Aerosolized Anthrax Actions Steps/Issues
|
Actions/Issues |
Lead Agency/ |
| Supporting Agencies |
| Trigger Point #1 – Credible Intelligence of a Plan to Conduct a Biological Attack Using Aerosolized Anthrax |
| HHS Strategy: Begin preparation for a large-scale public health response in the event of widespread infection of the exposed populace. |
| Planning and Coordination |
|
1. Consider HHS transition from “normal” to coordinated Departmental emergency response operations. |
ASPR |
| OPDIVs/Agencies |
|
2. Begin structured planning process. |
ASPR |
| Situation update. |
| Required tasks |
| Available assets |
| Determine constraints |
| Identify critical facts and assumptions |
| Determine critical information requirements |
| Plan the use of time |
|
3. Prepare/Initiate response activities through ASPR. |
ASPR |
| Initiate notification roster. |
OPDIVs/Agencies |
| Determine additional EMG staffing requirements and OPDIV EOC activation requirements. |
|
| Prepare daily or more frequent situation reports for the Secretary on preparedness efforts. |
|
| Establish and maintain contact with appropriate RHAs |
|
|
4. Coordinate/Conduct meeting between ASPR and OSG to determine possible missions, deployments. |
ASPR,/OSG |
| POD Reinforcement/Augmentation/Establishment |
OPDIVs |
| Epidemiology Support |
|
| Medical Treatment Support |
|
| Subject Matter Expert Support |
|
|
5. Consider establishing HHS Emergency Management Group. |
ASPR |
| Designate Incident Manager. |
OPDIVs/Agencies |
| Begins response planning in coordination with relevant support agencies. |
|
| Begin development of possible ESF #8 mission assignments in coordination with ESF #8 partners, Territory/Tribal/State/local officials and DHS. |
|
|
6. Begin coordination with the Interagency, including DHS and DOS, and the White House. |
ASPR |
| Prepare/Detail required liaison officers (DHS, SIOC, NCTC) and other agencies as requested. |
OPDIVs/Agencies/ |
| Request appropriate agencies provide LNOs to HHS. |
ESF #8 Supporting Agencies/Federal Partners |
| Alert ESF #8 partners. |
|
| Begin coordination with appropriate DHS/FEMA contacts (RRCC, RECs, etc) |
|
|
7. Establish and maintain contact with CDC DEOC. |
ASPR |
| CDC |
|
8. Schedule/Convene meeting of the Emergency Preparedness and Response Group. |
ASPR |
|
9. Support activation/deployment of advance elements of Federal Response Teams (FIRST, ERT-A, ERT-N, IRCT-A, DEST, etc.) as required. SMEs to consider: |
ASPR |
| Epidemiologist |
OPDIVs/Agencies |
| PODs expertise |
|
|
10. Alert/Deploy the Incident Response Coordination Team. Specific SMEs to consider: |
ASPR |
| Epidemiologist |
OPDIVs/Agencies |
| PODs expertise |
|
|
11. Formalize and distribute ESF #8 response structure, decisional authorities, and trigger points for health & medical interventions. |
ASPR |
| ESF #8 Supporting Agencies |
|
12. Determine readiness of local, Region, Tribal, Territory, State and Federal public health and emergency agencies to implement anthrax response measures (e.g. Receipt of SNS, PODs, etc.) |
ASPR/OGC/CDC |
|
13. Review risk status (i.e., health screening and vaccination status) of all federal and contractor employees who could potentially deploy in support of ESF #8 anthrax response activities and provide additional screening and vaccination as needed and available. |
ASPR |
| ESF #8 Supporting Agencies |
|
14. Establish contact with key public health, healthcare, and community partners (e.g. Region/Tribe/ Territory/State Health Department, Region/Tribe/Territory/State OEM, Region/Tribe/Territory/State Hospital Association, etc.) |
ASPR |
| OPDIVs/Agencies |
|
15. Establish and publish schedule for recurring activities (Conference Calls, VTCs, etc.) |
ASPR |
| OPDIVs/Agencies/ESF #8 Supporting Agencies/Federal Partners |
|
|
|
| Surveillance, Investigation, and Protective Health Measures |
|
16. Provide updated information to medical providers and healthcare organizations seeking treatment and management guidance and algorithms for anthrax exposure. |
CDC |
| ASPR/ASPA/OPDIVs |
|
17. Coordinate lab surge capabilities with CDC and State/Region/Territory/Tribal/local authorities. |
