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U.S. Department of Health and Human Services

Hurricane Response Playbook

2010 Hurricane Season Concept of Operations (CONOPS)

1. Purpose:

This document outlines the concept of operations for coordinating Federal public health and medical assets in preparation for, in response to or to recover from threats from severe weather events or hurricanes during the 2010 Atlantic Hurricane Season.

2. Situation:

See Section 1 for an overview of threat situation and assumptions, National Planning Scenario #10 (Hurricane).

3. Mission:

The Department of Health and Human Services (HHS) with the support of its National Response Framework (NRF) Federal Partners will lead all Federal public health and medical support in the United States and its territories to prepare for, respond to, and recover from the effects of the 2010 hurricane season. HHS Operating and Staff Divisions and ESF #8 Partners will provide Federal assets and capabilities to support time-sensitive life-saving, life-sustaining, public health and medical infrastructure, and stabilization missions to supplement SLTT response and recovery capabilities to include but not limited to behavioral health care for both incident victims and response workers, the medical needs of at-risk individuals, and as appropriate, veterinary care.

4. Concept of Operations:

Intent: The Secretary’s intent is to: 1) prevent medical hardships caused by disasters by developing policies, plans, and strategies to mitigate the effects of a disaster on the medically fragile; 2) protect the nation’s at-risk individuals and healthcare providers by providing medical support, supplies, transportation and personnel to SLTT preparation efforts; 3) respond to a disaster and coordinate Federal operational activities to support SLTT response efforts; and 4) assist SLTT medical and public health transition to recovery efforts.

All response and recovery planning and operational activities will be initiated and executed in compliance with the NRF, National Incident Management System (NIMS), and the HHS ESF #8 Concept of Operations Plan for Public Health and Medical Emergencies, and the FEMA 2010 Federal Interagency Hurricane Concept Plan (CONPLAN). The 2010 hurricane response and recovery planning is focused on developing and coordinating collaborative, interagency and multi-jurisdictional operational activities and capabilities to:

  • Save and Sustain Lives
  • Ensure Safety and Health of Deployed Personnel
  • Ensure the Integrity of the Public health and Medical Infrastructure including HHS Assets
  • Maintain Situational Awareness
  • Demobilization and Transition to Recovery

ESF #8 response and initial recovery planning and operational activities will consider medical evacuation and shelter-in-place (SIP) options and resources for individuals with medical needs in hospitals, nursing homes, assisted living facilities, at-risk individuals, people with special medical needs, and those dependent upon the assistance of service animals to conduct daily activities.

5. Phases of Support:

The ESF #8 response to a developing hurricane event will occur in three phases, which correspond to the FEMA 2010 CONPLAN. The CONPLAN was developed in accordance with HSPD-8, Annex I, the Integrated Planning System.

The Phases are based on the onset of tropical storm force winds. The onset of tropical storm force winds is referred to as “H” hour. For example, H-120 hours is 120 hours prior to the onset of tropical storm force winds. Landfall “L” is when the eye of the storm reaches land. The phases are as follows:

Phase 0: Steady State.

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

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

Phase 3: Post-Incident (Recovery and Mitigation.)
     Phase 3-a: Demobilization and Deactivation
     Phase 3-b: Recovery and Mitigation

Phases Summary:

Phase 0: Steady State.

The Office of the Assistant Secretary for Preparedness and Response (ASPR) initiatives, policies or strategies to prepare governments and healthcare organizations to reduce evacuation requirements, mitigate any potential effects, and provide for better preparation include the Hospital Preparedness Program (HPP). Current program priority areas include interoperable communication systems, bed tracking, personnel management, fatality management planning and hospital evacuation planning. During the past five years HPP funds have also improved bed and personnel surge capacity, decontamination capabilities, isolation capacity, pharmaceutical supplies, training, education, drills and exercises.

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

The focus of Phase I is to ensure that the Secretary of HHS, through the Assistant Secretary for Preparedness and Response (ASPR) and the Emergency Management Group (EMG) as well as the ESF #8 partners receive the most current and accurate situational awareness information concerning communications relevant to emerging and potential threats and that ESF #8 response assets are postured to respond in a timely manner. The strategy for Phase I is to closely monitor events and begin review of advance preparations required to facilitate an effective and timely response; and to establish an alert posture for forward deployment and pre-positioning of assets that may be required just prior to and immediately after landfall to expedite a sustained response.

