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U.S. Department of Health and Human Services

Appendix 4: Required Components of a Response Plan

A complete response plan has all of the required components identified in the FOA as well as in the 2017-2022 Health Care Preparedness and Response Capabilities. HCCs may elect to address the components associated with the response plan in two separate documents or in multiple documents; however, all components must be documented.

Required Components of a Response Plan

Each HCC funded by the recipient must develop a response plan that is informed by its members’ individual emergency operations plans and submit the plan to ASPR with annual progress reports. Each HCC’s response plan must describe the HCC’s operations that support strategic planning, information sharing, and resource management. The plan must also describe the integration of these functions with the ESF-8 lead agency to ensure information is provided to local officials and to effectively communicate and address resource and other needs requiring ESF-8 assistance. In cases where the HCC serves as the ESF-8 lead agency, the HCC response plan may be the same as the ESF-8 response plan.

The interests of all members and stakeholders should be considered in the response plan; however, each HCC must coordinate the development of its response plan by involving core members and other HCC members so that, at a minimum, acute care hospitals, EMS, emergency management agencies, and public health agencies are represented in the plan. Each HCC must review and update its response plan regularly, as well as after exercises and real incidents.

The HCC response plan can be presented in various formats, including the placement of information described below in a supporting annex. Regardless of the format, each HCC’s response plan must clearly outline:

  • HCC integration with the jurisdiction’s ESF-8 lead agency to ensure information is provided to local, state, and federal officials.

  • The HCC's ability to effectively communicate and address resource needs requiring ESF-8 assistance. In cases where the HCC serves as the jurisdiction’s ESF-8 lead agency, the HCC response plan may be the same as the ESF-8 response plan.

  • The HCC's ability to support the increase of emergency and inpatient services to meet the demands of a medical surge event (with or without warning; short or long duration). All communities should be prepared to respond to conventional and mass violence trauma.

  • The HCC's ability to determine bed, staffing, and resource availability; identify patient movement requirements; support acute care patient management and throughput; initiate and support crisis care plans.

  • The provision of behavioral health support and services to patients, families, responders, and staff.

  • The incorporation of available resources for management of mass fatalities through ESF-8.

Each HCC should also monitor their members’ progress toward closing gaps in their own plans and offer assistance to help close the gaps as appropriate.

More information about the HCC response plan can be found in Capability 2, Objective 1, Activity 2 of the 2017-2022 Health Care Preparedness and Response Capabilities.

Required Components of a Specialty Surge Annex

HCCs must provide a complete and approved response plan annex addressing the required annual Specialty Surge requirement. HCCs must include a draft response plan annex addressing pediatric surge completed and uploaded into the CAT. Final plans must be submitted with the FY2019 Annual Progress Report (APR).

HCCs must develop complementary, coalition-level annexes to their base medical surge/trauma mass casualty response plan(s) to manage a large number of casualties with specific needs. Recipients should incorporate the HCC annexes into their jurisdiction's plan for awareness and to support coordination of state resources. In addition to the usual information management and resource coordination functions, each specialty surge annex framework should be similarly formatted and emphasize the following core elements:

  • Indicators/triggers and alerting/notifications of a specialty event
  • Initial coordination mechanism and information gathering to determine impact and specialty needs
  • Documentation of available local, state, and interstate resources that can support the specialty response and key resource gaps that may require external support (including inpatient and outpatient resources)
  • Access to subject matter experts – local, regional, and national
  • Prioritization method for specialty patient transfers (e.g., which patients are most suited for transfer to a specialty facility)
  • Relevant baseline or just-in-time training to support specialty care
  • Evaluation and exercise plan for the specialty function

In addition to the general requirements above, the specialty surge annex must address additional factors for each of the specialties listed below (depending upon which is exercised which year):

  • Pediatric (FY2019)
    • Local risks for pediatric-specific mass casualty events (e.g., schools, transportation accidents)
    • Age-appropriate medical supplies
    • Mental health and age-appropriate support resources
    • Pediatric/Neonatal Intensive Care Unit (NICU) evacuation resources and coalition plan
    • Coordination mechanisms with dedicated children’s hospital(s)