CDC |
| OPDIVs |
|
18. Begin collecting and collating applicable information for the area. |
ASPR |
| GIS |
OPDIVs/Agencies/Federal Partners |
| Meteorological |
|
| Transportation |
|
| Intelligence |
|
| Law Enforcement |
|
|
|
|
| Vaccine, Antibiotic, and Anthrax Immune Gloulin Utilization Policies |
|
19. Confirm vaccine and antibiotic availability vs. requirements. |
ASPR |
| Current inventories |
OPDIVs/Agencies/ Federal Partners |
| Current/Surge production capabilities |
|
|
20. Develop a plan to determine the use of scare resources (Vaccine, Antibiotic, and Anthrax Immune Gloulin) |
ASPR |
| OPDIVs/Agencies/ Federal Partners |
|
|
|
| Healthcare and Emergency Response |
|
21. Request/Review appropriate Region, Tribe, Territory, State, and local emergency management plans, focusing on: |
ASPR |
| Point of Dispensing (POD) operations |
CDC |
| City Readiness Initiative |
|
| Patient regulating and movement processes |
|
| High acuity care expansion capability |
|
|
22. Consider increasing the capacity of medical and emergency response systems to meet expected needs by identifying/alerting/deploying/distributing: |
ASPR |
| Federal healthcare assets, including NDMS, FMS and ESF #8 partner assets |
OPDIVs/Agencies/ ESF #8 Supporting Agencies |
| o Epidemiological support |
|
| o Veterinary surveillance |
|
| o Laboratory activities |
|
| o Critical care capability |
|
| o POD capabilities (augmentation/establishment) |
|
| o Commissioned Officer Corps |
|
| o Pharmacy activities |
|
| o NDMS Teams |
|
| SNS stockpile of antibiotics, vaccine, and other appropriate supplies and material |
|
| Additional reagents and consumables for surge testing at appropriate LRN laboratories |
|
|
|
|
| Communications and Outreach |
|
23. Review Communications Plan. |
ASPA |
| o Mitigation |
ASPR |
| o Preparedness |
|
| o Response |
|
| o Recovery |
|
|
24. Review Media Campaign Plan. |
ASPA |
| Contacts |
ASPR |
| Information requirements |
|
| Timelines |
|
|
25. Identify SMEs on medical and public health aspects of anthrax exposure |
ASPA/CDC |
| ASPR |
|
26. Identify HHS spokesperson(s). |
ASPA |
| ASPR |
|
27. Identify public affairs liaison officer assignments and responsibilities. |
ASPA |
| ASPR |
|
|
|
|
Actions/Issues |
Lead Agency |
| Supporting Agency |
| Trigger Point #2 – Notification of a BioWatch Actionable Result (BAR) |
| HHS Strategy: Take aggressive actions to assist Region, Tribe, Territory, State and local officials in establishing an effective postexposure prophylaxis program (PEP) and in the management of inhalation anthrax cases. |
|
| Planning and Coordination |
|
1. If in combination with credible intelligence, HHS transitions from “normal” to coordinated Departmental emergency response operations. |
ASPR |
| OPDIVs/HHS Agencies |
|
2. If in combination with credible intelligence, establish HHS Emergency Management Group. |
ASPR |
| Designate Incident Manager. |
OPDIVs/HHS Agencies |
| Begins response planning in coordination with relevant support agencies. |
|
| Begin development of possible ESF #8 mission assignments in coordination with ESF #8 partners, State/local officials and DHS. |
|
|
3. Begin/Continue supporting activation/deployment of advance elements of Federal Response Teams (FIRST, ERT-A, ERT-N, IRCT-A, DEST, etc.) as required. SMEs to consider: |
ASPR |
| Epidemiologist |
OPDIVs/HHS Agencies |
| PODs expertise |
|
|
4. If in combination with credible intelligence, deploy Incident Response Coordination Team (IRCT) |
ASPR |
| OPDIVs/HHS Agencies |
|
5. Review Federal BioWatch Conference Call Agenda. |
EMG |
|
6. Identify Federal BioWatch Conference Call participants from HHS. |
EMG |
|
7. Obtain BioWatch Area Profile for the affected regions. |
EMG |
| CDC |
|
8. Participate in Federal BioWatch Conference Call. |
EMG |
|
9. Begin/Continue response activities |
EMG |
| Maintain contact with appropriate RHAs and other public health agencies |
OPDIVs/HSS Agencies/ESF #8 Partners (DOD, VA, DHS, DOT, EPA, OSHA, DOJ, ARC, etc) |
| Maintain communications with appropriate DHS/FEMA contacts (RRCC, RECs, etc) |
