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Trigger Point #3 – Confirmed Cases of Inhalation Anthrax Identified in a U.S. City
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HHS Strategy: Take aggressive actions to assist state, local, and territorial officials in providing surge capacity and continued recommendations and assistance in the management of inhalation anthrax cases.
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Planning and Coordination
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1. Confirm clinical cases of inhalation anthrax.
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2. Declare a Public Health Emergency
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3. Recommend the Secretary of DHS declare an Incident of National Significance
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4. Participate in establishment of US Government executive structure for management of the incident.
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5. Begin/Continue to coordinate response efforts with ESF #8 Supporting Agencies, DHS, other Federal Partners, and the White House.
o Provide appropriate LNOs
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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, State, local, Region, Tribe, Territory, and private-sector levels.
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7. Begin/Continue deployment activities of appropriate response capabilities.
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8. Establish/Sustain ongoing communication with ESF #8 partners regarding logistical and operational planning.
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9. Grant OPHS/OSG the authority to activate all PHS CC and deploy as needed
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10. Coordinate with FBI to provide support for any criminal investigation.
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11. Convene Medical Interagency Coordination Group (MIACG) to determine medical regulating policy as well as which FCC PRAs should be alerted and/or activated.
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Who are the appropriate team members?
What FCC PRAs should be activated/alerted?
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EMG
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OPDIVs/
Agencies
NOC
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Email
Telephone
Briefing
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Immediately/
Until Complete
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12. Establish/Maintain communications with CDC DEOC.
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13. Maintain contact with key public health, healthcare, and community partners (i.e., Region/Tribe/Territory/State/local Health Department, Region/Tribe/Territory/State/local OEM, Region/Tribe/Territory/State/local Hospital Association, etc.)
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14. Process required mission assignments.
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15. Complete ESF #8 Mission Assignment Subtasking Requests.
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16. HHS Incident Response Coordination Team (IRCT)
o Deploy to designated area.
o Conduct/Submit situation assessments.
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.
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Surveillance, Investigation, and Protective Health Measures
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17. Maintain situational awareness public health activities ongoing in the affected area.
o Laboratory Analysis
o Public Health Surveillance
o Environmental Surveillance
o Human Surveillance
o Veterinary Surveillance
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18. Track/map inhalation anthrax cases in coordination with CDC and State and local health officials.
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What is the pertinent information for each identified anthrax case (date, time, location, exposure, etc)?
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IRCT/EMG
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NOC, CDC, State/Local Agencies
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Email, VTC
Telephone
Briefing
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Immediately/ Ongoing
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19. Use available models and applicable data to assist in the identification of potentially exposed people.
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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.
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What is the distribution plan?
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IRCT/EMG
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NOC, CDC, State/Local Agencies
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Email, VTC
Telephone
Briefing
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Immediately/ Until Complete
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21. Issue updated case definitions and guidance for specimen management, laboratory testing, and enhanced surveillance.
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22. Issue guidance in decontamination and secondary exposure
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Vaccine, Antibiotic, and Anthrax Immune Globulin Utilization Policies
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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.
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What is the availability of AVA?
What are the mass dispensing regulatory requirements?
Is an EUA required? If yes, how do I obtain it?
What State and local agencies will be responsible for mass vaccination?
What is their contact information?
Do they have the assets to conduct mass vaccination?
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IRCT/EMG
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OPDIVs/
Agencies (FDA)
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Email
Telephone
Briefing
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Immediately/
Until Complete
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24. Assess candidate vaccines for licensure
o Explore the rapid development, licensure, and production of new anthrax vaccines.
o Evaluate dose-optimization strategies to maximize the use of limited vaccine stocks.
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25. Work with manufacturers to expedite public-sector vaccine/antibiotic-purchasing.
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26. Provide regulatory guidance to vaccine/antibiotic manufacturers for the manufacture and shipment of anthrax vaccines and antibiotics.
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27. Mobilize healthcare partners and request activation of State-based plans for distributing and administering vaccines and antibiotics.
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28. Allocate vaccines, antibiotics and AIG.
