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U.S. Department of Health and Human Services

Hurricane Response Playbook

Actions & Issues

Introduction

These preparedness and response action steps complement the ESF #8 Hurricane Concept of Operations and provide decision support for coordinating and/or managing the Federal public health and medical assets required prior to and in the aftermath of a hurricane or tropical storm making landfall in the United States or its territories. It allows for a fully scalable approach for directing support operations that provide assistance to SLTT authorities in responding to and initiating the recovery from a major tropical storm or hurricane.

This playbook only highlights key actions and decision points and is not intended to be a comprehensive list of actions required in response to a hurricane landfall.

Phasing of Support: The ESF #8 Response to a developing hurricane event will occur in three phases, which correspond to the FEMA 2010 Federal Interagency Hurricane Concept Plan (CONPLAN). The CONPLAN was developed in accordance with HSPD-8, Annex I, the Integrated Planning System.

The Phases are as follows:

Phase 0: Steady State.

Phase 1: Prepare: (Considered to be from the start of hurricane season up to H-72)
Phase 1a: Normal Operations; (Considered to be up to H-120)
Phase 1b: Elevated Threat; (Considered to be H-120 hours to H-96 hours)
Phase 1c: Credible Threat. (Considered to be H-96 to H-72)

Phase 2: Incident and Incident Response (Considered being H-72 to L+120)
Phase 2-a.: Initial Response (H-72 to H-24) Presidential Declaration/MA
Phase 2-b. Sustained Response (H-24 to L+120) Presidential Declaration thru Post-Landfall

Phase 3. Post-Incident (Recovery and Mitigation.)

Structure of Action Steps: The following table of action steps is organized by response phase and stage. Each stage is further segmented by functional area:

  1. Planning and Coordination;
  2. Healthcare, Emergency Response, and At-Risk Individuals;
  3. Pharmaceuticals, Medical Supplies and Equipment;
  4. Patient movement, and
  5. Communication and Outreach

Phase 0 – Steady State
Continuously prior to event
Trigger Event 1: Beginning 2010 Hurricane Season - June 1, 2010 – November 30, 2010
ESF #8 Strategy: Closely Monitor Events and Begin Review of Advance Preparations Required to Facilitate an Effective and Timely Response
Normal Operations: HHS Secretary’s Operations Center (SOC) continually collects, analyzes and disseminates intelligence and information to allow the ASPR and DASOPEO to anticipate requirements and to react effectively.

Actions/Issues Lead Agency/Supporting Agency
A. Planning and Coordination
1. ASPR initiatives, policies or strategies to prepare governments and healthcare organizations to reduce evacuation requirements, mitigate any potential affects, and provide for better preparation. ASPR/OPEO
2. SLTT initiatives strategies to prepare governments and healthcare organizations to reduce evacuation requirements, mitigate any potential affects, and provide for better preparation are: Regional Program initiatives or plans to prepare governments and healthcare organizations to reduce evacuation requirements, mitigate any potential affects, and provide for better preparation. SLTT Entities
3. Gap Analysis RECs
4. Review and revise playbook based on FEMA CONPLAN OPP

Phase 1 –Prepare
(From the start of hurricane season up to H-72)
Trigger Event 1: Beginning 2010 Hurricane Season - June 1, 2010 – November 30, 2010
Trigger Event 2: NOAA/NHC Tropical Storm Advisory indicating development of potentially damaging tropical event
Trigger Event 3: Formal Alert notification from FEMA/NRCC
ESF #8 Strategy: Closely Monitor Events and Begin Review of Advance Preparations Required to Facilitate an Effective and Timely Response

