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April 16
Hospital Preparedness Program: Celebrating 15 Years of Health Care Preparedness and Response

Whether from devastating hurricanes, terrorist attacks, or deadly disease outbreaks, the United States regularly faces crises that threaten the health and safety of Americans. Saving lives during these events requires thorough planning and dedicated coordination to ensure the nation’s health care system is ready when disaster strikes.

Health care readiness is at the heart of ASPR’s Hospital Preparedness Program (HPP). As the only source of federal funding to prepare the nation’s mostly private health care system to respond to emergencies, HPP has been supporting health care system readiness around the country for the past 15 years.

Thumbnail of HPP Video

Supporting the development and sustainment of health care coalitions (HCCs) is key to HPP’s success. HPP encourages diverse organizations to work together through HCCs to make sure their communities are ready to respond during emergencies. When asked about the program, over 95% of HCCs state that HPP funding, guidance, and technical support have improved their ability to decrease morbidity and mortality during disasters.

Nationwide Map of Health Care Coalitions

Map of Health Care Coalitions

Today, HPP supports more than 470 HCCs around the country. HCCs promote information sharing and relationship-building within communities and among the health care and public health partners that rely on one another during emergencies. With over 31,000 members nationwide, HCCs reflect the diversity of the communities they serve. They also represent a comprehensive picture of the organizations involved in keeping a community prepared and safe.

Preparing the nation’s private health care system to collaboratively plan for and respond to emergencies takes coordination, innovation, and continued diligence, and HPP-supported programs to protect health and save lives in the face of new and emerging threats.

Following the 2014 Ebola outbreak, HPP helped establish a nationwide treatment network for Ebola and other infectious diseases and supported the creation of the National Ebola Training and Education CenterExit Icon (NETEC) to ensure our nation’s health care system had a structure in place to respond to emerging infectious diseases.

HPP has overseen an investment of nearly $6 billion in the nation’s health care system over the past 15 years. This investment has helped improve patient outcomes and enable a more rapid recovery in the process. HCCs supported by HPP have led responses to numerous events, saving countless lives in the process.

Twenty-first century health threats will continue to emerge and challenge the nation in new and different ways. Though the future may be uncertain, HPP will remain a constant, integral part of protecting Americans everywhere – helping to keep health care systems prepared and ready with dedication, diligence, and determination.

April 11
Decontamination Decoded: Disrobing, Dry Wiping Removes 99% of Chemical Contaminants

Last month, a truck carrying 4,400 gallons of hydrochloric acid collided with a train in Centerville, PA. For several hours, a column of white vapor floated above the wreckage. Emergency responders acted quickly to evacuate residents in the area and clean up the spill.

On a daily basis, thousands of businesses use our nation’s roads and railways to transport hazardous chemicals used for industrial or household purposes. Whether a chemical is released by accident, such as the case in Centerville, or intentionally by rogue assailants, terrorist organizations, or non-state actors the result is the same: large numbers of people could be harmed by inhaling, ingesting, or otherwise coming in to contact with hazardous chemicals. The need to decontaminate an overwhelming number of people has garnered wide interest among policy makers and emergency planners.

ASPR’s Biomedical Advanced Research and Development Authority (BARDA) sponsored a set of scientific studies at the University of Hertfordshire on chemical decontamination. The results of these studies, codified as the Primary Response Incident Scene Management (PRISM) Guidance for Chemical Incidents, will help local emergency management planners and first responders prepare for and respond to disasters involving chemical agents.

PRISM, BARDA’s most recent guidance for decontamination, recommends three steps that will reduce exposure and remove more than 99% of chemical contamination: (1) move quickly away from the hazardous area (if feasible); (2) carefully remove all clothes; and (3) wipe skin with a paper towel or dry wipe.

If done quickly, disrobing reduces contamination by 90 percent (see figure 1).

Graph described in the text above
Figure 1: Relationship between effectiveness of disrobing (arb1) and time at which disrobing is complete.2

Implementing dry-decontamination techniques, such as wiping skin with a paper towel, reduces contamination by an additional 9 percent (see figure 2).

Graph described in the text above
Figure 2: Relationship between effectiveness of decontamination (arb) and time at which decontamination is initiated.

Implementing the Three Steps

Prompt, orderly movement away from hazardous areas is key. Inappropriate or delayed evacuation may worsen exposure to hazardous materials.

Once evacuated from the hot zone or safely sheltered, patients should remove their clothes. Removing contaminated clothing limits transfer of contaminant from clothing onto skin and prevents secondary exposure through off gassing of clothing. If possible, cut off clothing rather than pull it over the head. If appropriate cutting instruments are not available, patients should hold their breath and pull clothing away from the face when removing clothes over their heads. Contaminated clothing should be treated as hazardous waste.