|
|
10. Establish contact with key public health, healthcare, and community partners (e.g., Region/Tribe/ Territory/State Health Department, Region/Tribe/Territory/State OEM, Region/Tribe/Territory/State Hospital Association, etc.) |
EMG |
| OPDIVs/HHS Agencies |
|
11. Monitor completion, assess quality of, and provide guidance to fill gaps in anthrax—related public health and medical preparedness and response plans at Federal, Region, Tribe, Territory, State, local, and private-sector levels |
EMG |
| OPDIVs/HHS Agencies/ESF #8 Partners (DOD, VA, DHS, DOT, EPA, OSHA, DOJ, ARC, etc) |
|
|
12. Initiate/Increase deployment activities |
EMG |
| Roster personnel |
OPDIVs/HHS Agencies/ESF #8 Partners (DOD, VA, DHS, DOT, EPA, OSHA, DOJ, ARC, etc) |
| Conduct any necessary fit testing, health screening and/or vaccination (as applicable and available) |
|
| Confirm logistical capability to support deployments, including transportation |
|
| Ensure that laboratories in support of the LRN are operational and verify their analytical capability |
|
| Expand Interagency/Intergovernmental coordination |
|
| Identify and coordinate medical credentialing requirements as required |
|
|
13. Request interagency representatives to staff the ESF#8 EMG branches. |
EMG |
| Unified Planning Branch |
ESF #8 Partners (DOD, VA, DHS, DOT, EPA, OSHA, DOJ, ARC, etc) |
| Unified Logistics Branch (includes Private Sector Assistance, and Mortuary Affairs) |
|
| Unified Operations Branch |
|
| Unified Administration and Finance Branch |
|
| Combined International Assistance Branch (OMSPH, OGHA) for possible reception of international relief effort assets |
|
| Patient Movement Branch |
|
|
|
|
|
|
| Surveillance, Investigation, and Protective Health Measures |
|
14. Maintain situational awareness public health activities ongoing in the affected area. |
EMG |
| Laboratory Analysis |
CDC |
| Public Health Surveillance |
|
| o Environmental Surveillance |
|
| o Human Surveillance |
|
| o Veterinary Surveillance |
|
|
15. Support Event Reconstruction and Plume Modeling efforts. |
EMG |
| OPDIVs/HHS Agencies/ESF #8 Partners (DOD, VA, DHS, DOT, EPA, OSHA, DOJ, ARC, etc)/Federal Partners |
|
16. Monitor Intelligence Analyses and Law Enforcement efforts. |
EMG |
| DHS, FBI, NCTC |
|
|
|
| Vaccine, Antibiotic, and Anthrax Immune Globulin Utilization Policies |
|
17. Begin/Continue to confirm vaccine and antibiotic availability vs. requirements. |
EMG |
| Current inventories |
OPDIVs/HHS Agencies/ESF #8 Partners (DOD, VA, DHS, DOT, EPA, OSHA, DOJ, ARC, etc)/Federal Partners |
| Current/Surge production capabilities |
|
|
18. Begin developing estimates of possible requirements |
EMG |
| o Vaccines |
OPDIVs/HHS Agencies/ESF #8 Partners (DOD, VA, DHS, DOT, EPA, OSHA, DOJ, ARC, etc)/Federal Partners |
| o Antibiotics |
|
|
|
|
| Healthcare and Emergency Response |
|
19. Begin to alert, roster and deploy Federal medical and public health personnel. |
EMG |
| Activate Occupational Safety and Health Plan. |
OPDIVs/HHS Agencies/ESF #8 Partners (DOD, VA, DHS, DOT, EPA, OSHA, DOJ, ARC, etc)/Federal Partners |
| If needed, use HHS Intermittent Hiring Authorities to roster and redirect available civilian volunteers to areas most in need. |
|
| Coordinate requirements with appropriate Region, Tribe, Territory, State and local public health officials. |
|
|
|
|
20. Review appropriate Emergency Management Assistance Compacts (EMAC). |
EMG |
| CDC |
|
21. Support Region, Tribe, Territory, State and local public health activities ongoing in the affected area. |
EMG |
| Epidemiological support |
OPDIVs/HHS Agencies/ESF #8 Partners (DOD, VA, DHS, DOT, EPA, OSHA, DOJ, ARC, etc)/Federal Partners |
| Veterinary surveillance |
|
| Laboratory activities |
|
| Critical care capability |
|
| POD capabilities (augmentation/establishment) |
|
| Commissioned Officer Corps |
|
| Pharmacy activities |
|
| NDMS Teams |
|
|
22. Consider increasing the capacity of medical and emergency response systems to meet expected needs by identifying/alerting/deploying/distributing: |
EMG |
| Federal healthcare assets, including NDMS, FMS and ESF #8 partner assets |