Phase 1-a: Normal Operations
(Up to H-120)
Trigger: NOAA/NHC Tropical Storm Advisory
Actions/Issues Lead Agency/Supporting Agency
A. Planning and Coordination
1. Establish contact through the National Operations Center/National Response Coordination Center (NRCC) to maintain a heightened state of situational awareness OPEO/SOC
2. Review and validate ESF #8 Hurricane Playbook OPEO
3. Review and validate ESF #8 Essential Elements of Information (EEIs), information collection strategies and methodologies, and related decision points ASPR’s Fusion Cell/All
4. Ensure financial and acquisition personnel and systems are brought to and maintained at the highest state of readiness HHS/ASPR/ASAMDOD/VA/FEMA
5. Ensure Pre-Scripted Mission Assignments (PSMAs) and existing interagency and contractual vehicles are available for rapid implementation and execution OPEO
6. Review emergency personnel rosters and equipment in support of active and sustainable field response and recovery operations All
7. Establish and maintain required communication and coordination links via normal communication channels with ESF #8 Partners and Regional and State counterparts All
8. Establish and maintain additional lines of communication and coordination with non-collocated command, control and coordination entities (e.g., White House Situation Room, Homeland Security Council) OPEO/SOC
9. Review MOUs, MOAs and Mutual Aid Agreements with emergency management agencies, SLTT and other organizations in the potentially affected areas. All
10. Review plans to address surge capacity for medical functions such as:
  1. Health care facility staff augmentation
  2. Shelter in place vs. evacuation for health care facilities in path of storm
  3. Special requirements for treating the aging and pediatric patients
OPEO-EMG/AOA/ABC
11. Send, as requested by DHS and FEMA, pre-identified representatives, authorized to coordinate and make decisions, to multi-agency and multi-jurisdictional groups. HHS/DOD/VA/DOT/ARC
12. Test Government Emergency Telecommunications System (GETS) accounts and cards for landline and cellular telephones; ensure that appropriate interagency Telecommunications Service Priorities (TSP) and Wireless Service Priorities (WSP) actions are coordinated and ready for immediate post-incident implementation and execution HHS/DOD/VA/DOT/ ARC/CDC/FDA
13. Initiate testing of communications systems, i.e. Video Teleconference (VTC), emergency contact communications, and cascading call-down lists All
14. Direct rostered personnel to prepare for deployment by reviewing all deployment requirements, procedures and practices and review alert, activation, and deployment standard operating procedures, practices, and protocols All
15. Initiate information and data collection, analysis, and assessment based on available quantitative data and derived from the Hurricane Incident Essential Elements of Information Collection Plan All
16. Determine preliminary staffing augmentation to IMAT, RNA OPEO/REC/IRCT
17. Identify and verify key US Government executive structure and incident management structure contacts OPEO/OPS
18. Identify any specific medical materiel required for CDC/DSNS response to hurricanes and natural disasters and put regulatory mechanisms in place, if necessary, for the use of the materiel during the emergency. HHS/CDC/DSNS/FDA
19. Activate ESF #8 hurricane response planning for coordinated and parallel planning IAP development. OPEO Plans/All
20. Include requirements of at-risk individuals in incident action plan OPEO/PLANS/ABC/ACF OD/OCR
21. Update situational awareness and ensure visibility of the common operating picture is maintained in (HSIN) and WebEOC OPEO/SOC
22. Begin GIS Modeling/Gap Analysis SOC/Fusion
23. Verify readiness of logistics requirements OPEO/LOG
24. Prepare to send planning rep to FEMA NRCC Interagency Planning Group Meetings OPEO/Plans
B. Healthcare, Emergency Response, and At-Risk
1. Verify response posture of ESF #8 (all-inclusive) OPEO
2. Issue Warning Order to ESF#8 response Teams (ESF #8, Rapid Deployment Force (RDF), Applied Public Health (APHT), Mental Health (MHT), At-Risk SMEs, Incident Response Coordination (IRCT), Advance Logistics Reception Team (ALRT) and external agencies). EMG/OPEO/OFRD
3. Verify response posture of ESF #8 (equipment/caches/personnel) CDC/NDMS/ASPR-LOG/ OFRD/MRC/ESAR-VHP
4. Issue advisories as appropriate to CDC/Division of Strategic National Stockpile (CDC/DSNS) for possible CDC/DSNS FMS-ST deployment CDC/DSNS
5. Determine availability of personnel for deployment to staff FMS OPEO/OFRD
VA/DOD
6. Predetermine logistics hubs for early forward placement of FMS equipment/supply sets OPEO/LOG
CDC/DSNS
7. Develop deployment plan for use during contra-flow evacuation EMG/DOT
8. Alert and ascertain preparedness for laboratories in Laboratory Response Network (LRN) (includes SLTT, Federal public health labs, and 25 DOD labs) and impacted states’ veterinary diagnostic laboratories. Verify readiness status of Public Health laboratories in the potentially affected areas and address the key public health issues:
  1. Operational status
  2. Contingency Planning/Continuity of Operations for communications, transport of specimens, testing and staffing
  3. Surge capacity planning
  4. Testing water samples for potable water
CDC/DOD
9. Monitor the Health Alert Network (HAN) CDC
10. Determine procedures for uncompensated medical care OPEO/CMS
11. Identify medical and public health staff or other civilians as needed to augment medical and veterinary facilities and mass care shelters. OPEO/OFRD/OPDIVs/ ARC
12. Address any special requirements for treating the aging and pediatric patients. OPEO-EMG/AOA/ABC
C. Surveillance, Investigation, and Protective Health Measures
1. Ascertain preparedness status of laboratories with select agents CDC
2. Verify Public Health surge teams readiness for deployment (Public Health RNA Team, Veterinary RNA Team etc.) CDC
3. Verify that public health and veterinary RNA surveillance tools and personnel are ready for deployment and implementation. CDC
4. Verify readiness of public health surveillance teams CDC
5. Review public health preparedness messages CDC
D. Pharmaceuticals, Medical Supplies and Equipment
1. Verify readiness status of ESF #8 Response, assets, caches. OPEO-LOGS
2. Ascertain the status of vaccination supplies in the potentially affected areas. CDC/EOC
3. Ascertain the status of essential medical material including materials for special and emergency at-risk population needs and identify gaps. OPEO/LOG/ABC
4. Ascertain the status of blood supplies in the potentially affected areas. ASPR/OPHS/AABBTF
5. Ascertain need to request pharmaceuticals, medical supplies, and equipment from foreign countries. As appropriate, request needed resources through the International Assistance System (IAS). EMG/DOS/USAID/FEMA/HHS/OGHA
E. Patient movement
1. Identify and coordinate potential receiving, distribution, transportation and coordination of network system HHS/DOT/DOD/VA/FEMA
2. Identify and coordinate patient movement and enablers HHS/ESF #8/DOT/ DOD/VA/FEMA
3. Identify and synchronize planning with evacuation management jurisdictions. HHS/FEMA/DOT/DOD
4. Identify and coordinate with States JFO/IRCT to pre-identify and prioritize potential evacuation routes, patient transport routes and patient tracking. OPEO/OPS/OPEO PLANS
5. Identify and coordinate public health, medical and support needs for at-risk population movement. FEMA/ACF/ABC/OPEO/OD/OCR
6. Alert ESF #8 Federal Coordinating Centers (FCC) to be prepared to begin bed counts. HHS/VA/DOD
7. Coordinate with the National Guard Bureau for potential evacuation support. HHS/NGB
8. Alert Contractor of the Federal Medical Ambulance Contract. Do gap analysis. Anticipate State needs. HHS/FEMA
F. Communications and Outreach
1. Coordinate public health messages through PAO communication channels CDC/ASPA/ASPR
2. Review and update Health Alert Network advisories and other risk communications information CDC/HHS-ASPA
3. Review FDA guidance to regulated industry and public health and public service messages related to safety of FDA-regulated products – food, medication, medical devices, blood, and pet food. FDA/AABB TF
4. Coordinate public health messages with foreign governments if the affected areas are OCONUS, near national borders or in cross-border areas. EMG/DOS/USAID/ HHS-OGHA
5. Review and update information on HHS and CDC’s websites covering hurricane preparedness, response, injury prevention, cleanup activities, etc. ASPA/CDC
6. Address and communicate special public health risks and precautions for managing the public health threats due to oil contamination caused by tidal and storm surge ASPR/EMG
7. Review messages to hospitals regarding canceling elective surgeries. ASPR/OPHS