To remove hazardous material from the skin and hair, blot exposed skin and hair with any available dry absorbent material, such as paper towels or cloths. Use wet decontamination (e.g., swimming pool showers, sprinklers, or bottled water) when the contaminant provokes immediate skin irritation or is particulate in nature. Carry out these improvised decontamination efforts starting from the head working toward the toes, concentrating on exposed areas such as the scalp (hair), face, neck, arms, and hands. Since chemicals often act rapidly, initiating these actions as soon as possible—even on your own if instructed to do so—may be the most important factor in preventing illness.

Responders should carry out a dynamic risk assessment at the scene to determine if gross decontamination, e.g., the ladder pipe system, and technical decontamination, the use of specialized decontamination units, should be conducted to decontaminate patients further. Drying the skin after using the ladder pipe system or any other type of showering is a key step in removing contaminants from the skin surface. Treat used towels as contaminated waste.

Addressing the Challenges to Implementation

The biggest challenge for responders may be getting people to cooperate. Asking patients to take off their clothes can lead to anxiety, non-compliance, and security issues at the scene of an incident. Good communication is key to acquiring the trust and cooperation of patients. Provide information about why disrobing and decontamination are necessary, in terms of protecting oneself and other people and places, including home and family. Performing wet decontamination on clothed individuals will result in the transfer of contaminant to the skin. Also provide privacy or modesty protections—such as blankets or plastic sheets—when possible.

Another challenge is working with patients who are unable to comply with instructions due to mental impairment, physical disability or simply an inability to understand the spoken language. Plans need to be in place to rapidly identify and provide these patients appropriate assistance.

If you are not familiar with PRISM and the guidance it provides local community responders, check it out today. Also available for download is the complementary set of patient decontamination principles: Patient Decontamination in a Mass Chemical Exposure Incident: National Planning Guidance for Communities. Additional resources about chemical decontamination are available through ASPR TRACIE, including technical assistance specialists for one-on-one support and a peer-to-peer discussion board.

1The arbitrary unit expressing effectiveness (arb) gages 1 as being completely effective and .2 as being least effective.
2Primary Response Incident Scene Management (PRISM) Guidance for Chemical Incidents, p.21 & 31

March 29
Returning to Readiness: Strengthening Psychological Resilience by Building Behavioral Health Coalitions

The 2017 Atlantic hurricane season was one of the most destructive in recent history. During the recovery phase of a disaster, all impacted areas strive to stabilize, rebuild, recover, and be ready for the next emergency. Returning to readiness is a slow pivot and a relentless fight to re-establish broad public health and medical care services. The challenges and issues following a large-scale disaster are often too complex for any one agency or organization to address. Assembling a coalition of community stakeholders can be an effective strategy to determine what health care support services and treatment options are available, who the providers are, and whether gaps or duplication of services exist.

During the response to Hurricanes Irma and Maria, responders identified that many communities in Puerto Rico and the U.S. Virgin Islands (USVI) were not emotionally or psychologically prepared for an extended disruption in basic behavioral health services. A behavioral healthcare coalition can help communities swiftly assess their needs and begin to address the mental health needs of survivors. Further, a behavioral health coalition can serve as a vital network to address the needs of individuals and the community as time progresses.

For years, the Department of Health and Human Services (HHS) has used behavioral health coalitions to facilitate communication across provider groups; coordinate health care efforts; help identify existing and emergent needs; eliminate duplication of services; and launch community-wide initiatives in targeted areas. Building a community-based coalition for behavioral health also allows the long-term opportunity to have organizations coordinate their resources and services to bring about the most effective and efficient delivery of programs. In short, these types of coalitions empower their communities by forging partnerships to help meet behavioral health needs.

HHS Implements the Behavioral Health Coalition Concept in Puerto Rico and USVI

During the response and recovery to Hurricanes Irma and Maria, public health advisors from the Substance Abuse and Mental Health Services Administration and behavioral health subject matter experts (SMEs) from the United States Public Health Service facilitated the development and implementation of behavioral health coalitions in Puerto Rico and USVI. Each coalition involved service providers and funders, Voluntary Organizations Active in Disaster, non-governmental organizations, and governmental agencies.

In Puerto Rico, behavioral health coalition members utilized the Disaster Behavioral Health Coalition Guidance to structure its activities. This coalition’s diverse membership collectively identified concerns and solutions, and formed action plans to address the behavioral health needs for response and recovery.

As a result, the behavioral health coalition in Puerto Rico accomplished the following:

  • established regional behavioral health points of contact to facilitate coordination of services during recovery activities;
  • disseminated Centers for Medicare and Medicaid Services issued waivers to pharmacists and medical providers allowing patients to receive behavioral health services, including prescription coverage, without preauthorization;
  • collaborated with FEMA and the government of Puerto Rico to develop behavioral health media campaigns to disseminate around the 2017 winter holidays;
  • evaluated the existing clinical capacities (i.e. number of providers) present on the island following the impact of the hurricanes; and
  • ensured long-term support by institutionalizing the behavioral health coalition within the Administración de Servicios de Salud Mental y Contra la Adicción (ASSMCA), which is the government of Puerto Rico’s Administration for Mental Health and Addiction Services. ASSMCA aims to expand the behavioral health coalition’s activities by creating a Disaster Preparedness Group to increase communications at-large among social services agencies to develop a comprehensive behavioral health plan for Puerto Rico.