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29. Monitor vaccine use.
o Monitor that vaccine distribution follows existing plans for priority groups.
o Assist with implementation of a call-back system or immunization registry that would accomplish the goals of vaccination.
o Monitor anthrax disease outcomes among vaccinated persons
o Monitor reported adverse events associated with vaccine use.
o Implement protocols and databases for monitoring vaccine safety, and for tracking vaccine usage, including second and third dose uptake.
o Use existing vaccine-monitoring systems to conduct population-based surveillance for adverse events.
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30. Monitor antibiotic use.
o Support data-collection efforts on the distribution of State or Federal supplies of antibiotic, the occurrence of adverse events following administration of antibiotics.
o Implement existing drug-monitoring systems to allow population-based surveillance for adverse events following the use of antibiotics for treatment and/or prophylaxis.
o Use existing antibiotic use-monitoring systems to conduct population-based surveillance for adverse events.
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31. Anthrax Immune Globulin (AIG) use.
o Mobilize healthcare partners and request activation of State-based plans for distributing and administering AIG.
o Allocate AIG.
o HHS to determine use of scarce resources
o Monitor AIG use.
o Monitor that AIG distribution follows existing plans for priority groups.
o Monitor reported adverse events associated with AIG use.
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Healthcare and Emergency Response
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32. Continue to alert, roster and deploy Federal medical and public health personnel.
- Continue Occupational Safety and Health Plan.
- 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.
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What are the updated requirements?
What capabilities are needed?
What is the deployment critieria?
What predeployment activities must take place?
Staging areas?
Logistical requirements?
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IRCT/EMG
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Agencies
OPDIVs
Federal Partners
Internet
Email
Telephone
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Email
Telephone
Briefing
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Immediately/
Ongoing
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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.
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34. Continue to gather data on bed counts and other critical resources.
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35. If required, deploy medical materiel and pharmaceuticals from the SNS. Prepare to requisition/deploy additional vaccine/antibiotics/AIG through VMI.
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36. Trigger the healthcare community to implement protocols related to the allocation of scarce healthcare resources.
o Protocols that triage patients’ access to hospitalization, intensive care, and ventilators.
o Develop/Issue guidance on allocation of scarce Federal healthcare assets (personnel, equipment, supplies).
o Implement alternative staffing plans to leverage scarce local health and medical personnel.
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What are the resource shortfalls?
What are alternate methods that may address shortfalls?
What procedures and policies can be established/implemented to increase capability?
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IRCT/EMG
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Agencies
OPDIVs
Federal Partners
Internet
Email
Telephone
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Email
Telephone
Briefing
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Immediately/
Ongoing
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37. Begin coordinating patient transportation plan to move patients to definitive care facilities nationwide, FCCs, NDMS, VA, DOD, etc.
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What are the requirements?
What resources are available?
What tracking mechanism will be used?
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IRCT/EMG
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Agencies
OPDIVs
ESF #8 Partners
Federal Partners
Internet
Email
Telephone
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Email
Telephone
Briefing
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Immediately/
Ongoing
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38. Conduct patient movement requests as required.
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39. Support/Conduct behavioral health operations.
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40. Begin National Hospital Surge Capacity Activities
- Contact affected States and Region to determine remaining public health and medical infrastructure and assets (HHS Regional Emergency Coordinator).
- Establish medical communications with affected area.
- 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.)
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Communications and Outreach
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41. Continue execution of Communications Plan.
o Provide information on medical and public health response activities.
o 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
o Provide regular public updates.
o 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.
o Instruct the public on preventive measures.
o Instruct the public on response measures.
o Conduct "desk-side briefings" and editorial roundtables with news media decision-makers.
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43. Provide behavioral expertise to help craft messages.
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44. Coordinate communications plan with local and State Public Information Officers.
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45. Coordinate press releases with local and State Public Information Officers.
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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.
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47. Participate in coordinated interagency communications campaign.
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48. Activate and surge hotline capacity for medical and behavioral health questions.
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49. Update appropriate HHS websites (HHS, CDC, NIH, FDA).
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50. Activate the CDC-INFO telephone line to provide relative information to the public.
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51. Provide healthcare providers clinical management guidelines for hospitals, long-term care facilities, and outpatient settings.
o Assess and resolve clinical issues related to inhalation anthrax treatment.
o 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
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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).
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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.
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