The HHS-EMG and ESF #8 Partners will review the readiness and deployment posture of personnel and resources in preparation to support active and sustainable field response and recovery operations; ensure US Government financial, acquisition, and personnel systems are brought to, and maintained at, the highest state of readiness; establish and maintain required communication and coordination links with other Federal agency representatives to ensure optimal situational awareness and resource visibility in preparation for the anticipated mission and objectives.

The transition from Normal Operations to Elevated Threat is triggered by the receipt of a US Department of Commerce National Oceanic and Atmospheric Administration, National Weather Service/National Hurricane Center/Tropical Prediction Center (USDOC/NOAA/NWS/NHC/TPC) tropical advisory indicating the development of a potentially damaging tropical event (i.e., tropical storm or hurricane).

The Secretary’s Operations Center (SOC) will maintain a 24/7 watch and track the NHC advisories. The EMG will review and assess the readiness status of ESF #8 resources in preparation for ESF #8 missions. The EMG will also review and prepare to execute Pre-Scripted Mission Assignments (PSMAs) and ensure all existing interagency agreements and contract vehicles (with Federal Partners, SLTT agencies, National Voluntary Organizations Active in Disaster (NVOAD) and private sector in the likely impact areas) are available for rapid implementation and execution.

Phase 1-a: Normal Operations. (Considered to be any time up to H-120 hours)

This phase addresses all the actions taken before a severe tropical storm or hurricane makes landfall. This phase transitions from normal operations on the June 1st start of the 2010 hurricane season, through Credible Threat. The priority efforts are focused on awareness, preparedness and protection.

Phase 1-b: Elevated Threat. (Considered to be H-120 hours to H-96 hours)

The next key trigger event is the formal alert notification to the US Government’s Federal Executive Branch emergency management community and its SLTT, and private sector partners by FEMA, via the FEMA NRCC to be prepared to activate and deploy at a specific time in support of a major hurricane or tropical storm making landfall in the United States or its territories. FEMA will activate select ESFs to conduct initial incident-specific operational planning. Following receipt of a FEMA notification to assume an alert posture, EMG OPs will issue a Warning Order (alert notification which may include activating the ESF #8 system) to primary and support departments, agencies, team personnel, and support staff that may be required to forward deploy assets, directing them to assume a heightened state of alert in preparation for possible ESF #8 activation and deployment. The Office of Preparedness and Emergency Operations (OPEO) will appoint an Operations Section Chief and direct development of an Operations Order.

EMG LOGs will prepare all equipment sets/caches/kits for transport, activate the Advance Logistics Reception Team (ALRT), and the Logistics Response Assistance Team (LRAT) to work with CDC to prepare Federal Medical Stations (FMS) assets for transport and serve as the logistics advance element for the IRCT. This will include Title 10 DOD aeromedical evacuation patient movement assets that are operating with a valid Mission Assignment and Title 32 DOD aeromedical evacuation patient movement assets that are operating under appropriate State control.

EMG PLANS will review Essential Elements of Information (EEIs), Pre-scripted Mission Assignments (PSMAs), and maintain situational awareness.

Regional Emergency Coordinators (RECs) will coordinate with the state and FEMA region officials in potentially affected areas in order to determine the potential need for ESF#8 support, and review PSMAs.

ESF #8 Team Rosters will be reviewed and teams placed on alert for activation.

HHS EMG will begin daily coordination conference calls with ESF #8 Partners. Assets required immediately may include an IRCT-A.