In USVI, federal SMEs helped the island develop a broad-based behavioral health coalition soon after the hurricanes hit the island. This coalition is now working with the U.S. Virgin Islands’ Territorial Mental Health Director and other private behavioral health service providers, behavioral health patient advocates, and governmental agencies to develop a jurisdictional health plan that identifies the top three behavioral health priorities and action plans to strengthen the long-term recovery of the behavioral health system across the island.

Every community is different, and there is no standard for how long a community takes to recover. Developing a behavioral health coalition that is prepared to function during all phases of the disaster management cycle is one way to strengthen community resilience.

The Office of the Assistant Secretary for Preparedness and Response’s Division of At-Risk, Behavioral Health, and Community Resilience created the Disaster Behavioral Health Coalition Guidance. The guide offers recommendations on behavioral health coalition membership and the activities this type of coalition should implement before, during, and after a disaster strikes.

March 19
Texas Moves Full-Speed Ahead to Implement Health and Social Service Projects to Improve Resilience and Build Sustainability

More than six months after Hurricane Harvey made landfall, Texas is still recovering. But, with so many people and organizations in need of help, where is the best way for the state of Texas and its partners to focus their health and social services recovery efforts?

Six teams of recovery specialists, led by the HHS Office of the Assistant Secretary for Preparedness and Response, worked with representatives from the Texas Health and Human Services Commission and the Texas Department of State Health Services to identify projects as a part of the Health and Social Services Landscape Assessment, which was completed in October 2017.

The assessment found high, sustained levels of stress among responders, clergy, caregivers, school staff members, and students. Health care providers (e.g., hospitals, physicians’ practices, skilled nursing facilities, institutional providers, and other non-institutional providers in rural areas) lacked sufficient access to medical equipment and supplies, pharmaceutical supplies, and medical transport. Plus, existing behavioral health services could not meet the current needs.

With assessment data in hand, Texas Governor Greg Abbott was quick to request follow-up assistance from HHS to support five health and social service projects; the immediate goal being to help the hardest hit areas in Texas recover from the damage caused by Harvey. The long-term goal is to provide Texas health and human service facilities the information and resources needed to enhance their systems statewide and build resiliency for future storms.

  1. Peer‐to-Peer Education Sector Project. This project aims to facilitate multiple peer-to-peer mentoring workshops that provide an opportunity for school district leaders, such as those in New York, Florida, Louisiana, and Connecticut, who have experience with disaster recovery, to interact and share lessons learned with Texas school district leaders currently engaged in recovery. The peer-to-peer mentoring provides a support system for school leaders, helping them to build capacity through improved problem-solving capabilities and resource procurement.
  2. Children and Youth Planning Workshops Recovery Project. This project aims to establish Children and Youth Task Forces (CYTF) in several affected counties to help identify and address children, youth, and family service needs during the preparation, response, and recovery phases of a disaster. Through a planning workshop, a county agency along with child-serving stakeholders at the state and federal levels, non-profit and private organizations, and national voluntary organizations active in disasters will meet to discuss child and youth recovery needs. The CYTF model has been implemented in several recent disasters, including the Joplin, Missouri tornadoes, Hurricane Isaac, and Superstorm Sandy.
  3. Health Care Systems Recovery Capacity and Capabilities Project. This project aims to heighten awareness of and engage in efforts to address the unmet needs among health care providers whose facilities, services, and client base were affected by Hurricane Harvey. Through regional and local meetings, the HSS RSF will share a resource tool kit on how to leverage existing relationships and emerging opportunities between federal and regional partners, local health authorities, and state health care coalitions (HCCs) to address supply issues and other barriers to expeditious recovery.
  4. Psychological First Aid Train the Trainer (TtT) Project. This project aims to train and build a cadre of school personnel, farmers and ranchers, behavioral health professionals, and disaster recovery workers to teach Psychological First Aid (PFA). TtT programs are designed to increase the number of people who have the knowledge and skills to support the behavioral health needs of community members, children, and youth by identifying risk behaviors for negative behavioral health outcomes, recognizing common stress reactions, sharing self-care strategies, and making referrals as appropriate.
  5. Peer Support Program for First Responders Project. This project aims to increase state/county capacity to provide a peer support program to help first responders who are experiencing higher than usual level of stress, anxiety, and negative feelings. To become certified peer supporters, volunteer fire fighters will receive training from experienced fire service and behavioral health clinicians. The course will focus on active listening, suicide awareness and prevention, crisis intervention, referrals to local resources, and relationships with local behavioral health providers.

Once these projects are complete, the federal government will utilize lessons learned from each project to improve the resources and services it offers other states during the post-disaster recovery phase.

The landscape assessment and project-based technical assistance provided to Governor Abbott is available to any state, local, territorial, or tribal official that activates the Health and Social Services Recovery Support Function within the National Disaster Recovery Framework.