 

Phase 1b: Elevated Threat
(Approximately: H-120 (5 days) to H-96 (4 days)
Trigger: Formal Alert notification from FEMA/NRCC
Actions/Issues Lead Agency/Supporting Agency
A. Planning and Coordination
1. Upon receipt of the NOC/NRCC Operations Order: (Alert Notification)
  1. Perform assigned tasks commensurate with non-emergency position descriptions and operate within respective organization assignments.
  2. Maintain situational awareness and visibility of the common operating picture (COP) presented by the NHC Tropical Advisories and the HSIN Federal Operations portal.
  3. Prepare and distribute situation and spot reports using HSIN
  4. Review the current alert posture and readiness of emergency personnel and teams, to include equipment and facilities
    1. Update pre-deployment checklists (medical, physical, legal, etc…) and rosters.
    2. Ensure personnel skill set list is matched with appropriate training.
    3. Identify administrative and logistical deployment requirements.
    4. Review standard operating procedures (SOP), practices, protocols and processes.
    5. Verify equipment lists and “fly-away” kits are on-hand, complete and available for deployment.
  5. Be prepared to activate and deploy resources when directed.
  6. Initiate contacts with Federal, Regional, SLTT officials to include private sector representatives in accordance with statutory authorities
  7. Alert and possibly Activate NDMS.
    		ASPR/EMG Incident Manager/SOC/CDC/EOC
    2. Ensure that the HHS Secretary is notified of the threat and is receiving regular updates. ASPR
    3. Increase EMG activation level to correspond with NRCC OPEO
    4. Alert OPDIVs and STAFFDIVs OPEO
    5. Alert ESF #8 Partners OPEO
    6. Issue EMG LNO request to ESF #8 Partners to be prepared to (BPT) staff SOC/HHS-EMG OPEO
    7. Review staffing of EMG for potential augmentation OPEO
    8. Activate the IRCT-A to support applicable mission EMG
    9. Lead scheduled National ESF #8 Video Teleconferences to maintain situational awareness and to identify potential issues from the States and/or Regions EMG Incident Manager
    10. Participate in video teleconferences and other conference calls with DHS/FEMA and ESF # 8 partners concerning the situation, mission, and objectives All
    11. Map projected path established by National Weather Service/National Hurricane Center and impact on public health & medical infrastructure. Initiate pre-landfall geo-spatial imaging SOC/Fusion
    12. Check on status of FEMA Surge Account funding EMG/A&F
    13. Perform pre-impact analysis of the likely consequences on the public health, at-risk and medical critical infrastructures. EMG Plans/OD/ACF
    14. Activate logistics infrastructure.
    1. Identifies field lodging support for teams/personnel as required
    2. Be prepared to provide all non-medical logistics support
    		DHS/FEMA/EMG/LOG
    15. Verify ability of FEMA logistics to assist ESF#8 logistics requirements DHS/FEMA/LOG/EMG/LOG
    16. Notify CDC of likely locations for deployment of FMS and ESF #8 assets. EMG/ CDC/DSNS
    17. Continue ESF #8 hurricane response planning for coordinated and parallel planning Incident Coordination Plan (ICP) development. EMG Plans/ All
    18. Provide clear guidance to CDC/DSNS for number of FMS(s) required, deployment timeframe for FMS and other materials. OPEO/EMG
    19. Identify HHS staff in potentially affected areas and follow up with health and safety checks HHS/OPDIVs
    20. Establish contact with coordinators of state-based volunteer registries. EMG Plans/ESAR-VHP
    21. Alert Medical Reserve Corps (MRC) units in the forecasted strike zone through OCV/MRC communication mechanisms. MRC
    22. Review/Update Incident Response Coordination Team (IRCT) Roster OPEO/OPS
    23. Roster advance elements (IRCT-A); Plan to move ALRT/LRAT; roster DMAT to support applicable mission task force(s). FEMA rosters IMAT. HHS/FEMA/VA/ DOD
    24. Begin capturing after-action comments All
    25. Alert pre-rostered teams (RDF, Public Health, Mental Health, NDMS, IRCT, interagency ESF#8 teams) for possible deployment. Does not indicate formally putting ESF #8 on alert. OPEO OPS/ OPEO PLANS/ OFRD
    26. Alert HHS Senior Health Officials (SHO) ASPR/OPEO
    B. Healthcare, Emergency Response, and At-Risk
    1. Alert CDC’s EOC for heightened readiness posture. EMG
    2. Place resources (FMS, equipment caches and supplies etc) in alert posture and prepare for deployment EMG/CDC/ALL
    3. Pre-determine potential requirements for DOD or VA for staffing medical resources (e.g., FMS and augmentation health care facilities) EMG-OPS/PLANS/ ALL
    4. Alert medical and public health staff or other civilians as needed to augment Medical and Mass Care Shelters OPEO/OFRD/ OPDIVs/ OCV-MRC/ARC
    5. Work with IMAT-A and IMAT and RRCC/NRCC to pre-identify requirements which enable medical and veterinary personnel to provide support OPEO/OPS-OPEO PLANS
    C. Surveillance, Investigation, and Protective Health Measures
    1. Ascertain the status of vaccination requirements in the potentially affected areas. CDC/EMG-LOG
    2. Alert HHS OPDIVs with regard to potential deployments for response ops (e.g., Epidemiological, Food Inspection, Sanitation, Veterinary etc.) EMG
    3. Work with regional or National IMAT and RRCC/NRCC to identify potential personnel required to enable ESF #8 to identify public health hazards (e.g. food safety, water quality, waste disposal, vector control, hygiene, and any environmental health support) OPEO/CDC/ FDA/IHS/DOD
    4. Refine plans for at-risk individuals
    5. Refine plans to ensure provision of appropriate behavioral health services. OPEO/OPS/PLANS ABC/OD/ ACF/ OCR
    D. Pharmaceuticals, Medical Supplies and Equipment
    1. Notify OPEO –Logistics to begin preparations to load resources (FMS, equipment caches and supplies) for possible deployment. EMG-LOG/CDC/DSNS
    2. Work with regional or National IMAT, and RRCC/NRCC to identify and prioritize assembly areas of pre-deployment of medical supplies to strategic locations OPEO/OPS- PLANS- LOG
    3. Pre-identify and prioritize assembly areas of pre-deployment of medical supplies to strategic locations OPEO/OPS- PLANS – LOG/DOD/VA
    4. Work with regional or National IMAT and RRCC/NRCC to pre-identify any potential DOD requirements to provide military medical logistics support (medical equipment/supplies, medical diagnostics/blood products) OPEO/OPS- PLANS – LOG/DOD LNO
    E. Patient Evacuation
    1. Work with regional or National IMAT and RRCC/NRCC to pre-identify potential evacuation routes, patient transport routes, and patient tracking requirements OPEO/OPS- PLANS
    2. Continue coordination with States to identify contra-flow, potential evacuation routes, patient transport routes IRCT-A/DOT /DOD/VA/ESF #8
    3. Request DOD assistance to prepare to provide support for the evacuation of seriously ill or injured patients to pre-identified locations. HHS/ESF #8/DOD
    4. “FEMA requests DOD aeromedical evacuation resources in coordination with ESF #8 EMG to place Joint Patient Movement Teams, Aeromedical Evacuation (AE) personnel and equipment on be prepared to deploy status DHS/FEMA DOD/EMG
    5. Alert Ambulance contract for medical transportation (ground, air and para-transit ambulances) FEMA/HHS/OPEO-OPS/ESF #8
    6. Notify American Association of Blood Banks Task Force on Domestic Disasters and Acts of Terrorism (AABB Task Force) of locations to which seriously ill or injured patients will be evacuated in case blood products are needed EMG/OPHS – blood safety
    F. Communications and Outreach
    1. Ensure ongoing coordination with the SLTTs health authorities ASPA/CDC/RHA
    2. Schedule and conduct a situation briefing for ESF partners and OPDIVS/STAFFDIVS EMG
    ALL
    3. Invite delegates from the affected SLTT to participate in ESF #8 Conference Calls as appropriate. EMG

