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U.S. Department of Health and Human Services

Action Steps/Issues

 Phase 0: Credible Intelligence 
Trigger Point  Credible Intelligence of a Plan to detonate a Radiological Dispersal Device (RDD) or a Radiological Explosive Device (RED) in a U.S. City 
 HHS Strategy Begin preparation for public health and human service response in case of an RDD or RED

NOTE: Appropriate security classification will be maintained for all discussions related to Phase 0
 

Phase 0 Actions/Issues  Lead/Support Agency 
A.    PLANNING AND COORDINATION 

1. HHS transition from “normal” to “Coordinated Departmental Emergency Response Operations” 

 

2. Begin structured planning process. Brief the Secretary/Deputy Secretary

  • Situation update.
  • Required tasks
  • Available assets
  • Determine constraints
  • Identify critical facts and assumptions
  • Determine critical information requirements
 

3. Activate the EMG 

  •  Initiate notification roster
  • Determine additional EMG staffing requirements and OPDIV EOC activation requirements
  • Prepare daily or more frequent situation reports for the Secretary on preparedness efforts
  • Designate Incident Manager (IM)
  • Begins response planning in coordination with relevant support agencies
  • Begin development of possible ESF #8 mission assignments in coordination with ESF #8 partners, State/local officials and DHS
  • Establish and maintain contact with OPDIVS  and ESF#8 Federal partners
  • Establish and maintain contact with appropriate RECs
  • Develop initial Incident Action Plan (IAP)
 

 4. Coordinate/Conduct meeting to determine possible missions, deployments

  • Consider the requirement to establish PODs
  • Epidemiology Support
  • Medical Treatment Support
  • Subject Matter Expert Support
 

5. Begin coordination with the Interagency, including DHS and DOS, and the White House

  • Prepare/Detail required liaison officers to DHS and other agencies as requested
  • Alert ESF #8 partners
  • Begin coordination with appropriate DHS/FEMA contacts (RRCC, RECs, etc)
  • Alert/Deploy the Incident Response Coordination Team

SEC HHS/ASPR/ESF #8 Supporting Agencies

ASPR/IM 

6. Formalize and distribute ESF-8 response structure, decisional authorities, and trigger points for public health & medical interventions. 

ASPR/ESF #8 Supporting Agencies 

7. Review risk status (i.e., health screening and countermeasure status) of all federal and contractor employees who could potentially deploy in support of ESF-8 response activities. 

ASPR/ESF #8 Supporting Agencies 

8. Establish contact with key public health, healthcare, and community partners (i.e., State Health Department, State OEM, State Hospital Association, etc.) 

ASPR/RECs 

9. Establish and publish schedule for recurring activities (Conference Calls, VTCs, etc.)

ASPR/IM 
 B.    HEALTHCARE, EMERGENCY RESPONSE AND HUMAN SERVICES

10. Request/Review appropriate State, Tribal and local emergency management plans, focusing on:

  • Point of Dispensing (POD) operations\
  • City Readiness Initiative
  • Patient regulating and movement processes
  • High acuity care expansion capability 
SEC
HHS/ASPR/CDC/ESF #8 Supporting Agencies 

11. Consider increasing the capacity of medical and emergency response systems to meet expected needs by identifying/alerting/pre-staging/deploying/distributing:

  • Federal healthcare assets, including NDMS, FMS and ESF #8 partner assets
  • Epidemiological support
  • Veterinary surveillance
  • Laboratory activities
  • Critical care capability
  • POD capabilities (augmentation/establishment)
  • Commissioned Officer Corps Teams
  • Pharmacy activities
  • NDMS Teams
  • Medical/Surgical/Burn Nurse teams
  • SNS counter measures and other appropriate supplies and material
  • Additional reagents and consumables for surge testing at appropriate LRN laboratories  
ASPR
OPDIVs/Agencies/ ESF-8 Supporting Agencies 
C.    SURVEILLANCE, INVESTIGATION, AND PROTECTIVE HEALTH MEASURES 

12. Provide updated information to medical providers and healthcare organizations seeking treatment and management guidance and algorithms for RDD/RED exposure. 