Need disaster recovery subject matter expertise, technical assistance, or planning support? See what the federal government’s Health and Social Services Recovery Support Function can do for your state. State, local, territorial, or tribal officials with questions can reach out to the ASPR Recovery Team.​

March 19
Fighting microscopic threats through international collaboration: Health ministers use lessons learned from the 1918 influenza pandemic to strengthen pandemic preparedness and global health security

One hundred years ago, the 1918 influenza pandemic caused massive devastation, ultimately infecting over 500 million people and killing between 50 and 100 million individuals worldwide. During recent outbreaks of influenza, Ebola, and other emerging infectious diseases, we have learned how critical collaboration among countries and international organizations is for an expedited and more effective response. Working together with our partners to strengthen global health security is crucial to protect Americans from pandemics and other health security threats despite whether they start at home or abroad.

GHSI Heads of Delegations begin the 18th Ministerial Meeting of the Global Health Security Initiative
GHSI Heads of Delegations begin the 18th Ministerial Meeting of the Global Health Security Initiative.*

On March 9, the United Kingdom hosted the 18th Ministerial Meeting of the Global Health Security Initiative Exit Icon(GHSI) in London, England. Ministers of health and delegations from the United States, Canada, France, Germany, Italy, Japan, Mexico, and the United Kingdom, along with leaders from the European Commission and the World Health Organization, came together to continue their work on strengthening their national and collective capacity to respond to chemical, biological, radiological, and nuclear (CBRN) threats and diseases with pandemic potential.

Since 2001, these partner nations have worked together to share lessons learned from past crises and to prepare for future challenges by developing and implementing a myriad of policies and tools such as emergency communication and response coordination plans; platforms for threat and risk assessment and early alerting and reporting of health threats; sharing of scientific and public health knowledge and practices; and tackling critical global issues like sample sharing, international deployment of medical countermeasures, and the strengthening of laboratory networks, among others.

This year’s ministerial meeting focused on the need to have a common approach to evidence based, non-pharmaceutical interventions (NPIs) to slow the spread of influenza and on how best to communicate uncertainty and address public risk perception during a public health emergency.

In many cases, NPIs can be the first or only line of defense to help slow the spread of illness during a pandemic before vaccines and anti-viral medicines are available. When properly and timely Implemented, NPIs can delay an outbreak’s peak, reduce the total number of cases, and buy time for the development of a vaccine. Closing schools, canceling mass gatherings such as worship services and sports or entertainment events, and implementing border health measures to control the spread of disease can help save lives.

As parts of the United States deal with the current seasonal influenza, we can see the impacts of some of these interventions first hand. Schools in a dozen states have temporarily closed in hopes of curtailing the spread of disease. Of course in a flu pandemic, the decisions made by one country may have impact worldwide, which is why international dialogue and coordination are critical in implementing measures that don’t unnecessarily interfere with trade and travel, in accordance with the mandate of the International Health Regulations (2005) Exit Icon.

Communicating uncertainty and addressing risk perception during a public health emergency is critical to a successful response and should be integrated into all phases of preparedness and planning. Ministers agreed that communicating in a transparent way at the right time, even when there are knowledge gaps, can help create public trust, decrease fear, and ultimately save lives.

During this year’s meeting, GHSI partners made great progress in improving collaborative preparedness and responding to international CBRN terrorism, while reaffirming their commitment to this collaboration. Among other topics, they recognized the growing health security threat posed by opioids and committed to further exploring collaboration with the security sector. They also acknowledged the successful collaboration with the WHO to finalize the Operational Framework for the Deployment of the WHO’s Smallpox Vaccine Emergency Stockpile (SVES) in Response to a Smallpox Event Exit Icon and welcomed the renewed leadership and collaboration to further address the public health implications of sample sharing and the importance of sharing sequences and meta-data.

The full summary of key meeting outcomes can be found in the 2018 Ministerial Communiqué Exit Icon.

For more information on ASPR’s roles in global health security and GHSI, visit the HHS/ASPR Division of International Health Security, and the Global Health Security Initiative Exit Icon.

*GHSI Heads of Delegation, pictured from left to right:

  • Dr. Chieko Ikeda, Senior Assistant Minister for Global Health, Ministry of Health, Labour and Welfare, on behalf of the Honourable Katsunobu Kato, Minister of Health, Labour and Welfare, Japan
  • Dr Peter Salama, Deputy Director-General, Emergency Preparedness and Response, World Health Organization Health Emergencies Programme
  • Dr. Robert P. Kadlec, Assistant Secretary for Preparedness and Response, on behalf of the Honourable Alex M. Azar II, Secretary of Health and Human Services, United States
  • Dr. Sandro Bonfigli, Directorate General of Health Prevention, Ministry of Health, on behalf of the Honourable Beatrice Lorenzin, Minister of Health, Italy
  • Dr. Pablo Kuri, Undersecretary for Prevention and Health Promotion, on behalf of the Honourable José Ramón Narro Robles, Secretary of Health, Mexico
  • The Honourable Ginette Petitpas Taylor, Minister of Health, Canada
  • The Right Honourable Jeremy Hunt, Secretary of State for Health and Social Care, United Kingdom
  • Karin Knufmann-Happe, Director General for Health Protection, Disease Control and Biomedicine, on behalf of the Honourable Hermann Gröhe, Federal Minister of Health, Germany
  • Dr. Jérôme Salomon, Director General of Health, Ministry of Solidarity and Health, on behalf of the Honourable Agnès Buzyn, Minister of Solidarity and Health, France
March 12
Lessons from Fukushima: New guide provides answers to save lives and improve emergency medical response