    Phase 1-c: Credible Threat
    (H-96 (4 days) to H-72 (3 days))
    Trigger: Receipt of FEMA/NRCC Operation Order for Activation of ESF #8
    Actions/Issues Lead Agency/Supporting Agency
    A. Planning and Coordination
    1. Increase EMG Staffing level to include selected liaisons and specialties
    1. Expand Ops, Planning, Log, and SME cells as required
    2. Initiate Administration/Finance section if not already activated
    3. Request LNO from ESF #8 partners as required (e.g., DOT, DOD, VA, DHS/FEMA, ARC)
    		ASPR
    2. Operations Section
    1. Issue initial Operations Order
    2. Continue daily HHS-EMG ESF #8 Coordination call
    3. Prepare to Deploy IRCT
    4. Prepare to deploy SHO if needed
    5. Prepare and possibly deploy ALRT and initial response forces (2 DMATs and associated caches)
    6. VMAT Strike Team and cache
    7. Alert advance elements of applicable mission task force(s)
    8. Prepare to deploy rostered teams (RDF, APHT, MHT, IRCT-A, At-Risk subject matter specialists and DOD patient movement enabling teams)
    9. Begin to execute PSMAs (as appropriate) in coordination with FEMA Mission Assignment Coordinators RRCC/NRCC
    10. Begin to produce GIS modeling of potential impact area of storm track
    		EMG-OPS
    EMG-LOG
    OFRD
    Fusion
    3. Planning Section
    1. Prepare Incident Coordination Plan and assure plans are coordinated with ESF #8 support agencies, OP/DIVs/Staff DIVs and States.
    2. Analyze vulnerability of key resources, critical infrastructure in the expected impact zone.
    		EMG Plans/CIP
    4. Logistics Section
    1. Coordinate non-medical support with FEMA
    2. Refine medical supply concept support plan.
    		EMG LOG/DHS/FEMA
    EMG LOG/DOD
    5. Administration and Finance
    1. Be prepared to develop RFA cost estimates
    2. BPT to track MA expenditures
    		EMG A&F
    6. Upon receipt of the NOC/NRCC Operations Order Amendment,
    1. Staff the ESF #8 desk at the NRCC as required
    2. Update situational awareness and ensure visibility of the common operating picture is maintained.
    3. Ensure that all essential functions can be performed and all related services can be provided following landfall.
    4. Initiate incident-specific information and data collection, analysis, and assessment.
    5. Perform pre-impact effects and consequences modeling and simulation analysis on the geography, demographics and population, and critical infrastructures.
    6. Ensure appropriate departmental and agency financial and acquisition personnel and systems are brought to and maintained at the highest state of readiness.
    7. Confirm essential communication and coordination links with Other Federal Agencies (OFA) and State partners to ensure optimal information sharing, and a common understanding of the expected mission and objectives.
    8. Initiate tests of emergency contact communications, cascading call-down lists and TTY devices.
    9. Initiate video teleconferences and other conference calls within ESF #8 emergency management community concerning the situation, mission and objectives
    10. Confirm lines of communication and coordination with non-collocated command, control coordination entities.
    11. Senior managers test GETS cards
    12. Confirm all essential Telecommunications Service Priorities (TSP) and Wireless Service Priorities (WSP) actions are coordinated and ready for immediate post-incident implementation and execution.
    13. Continue to review and validate internal and interagency senior officials’ “playbooks” and “checklists” including.
      1. Essential Elements of Information (EEI)
      2. Information collection requirements and capabilities
      3. Information analysis and intelligence procedures
      4. Reporting requirements
      5. Initial response requirements post-landfall
    14. n.) Prepare to execute Pre-Scripted Mission Assignments (PSMAs) and ensure existing interagency and contractual vehicles are available for rapid implementation and execution
    		EMG ALL
    7. Continue to map projected path of tropical storm as established by National Weather Service, National Hurricane Center. (Continue pre-landfall GIS mapping) EMG
    8. Review pre-impact analyses of the likely consequences to the public health, medical and at-risk critical infrastructures EMG
    9. Verify readiness of rostered personnel teams, including PHS and ESF #8. EMG – OPS/A&F
    10. Provide all ESF #8 partners (HHS and non-HHS) with specific reporting/requesting guidance for entry into the area of operations. EMG OPS
    11. Prepare supplies and equipment packages (logistics support) for all ESF #8 HHS teams / personnel (note that CDC supports FMS). OPEO/LOG
    CDC/DSNS/ALL
    12. Determine which FCCs will be activated for patient movement EMG/DOD/VA
    13. Activate ESF #8 patient movement as appropriate. OPEO/OPS
    14. Maintain situational awareness of patient movement flow ESF #8/DOD/VA