HHS-EMG will verify readiness status of ESF-response teams and equipment caches – ESF #8, medical, veterinary, public health, behavioral health, at-risk individuals, patient movement and field management teams, including but not limited to:

  • Incident Response Coordination Teams (IRCT) – ESF #8 field response command, control and coordination
  • Advance Logistics Reception Team (ALRT) – forward deployment for ALRT cache
  • ESF #8 Teams – Disaster Medical Assistance Teams (DMATs), Disaster Mortuary Response Teams (DMORTs), National Veterinary Response Teams (NVRTs)
  • National Medical Response Teams (NMRTs)
  • Rapid Deployment Force (RDF) – medical surge capacity, staff FMS and augmentation at health care facilities.
  • Applied Public Health Teams (APHT) public health surge capacity for state department of health
  • Mental Health Teams (MHT)
  • Federal Medical Station Strike Team (FMS-ST)
  • SMEs for At-Risk Individuals (including pediatrics) and Behavioral Health issues
  • DOD Aeromedical Evacuation Teams – patient movement

HHS-EMG will begin to review plans to address surge capacity in affected states for anticipated medical requirements (pre-hospital emergency medical assistance, health facility staff augmentation, facility shelter-in-place vs. evacuation options) and public health functions (public health labs, food safety, injury and disease outbreak surveillance and control, environmental health and veterinary support etc.); and monitor and maintain blood and blood products supply through HHS/OSG and the American Association of Blood Banks Interagency Task Force on Domestic Disasters and Acts of Terrorism (AABB TF)

Phase 1-c: Credible Threat. (Considered to be H-96 to H-72)

This stage addresses the actions taken to respond to a specific storm system. Upon receipt of a FEMA/NRCC activation order, HHS-EMG Operations will issue and initial Operations Order to ESF #8 Partners. HHS EMG will participate in FEMA/NRCC conference calls concerning the situation, mission and objectives. HHS EMG will continue daily national ESF #8 conference calls to maintain situational awareness and identify potential issues from States and or Regions.

Efforts in this stage focus on the activation and initial deployment of resources to pre-incident locations. EMG Operations will issue an Execute Order (EXORD). It may be necessary to pre-deploy (stage) and/or pre-position enabling assets prior to declaration of an emergency or major disaster using FEMA surge account funds. Per the FEMA Federal Interagency Hurricane CONPLAN, FEMA and other federal agencies will operate under their own statutory authorities, funded by the Surge Account, to pre-position (stage) personnel and resources in locations favorable to providing timely and efficient access to areas of operations. When the Mission Assignment is signed, HHS may stage response assets such as the IRCT-A, Advance Logistics Reception Team (ALRT) and associated cache, ESF #8 personnel, Federal Coordinating Center (FCC) points of contact, and others as appropriate, in order to have teams positioned forward to support pre-landfall patient movement requirements and to begin operations in the affected area as soon as possible after landfall. Additionally, HHS-EMG may begin to lean forward by alerting contractors of potential requirements that may call for private sector support. Following receipt of an approved mission assignment (MA) team members and their associated equipment caches will deploy to their designated mission locations.

The HHS EMG staffing will be increased as necessary and additional liaison officers (LNOs) will be requested from ESF #8 Partners (DOD, VA, ARC, CDC, and EPA etc). ESF #8 regional and field representatives may begin to deploy with FEMA Incident Management Assistance Teams (IMATs, FEMA National/Regional Incident Management Assistance Team (IMAT), State EOCs and Health Departments. HHS-EMG and ESF #8 representatives at RRCC may begin to push and execute PSMAs (as appropriate). Veterinary services may be initiated by NVRT Strike Teams which may be augmented by PHS Commissioned Corps and Veterinary Medical Reserve Corps (VMRC) personnel.

Key actions at this point may include activating the NDMS patient movement system (if needed), preparing to deploy a full IRCT (ESF#8 field command, control and coordination) and further integrating HHS operations with the FEMA Initial Operating Facility (IOF), if established, including preparing to deploy a Senior Health Official (SHO) (if the HHS Secretary deems the event to be large enough to warrant deployment of a SHO), and maintaining situational awareness and readiness of pre-positioned assets. Additionally, if patient movement is to be utilized, it is key that DOD be provided the funding and MAs to fully execute pre-landfall movement.