SEC HHS/ASPR/CDC/IGA 

13. Coordinate lab surge capabilities with CDC and State/Tribal/local authorities. 

SEC HHS/ASPR/CDC 

14. Begin collecting and collating applicable information for the area.

  • GIS
  • Meteorological\
  • Transportation
  • Intelligence
  • Law Enforcement
     
ASPR/IGA/ESF #8 Supporting Agencies 
D.    PHARMACEUTICALS, MEDICAL SUPPLIES AND EQUIPMENT:  

15. Decisions to pre stage or deploy medical countermeasures need to be made based on the credibility of the intelligence and the threat 

 
E.    PATIENT EVACUATION   

16. Decisions on hospitalized patient evacuation need to be made based on the credibility of the intelligence and the threat 

 
F.    COMMUNICATIONS AND OUTREACH 

17. Review Communications Plan.

  • Mitigation
  • Preparedness
  • Response
  • Recovery 
ASPA/ASPR 

18. Review Media Campaign Plan.

  • Contacts
  • Information requirements
  • Timelines
ASPA/ASPR

19. Identify SMEs on medical and public health aspects of RDD/RED exposure

ASPA/ASPR/CDC

20. Identify HHS spokesperson(s).

ASPA/ASPR

21. Identify public affairs liaison officer assignments and responsibilities.

ASPA/ASPR

Phase I: Early (0-12 Hours Post Detonation RDD)
Trigger Point  Detonation of an Improvised Explosive Device, Radiological Material Realized Actions Steps start at this point on the absence of credible intelligence)
ESF #8 Strategy  Closely monitor events and Begin review of advance preparations required to facilitate an effective and timely response

              Phase 1 Actions/Issues  Lead/Support Agency 
              A.    PLANNING AND COORDINATION 

              1. Activate Emergency Support Functions (ESF)s in support of the even

              FEMA/DHS 

              2. Consider declaring a public health emergency

              HHS Secretary 

              3. Activate all components of the EMG to include selected liaisons and specialties

              • Expand Ops, Planning, Log, and SME cells as required
              • Request LNO from ESF #8 partners as required (e.g. DOT, DoD, VA, DHS/FEMA, ARC, DOE, EPA, OSHA, FEMA Recovery LNO)
              • Request LNO from operating/staff divisions
              • Working with State & Local Authorities and DHS  determine the event as an RDD/RED and the type of radiological agent to determine the appropriate countermeasures
              ASPR 

              4. Provide representative to ERT-A and Deploy IRCT –A, IRCT (including SHO)

              1. Operations Section
                •  Initiate regular HHS-EMG Coordination Call
                • Alert rostered teams (RDF, APHT, MHT, NDMS IRCT, HHS Human Services  technical assistance team and subject matter expert assessment team) 
              2. Planning Section
                • Prepare Incident Action Plan and assure plans are coordinated with ESF #8 support agencies, IRTC, OpDivs/Staff Divs and DHS/FEMA.
                • Analyze vulnerability of critical health care infrastructure in the expected impact zone.
              3. Logistics Section
                • Coordinate medical support within HHS
                • Coordinate non-medical support with FEMA 
              4. Administration and Finance
                • Ensure that funds are available to support operations
                • Process Mission Assignments and Sub Tasks
                • Track mission assignments
                • Institute tracking of deployed personnel 

              EMG
              EMG-OPS

              EMG/OFRD
              EMG/HSC liaison

              EMG Plans/OPEO CIKR and FEMA recovery liaison

              EMG LOG/DHS/FEMA
              EMG LOG/DoD
              EMG A&F

               