    15. Activate the American Association of Blood Banks Interagency Task Force on Domestic Disasters and Acts of Terrorism (AABB) to assess the current blood supply levels throughout the country. HHS/OPHS
    16. Coordinate with AABB Task Force to identify supply levels at the supporting healthcare, critical infrastructure and key resources for the incident. Activate supply distribution plans for affected region(s). HHS/OPHS
    17. Obtain approval for AABB Task Force coordinated public information assistance announcement re: the adequacy and safety of the nation’s blood supply. HHS/OPHS
    18. Activate HAvBED system to track hospital bed capacity EMG/Fusion/SOC
    19. Stage/Deploy assets to pre-incident locations as necessary (under surge account funding): ALRT Cache, ESF #8 personnel, Federal Coordinating Center (FCC) points of contact, and others as appropriate. It is imperative that the ALRT and LRAT is moved first and in place to receive additional assets listed here and elsewhere. EMG-OPS
    EMG-LOG
    B. Health Care, Emergency response, and At-Risk
    1. Maintain alert CDC’s EOC for heightened readiness posture. EMG
    2. Retain resources (FMS, equipment caches and supplies etc) in alert posture and prepare for deployment EMG/CDC/ALL
    3. Continue to pre-determine potential requirements for DOD or VA for staffing medical resources (e.g., FMS and augmentation health care facilities) EMG-OPS/PLANS/ ALL
    4. Keep medical and public health staff or other civilians on alert as needed to augment Medical and Mass Care Shelters OPEO/OFRD/ OPDIVs/ OCV-MRC/ARC
    5. Continue to work with regional/national IMAT and RRCC/NRCC to pre-identify requirements which enable medical and veterinary personnel to provide support OPEO/OPS-OPEO PLANS
    C. Surveillance, Investigation, and Protective Health Measures
    1. Continue to ascertain the status of vaccination requirements in the potentially affected areas. CDC/EMG-LOG
    2. Keep HHS OPDIVs alerted with regard to potential deployments for response ops (e.g., Epidemiological, Food Inspection, Sanitation, Veterinary etc.) EMG
    3. Continue to work with regional/national IMAT and RRCC/NRCC to identify potential personnel required to help ESF #8 assess public health hazards (e.g. food and water safety, waste disposal, vector control, other environmental threats) OPEO/CDC/ FDA/IHS DOD
    D. Pharmaceuticals, Medical Supplies and Equipment
    1. Continue OPEO –Logistics preparations to load resources (FMS, equipment caches and supplies) for possible deployment. EMG-LOG
    CDC/DSNS
    2. Continue to work with regional / National IMAT and RRCC/NRCC to identify and prioritize assembly areas of pre-deployed of medical supplies to strategic locations OPEO/OPS- PLANS- LOG
    3. Continue to pre-identify and prioritize assembly areas of pre-deployment of medical supplies to strategic locations OPEO/OPS- PLANS – LOG/ DOD/VA
    4. Continue to work with regional or National IMAT and RRCC/NRCC to pre-identify any potential DOD requirements to provide military medical logistics support (medical equipment/supplies, medical diagnostics/blood products) OPEO/OPS- PLANS – LOG/DOD LNO
    5. Ascertain need to request approved or cleared pharmaceuticals, medical supplies, and equipment from foreign countries. As appropriate, request needed resources through the International Assistance System (IAS). Address steps to be taken to determine U.S. regulatory status of any donated product). EMG/DOS/USAID
    FEMA
    HHS/OGHA/FDA
    E. Patient Evacuation
    1. Continue to work with regional or National IMAT and RRCC/NRCC to pre-identify potential evacuation routes, patient transport routes, and patient tracking via (Joint Patient Assessment Tracking System) JPATS requirements OPEO/OPS- PLANS
    2. Continue coordination with States to identify contra-flow, potential evacuation routes, patient transport routes IRCT-A/DOT /DOD/VA ESF #8/
    3. Retain DOD assistance to prepare to provide support for the evacuation of seriously ill or injured patients to pre-identified locations. HHS/ESF #8/DOD
    4. FEMA continues to coordinate with DOD aeromedical evacuation resources and with ESF #8 EMG to place Joint Patient Movement Teams, Aeromedical Evacuation (AE) personnel and equipment on “be prepared to deploy status” DHS/FEMA DOD/EMG
    5. Monitor alert status of the Ambulance contract for medical transportation (ground, air and para-transit ambulances) FEMA/HHS/OPEO-OPS/ESF #8
    6. Keep the American Association of Blood Banks Task Force on Domestic Disasters and Acts of Terrorism (AABB Task Force) informed of locations to which seriously ill or injured patients will be evacuated in case blood products are needed EMG/OPHS – blood safety
    F. Communications and Outreach
    1. Continue to ensure ongoing coordination with the SLTT health authorities ASPA/CDC/RHA
    2. Continue situation briefing(s) for ESF partners and OPDIVS/STAFFDIVS EMG, ALL
    3. Invite delegates from the affected SLTT to participate in ESF #8 Conference Calls. EMG