To anticipate potential requirements for patient movement, HHS will maintain visibility of state evacuation plans, state mandatory evacuation orders, state requests for pre-landfall declarations, and health care facility shelter-in-place and evacuation plans. To be fully prepared to respond to requests to support pre-landfall patient movement efforts through DOD aeromedical evacuation capabilities and VA/DOD FCC support, it may be necessary to stage the following assets and resources: DOD aeromedical evacuation liaison teams, mobile aeromedical staging facilities, patient movement enablers, other ESF #8 Medical Teams, NDMS Strike Teams, and Federal ambulance contract resources for medical transportation.

For landfalls expected Outside of the Continental United States (OCONUS) or cross-border landfalls, the HHS-EMG will begin coordination with Department of State and USAID/Office of Foreign Disaster Assistance to support anticipated public health and medical requirements.

HHS-EMG will continue to analyze vulnerability of health care and public health critical infrastructure in expected impact zone, performing pre-impact effects and consequence modeling and simulation analyses. GIS modeling products are triggered and made available by tropical storm advisory and response stage (ASPR Fusion Cell).

HHS will coordinate with FEMA ESF #6 on anticipated requirements to provide medical support for Federal mass evacuation. Some evacuees (who may have a functional need for FEMA transportation support) will present with medical issues that could make an extended evacuation travel time difficult or not manageable by normal means of transportation. Additionally, consideration must be given to the transportation needs of individuals with Service Animals These at-risk individuals will be evaluated and either have their functional need for medical care met (medications, caregiver support etc.) and then be transported with the general population or alternatively be medically evacuated. Evacuees will be evaluated for medical support needs at Reception Processing Sites/Embarkation Sites, Debarkation Sites and Congregate Care Shelters as necessary. Medical support may be provided through HHS medical strike teams (ESF #8 medical response teams augmented by Medical Reserve Corps [MRC] personnel).

Phase 2: Incident and Incident Response Phase (Considered to be 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 2-a: Initial Response.

The EMG is at full-staffing (Level 1) with LNOs from ESF #8 partners as required. Efforts in this stage focus on the deployment of ESF #8 resources from pre-incident locations (staged at mobilization site or activated in place) to staging locations. A key trigger event is a Presidential Declaration of a major disaster or emergency under the Robert T. Stafford Disaster Relief and Emergency Assistance Act, when landfall of a major hurricane is imminent. FEMA guidance specifies that the evacuation of 100,000 persons or three (3) contiguous counties could trigger a pre-landfall emergency/disaster declaration.

Once a major disaster or emergency declaration has been made under the Stafford Act, and/or a determination has been made that an event is a public health emergency, and a mission assignment is issued, ESF #8 partners will commence providing 24/7 support where needed to save lives, minimize adverse health and medical effects and stabilize the public health and medical infrastructures.

Initial focus will be medical evacuation requirements, caring for and evacuating critical patients out of the affected area to NDMS receiving hospitals... Mass patient movement includes medical regulating processes and patient transportation systems to evacuate ill or injured patients from a disaster area to facilities where they may receive medical care. The Global Patient Movement Requirements Center (GPMRC) will regulate patients to designated Federal Coordinating Centers. GPMRC passes the validated requirements to 618 TACC (618th Tanker Airlift Control Center.). 618 TACC coordinates aeromedical evacuation to the appropriate offload airfield.

HHS-EMG may establish a Patient Movement Coordinating Group, under the Operations Section Chief, in the EMG to liaison with, DOD, VA and Department of Transportation (DOT); with participation from the American Red Cross (ARC) and SLTT agencies to move patients by air or by ground from locally operated points of embarkation/ aeromedical marshalling points to medical facilities outside the anticipated impact area.

The Federal Ambulance Contract will be activated to support patient movement and based on validated state plan requirements for ambulance (ground, air, para-transit vehicles).

Under the provisions of the Americans with Disabilities Act (ADA), individuals with a disability should have access to their service animals at all times. Service animals are defined as animals that are individually trained to perform tasks for people with disabilities such as guiding people who are blind, alerting people who are deaf, pulling wheelchairs, alerting and protecting a person who is having a seizure, or performing other special tasks. Service animals are working animals, not pets. Transportation of a service animal is authorized without charge when accompanying the handler who is otherwise authorized for transportation.

If individuals with a disability are evacuated by DOD, DOD personnel will make every effort to ensure individuals with disabilities are not separated from their service animal.