              5. Upon receipt of the NOC/NRCC Activation Order

              1. Update situational awareness and ensure visibility of the common operating picture is maintained.
              2. Staff the ESF #8 desks at the NRCC, IMPT, NOC, as requested
              3. Ensure that all essential functions can be performed and all related services can be provided.
              4. Initiate incident-specific information and data collection, analysis, and assessment
              5. Perform effects and consequences modeling and simulation analysis on the geography, demographics, and population, including the at-risk population and critical infrastructures. Coordinate with IMAAC.
              6. Confirm essential communication and coordination links with Other Federal Agencies (OFA) to ensure optimal information sharing, and a common understanding of the expected mission and objectives.
              7. Establish initial Battle Rhythm video teleconferences and other conference calls within ESF #8 emergency management community concerning the situation, mission and objectives
              8. Confirm lines of communication and coordination with non-collocated command and control entities.
              9. Continue to review and validate internal and interagency senior officials’ “playbooks” and “checklists” including:
                • Essential Elements of Information (EEI)
                • Information collection requirements and capabilities;
                • Information analysis and intelligence procedures; and
                • Reporting requirements
              10. Prepare to execute Pre-Scripted Statements of Work (PSOWs) and Sub Tasks to ESF#8 partner departments and agencies and HHS OpDivs/StaffDivs and ensure existing interagency and contractual vehicles are available for rapid implementation and execution
              11. Disseminate IMACC products as appropriate
              EMG ALL, IMAAC

              6. Compare pre-impact with initial post-impact of the likely consequences to the public health, medical and human services critical infrastructures

              EMG

              7. Provide all ESF#8 partners with specific reporting/requesting guidance on dosimetry and personal protective equipment for entry into the area of operations.

              EMG, SME Cell

              8. Deploy supplies and equipment packages (logistics support) for all ESF #8 teams / personnel deployed in support of ESF #8 missions

              OPEO/LOG
              CDC/DSNS

              9. Coordinate with the potentially deployed IRCTs to stage FMS and advance personnel to set-up and install FMS Installation Team

              OPEO/IRCT/CDC/JFO/ARC CDC/DSNS/OFRD

              10. Establish and maintain contact with key public health, healthcare, and community partners, including partners serving the at-risk population

              ASPR/CDC/CMS/OCR/ IGA/SME

              11. Develop, release and communicate guidance to public health officials and community partners, EMS for response, including counter-measures, concepts of operations, protective action guidelines, triage information, food safety, shelter in place, water safety, etc.

              ASPA/CDC

              12. Upon receipt of Mission Assignment from FEMA execute the appropriate sub tasks as required.

              DHS/FEMA/OPEO-EMG/ ESF #8 partners

              13. Deploy other logistics assets for ESF #8 teams/personnel to staging locations

              EMG-LOG

              14. Assess and coordinate  Security Requirements for ESF #8 assets

              EMG-OPS
              B.    HEALTHCARE, EMERGENCY RESPONSE AND HUMAN SERVICES

              15. Activate and deploy NDMS teams and patient movement components as appropriate.

              OPEO

              16. Request NDMS , HaVBED and BARTs bed counts

              OPEO

              17. 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

              18. Coordinate with AABB Task Force to identify supply levels at the supporting medical facilities for the incident.  Activate supply distribution plans for affected region(s).

              HHS/OPHS

              19. Obtain approval for AABB Task Force coordinated public information assistance announcement re: the adequacy and safety of the nation’s blood supply.

              HHS/OPHS

              20. Request assessment of healthcare infrastructure from the IRCT(s).

              HHS/ASPR CIKR

              21. Identify sites of opportunity for RTR 1-3,and MC and AC sites (as needed)

              IRCT

              22. Obtain evacuation and patient transportation routes

              .

              23. Obtain decontamination sites for support at extraction points and/or at Triage locations.

              .

              24. Obtain receiving, distribution and transportation Hubs (logistics Stand-up)

              .

              25. Stage/Deploy ESF #8 teams and equipment caches as required in support of MC sites.

              NDMS/OPEO-LOG & NDMS

              26. Coordinate with FEMA requirements for medical personnel augmentation at general/mass care shelters

              HHS Human Services/ARC/ESF #6

              27. Activate the Ambulance Contract for medical transportation (ground, air and para-transit ambulances)

              EMG/FEMA

              28. Activate Radiation Injury Treatment Network to potentially receive patients with Acute Radiation Syndrome.

              OPEO

              29. Activate the Rapid Response Victim Registry

              CDC

              30. Request DOJ to establish missing persons HOTLINE or integrate with the National Center for Missing and Exploited Children for tracking of patients, persons looking for family members