    Phase 2 – Incident and Incident Response
    (H-72 (4 days) thru L+120 (5 days))
    Trigger Event 5: Presidential Emergency or Major Disaster Declaration under the Robert T. Stafford Disaster Relief Act and FEMA issues Mission Assignment to Deploy
    ESF #8 Strategy: Rapidly Deploy ESF #8 Assets to Assist SLTT Officials by Providing Assistance Where Needed in Saving Lives, Minimizing Adverse Health and Medical Effects, and Stabilizing Public Health, Medical and At-Risk Infrastructure

    Phase 2-a – Initial Response
    (H-72 (3 days) to H-24 (1 day)
    Trigger: Presidential Emergency or Major Disaster Declaration and FEMA issues Mission Assignment to deploy
    Actions/Issues Lead Agency/Supporting Agency
    1. Increase EMG activation level to full staffing (Level 3) EMG Managers
    2. Initiate deployment actions for appropriate ESF #8 Regional and State resources
    1. Provide representative for Regional IMAT (usually the Regional Emergency Coordinator)
    2. Provide representative to State EOC and or Health Department.
    3. Staff the ESF #8 desks in the NRCC and RRCC according to ICS requirements
    		EMG
    3. Deploy LRAT and ALRT Cache and initial response force package (including 2 DMATs and 8 caches) EMG
    4. Deploy SHO to JFO (if Secretary determines event is large enough to warrant) HHS Secretary/ASPR/EMG
    5. Deploy IRCT(s) including SMEs if necessary, including Reps to State EOCs, etc. EMG
    6. Activate NDMS response teams
    7. Stage/deploy public health, medical, veterinary, behavioral health and at-risk personnel assets as needed HHS/DOD/VA/ABC
    8. Stage/deploy NDMS teams and equipment caches to forward to staging locations OPEO-LOG
    9. Coordinate medical support requirements at mass care shelters HHS/ABC/ARC /ACF
    10. Coordinate with the potentially affected states to stage FMS and advance personnel to set-up and install – FMS ST) OPEO/IRCT/CDC/JFO/ARC CDC/DSNS/OFRD
    11. Develop more detailed impact analysis 24 hours prior to an event that further defines the impact area based on detailed models. This analysis is refined on a 12, 8, and 4-hour basis, as determined by updated data. EMG PLANS/ SOC/RECS
    12. Validate communications infrastructure EMG LOG-IT
    13. Deploy ESF#8 formulary items as directed CDC/DSNS/OFRD
    14. Alert VA to be prepared to provide health and medical logistics/supply support via National Acquisition Center (NAC). EMG- LOG/VA
    15. Support pre-landfall patient movement efforts, if initiated. Deploy AE components as required to support MA. EMG/DOD
    16. Deploy other logistics assets for ESF #8 NDMS teams/personnel to staging locations EMG-LOG
    17. Determine Security Requirements for ESF #8 assets in coordination with ESF #13 U.S. Dept. of Justice EMG-OPS/USDOJ
    18. Stage rostered teams (OFRD, NDMS, other ESF #8 personnel) to designated FEMA logistics bases EMG/OSG/CDC/FDA/
    ABC/ACF/AOA
    19. Verify security/destruction of select agent hazardous materials in the immediate pre-landfall period. CDC
    20. Activate the Ambulance contract for medical transportation (ground, air and para-transit ambulances) EMG/FEMA
    21. Develop a scaleable demobilization and deactivation plan for the release of appropriate ESF #8 components. A draft HHS demobilization plan is available on the SOC Portal OPEO/PLANS/Shared Documents ALL