OPDIVs/HHS Agencies/ESF #8 Partners (DOD, VA, DHS, DOT, EPA, OSHA, DOJ, ARC, etc)/Federal Partners |
| o Epidemiological support |
|
| o Veterinary surveillance |
|
| o Laboratory activities |
|
| o Critical care capability |
|
| o POD capabilities (augmentation/establishment) |
|
| o Commissioned Officer Corps |
|
| o Pharmacy activities |
|
| o NDMS Teams |
|
| SNS stockpile of antibiotics, vaccine, and other appropriate supplies and material |
|
| Additional reagents and consumables for surge testing at appropriate LRN laboratories |
|
|
|
|
| Communications and Outreach |
|
23. Begin/Continue review and update of Communications Plan. |
ASPA |
| EMG |
|
24. Begin/Continue review and update of Media Campaign Plan. |
ASPA |
| EMG |
|
25. Review BioWatch Area Communications Plan. |
ASPA |
| EMG |
|
26. If a JIC is established at the local and/or Region, Tribe, Territory, State level, coordinate communications and media activities as appropriate. |
ASPA |
| EMG |
|
27. Coordinate communications plan with local and Region, Tribe, Territory, State Public Information Officers. |
ASPA |
| EMG |
|
28. Coordinate press releases with local and Region, Tribe, Territory, State Public Information Officers. |
ASPA |
| EMG |
|
|
|
|
|
|
|
Actions/Issues |
Lead Agency |
| Supporting Agency |
| Trigger Point #3 – Confirmed Cases of Inhalation Anthrax Identified in a U.S. City |
| HHS Strategy: Take aggressive actions to assist Region, Tribe, Territory, State, and local officials in providing surge capacity and continued recommendations and assistance in the management of inhalation anthrax cases. |
|
|
| Planning and Coordination |
|
1. Confirm clinical cases of inhalation anthrax. |
EMG |
| CDC |
|
2. Declare a Public Health Emergency |
Sec HHS |
|
3. Recommend the Secretary of DHS declare an Incident of National Significance |
Sec HHS/Sec DHS |
| EMG/NOC |
|
4. Participate in establishment of US Government executive structure for management of the incident. |
EMG |
| OPDIVs/HHS Agencies/ESF #8 Partners (DOD, VA, DHS, DOT, EPA, OSHA, DOJ, ARC, etc) |
|
5. Begin/Continue to coordinate response efforts with ESF #8 Partners (DOD, VA, DHS, DOT, EPA, OSHA, DOJ, ARC, etc), DHS, other Federal Partners, and the White House. |
EMG |
| Provide appropriate LNOs |
OPDIVs/HHS Agencies/ESF #8 Partners (DOD, VA, DHS, DOT, EPA, OSHA, DOJ, ARC, etc) |
|
6. Begin/Continue monitoring the completion of, assessing the quality of, and providing guidance to fill gaps in anthrax—related public health and medical preparedness and response plans at Federal, Region, Tribe, Territory, State, local and private-sector levels. |
EMG |
| OPDIVs/HHS Agencies/ESF #8 Partners (DOD, VA, DHS, DOT, EPA, OSHA, DOJ, ARC, etc) |
|
7. Begin/Continue deployment activities of appropriate response capabilities. |
EMG |
| OPDIVs/HHS Agencies/ESF #8 Partners (DOD, VA, DHS, DOT, EPA, OSHA, DOJ, ARC, etc) |
|
8. Establish/Sustain ongoing communication with ESF #8 partners regarding logistical and operational planning. |
EMG |
| ESF #8 Partners (DOD, VA, DHS, DOT, EPA, OSHA, DOJ, ARC, etc) |
|
9. Grant OPHS/OSG the authority to activate all PHS CC and deploy as needed |
Sec HHS |
| OPHS/OSG |
|
10. Coordinate with FBI to provide support for any criminal investigation. |
EMG |
| OPDIVs/HHS Agencies/ESF #8 Partners (DOD, VA, DHS, DOT, EPA, OSHA, DOJ, ARC, etc) |
|
11. Convene Medical Interagency Coordination Group (MIACG) to determine medical regulating policy as well as which FCC PRAs should be alerted and/or activated. |
EMG |
| OPDIVs/HHS Agencies/ESF #8 Partners (DOD, VA, DHS, DOT, EPA, OSHA, DOJ, ARC, etc) |
|
12. Establish/Maintain communications with CDC DEOC. |
EMG |
| CDC |
|
13. Maintain contact with key public health, healthcare, and community partners (e.g., Region/Tribe/ Territory/State Health Department, Region/Tribe/Territory/State OEM, Region/Tribe/Territory/State Hospital Association, etc.) |
EMG |
| OPDIVs/HHS Agencies |
|
14. Process required mission assignments. |
EMG |
| ESF #8 Partners (DOD, VA, DHS, DOT, EPA, OSHA, DOJ, ARC, etc) |
|
15. Complete ESF #8 Mission Assignment Subtasking Requests. |