              ACF
              C.    SURVEILLANCE, INVESTIGATION, AND PROTECTIVE HEALTH MEASURES

              31. Deploy the Interagency Advisory Team (A Team)

              EMG - SME

              32. Provide recommendations regarding decontamination and medical management

              EMG - SME
              D.    PHARMACEUTICALS, MEDICAL SUPPLIES AND EQUIPMENT:

              33. If SNS assets required, deploy CDC TARU team and/or FMS teams as necessary

              EMG/CDC/DSNS/OFRD

              34. Deploy SNS radiation countermeasures as indicated by type of radionuclide and types of injury

              CDC/DSNS

              35. Alert VA to be prepared to provide health and medical logistics/supply support via National Acquisition Center (NAC).

              EMG- LOG/VA

              36. Submit EUA /IND for countermeasures that are not FDA approved. (EUA Playbook)

              EMG FDA
              E.    PATIENT EVACUATION

              37. Convene Medical Interagency Coordinating Group (MIACG) to evaluate and make recommendations regarding the medical need and patient evacuation, including evacuation of members of the at-risk population.

              OPEO/NDMS
              F.     COMMUNICATION AND OUTREACH

              38. Participate in the National Incident Communications Conference Line (NICCL) composed of Federal public affairs officers as well as local and state public affairs officers.  The goal of the NICCL is to develop and implement a coordinated communications plan that ensures the provision of timely and accurate information across all levels of government (“one voice”).

              .

              39. Provide information on medical and public health response activities with as much granularity as possible

              SEC HHS, ASPR, ASPA, CDC, DHS, SHO, OCR

              40. Provide anticipatory guidance on how the public health and medical response (including mass fatality management) will unfold over time

              41. Explain the rationale for difficult decisions that must be made due to overwhelming need in the context of resource scarcity (e.g., first priority is to save as many lives as possible)

              42. Provide behavioral health expertise to help craft messages

              43. Provide talking points that give protective guidance (“Protective Action Guidelines” (PAG) e.g., worker health and safety; decontamination, evacuation vs. shelter-in-place); information on the zone of exclusion, and where/how to seek care

              44. Provide information (when available) for Medical Providers seeking treatment and management guidance and algorithms.(REMM)

              45. Identify SMEs on medical and public health aspects of radiation health

              46. Identify HHS spokesperson(s)

              47. Ensure that in communicating with the public, the needs of at risk, such as individuals with disabilities and individuals with limited English proficiency, are taken into account

              48. Ensure communication with the at risk population, including limited English proficient individuals and individuals with disabilities


              Phase II: Intermediate Phase (12-72 Hours Post Detonation RDD)
              Trigger Point Arrival of Federal Assets to Locale of Detonation 
              ESF #8 Strategy  Rapidly deploy ESF #8 assets to assist state, tribal, ,or local officials providing assistance where needed in saving lives, minimizing adverse health effects, stabilizing public health, medical and human services infrastructure. 

              Phase II Actions/Issues  Lead/Support Agency
              A.    PLANNING AND COORDINATION

              1. Coordinate rapid needs assessments with FEMA (public health, medical and human services infrastructure) 

              EMG

               2. Adjust HHS-EMG Staffing levels as required

              1. Expand Ops, Planning, Log, A&F and SME cells as required
              2. Request additional LNOs from ESF #8 partners as required (e.g., DOT, DoD, VA, DHS/FEMA, ARC, DOE, EPA, OSHA)
              EMG/OFRD/ESF #8 Partners 

              3. Make necessary adjustments to pre-scripted Sub Tasks 

              EMG – OPS/A&F 

              4. Update situational awareness of hospital and healthcare infrastructure facilities (including power, water and debris) in the impact zone. Determine capability to continue operations.

              EMG-CIKR 

              5. Prepare tasks for USACE/ESF#3 to prioritize continuity of operations for hospital and healthcare infrastructure facilities (includes power, water and debris removal).  