The service animal must be properly harnessed or leashed or otherwise in the control of the handler. To avoid creating a safety hazard, the service animal should not occupy the aisle. The service animal shall be permitted to accompany his handler in all areas in which persons without disabilities are normally allowed to go. Proper sanitation is the responsibility of the handler and must be maintained at all times.

The service animal may be removed from the premises if the animal is out of control and the owner does not take effective action to control the animal, or the animal poses a direct threat to the health or safety of others.

DOD is required to make reasonable accommodations to provide care and food for a service animal and provide a location for the animal to relieve itself.

International transportation of service animals shall be subject to established country quarantine procedures. Should it be necessary to detain the service animal pending determination of his admissibility, the handler shall have the opportunity to make provisions for appropriate holding facilities satisfactory to the cognizant quarantine officer. The handler shall bear the expense of such animal detention facility, including necessary examinations and vaccinations, and other expenses incurred due to the service animal accompanying the handler.

Situational awareness of hospitals and other health care facilities in the expected impact zone will be updated at regular intervals to determine capability to continue operations (power, water, debris) or whether rescue operations are required. Impact analysis will be refined at 24, 12, 8 and 4 hours. HHS may request support from United States Army Corps of Engineers (USACE) ESF #3 and FEMA.

Title 10 DOD aeromedical evacuation patient movement assets will be staged after receiving a valid Mission Assignment and Title 32 aeromedical evacuation patient movement assets will be staged with appropriate orders from the applicable State.

HHS medical and veterinary strike teams may be tasked to support medical requirements related to FEMA Federal mass evacuation at reception processing, embarkation and debarkation sites and Federal congregate care shelters. Additionally, they may be called upon to support DOD Disaster Aeromedical Staging Facilities (DASF) at the designated points of embarkation.

When tropical storm force winds hit landfall, there will be a complete hold on all patient movement operations until the storm passes; aeromedical operations will depend on wind speeds. A shelter-in-place assessment of medical facilities with patients remaining in the area of impact will be conducted

DOD will ensure our personnel that support the DASF are moved to safety as part of their operational movement. Patient movement will resume post-landfall as required by damage to the health care infrastructure in the impacted area.

HHS-EMG will initially coordinate deployed ESF #8 assets in the field (e.g., security at set-up location and ESF #8 response teams), until the IRCT-A/IRCT is functionally ready to assume control.

HHS-EMG may activate the Emergency Prescription and Medical Equipment Assistance Program (EPAP) capability (as appropriate) to administer and provide a national network of pharmacies and sufficient personnel to address evacuee emergency prescription requirements under a mission assignment. In a sustained response, eligible evacuees will be provided essential pharmaceutical and Durable Medical Equipment (DME) written prescription assistance limited to a one-time 30-day supply to treat an acute condition, to replace maintenance prescription drugs (including psychotropics) or medical equipment lost as direct result of the declared emergency or as a secondary result of loss or damage caused while in transit from the emergency site to a designated shelter facility (in coordination with FEMA).

Phase 2-b: Sustained Response.

After the hurricane makes landfall, accurate public health and medical status assessments are necessary for the EMG and ESF #8 Support Agencies to plan for and sustain public health and medical response operations, to anticipate the need for follow-on personnel, supplies and equipment, and to provide other pertinent information as required to facilitate the response. HHS EMG will support the HHS Secretary’s determination and execution of a public health emergency declaration as necessary. Patient movement operations may begin in certain states/regions depending on the level of the incident or will resume as required. HHS will coordinate the return of patients moved or transported by the ESF #8.

During sustained response and recovery, the SOC will maintain comprehensive situational awareness of the national-level domestic operating picture as well as the specific incident or incidents in order for them to make informed operational employment and resource allocation decisions.

The IRCT is fully functional, coordinating ESF #8 missions in the field. Upon deployment of an IRCT, CDC deploys (when appropriate) a CDC liaison appropriate for the response to the IRCT. The CDC liaison will support the IRCT leader with reach back capability to CDC EOC for technical assistance from within CDC. The CDC Public Health Team Lead will report to the IRCT Operations Section Chief. Requirements for augmentation personnel will be assessed by EMG.

