Performance Measure 6

Goal or Target

One hundred percent of HCCs must submit a draft and final response plan specialty surge annex each fiscal year. Final plans must be submitted with the Annual Progress Report (APR).

Each HCC’s specialty surge annex must have 100 percent approval by the core member organizations of each HCC for every fiscal year. One hundred percent of additional member organizations have been provided an opportunity to provide input into the specialty surge annex, and 100 percent of core and additional member organizations have received a final copy of the response plan annex.

HCCs must have a draft response plan annex addressing burn care surge or infectious disease preparedness and surge completed and uploaded in the CAT by April 1, 2021. Final plans must be submitted with the FY2020 APR. ASPR will use this measure as a benchmark to assess achievement of preparedness goals for the health care system. Pursuant to Section 319C-1(g)(5) of the Public Health Service Act, failure to achieve this benchmark for one of two consecutive years may result in withholding of 10% of funding amounts and increased withholding amounts in subsequent years that this benchmark is not met.

Operational Intent

Integration of complementary coalition-level specialty surge annexes will support HCC management of large numbers of casualties with specific needs. Recipients should incorporate the HCC annexes into their jurisdiction’s plan for awareness and support coordination of state resources. 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

In addition to the general requirements above, the specialty surge annex must address additional factors per 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 FY2021)¹
• 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 FY2021)²
• 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 integrating 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 Radiation Injury Treatment Network (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 personal protective equipment (PPE) for HAZMAT events
• Review and update CHEMPACK (and/or other chemical countermeasure) mobilization and distribution plan
• Coordinate training for HCC 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 Homeland Security Exercise and Evaluation Program (HSEEP) principles for exercises and planning. The data sheet is a web-based form, 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.

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.

Data Reporting

During the specified time period for end-of-year reporting, recipients should enter this information on behalf of each HCC into the end-of-year performance measure module in PERFORMS. SPPR will calculate percentages.

^1. 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.

^2. 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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