Quick questions: A nuclear incident has occurred in your community and people are going to come to you for help. Do you know which medical issues you should focus on first? Or which steps need to be taken immediately after an incident to best protect the public? Or what resources might be available to help?

Before you answer “no” to any of those questions, download a copy of the newly released Decision Maker’s Guide: Medical Planning and Response for a Nuclear Detonation.

An effective medical response and an infrastructure prepared to protect itself from fallout could save tens of thousands of lives following device nuclear incident. During the response to the Fukushima Daiichi nuclear power plant disaster in Japan over seven years ago, integration of large amounts of complex information and evidence-based guidance into real-time decision making and response was shown to be nearly impossible without direct contact between leaders and subject matter experts.

Fortunately, not many people were exposed to radiation following the Fukushima disaster in 2011. However, the response to that incident identified the need for a “to-the-point” guide for upper-level decisions makers, including government officials, emergency managers and planners. That guide is now available. Let’s learn from the challenges during the Fukushima response seven years ago, and not place ourselves in a similar situation.

The Guide (or the DMG) is meant for senior operational responders, emergency managers, public health advisors, healthcare officials, government officials, and other policy and decision-makers to assist preparedness and response decision making by providing readily accessible information that quickly describes what to do. The DMG is based on critical scientific and medical aspects of a nuclear incident as well as the response organization and resources anticipated to be required or available during a response.

The DMG is released in collaboration with Radiation Emergency Medical Management (REMM). REMM is a resource for medical practitioners who may not typically treat radiation injuries to provide guidance about clinical diagnosis and treatment of radiation injury during radiological and nuclear emergencies. The platform provides just-in-time, evidence-based, usable information with sufficient background and context to make complex issues understandable to help them administer the most appropriate care during a disaster.

As an informational resource and practical tool, the DMG presents essential background information that provides the “why” behind critical issues and decisions that must be made in the complex response to a nuclear detonation. To ensure that vital information is quickly accessible when needed, the DMG outlines key issues and explains why those issues are critical to best protecting people exposed during large-scale radiation incidents. This approach allows responders to focus on what’s actually important – saving lives.

To do this, the DMG introduces the innovative “Dynamic Navigation” feature that takes complex scientific and operational information and translates it into a question-based, time-phased structure so that decision-makers can know what to do and what to anticipate during each phase of an incident. With this innovation, medical response decision-makers, planners, and leaders do not require expertise in radiation response and the DMG points them to the questions they need to ask and provides answers in the timeframes required for success. This helps ensure that the most impactful decisions can be made during each critical time interval to save lives after a radiological or nuclear disaster.

The “Dynamic Navigation” feature is also structured to layer information so that the first sections are 1 and 2 page summaries of specific topics or action items highlighting decision making considerations, key information, and “need to know” facts. Each summary provides links to in-depth guides where details and background information can be found in addition to links to additional details and references if readers want to dive deeper into a topic.

The DMG is an updated and more usable version of existing guidance found in Medical Planning and Response for a Nuclear Detonation: A Practical Guide. The DMG can be downloaded as a fully functional PDF for desktop, handheld, and mobile use, used on-line, or printed. A future DMG Version 3 will feature additional updated information as well a full web-based version.

Even if you think that as a medical response planner, responder, or leader you wouldn’t need to use the DMG, downloading it now ensures you will have it in case you need it. You can also download Mobile REMM, which provides a dose estimator, triaging tools, and more. Having critical resources at your fingertips in the event of a radiological or nuclear disaster can help you make better decisions that save the lives when seconds count.

February 21
Aging and Disability Task Force: An Access and Functional Needs Approach to Addressing the Unmet Disaster Needs Following Hurricanes Irma and Maria

The recent impacts of Hurricanes Irma and Maria left Puerto Rico and the U.S. Virgin Islands (USVI) in complete devastation. Buildings and homes were destroyed. Hospitals, dialysis centers, and pharmacies that weren’t destroyed were closed due to water and wind damage or a lack of electricity. Transportation services were lacking or, in some areas, non-existent. These issues affected everyone; however, people with access and functional needs – including older adults and people with disabilities – were particularly vulnerable in the hurricanes’ aftermath.