  • Burn (FY2020 or 2021) 36
    • Local risks for mass burn events (e.g., pipelines, industrial, terrorist, transportation accidents)
    • Burn-specific medical supplies
    • Coordination mechanisms with American Burn Association (ABA) centers/region
    • Incorporation of critical care air/ground assets suitable for burn patient transfer

  • Infectious Disease (FY2020 or 2021) 37
    • Expanding existing Ebola concept of operations (CONOPs) plans to enhance preparedness and response for all novel/high consequence infectious diseases
    • Developing coalition-level anthrax response plans
    • Developing coalition-level pandemic response plans
    • Including healthcare-associated infection (HAI) professionals at the health care facility and jurisdictional levels in planning, training, and exercises/drills
    • Developing a continuous screening process for acute care patients and integrate information with electronic health records (EHRs) where possible in HCC member facilities and organizations
    • Coordinating visitor policies for infectious disease emergencies at member facilities to ensure uniformity
    • Coordinating medical countermeasures (MCM) distribution and use by health care facilities for prophylaxis and acute patient treatment
    • Developing and exercising plans to coordinate patient distribution for highly pathogenic respiratory viruses and other highly transmissible infections, including complicated and critically ill infectious disease patients, when tertiary care facilities or designated facilities are not available

  • Radiation (FY2022)
    • Local risks for radiation mass casualty events (e.g., power plant, industrial/research, radiological dispersal device, nuclear detonation)
    • Detection and dosimetry equipment for EMS/hospitals
    • Decontamination protocols
    • On-scene triage/screening, assembly center, and community reception center activities
    • Treatment protocols/information
    • Coordination mechanisms with hematology/oncology centers and RITN

  • Chemical (FY2023)
    • Determine risks for community chemical events (e.g., industrial, terrorist, transportation-related)
    • Decontamination assets and throughput (pre-hospital and hospital), including capacity for dry decontamination 
    • Determine EMS and hospital PPE for HAZMAT events
    • Review and update CHEMPACK (and/or other chemical countermeasure) mobilization and distribution plan
    • Coordinate training for their members on the provision of wet and dry decontamination and screening to differentiate exposed from unexposed patients
    • Ensure involvement and coordination with regional HAZMAT resources (where available), including EMS, fire service, health care organizations, and public health agencies (for public messaging)
    • Develop plans for a community reception center with public health partners

ASPR has clarified the special surge annex tabletop/discussion exercise format and data sheet requirement for each required specialty surge annex (i.e., FY2019 Pediatric Care Surge Annex, FY2020 Burn Care Surge Annex or Infectious Disease Preparedness and Surge Annex, FY2021 Burn Care Surge Annex or Infectious Disease Preparedness and Surge Annex, FY2022 Radiation Emergency Surge Annex, and FY2023 Chemical Emergency Surge Annex). Recipients and HCCs must validate their specialty surge annexes via a standardized tabletop/discussion exercise format that meets HSEEP principles for exercises and planning. The data sheet is a web-based form and is being developed as a module in the CAT where the data can be input directly. Detailed instructions will be provided regarding the specific information that should be entered into the CAT.

NOTE: The Pediatric Surge TTX and associated data sheet in the CAT were waived in FY2019 due to real-world COVID-19 response.

ASPR has clarified the requirement for incorporating transfer agreements into corresponding specialty surge annexes. Transfer agreements with pediatric, trauma, and burn centers should be referenced in the corresponding HCC specialty surge annexes. HCCs are not required to obtain a copy of all transfer agreements, nor do they need to be included in the annex; however, HCCs should be capable of demonstrating their knowledge of existing transfer agreements that support each specialty surge annex. HPP FPOs will verify the availability of transfer agreements during recipient site visits. ASPR understands that some specialty centers do not use written transfer agreements but will always accept referrals (subject to resources available). If this the case, a statement by the specialty center to this effect will suffice.

36 Due to the Coronavirus Disease 2019 (COVID-19), HCCs must develop either the Burn Care Surge Annex or the Infectious Disease Preparedness and Surge Annex in FY2020 and must develop the other in FY2021

37 Due to the Coronavirus Disease 2019 (COVID-19), HCCs must develop either the Burn Care Surge Annex or the Infectious Disease Preparedness and Surge Annex in FY2020 and must develop the other in FY2021

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  • This page last reviewed: November 05, 2020