ESF #8 representatives will support FEMA JFO and Rapid Needs Assessment (RNA) Teams post-landfall to identify public health hazards (e.g., food safety, water quality, waste water and solid waste disposal, vector control and other environmental health support).

ESF #8 fatality management assets (HHS, DOD, VA) may be deployed in support of state mortuary operations, if required.

The IRCT will deploy staged FMS and associated personnel (FMS ST, RDF, VA, etc.) as required.

HHS CDC/Office of Force Readiness and Deployment (CDC/OFRD) may provide public health technical assistance to state health departments in the surveillance and investigation of disease outbreaks, injury and illness and provide support to address identified public health concerns.

HHS ABC/Substance Abuse and Mental Health Services Administration (ABC/SAMHSA) may provide behavioral health technical assistance to State Mental Health Authorities (SMHA) and State Disaster Mental Health Coordinators (SDMHC) to assess the need for and facilitate the provision of federal behavioral health assets to include Crisis Counseling Program funding.

HHS (FDA) will conduct inspections and damage assessments of FDA regulated facilities and products (Human Drugs, Biologics, Medical Devices, Human Food, Animal Food, and Veterinary Drugs). FDA may provide support to states and local agencies in inspecting and conducting damage assessments of retail food establishments and pharmacies in impacted areas. Safety and security of the food supply will be assessed in coordination with USDA Food Safety Inspection Service (FSIS) and EPA.

HHS will provide accessible (Section 508 compliant) hurricane and public health risk communication messages and advisories specific to impacted communities. These materials will support state and local risk communication efforts and support FEMA ESF #15 and the Joint Information Center messaging for press releases.

Phase 3: Post-Incident:

Phase 3-a: Demobilization and Deactivation

Phase 3-b: Recovery and Mitigation

Phase 3-a: Demobilization and Deactivation

The demobilization and deactivation phase, and the associated procedures, processes, practices, and protocols is triggered when sufficient progress has been made in restoring functionality to the impacted area and that the critical life- and economy-sustaining critical infrastructures are able to support safe reentry and repopulation. The demobilization and deactivation of a specific response asset is initiated when its specific task or mission assignment is complete or when it is determined by the state/FEMA the magnitude of the event no longer warrants continued use of the specific federal asset.. At the direction of the Federal Coordinating Officer (FCO) the various planning sections develop a scaleable demobilization and deactivation plan for the release of appropriate components. These demobilization plans will be forwarded to EMG Operations to review and approve as appropriate – issuing the Demobilization Order. Release of resources will be coordinated through the daily ops/log call and transition to OPEO Operations will occur once in transit by bus/van or on an airline returning to their final destination. As the need for full-time interagency coordination at the JFO ceases, the IRCT plans for selective release of federal medical resources, demobilization, deactivation, and closeout. Federal agencies then work directly with their grantees from their regional or HQ offices to administer and monitor individual recovery programs, support, and technical services. The IRCT will be scaled down to a level that ensures continued visibility on the execution of longer-term mission assignments and to maintain situational awareness of ongoing response operations. The HHS-EMG may scale down operations commensurate with field activities or the operational tempo of the NRCC.

As response operations begin to diminish, Incident Commanders demobilize Federal agencies from their respective operations. The IRCT may remain operational at reduced staffing to maintain continued visibility on the execution of longer term mission assignments and maintain situational awareness to support additional response operations.

When the Federal response effort is deactivated, specific procedures for deactivation will be followed to ensure proper record keeping and handling of contracts as well as recovery of deployed equipment, materials, and medical records. Demobilization and deactivation activities are planned, coordinated, and executed to ensure that Federal, SLTT, and private sector response and recovery personnel are maintained at the highest state of readiness commensurate with operational field response and recovery operations.

These activities are also planned to ensure that a smooth and transparent transition to long-term recovery can be sustained. Demobilization and deactivation activities ensure that the appropriate government jurisdictions, and private sector components, under local government regulation and oversight, resume direct authority for operations and administration as soon as effectively possible.

HHS-SAMSHA may administer and support Crisis Counseling Program (CCP) grants to States for disaster-related behavioral health needs in coordination with FEMA as necessary.