EMG |
| ESF #8 Partners (DOD, VA, DHS, DOT, EPA, OSHA, DOJ, ARC, etc) |
|
16. HHS Incident Response Coordination Team (IRCT) |
IRCT |
| o Deploy to designated area. |
EMG/OPDIVs/HHS Agencies/ |
| o Conduct/Submit situation assessments. |
ESF #8 Partners (DOD, VA, DHS, DOT, EPA, OSHA, DOJ, ARC, etc) |
| o POD operations |
|
| o Epidemiology investigations |
|
| o Critical care capabilities |
|
| o Establish liaison with appropriate Federal management and support centers (RRCC/JFO, JOC, JIC, DEST, etc.). |
|
| o Establish “trouble desk” to facilitate coordination of HHS functions with local/State officials. |
|
| o Coordinate with HHS regional personnel and other Federal assets (e.g. PFO and/or FCO). |
|
| o Provide Federal field management/coordination for deployed HHS assets. |
|
| o Participate in appropriate conference calls/VTCs. |
|
| o Track and monitor all missions approved by the Incident Manager and ESF #8 Support Agencies. |
|
|
|
|
| Surveillance, Investigation, and Protective Health Measures |
|
17. Maintain situational awareness public health activities ongoing in the affected area. |
EMG |
| Laboratory Analysis |
CDC |
| Public Health Surveillance |
|
| o Environmental Surveillance |
|
| o Human Surveillance |
|
| o Veterinary Surveillance |
|
|
18. Track/map inhalation anthrax cases in coordination with CDC and Region, Tribe, Territory, State and local health officials. |
EMG |
| CDC |
|
19. Use available models and applicable data to assist in the identification of potentially exposed people. |
EMG |
| CDC |
|
20. Continue to prepare and distribute reagents. CDC will develop, produce, and disseminate confirmatory laboratory tests/reagents to the Laboratory Response Network (LRN), if applicable. |
CDC |
| EMG |
|
21. Issue updated case definitions and guidance for specimen management, laboratory testing, and enhanced surveillance. |
CDC |
| EMG |
|
22. Issue guidance in decontamination and secondary exposure |
CDC |
| EMG |
|
| Vaccine, Antibiotic, and Anthrax Immune Globulin Utilization Policies |
|
23. Consult with FDA to ascertain the regulatory status, current data on safety and efficacy, and availability of products (in the SNS, vendor inventories, etc.) such as Anthrax Vaccine Adsorbed (AVA) and antibiotics appropriate for the treatment of inhalation anthrax patients. |
EMG |
| OPDIVs/HHS Agencies/ |
| ESF #8 Partners (DOD, VA, DHS, DOT, EPA, OSHA, DOJ, ARC, etc)/Federal Partners |
|
24. Assess candidate vaccines for licensure |
EMG |
| Explore the rapid development, licensure, and production of new anthrax vaccines. |
OPDIVs/HHS Agencies/ |
| Evaluate dose-optimization strategies to maximize the use of limited vaccine stocks. |
ESF #8 Partners (DOD, VA, DHS, DOT, EPA, OSHA, DOJ, ARC, etc)/Federal Partners |
|
|
|
25. Work with manufacturers to expedite public-sector vaccine/antibiotic-purchasing. |
EMG |
| OPDIVs/HHS Agencies/ |
| ESF #8 Partners (DOD, VA, DHS, DOT, EPA, OSHA, DOJ, ARC, etc)/Federal Partners |
|
26. Provide regulatory guidance to vaccine/antibiotic manufacturers for the manufacture and shipment of anthrax vaccines and antibiotics. |
EMG |
| OPDIVs/HHS Agencies/ |
| ESF #8 Partners (DOD, VA, DHS, DOT, EPA, OSHA, DOJ, ARC, etc)/Federal Partners |
|
27. Mobilize healthcare partners and request activation of State-based plans for distributing and administering vaccines and antibiotics. |
CDC |
| EMG/OPDIVs/HHS Agencies/ |
| ESF #8 Partners (DOD, VA, DHS, DOT, EPA, OSHA, DOJ, ARC, etc)/Federal Partners |
|
28. Allocate vaccines and antibiotics. |
CDC |
| EMG/OPDIVs/HHS Agencies/ |
| ESF #8 Partners (DOD, VA, DHS, DOT, EPA, OSHA, DOJ, ARC, etc)/Federal Partners |
|
29. Monitor vaccine use. |
CDC |
| Monitor that vaccine distribution follows existing plans for priority groups. |
EMG/OPDIVs/HHS Agencies/ |
| Assist with implementation of a call-back system or immunization registry that would accomplish the goals of vaccination. |
ESF #8 Partners (DOD, VA, DHS, DOT, EPA, OSHA, DOJ, ARC, etc)/Federal Partners |
| Monitor anthrax disease outcomes among vaccinated persons |
|