              EMG-CIKR/USACE/DoD 

              6. Review damage assessments and consult with FEMA regarding whether activation of ESF #14 is required

              EMG/ FEMA Recovery LNO/ OPEO-CIKR/IGA

              7. Develop common operating picture for long-term recovery and establish a transition to recovery plan

              EMG plans/ FEMA Recovery liaison/ OPEO-CIKR

              8. Produce ongoing and accurate public health, medical and human services status assessments, including status of at-risk population and service animals

              EMG, OCR

              9. Coordinate the requirement for Medicare/Medicaid and other statutory waivers for health, human services and other Federal benefits

              EMG/CMS/ACF/AoA/OCR  SAMHSA/FEMA Recovery Liaison

              10. Expedite new or re-enrollment into health and human services Federal Benefits

              EMG/HSG

              11. Capture after-action comments

              ALL
              B.    HEALTHCARE, EMERGENCY RESPONSE AND HUMAN SERVICES

              12. Deploy additional NDMS and PHS assets as required

              EMG/NDMS/OFRD

              13. Deploy staged personnel in accordance with Mission Assignments

              • Additional IRCTs as needed
              • ESF #8/HHS Teams (MERT, NMRT, DMORT-WMD, etc)
              • LNOs
              • Federal and non Federal partners
              EMG/OFRD/VA/DoD/ACF/ IGA

              14. Make necessary recommendations for at-risk persons regarding support needed

              EMG/OD/ACF/OCR/OPEO-Human Services Group

              15. Assess the need to use the Emergency System for Advance Registration of Voluntary Health Professionals (ESAR-VHP). 

              EMG /OPEO Hospital Program

              16. Assess need for MRC Federal-level activation

              EMG/OPHS-MRC

              17. Receive, process, track and sub-task (as needed) MAs

              EMG A&F

              18. Conduct and maintain Situational Awareness reporting, including reporting regarding the at-risk population

              IRCT/SOC/EMG

              19. Deploy ESF #8 medical and public health and HHS human services teams to augment shelters

              ACF

              20. Coordinate medical care support for mass care requirements

              EMG/ACF

              21. Deploy assets in support of fatality management as requested.

              EMG/NDMS
              C.    SURVEILLANCE, INVESTIGATION, AND PROTECTIVE HEALTH MEASURES

              22. Update dose rate data for responders and for potential reentry into safe regions

              EMG-SME/EPA, DOE, CDC

              23. 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.

              EMG/CDC/OCR

              24. Assist states through direct or technical assistance in the collection and analysis of data from injury, illness and mortality surveillance activities

              EMG/CDC

              25. Provide CDC staff to supplement state efforts to address identified public health issues/concerns

              EMG/CDC

              26. Conduct  inspections and  assess damage to FDA-regulated industry in impacted areas

              EMG/FDA

              27. Assist states with collection/analysis of FDA-regulated product samples

              EMG/FDA

              28. 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.

              EMG/FDA

              29. Conduct active review all adverse event reports related to FDA-regulated products

              EMG/FDA

              30. Assist States with surveillance efforts to determine product integrity of pharmaceuticals, medical supplies and equipment in aftermath of incident.

              EMG/FDA
              D.    PHARMACEUTICALS, MEDICAL SUPPLIES AND EQUIPMENT:

              31. Identify updated countermeasures, medical supplies and equipment

              EMG-SME

              32. Establish procedures for SNS shipments of necessary countermeasures, medical supplies, and equipment to affected area

              ENG/LOG/CDC/IRCT

              33. Activate Emergency Prescription Assistance Program (EPAP)

              IRCT/CMS
              E.    PATIENT EVACUATION

              34. Review and adjust patient evacuation/repatriation plans with ESF #8 partners.

              EMG/ NDMS/ DOT/ DoD/ VA/ ACF/ OD
              F.    COMMUNICATIONS AND OUTREACH

              35. Continue situation briefing/conference calls for ESF partners and OPDIVS/STAFFDIVS

              ALL

              36. Continue to participate in NICCL.

              • Continue providing information and anticipatory guidance to the public, including the at-risk population.
              • Reiterate rationale for difficult decisions that must be made due to overwhelming need in the context of resource scarcity (e.g. first priority is to save as many lives as possible).
              • Continue providing talking points on worker health and safety; decontamination, evacuation vs. shelter-in-place); information on the zone of exclusion, and where/how to seek care.
              • Maintain hotline capacity for medical and behavioral health questions.
              • Disseminate information on volunteer opportunities and rostering mechanisms (phone line, internet) decontamination, evacuation vs. shelter-in-place); information on the radiation zone, and where/how to seek care.
              HHS, DHS, ASPA, CDC, OCR