Requirements for long-term post-event health surveillance or investigation will be determined and continued assistance to States regarding surveillance and monitoring efforts of disaster-related illness in the affected area may be necessary. Responsibility for managing these activities will transition back to the HHS Regional Office Staff.

Phase 3-b: Recovery and Mitigation

Recovery. HHS may continue providing technical expertise or guidance to SLTT authorities as they rebuild their public health and medical infrastructures. In this role HHS supports ESF #14. The goal is to effect a smooth and transparent transition to long-term recovery. The Office of Public Health Science (OPHS) has the lead for recovery and the Regional Health Administrators (RHAs) are the action officers. The Regional Health Administrators (RHAs) work with the Regional advisory council (RAC) and other relevant OPDIV and STAFFDIV representatives as appropriate (convening a recovery group). The lead REC from the region and the Administration for Children and Families (ACF) regional administrator are key players in the transition from response to recovery. Depending on the nature of the recovery issues other OPDIV and STAFFDIV may be involved.


  1. HHS and ESF #8 Support Agencies will use the structures and processes described in National Incident Management System (NIMS) to sustain ESF #8 deployed resources. HHS will coordinate medical and non-medical logistics support with FEMA Logistics. FEMA Logistics will be expected to provide support and facilities management at FEMA managed sites such as the Joint Field Office (JFO), marshalling mobilization sites, advance staging bases, and base camps. Examples of the support include lodging, food, local ground transportation, fuel, potable water, site security, etc.
  2. The IRCT Logistics Section will provide and coordinate all logistical support activities with the appropriate FEMA logistics section for the current phase of staging or response, e.g., RRCC, regional IMAT, JFO, and Area Field Office.
6. Command, Control, Coordination:

The Secretary, HHS is responsible for interagency coordination of the public health and medical response under ESF #8. All public health and medical response efforts will be coordinated for the Secretary by the ASPR. Operations in preparation for, or in response to, a public health or medical emergency are managed and coordinated by the Emergency Management Group (EMG) under the direction of the ASPR. The EMG will typically operate out of the HHS Secretary’s Operations Center (SOC) in Washington, DC, but may relocate to designated alternate facilities. The EMG organizational structure has its foundation in the Incident Command System (ICS) structure with Operations, Planning, Logistics, and Administration / Finance Sections; but remains flexible in order to accommodate the functional requirements of headquarters and ESF operations. The Deputy Assistant Secretary/Director, for Preparedness and Emergency Operations (DASOPEO) (or his or her designee) is designated as the EMG Manager.

At the field level, HHS operational actions are coordinated through the ESF #8 Lead and the IRCT. In accordance with ICS concepts, the response operations of teams and personnel from ESF #8 partners and HHS divisions are coordinated through the Operations Section of the IRCT. The IRCT coordinates HHS actions into the larger Federal response via liaisons at the Federal JFO, Regional Response Coordination Center (RRCC), or the Regional IMAT location as appropriate. One member of the IRCT will be designated as the ESF #8 lead at the JFO, RRCC or regional IMAT. The liaisons are integrated into the JFO organizational structure and relay assignments to the IRCT, and information back to the EMG via the ESF #8 Lead and the IRCT. It is through these liaisons that HHS fulfils its role in the integrated Federal response by processing and executing FEMA MAs.

Note: The IRCT-Advance (IRCT-A) teams are pre-designated regional teams, designed to set up initial response operations and provide rapid situational assessments up through the EMG at HHS headquarters. Utilizing their established contacts with SLTT officials, they can help determine the level and type of Federal public health, medical and human services support and follow-on resources that may be required and requested. An IRCT-A is prepared to rapidly deploy and conduct operations up to the first 72 hours of response; after which, they will be augmented by the full IRCT. The Regional Emergency Coordinators (RECs) serve as the lead for their regional IRCT-As.

In large scale or complex response operations, a Senior Health Official (SHO) will deploy to function as the Secretary’s representative in the field. When deployed, the SHO is the liaison to the DHS Principal Federal Official (PFO) for public health and medical issues. The SHO provides high-level strategic planning for public health and medical services.

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  • This page last reviewed: February 14, 2012