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U.S. Department of Health and Human Services

Action Step: Phase 1

Action/ Issues Lead Agency/ Supporting Agency
Phase 1: – Pre-Incident: Credible intelligence of a plan to conduct a biological attack using botulinum food contamination. Situation Awareness / Preparedness & Alert.
Trigger: Introduction of credible intelligence pointing to a botulinum food contamination attack
ESF #8 Strategy: Begin preparation for a large-scale public health and medical response. Prepare to assist SLTT officials in establishing an effective post exposure program in the management of botulinum food contamination cases.
A. Planning and Coordination
1. Receive, assess and evaluate sensitive and classified information from the intelligence community and other sources OSSI / Classified Agencies
2. Share and relay sensitive classified information to authorized users within HHS with demonstrated “need to know.” OSSI / Classified Agencies
3. Review sensitive and classified information for impact on current or future response efforts. Sec HHS / Classified Agencies
4. Based on credible intelligence or involvement of terrorist groups, adjust this response plan as necessary to meet the expected challenges and changes required for response operations. ASPR / Classified Agencies
5. Consider HHS transition from "normal" to coordinated Departmental emergency operations. ASPR / OPDIVs, Agencies
6. Begin structured planning process.
  • Acquire situation update
  • Identify required tasks
  • Access available assets
  • Determine constraints (gaps)
  • Identify critical facts and assumptions
  • Determine critical information requirements
ASPR- Plans
7. Prepare and initiate activities through ASPR.
  • Verify and validate Alert and Notification roster.
  • Determine additional Emergency Management Group (EMG) staffing requirements and Operating Divisions’ (OPDIV) Emergency Operations Center (EOC) augmentation requirements.
  • Prepare daily (or as required) situation reports for the Secretary on preparedness efforts or in the event that the intelligence picture changes.
  • Specify intelligence requirements.
  • Establish and maintain contact with appropriate Regional Emergency Coordinator (REC).
ASPR / EMG Manager, REC, OPDIVs, Agencies
8. Coordinate and conduct meeting between ASPR, Office of the Surgeon General (OSG) OFRD, NDMS, and CDC/DSNS to determine possible missions, deployments and associated readiness.
  • Supplies and logistics support
  • Epidemiology support
  • Medical treatment support
  • Technical expert support
  • Patient evacuation support
9. Consider augmenting HHS EMG
  • Designate EMG Manager
  • Begins readiness planning in coordination with ESF #8 partners, SLTT officials
  • Receive ESF #8 mission assignments in coordination with partners, and SLTT officials
ASPR / OPDIVs, HHS Agencies
10. Consider alerting advance elements of federal response teams (e.g. IRCT). Technical experts to consider:
  • Supply and logistics
  • Patient movement
ASPR / OPDIVs, HHS Agencies
11. Through our Regional Emergency Coordinator and Hospital Preparedness Program Field Officers, establish contact with key public health, healthcare, and community partners (e.g., SLTT response entities, Health Departments, Emergency Management Agencies, and Hospital Associations.
  • RECs finalize mission assignment requests with the State(s)
REC / HPP / ASPR / OPDIVs, HHS Agencies
12. Conduct interagency coordination (e.g. DHS, DOS, and the White House).
  • Prepare and detail required liaison officers (DHS, Strategic Information and Operations Center (SIOC), National Counterterrorism Center (NCTC) and other agencies as requested
  • Consider requests for appropriate agencies to provide LNOs to HHS upon EMG activation as necessary
  • Alert ESF #8 partners if intelligence is credible and actionable.
  • Coordinate with appropriate DHS/FEMA contacts (Regional Response Coordination Centers (RRCC) if activated, and Regional Emergency Coordinator (REC).
ASPR / OPDIVs, HHS Agencies, ESF #8 Partners
13. CDC Emergency Operations Center (EOC) establishes and maintains contact with the SOC/EMG. ASPR / CDC
14. Convene the Emergency Management Group as required. ASPR / EMG Members
15. Place the Incident Response Coordination Team (IRCT), and Office of Force Readiness Deployment (OFRD), National Disaster Medical System (NDMS) on alert for the possibility of activation/deployment. ASPR / OSG, OPDIVs
16. Begin preparation and coordination activities.
  • Roster personnel
  • Confirm logistical capability to support deployments, including transportation
  • Determine support requirements to CDC’s LRN that are also members of the Food Emergency Response Network (FERN)
  • Expand Interagency / Intergovernmental coordination
  • EMG OPS releases Warning Order