| Monitor reported adverse events associated with vaccine use. |
|
| Implement protocols and databases for monitoring vaccine safety, and for tracking vaccine usage, including second and third dose uptake. |
|
| Use existing vaccine-monitoring systems to conduct population-based surveillance for adverse events. |
|
|
30. Monitor antibiotic use. |
CDC |
| Support data-collection efforts on the distribution of State or Federal supplies of antibiotic, the occurrence of adverse events following administration of antibiotics. |
EMG/OPDIVs/HHS Agencies/ |
| Implement existing drug-monitoring systems to allow population-based surveillance for adverse events following the use of antibiotics for treatment and/or prophylaxis. |
ESF #8 Partners (DOD, VA, DHS, DOT, EPA, OSHA, DOJ, ARC, etc)/Federal Partners |
| Use existing antibiotic use-monitoring systems to conduct population-based surveillance for adverse events. |
|
|
|
|
31. Anthrax Immune Globulin (AIG) use. |
CDC |
| Mobilize healthcare partners and request activation of State-based plans for distributing and administering AIG. |
EMG/OPDIVs/HHS Agencies/ |
| Allocate AIG. |
ESF #8 Partners (DOD, VA, DHS, DOT, EPA, OSHA, DOJ, ARC, etc)/Federal Partners |
| HHS to determine use of scarce resources |
|
| Monitor AIG use. |
|
| Monitor that AIG distribution follows existing plans for priority groups. |
|
| Monitor reported adverse events associated with AIG use. |
|
|
|
|
| Healthcare and Emergency Response |
|
32. Continue to alert, roster and deploy Federal medical and public health personnel. |
EMG |
| Support hospital augmentation in affected communities to offload low-acuity patients from hospitals. |
OPDIVs/HHS Agencies/ESF #8 Partners (DOD, VA, DHS, DOT, EPA, OSHA, DOJ, ARC, etc)/Federal Partners |
| If needed, use HHS Intermittent Hiring Authorities to roster and redirect available civilian volunteers to areas most in need. |
|
| Deploy and track Federal mass fatality response assets (NDMS, DoD). |
|
|
|
|
33. Support Region, Tribe, Territory, State use of Emergency Management Assistance Compacts (EMAC) to direct available medical and public health personnel to the affected areas. |
EMG |
|
|
34. Continue to gather data on bed counts and other critical resources. |
EMG |
| OPDIVs/HHS Agencies/ESF #8 Partners (DOD, VA, DHS, DOT, EPA, OSHA, DOJ, ARC, etc)/Federal Partners |
|
35. If required, deploy medical materiel and pharmaceuticals from the SNS. Prepare to requisition/deploy additional vaccine/antibiotics through VMI. |
CDC |
| EMG/OPDIVs/HHS Agencies/ |
| ESF #8 Partners (DOD, VA, DHS, DOT, EPA, OSHA, DOJ, ARC, etc)/Federal Partners |
|
36. Trigger the healthcare community to implement protocols related to the allocation of scarce healthcare resources. |
EMG |
| Protocols that triage patients’ access to hospitalization, intensive care, and ventilators. |
OPDIVs/HHS Agencies/ESF #8 Partners (DOD, VA, DHS, DOT, EPA, OSHA, DOJ, ARC, etc)/Federal Partners |
| Develop/Issue guidance on allocation of scarce Federal healthcare assets (personnel, equipment, supplies). |
|
| Implement alternative staffing plans to leverage scarce local health and medical personnel. |
|
|
|
|
37. Begin coordinating patient transportation plan to move patients to definitive care facilities nationwide, FCCs, NDMS, VA, DOD (GPMRC), etc. |
EMG |
| OPDIVs/HHS Agencies/ESF #8 Partners (DOD, VA, DHS, DOT, EPA, OSHA, DOJ, ARC, etc)/Federal Partners |
|
38. Conduct patient movement requests as required. |
EMG |
| OPDIVs/HHS Agencies/ESF #8 Partners (DOD, VA, DHS, DOT, EPA, OSHA, DOJ, ARC, etc)/Federal Partners |
|
39. Support/Conduct behavioral health operations. |
EMG |
| OPDIVs/HHS Agencies/ESF #8 Partners (DOD, VA, DHS, DOT, EPA, OSHA, DOJ, ARC, etc)/Federal Partners |
|
40. Begin National Hospital Surge Capacity Activities |
EMG |
| • Contact affected States and Region to determine remaining public health and medical infrastructure and assets (HHS Regional Emergency Coordinator). |
DOD, VA, DHS |
| - Establish medical communications with affected area. |
National Guard |
| - Encourage use of Emergency Management Assistance Compacts (EMAC) for emergency medical services (EMS), other medical and medical support assets. |
