictional level (where the primary incident management is occurring, who the lead management authority is, etc.).

On behalf of ESF #8, the IRCT receives tactical direction (e.g., instructions on where to report) from the appropriate State, Tribal, or jurisdictional authorities. Before Federal ESF #8 assets arrive on scene, a primary point of contact or liaison should be established. This may be the State's senior public health official or his/her designee. For State public health and medical planners, other critical preparedness planning considerations include the following:

  • Where will Federal support be staged and operate once it is committed to the State, Tribal, or jurisdictional incident response?[16]
  • What processes are in place to integrate external assets into State, Tribal, or jurisdictional incident management?
  • If the SNS is activated, is there an SNS plan in place that addresses:
    • How the SNS will be broken down once it arrives?
    • What priority system will be used to dispense SNS assets (e.g., elected officials, first responders, family members of first responders)?
    • How will the SNS be distributed to the public? If distribution centers have been established, how will the assets get there?
    • How will personnel responsible for distributing SNS get to the distribution centers? Have alternate plans been established?
  • If an FMS is activated, how will it be coordinated with the overall State and/or jurisdictional public health and medical response?
    • Have existing structures been identified to house FMSs?
    • Is there a protocol or mechanism available to provide operations support to the FMS?
    • How will patients be transported to an FMS and/or back to their primary area of residence?

Although Federal ESF #8 response teams will coordinate with State, Tribal, and jurisdictional incident management on tactical issues, the EMG, as directed by the ASPR, provides overall strategic direction to the IRCT Leader. The coordination of incident planning and response activities among Federal agencies occurs at the JFO. 


  1. Prior to the establishment of a JFO, requests for Federal assistance should be made to the RRCC.
  2. Not all ESF #8 mission assignments are issued directly to HHS; for example, DoD is tasked directly by FEMA to support the evacuation of patients and persons with medical special needs from a disaster area. Though it is directly tasked, DoD coordinates all activities related to this mission assignment with HHS.
  3. Federal assets deployed in anticipation of need are commonly "staged" on Federal property, such as military bases, prior to being assigned to State, Tribal, or jurisdictional management.  

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  • This page last reviewed: February 14, 2012