In response, the Office of the Assistant Secretary for Preparedness and Response (ASPR) created the Aging and Disability Taskforce to assess and address unmet social service needs for these at-risk populations. Members of the Taskforce included subject matter experts from the Administration for Community Living (ACL), the Office for Civil Rights, and ASPR’s Division for At-Risk Individuals, Behavioral Health and Community Resilience (ABC).

Obtaining situational analysis was critically important to highlighting programmatic impacts to older adults and people with disabilities. As a first step, the Taskforce facilitated effective communication and information sharing with the American Red Cross, federal civil rights attorneys, FEMA’s Office of Disability and Integration Coordination, and local networks that improve the lives of older adults and people with disabilities. The Taskforce also assessed impacts to ACL programs in Puerto Rico and USVI that provide essential support services to older adults and people with disabilities. These assessments focused on the status of building structures and the availability of accessible transportation, as well as access to clean water, food and medication, electricity, and personnel.

With this information in hand, the Taskforce was able to:

  • Provide technical assistance to further incorporate civil rights laws into emergency response and recovery activities for at-risk individuals;
  • Recommend response and recovery activities for programs severely impacted by the hurricanes; and
  • Develop an Evacuee Transition Plan for dialysis patients that were evacuated from USVI and stationed in Atlanta, GA.

The implementation of the Evacuee Transition Plan provides a breadth of information as the Incident Response Coordination Team transitions out of fulltime care coordination. The plan is intended to address the current needs of evacuees and ensure that their essential support services are maintained, including transportation, logistics, case management, food, and lodging.

This was the first time that ASPR convened a short-term taskforce with ACL colleagues, as well as the first activity requiring ACL to work across both its aging and disability programs to assess access and functional needs simultaneously.

Having a fulltime, onsite taskforce highlighted the need to address the access and functional needs of older adults and people with disabilities in order to maintain their health during a federal emergency response, and serves as a model for future disasters and public health emergencies.

February 15
ASPR’s New Vision for a Regional Disaster Health Response System Will Help Prepare Nation for 21st Century Health Security Threats

Early this week, I had the opportunity to discuss with colleagues at the University of Maryland Medical Center-Shock Trauma the concept of a regional disaster health response system that is capable of responding more effectively and efficiently to the ever-increasing array of 21st century health security threats.

ASPR Robert Kadlec touring UMD Medical Center's Shock Trauma Unit 

As the last several years have shown, the threat environment is more complex than ever – from infectious diseases with the potential to cause a pandemic, such as the H7N9 influenza virus, to state and non-state actors that have shown an interest in and willingness to use chemical, biological, radiological, or nuclear (CBRN) weapons, to cyber threats and severe weather. Building readiness and response capacity for these threats is my main priority and the catalyst for creating a regional disaster health response system.

The new framework would be built on a tiered regional system that emphasizes the use of local healthcare coalitions and trauma centers that integrate their medical response capabilities with federal facilities and local emergency medical services. This system would expand specialty care expertise in trauma and CBRN casualty management and coordinate medical response through mutual aid. A regional disaster health response  system also would incentivize the healthcare system to integrate measures of preparedness into daily standards of care.

Coalitions are the foundation of our disaster health response system. The regional healthcare coalitions created through ASPR’s Hospital Preparedness Program (HPP) are maturing (read Responding to Harvey: How a Houston-area Healthcare Coalition Modeled Success). Their work must not only continue but expand to include additional public and private sector partners (i.e., trauma centers, burn centers, pediatric hospitals, public health labs, and outpatient services).

Coalition partners help to ensure states are better prepared for an emergency by having in place the necessary guidelines and agreements for identifying who is doing what, when, and with what resources (equipment and personnel). But being prepared is only part of the disaster response equation. States and territories also need to be ready to respond quickly and efficiently. Real-time, real-world training is needed for all types of disasters, including CBRN tragedies. A standardized list of indicators must be identified and utilized to determine readiness for each disaster type.

Being ready for a disaster also entails the ability to handle medical surge capacity within a healthcare system. Currently, on any given day, our medical systems perform at near capacity. Mutual aid agreements need to be in place to quickly mobilize physicians and health practitioners from other states when needed without the bureaucratic frustrations and legal risks associated with medical licensing and liability issues.

ASPR is also looking at innovative approaches to incentivize healthcare preparedness. We look forward to continuing the dialogue with our state and local health system partners to explore various avenues to fund this system.

A regional disaster health response system will not happen overnight. Funding to support our nation’s healthcare readiness has declined steadily since 2005. Our healthcare system is largely privately run making it more difficult to get key players to agree to share resources for the benefit of the greater good. Part of my responsibility is to find ways to maximize the use of the available funds and to identify how to use them most effectively. My staff is also committed to developing a business case for readiness that will help competing organizations to work cooperatively. Coalitions are one way to bring together diverse and often competitive healthcare organizations with differing priorities and objectives.

Another step we are taking to help ASPR realize its new vision is to encourage every state and territory to adopt legislation, such as the Uniform Emergency Volunteer Health Practitioners Act Exit Icon, which allows any medical licensed volunteer to easily cross jurisdictional boundaries in an emergency.