|
| • Contact all HHS Regional Emergency Coordinators to determine and coordinate: |
|
| - Deployable medical assets; and |
|
| - Receiving facilities for patient transport. |
|
| • Request receiving facilities to activate surge plans augment their capacity (e.g., canceling elective surgery, implementing early discharge of patients to nursing facilities / home, etc.) |
AHA, ASTHO |
|
| Communications and Outreach |
|
41. Continue execution of Communications Plan. |
ASPA |
| Provide information on medical and public health response activities. |
EMG |
| Provide anticipatory guidance on how the public health and medical response (including mass fatality management) will unfold over time. |
|
| o Points of Dispensing Sites |
|
| o Post Exposure Prophylaxis |
|
| o City Readiness Initiative |
|
| Provide regular public updates. |
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| Provide regular public health updates to Congress, Governors, Mayors, State, local, and tribal health departments, local officials, other stakeholders, and the media regularly. |
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42. Continue execution Media Campaign. |
ASPA |
| Instruct the public on preventive measures. |
EMG |
| Instruct the public on response measures. |
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| Conduct "desk-side briefings" and editorial roundtables with news media decision-makers. |
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43. Provide behavioral expertise to help craft messages. |
ASPA |
| EMG |
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44. Coordinate communications plan with local and Region, Tribe, Territory, State Public Information Officers. |
ASPA |
| EMG/State and local JICs |
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45. Coordinate press releases with local and Region, Tribe, Territory, State Public Information Officers. |
ASPA |
| EMG/State and local JICs |
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46. Participate in the National Incident Communications Conference Line (NICCL) composed of Federal public affairs officers as well as local and state public affairs officers. |
ASPA |
| EMG |
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47. Participate in coordinated interagency communications campaign. |
ASPA |
| EMG |
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48. Activate and surge hotline capacity for medical and behavioral health questions. |
ASPA |
| EMG |
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49. Update appropriate HHS websites (HHS, CDC, NIH, FDA). |
ASPA |
| EMG |
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50. Activate the CDC-INFO telephone line to provide relative information to the public. |
CDC |
| ASPA/EMG |
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51. Provide healthcare providers clinical management guidelines for hospitals, long-term care facilities, and outpatient settings. |
CDC |
| Assess and resolve clinical issues related to inhalation anthrax treatment. |
ASPA/EMG |
| Distribute sample model protocols for early detection and treatment of inhalation anthrax and provide healthcare facilities with these protocols. |
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52. Update and disseminate national guidelines on diagnostic testing and use of antibiotics and vaccines |
CDC |
| ASPA/EMG/HHS Agencies |
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53. Assist the Department of State (primary agency) in coordinating international activities related to chemical, biological, radiological, and nuclear incidents and events that pose transborder threats. Cooperate with DOS to assist in communicating real-time actions taken by the United States and U.S. projections of the international consequence of the event (e.g., disease spread, travel restrictions, pharmaceutical supply and distribution, and displaced persons). |
DOS |
| ASPA/EMG/OMSPH |