    Phase 2-b- Sustained Response
    (H-24 (1 days) to L+120 (5 days) )
    Trigger: Presidential Emergency or Major Disaster Declaration and FEMA issues Mission Assignment to deploy
    Actions/Issues Lead Agency/Supporting Agency
    A. Planning and Coordination
    1. Coordinate rapid needs assessments with FEMA (public health, medical and at-risk infrastructure) EMG
    2. Determine need for Public Health Emergency and Social Security Act Section 1135 Waivers. Secretary HHS
    3. Make necessary adjustments to pre-scripted Mission Assignments (MAs) EMG/A&F
    4. Update situational awareness of hospital and healthcare infrastructure facilities (including power, water and debris) in the expected impact zone. Determine capability to continue operations, or whether rescue operations are required. EMG
    5. Review damage assessments and consult with FEMA regarding whether activation of ESF #14 is required. EMG/ FEMA recovery LNO
    6. Develop common operating picture for long-term recovery and establish a transition to recovery plan. OPHS
    7. Produce ongoing and accurate public health, medical, veterinary, and at-risk status assessments post-landfall, including status of at-risk population and service animals EMG/SOC/ALL
    8. Prior to Phase III, as situation warrants, begin ESF #8 redeployment/recovery/transition planning EMG/CDC/DSNS
    9. Capture after-action comments ALL
    B. Healthcare, Emergency Response, and At-Risk
    1. Deploy additional ESF #8 and PHS assets as required EMG/OFRD
    2. Deploy staged personnel in accordance with Mission Assignments
    1. Additional IRCT personnel as needed
    2. RDF, APHT, Mental Health, Veterinary, At-Risk Teams and SMEs
    3. LNOs
    4. VA and DOD
    		EMG/OFRD/VA/DOD
    3. Implement necessary measures for at-risk persons with need for additional support(s) EMG/OD/ACF/OCR/OPEO-/At-Risk
    4. Assess the need to use the Emergency System for Advance Registration of Volunteer Health Professionals (ESAR-VHP). EMG /OPEO ESAR VHP
    5. Assess need for Federal-level activation of OVMRC members EMG/OPHS/OCVMRC
    6. Receive, process, track and sub-task (as needed) MAs EMG A&F
    7. Enter affected area and commence providing 24/7 support to SLTT authorities IRCT/All
    8. Conduct and maintain Situational Awareness reporting IRCT/SOC/EMG
    9. Deploy medical, public health, mental health, at- risk staff or other civilians as needed to augment Mass Care Shelters EMG/All
    10. Determine if medical mass care procedures are required. EMG/All
    11. Deploy assets in support of fatality management as requested. EMG/VA
    12. Determine health and safety of deployed ESF #8 personnel in affected areas. EMG/IRCT Safety Officer
    13. Augment shelter in place facilities as required to sustain operations EMG
    14. Deploy veterinary medical team component to support working animals NDMS/NVRT
    C. Surveillance, Investigation, and Protective Health Measures EMG
    1. Monitor available surveillance data (i.e., BioSense, Emergency Management and Response (EMR), HAvBED). EMG/Fusion
    2. Identify surveillance gaps and refer to IRCT EMG/Fusion
    3. Produce EMR Report at regular intervals when EMR data are available EMG/Fusion
    4. Identify general population health exposure assessment gaps and refer to OPHS EMG/Fusion
    5. Collect data from HRSA, ACF and, SAMHSA supported grantees.
    1. Impact on HRSA, ACF, and SAMHSA funded services (Community Health Centers, Ryan White HIV/AIDS Clinics, Healthy Start Programs)
    2. Resources needed/future services
    3. Grantee/HRSA, ACF, AoA and SAMHSA attempts to address problem
    		HRSA/ ACF / SAMHSA/AoA/NIH
    6. Reach out to state epidemiologists to determine if assistance is needed EMG/CDC- coordinated with IRCT
    7. Assist states with surveillance for outbreak/reports of abnormal disease or disease rates and “pockets” of at-risk population in the affected areas, including the community, medical facilities, and shelters. CDC- coordinated with IRCT/OCR
    8. Assist states through direct or technical assistance in the collection and analysis of data from injury, illness and mortality surveillance activities CDC- coordinated with IRCT
    9. Provide ESF #8 staff to supplement state efforts to address identified public health issues/concerns CDC- coordinated with IRCT
    10. Conduct inspections and assess damage to FDA-regulated industry and products in impacted areas and determine impact on supply of critically needed medical products. (i.e. medical products and infant formula) FDA- coordinated with IRCT
    11. Provide technical assistance or subject matter expertise to states related to FDA-regulated products (food, drug, medical device and biologics safety) and conduct assessment of food retail establishments in impacted area. FDA- coordinated with IRCT
    12. Assist states with collection and/or analysis of FDA-regulated product samples from retail food establishments and pharmacies FDA- coordinated with IRCT
    13. Conduct assessment of food retail establishments and pharmacies in impacted area FDA coordinated with IRCT
    14. Conduct increased surveillance, detection and review of all adverse event reports related to FDA-regulated products used as part of the response to the emergency FDA- coordinated with IRCT
    15. Assist States with surveillance efforts to determine product integrity of pharmaceuticals and medical supplies/equipment in aftermath of incident. FDA- coordinated with IRCT
    16. Coordinate with SLTT environmental health departments to ascertain need for technical assistance, consultation, and support CDC- coordinated with IRCT
    17. Conduct vector surveillance and be prepared to coordinate vector control measures (e.g. aerial spraying). CDC- coordinated with IRCT
    D. Pharmaceuticals, Medical Supplies and Equipment
    1. Provide real time requirements for new pharmacy, medical supplies, and equipment to OPEO/LOGS IRCT LOGS
    2. As situation warrants, begin OPEO redeployment/recovery/transition planning EMG Plans/CDC/DSNS
    3. Activate Emergency Prescription Assistance Program (EPAP), if required. IRCT/LOGS
    4. FDA will coordinate the response to any drug shortages created by damage to manufacturing facilities FDA
    E. Patient movement
    1. Review and adjust patient movement plans with ESF #8 partners. EMG/DOT/ DOD/ VA/ OD
    2. When tropical storm force winds hit landfall, complete/hold on all patient movement operations until storm passes. Conduct last shelter-in-place assessment of medical facilities with patients remaining. EMG/DOD/DOT/VA/ FEMA
    3. Post-landfall resume patient movement (as required). EMG/DOD/DOT/VA/FEMA
    4. Assist coordination of movement of service animals in coordination with ESF#11. EMG/USDA/DOD/NDMS
    5. HHS Service Assess Teams (SAT) will facilitate the return of patients or the remains of patients to their originating hospitals, medical facilities, homes/ communities EMG SAT
    F. Communications and Outreach
    1. Continue situation briefing/conference calls for ESF partners and OPDIVS/STAFFDIVS ALL
    2. Coordinate communications efforts with SLTT Public Health Departments as well as affected foreign governments (for OCONUS or cross-border incidents). ASPA/CDC/FDA/DOS/JIC