The regional disaster health response system I propose will not replace the assistance HHS now provides through the National Response Framework and the National Disaster Recovery Framework. As HHS’ lead federal agency for Emergency Support Function #8, ASPR will continue to provide medical surge capacity and capability to support state, tribal, and jurisdictional response and recovery efforts. In fact, we have already begun the process of modernizing our Disaster Medical Assistance Teams, redefining their missions, who is part of their teams, how they do patient transport, and how they integrate with hospitals in providing definitive care.

Our regional staff will continue to work closely with state health and emergency management offices. In addition to managing HPP and providing grantees technical assistance through ASPR TRACIE, ASPR will continue to seek better ways to engage public and private partners in developing innovative solutions to the emerging threats of the 21st century.​

February 13
“One Team. One Mission. A Lot of Perseverance and Ingenuity” Keeps One HHS Hurricane Recovery Specialist Focused and Motivated to Serve

Greetings from Puerto Rico! I arrived on the island more than two months ago – my first deployment as part of the Department of Health and Human Services (HHS), Office of the Assistant Secretary for Preparedness and Response (ASPR) Health and Social Services (HSS) Recovery Support Function (RSF) team. The team consists of experts from different agencies within HHS working together for a common purpose: to restore and improve Puerto Rico’s health and social services. Being here is inspiring, and I am glad I have the opportunity to serve on this mission.

Working Together As One Team. I’ve been amazed at the breadth of the team’s expertise and experience. We have employees from the National Institutes of Health, the Centers for Disease Control and Prevention, the Administration for Children and Families, the Food and Drug Administration, the Health Resources and Services Administration, the Department of Education, and ASPR. Working together, bringing perspectives from different disciplines—including public health, environmental health, behavioral health, health care services, HIV/AIDs, elder care, school-based health care, social services, and cultural competency—is a win-win situation for everyone. Where one person may not have the necessary background, someone else on the team jumps in to support. We deploy as a team, and we work as a team to ensure every place we go has face-to-face access to HHS personnel who can problem solve their issues.

Fulfilling One Mission. Our team conducts a needs assessment during site visits to health and educational facilities and tailored conversations with key stakeholders. So far the team has visited more than 75 health care facilities, social service facilities, schools, and other key locations in Bayamon, Caguas, Fajardo, San Juan, Arecibo, and Ponce. We speak with health care professionals, teachers, and administrators to hear their stories, learn about their concerns, understand their barriers to recovery, and identify current and emerging needs. For example, one health center needed a second generator and access to ambulance services to transport patients to the nearest hospital. One teacher mentioned that her elementary school was not operating on a full-day schedule because they lacked consistent electricity and water.

Our team discovered that while emergency management planning might have varied at the municipality, community, and individual/family levels, no plans accounted for the scope of two, back-to-back hurricanes cutting off communications and electricity for a sustained period. During the immediate days following Hurricane Maria, family members living in the continental United States could not communicate easily with their loved ones on the island due to the lack of electricity and telephone service. This lack of communication has been stressful for people here. Behavioral health has emerged as another concern: understandably, many residents have had a difficult time handling the stress, anxiety, and fear following Hurricane Maria.

The information our team is gathering will give us a 360-degree view of the health and social services landscape in Puerto Rico. Ultimately, this information helps us, the central government of Puerto Rico, and municipalities to target short-term and long-term actions to help the island rebuild and prepare better for the next disaster.

Working with a Community that Perseveres. One of the most striking things I observed was the hopeful resilience of health care providers, teachers, administrators, and people in the communities eager to work together and with HHS to rebuild Puerto Rico.

During one of my visits, I met a local pediatrician nicknamed “Singer,” not because he could sing, but because he could “sew” (like the sewing machine) as in suturing wounds. Immediately after the hurricane hit, some residents began removing debris and clearing the streets. As a result, many people suffered cuts, and most needed stitches. The pediatrician leveraged his skills to meet the needs of his community. Witnessing this kind of ingenuity and fortitude has inspired me to be flexible, to think on my feet, and to help others in whatever capacity I can.

In the people of Puerto Rico, I see one mission, one team, and a lot of perseverance and ingenuity, and that sentiment keeps me focused and motivates me to give my utmost each day to the recovery mission in Puerto Rico.

If you are interested in serving as a Disaster Recovery Volunteer, contact Josh Barnes, HSS RSF National Coordinator, at

The U.S. Department of Health and Human Services, through the Health and Social Services Recovery Support Function, leads a coalition of 17 federal departments and agencies, each of whom manages programs, authorities, and capabilities that can support post-disaster health and social services recovery in Puerto Rico, or wherever the next major disaster happens. To learn more, visit ASPR Recovery.

HHS works with other federal and state partners to determine community needs and develop recovery strategies. These recovery strategies seek sustainable, actionable solutions to ensure public health safety, improve access to high-quality health care services, strengthen the health workforce, build healthy communities, and improve health equity by developing strategic partnerships and training and technical assistance resources.