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54. Coordiante with DOS (primary agency) in coordination with foreign states concerning offers of support, gifts, offerings, donations, or other aid. This includes establishing coordination with partner nations to identify the U.S.-validated immediate support in response to an Incident of National Significance. |
DOS |
| ASPA/EMG/OMSPH |
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Actions/Issues
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Lead Agency
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Supporting Agency
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Trigger Point #4 – Demobilization (Upon Release from Region, Tribe, Territory, State and Local Authorities)
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HHS Strategy: Establish effective policies and processes to allow Federal public health response personnel and equipment to rapidly and efficiently redeploy to their homestation.
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Planning and Coordination
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1. Review PHS section 319 declaration. (It expires automatically after 90 days, but can be renewed for 90 day periods based on the same or additional facts). |
Sec HHS |
| EMG/OPDIVs/HHS Agencies/ ESF #8 Partners (DOD, VA, DHS, DOT, EPA, OSHA, DOJ, ARC, etc) |
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2. Coordinate with Local and State incident management commands to facilitate a timely and orderly movement and redeployment of Federal assets. |
EMG |
| OPDIVs/HHS Agencies/ ESF #8 Partners (DOD, VA, DHS, DOT, EPA, OSHA, DOJ, ARC, etc)/Federal Partners/State and local Officials |
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3. Determine Demobilization decision (EMG) |
Sec HHS |
| EMG/OPDIVs/HHS Agencies/ ESF #8 Partners (DOD, VA, DHS, DOT, EPA, OSHA, DOJ, ARC, etc) |
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4. Notify Federally deployed Units / Entities of pending demobilization and redeployment of personnel and equipment |
EMG |
| OPDIVs/HHS Agencies/ ESF #8 Partners (DOD, VA, DHS, DOT, EPA, OSHA, DOJ, ARC, etc)/Federal Partners |
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5. Coordinate for Transportation |
EMG |
| OPDIVs/HHS Agencies/ ESF #8 Partners (DOD, VA, DHS, DOT, EPA, OSHA, DOJ, ARC, etc)/Federal Partners |
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6. Close out financial accounts at the incident area, if required |
EMG |
| GSA, DHS |
| (FEMA funds all Incidents of national Significance) |
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7. Request / Coordinate for SNS Redeployment |
EMG |
| Inventory (SNS and other Federal entities) |
CDC/ Federal Partners |
| Repack / Load configuration (SNS) |
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| Secure SNS (IAW ESF 13) |
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| Transport SNS and Federal entities (IAW ESF 1) |
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8. Plan/Coordinate Post Deployment Occupational Health and Safety screening |
EMG, USPHS |
| Federal Agencies |
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9. Coordinate for post deployment debrief at home station |
Federal Entities |
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| Surveillance, Investigation, and Protective Health Measures |
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10. Conduct Post deployment health screening |
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| Vaccine and Antibiotic Utilization Policies |
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11. Begin reconstitution of medical countermeasure supplies |
CDC |
| ASPR |
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| Healthcare and Emergency Response |
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12. Establish/Conduct Post Deployment Occupational Health and Safety screening program. |
EMG, USPHS |
| Federal Agencies |
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| Communications and Outreach |
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13. Evaluate communications plan and media plan |
ASPA |
| ASPR |
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