              Phase III: Intermediate/Late Phase (72 Hours – 2 Weeks Post Detonation)
              Trigger Point  Patients in Definitive Care
              ESF #8 Strategy To Effect a Smooth and Transparent Transition to Long- Term Recovery                                                                 

              Phase III Actions/Issues  Lead/Support Agency 
              A.    PLANNING AND COORDINATION

              1. Report to FEMA and local authorities on progress development in restoring minimal functionality to the medical and public health infrastructures 

              EMG/ FEMA recovery liaison/OPEO CIKR/DHS 

              2. At the direction of the JFO/NRCC, implement demobilization and deactivation plan for the release of appropriate ESF #8 components. 

              EMG 

              3. Adjust  ESF #8 assets 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. Capture items for the draft after-action report 

              TELL 

              5. Coordinate with IRCT and ESF#8 supporting agencies, the demobilization of ESF#8 resources when all operational objectives contained in the ESF#8 Incident Action Plan have been met or affected State, or DHS determines that resources are no longer needed. 

              EMG-OPEO-CIKR/FEMA Recovery Liaison 

              6. Deactivate and demobilize specific response assets when its specific task or Mission Assignment is completed. 

              EMG/DHS 

              7. Adjust HHS-EMG operations commensurate with field activities including all LNOs 

              EMG 

              8. Develop a demobilization plan 

              EMG ALL/IRCT 

              9. Coordinate the transition to recovery activities with OPDIV/STAFFDIVS 

              FEMA Recovery Liaison/ OPDIVS/STAFFDIVS 
               B.    HEALTHCARE, EMERGENCY RESPONSE AND HUMAN SERVICES

               10. Transition response to State and local authorities

              ALL 

              11. Demobilize personnel as required in accordance with MAs completion 

              ALL 

              12. Transition to routine operations for OPDIVs as appropriate. 

              ALL 
              C. SURVEILLANCE, INVESTIGATION, AND PROTECTIVE HEALTH MEASURES

              13. Determine need and requirements for long-term post-event surveillance or investigation, including surveillance of at risk population. 

              EMG/CDC, NCI, OCR 

              14. Continue assistance to States regarding surveillance efforts, including surveillance of at risk population. 

              EMG/CDC/OCR 

              15. Continue to coordinate with state, local, and tribal environmental health department to ascertain ongoing and/or anticipated need for technical assistance, consultation, and support 

              EMG 

              16. Continue to monitor worker safety and physical and mental health 

              EMG 

              17. Continue inspections of FDA regulated industry and work with states as needed to assess retail food establishments in impacted areas 

              EMG/FDA 

              18. Continue to assist states through collection and/or analysis of FDA-regulated product samples. 

              EMG/FDA 

              19. 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 

              EMG/FDA 

              20. Continue to review all adverse event reports related to FDA-regulated products 

              EMG/FDA 
              D.    PHARMACEUTICALS, MEDICAL SUPPLIES AND EQUIPMENT:

              21. Establish procedures for follow on shipments of necessary countermeasures, medical supplies, and equipment to affected area.

              EMG-Log/DHS/FEMA

              22. As situation warrants, begin SNS redeployment/recovery/transition planning

              EMG Log /CDC/IRCT

              23. Inventory and return non-essential equipment for reconstitution

              ALL
              E.    PATIENT EVACUATION

              24. Continue patient evacuation

              EMG
              F.    COMMUNICATIONS AND OUTREACH

              25. Continue situation briefing/conference calls for ESF partners and OPDIVS/STAFFDIVS until demobilization complete.

              HHS, EMG

              26. Continue coordination with IRCT until demobilization.

              EMG

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              • This page last reviewed: August 13, 2012