February 09
Recovering from a Major Disaster is a Marathon, Not a Sprint: Lessons Learned from One Texas Family

Disasters upend the lives of countless families – they not only destroy homes, businesses, schools, and roads, but they also can throw disaster survivor’s lives into chaos. Local leaders are suddenly confronted with decisions on a scale they’ve never encountered before and families must quickly learn how to support themselves and those who rely on them.

When homes are destroyed and the systems that people depend on every day – from water and sewer to roads and schools – are not functioning, it can be difficult if not impossible for some people to recover. When community and government organizations reach out to help people navigate complex processes, they are playing an important role in protecting health.

The Story of Mary and Her Family

Take for instance Mary* a single mother of four. When Hurricane Harvey hit in late August, her family evacuated to a shelter in Shreveport, Louisiana. She stayed in Shreveport until the family shelter closed a few weeks later. She then roomed with extended family until that was no longer an option.

FEMA’s Individuals and Households Program was available to help Mary recover. Although she applied for assistance before being evacuated, Mary was unaware of the requirement to have her home inspected.

When Mary went back to her home in Texas, she found a notice on her door that said she had been denied housing assistance through FEMA’s program. This assistance would have provided help in repairing her current home and temporary housing assistance.

Unaware of how to explain the extenuating circumstances and appeal the decision, Mary and her four children began living out of the family van. Within a week, the van caught fire due to an electrical shortage. For several days, Mary and her family bounced between shelters and hotels, never staying at one location for more than a night.

Feeding her family also became an issue. Shelters provide food, but when Mary couldn’t find a shelter for her family they also went without food. Although her children qualified for the free breakfast and lunch program at their school, all schools in her community closed, first due to extensive damage, and then for winter break. Unfortunately, the schools that were open were miles and miles away, and gas is expensive when you can’t put food on the table.

HHS Steps In to Help

On January 1, Mary’s plight reached the Immediate Disaster Case Management program. Administered by the Department of Health and Human Services’ (HHS) Administration for Children and Families, the program supports states, tribes, and territories by providing disaster case management services to individuals and families impacted by a disaster. Texas Governor Greg Abbott activated the program when he requested federal assistance through the National Disaster Recovery Framework.

The program’s Incident Management Team immediately began working with Health and Social Services Recovery Support Function (RSF) experts from HHS’ Office of the Assistant Secretary for Preparedness and Response (ASPR) to help problem resolve Mary’s situation. ASPR’s long-standing relationship with the Texas Health and Human Services Commission proved invaluable in that process. The commission helped expedite the various forms of disaster assistance available through FEMA, the state, the U.S. Department of Housing and Urban Development, and several non-profit organizations. Within a few days, Mary received temporary HUD housing, help in repairing her existing home, and assistance with other unmet family needs.

Communities Need Information about Recovery before Disaster Strikes

Before storms strike, emergency management and health officials provide life-saving information about taking shelter or preparing homes to withstand the storm. Health and social services agencies, advocates, and faith-based and community organizations need to work with those officials to provide additional information to residents so they’re ready to recover from the storm as well.

For example, all households applying for federal disaster assistance must have their homes inspected for damage. The homeowner, or someone 18 years of age or older who lived in the household prior to the disaster, must be present for the schedule appointment to provide the inspector with proof of ownership/occupancy, insurance documents, and a list of damages, among other items.

That means people need to have copies of those essential documents in a waterproof bag in a safe place they can access after the storm. Those documents could be part of an emergency kit. Residents who leave their homes should tape their contact information to their door.

In Mary’s case, she and her family were in Shreveport and didn’t know to return home for a scheduled FEMA inspection. When Mary didn’t show for the inspection, the request for assistance was denied. Because she did not notify FEMA of how to contact her, she never received notification of the denial.

The U.S. federal government has approved nearly 370,000 Individual Assistance applications submitted by Texas residents, and approved payment of more than $1.5 billion. The government is there for the long term, and wants to help all eligible citizens. At the same time, however, it must implement procedures, such as verifying an applicant’s identity, to prevent fraud and ensure that applicants receive the disaster assistance intended for them.

Balancing the need for responsible government oversight with the needs of the people you serve can be a challenge. Before a disaster occurs, help the communities you serve learn more about the state and federal disaster assistance process. For more information about the forms of federal assistance available, including IHP, the requirements of the home inspection process, how to check your application’s status, and what to do if your application is denied, visit or call 800-621-3362. In most cases, the federal government will also establish Disaster Recovery Centers (DRC) in the local area. A DRC is a readily accessible facility or mobile office where survivors may go for information about recovery programs or other disaster assistance programs, and to ask questions related to their case.

Disaster recovery can be challenging for anyone, but it is especially difficult for people who were economically disadvantaged or faced other challenges before the disaster struck. By working with at-risk members of your community and helping them navigate the disaster recovery process, you can help protect health, promote wellness, and save lives.

*To protect the identity of the family portrayed in this blog, we did not use the mom’s real name.

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