ASPR / OPDIVs, HHS Agencies, ESF #8 Partners
17. Formalize ESF #8 response plan and task organization (proposed deploying elements) for possible health and medical interventions. ASPR, ESF #8 Supporting Agencies
18. Request that the REC work with the State to determine readiness of SLTT public health and emergency agencies to implement botulinum food contamination attack response measures. ASPR / OGC, CDC, REC
19. Request interagency representatives to staff the ESF #8 EMG sections.
  • Planning Section
  • Logistics Section (includes Private Sector Assistance, and Mortuary Affairs)
  • Operations Section
  • Administration and Finance Section
EMG / ESF #8 Partners
20. Establish contact with key public health, healthcare, and community partners, Offices of Emergency Management (OEM), and Hospital Associations and appropriate food industry leaders through appropriate channels RECs / HPP Field Officers / ASPR / FDA, OPDIVs, Agencies
21. Establish and publish schedule for recurring activities (Conference Calls, VTCs, etc.) i.e. “Battle Rhythm ASPR / OPDIVs, HHS Agencies. ESF #8 and other Federal Partners
B. Surveillance, Investigation, and Protective Health Measures
22. Work through the Regional Emergency Coordinator (REC) and CDC’s EOC to obtain situational awareness of public health activities ongoing in the possibly affected area.
  • Laboratory Analysis
  • Public Health Surveillance
    • Human Surveillance
      •  To identify the source of food contamination
      •  For early detection of those who are exposed
      •  The extent of population who may have been exposed
23. Provide updated information to medical providers and healthcare organizations seeking treatment and management guidance for potential food contamination. CDC / ASPR, ASPA
24. Assess public health and medical capability and expected shortfalls in potentially affected area(s) RECs / EMG, OPDIVs, HHS Agencies
25. Plan for lab surge capabilities with CDC for the LRN, FDA/USDA for FERN, and DHS for the Integrated Consortium of Lab Networks (ICLN) ASPR /CDC / FDA / USDA / DHS
26. Enhance surveillance for the potentially affected area.
  • Intelligence
  • Law Enforcement
OSSI / ASPR, OPDIVs, Agencies, Federal Partners
C. Antitoxin and Ventilator Allocation
27. Begin developing estimates of possible requirements.
  • Antitoxins
  • Ventilators
28. Confirm antitoxin and ventilator availability in relation to the projected requirements.
  • Current ventilator inventories
  • Current / Surge production capabilities
ASPR / CDC(SNS), BARDA, RECs, PHEMCE, OPDIVs, Agencies, Federal Partners
29. Update plans for distribution of resources (antitoxins and ventilators). ASPR / OPDIVs, Agencies, Federal Partners, CDC
D. Healthcare and Emergency Response
30. Based on affected area plans, ensure response support includes the following high demand areas:
  • Patient movement processes
  • High acuity care surge capacity e.g. ICU beds with appropriate staffing
  • High density, high demand healthcare resources
    • RT’s, vents
31. Verify response posture and prepare for surge of federal support to increase in the capacity of medical and emergency response systems taking treatment of all age groups into account.
  • ESF #8 healthcare assets (equipment/caches), including National Disaster Medical System (NDMS), Federal Medical Stations (FMS) and ESF #8 partner assets
    • Epidemiological support
    • Veterinary surveillance
    • Laboratory activities, coordinate with CDC for LRN and DHS for ICLN
    • Critical care capability
    • Deployable hospitals
    • Public Health and Medical personnel (NDMS, PHS CC, MRC, ESAR-VHP)
  • SNS stockpile of antitoxin / ventilators and other appropriate supplies and material
ASPR / OPDIVs, Agencies, ESF #8 Supporting Agencies
32. Begin to alert, roster and consider deployment options for federal medical and public health personnel.
  • Prepare Occupational Safety and Health Plan.
  • Determine travel and lodging requirements
EMG / OPDIVs, HHS Agencies, ESF #8 and other Federal Partners
E. Communications and Outreach
33. Review and update Risk Communications Plan to include special medical needs and at risk populations.
  • Mitigation
  • Preparedness
  • Response
  • Recovery
34. Review and update Media Campaign Plan.
  • Contacts
  • Information requirements
  • Timelines
35. Review FDA guidance to regulated industry, public health, and public service messages related to safety of FDA-regulated products. ASPA / FDA, AABB TF
36. Identify Technical Experts on medical and public health aspects of botulinum food contamination ASPA & CDC / ASPR. USDA, FDA
37. Identify HHS spokesperson(s). ASPA / ASPR, OSG, CDC, FDA
38. Identify public affairs liaison officer assignments and responsibilities. ASPA / ASPR

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  • This page last reviewed: August 06, 2013