    Phase 3 – Post-Incident -Recovery
    Trigger Event 6: Unified Command determines that sufficient progress has been made in restoring minimal functionality to affected area and that life- and economy-sustaining critical infrastructures are able to support reentry and repopulation
    ESF #8 Strategy: To Effect a Smooth and Transparent Transition to Long-Term Recovery

    Phase 3-a –
    Post-Incident - Recovery
    Actions/Issues Lead Agency/Supporting Agency
    A. Planning and Coordination
    1. Determine with FEMA and local authorities that sufficient progress has been made in restoring minimal functionality to affected and impacted area and that the medical and public health infrastructures are able to support reentry and repopulation. EMG/DHS
    2. At the direction of the JFO/NRCC, implement demobilization and deactivation plan for the release of appropriate ESF #8 components. ALL
    3. Scale IRCT to reduced staffing to ensure (a) continued visibility on the execution of longer term Mission Assignments and (b) maintain situational awareness to support additional response operations. EMG
    4. Complete draft of after-action report ALL
    5. Demobilize and deactivate specific response assets when this specific task or Mission Assignment is completed or when it is determined the magnitude of the event does not warrant continued use of the asset EMG/DHS/FEMA
    6. Scale down HHS-EMG operations commensurate with field activities including all LNOs EMG
    7. As ESF #8 assets demobilize, prepare for the orderly transfer to recovery with OPHS as lead with RHAs as action officers. EMG/OPHS
    8. OPHS designates the appropriate RHA to serve as the Regional Coordinator OPHS
    9. Provide briefings on public health and medical sector needs to Chamber’s Business Civic Leadership Center (BCLC), top 20 donors, NGOs, and non-profits that contribute/support our sector. Schedule subsequent briefings as necessary. OPHS
    HHS-IGA/RD
    10. Transition back to OPDIVs/STAFFDIVs, implementing actions under their own authority. ALL
    11. Coordinate with IRCT and ESF#8 supporting agencies, the demobilization of ESF#8 resources when all operational objectives contained in the Incident Coordination Plan have been met or affected State, or DHS determines that resources are no longer needed. EMG-OPEO
    12. Address any special recovery requirements for the aging and pediatric populations OPEO EMG/AOA/ABC
    B. Healthcare, Emergency Response, and At-Risk
    1. Transition response to SLTT authorities ALL
    2. Demobilize personnel as required in accordance with MA completion ALL
    3. Transition to routine operations for OPDIVs as appropriate. EMG
    C. Surveillance, Investigation, and Protective Health Measures
    1. Determine requirements for long-term post-event surveillance or investigation. CDC
    2. Continue assistance to States regarding surveillance efforts including outbreak reports of abnormal disease/injury or disease/injury rates in the affected areas and surveillance of at-risk individuals. CDC//OD/ACF/SAMHSA
    OCR
    3. Continue to coordinate with SLTT environmental health department to ascertain ongoing and/or anticipated need for technical assistance, consultation, and support ALL
    4. Continue to monitor worker safety and physical and mental health EMG/CDC-NIOSH/OSHA
    5. Continue inspections and assessments of FDA regulated industry and products and work with states as needed to assess retail food establishments and pharmacies in impacted areas FDA
    6. Continue to assist states through collection and/or analysis of FDA-regulated product samples. FDA
    7. Continue to provide states technical assistance or subject matter expertise related to FDA-regulated products food, drug, medical device and biologics safety; water safety as it affects FDA-regulated products; informed consent; clinical trials FDA
    8. Conduct increased surveillance, detection and review of all adverse event reports related to FDA-regulated products used as part of the response to the emergency FDA
    D. Pharmaceuticals, Medical Supplies and Equipment
    1. Establish procedures for follow on shipments of necessary pharmaceuticals, medical supplies, and equipment to affected area. EMG/DHS/FEMA
    2. Inventory and return non-essential equipment for reconstitution ALL
    3. Continue to assist states as needed with surveillance efforts to determine product integrity FDA
    E. Patient movement
    1. HHS Service Assess Teams (SAT) will continue to facilitate the return of patients or the remains of patients to their originating hospitals, medical facilities, homes/ communities. EMG SAT
    F. Communications and Outreach
    1. Continue situation briefing/conference calls for ESF partners and OPDIVS/STAFFDIVS until demobilization complete. HHS-EMG
    2. Continue coordination with State Health Officials until demobilization. IRCT
    3. Address and communicate special public health risks and precautions for managing the public health threats due to oil contamination caused by tidal and storm surge ASPR EMG


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    • This page last reviewed: February 14, 2012