Emergency Support Function #8

When incident needs challenge or exceed the medical or public health response capabilities of local, State, Tribal, or regional response assets, Federal public health and medical assistance may be made available under ESF #8 of the NRP. This support may be provided in response to a variety of public health and medical events, including the following:

• Natural and man-made disasters and public health and medical emergencies
• Terrorist threats or incidents using chemical, biological, nuclear/radiological, or large explosive devices
• Infectious disease outbreaks and pandemics
• Animal health emergencies, such as those in support of ESF #11 (e.g., Bovine Spongiform Encephalopathy, Hoof and Mouth Disease)
• Any other circumstance that creates an actual or potential public health or medical emergency where Federal assistance may be necessary.

The Pandemic and All Hazards Preparedness Act amended section 2801 of the PHS Act to state that the Secretary of HHS shall lead all Federal public health and medical response to public health emergencies and incidents covered by the NRP. Federal public health and medical assistance provided under ESF #8 of the NRP may be categorized according to the functional areas described below.

1. Assessment of Public Health/Medical Needs: HHS, at the request of DHS, mobilizes and deploys ESF #8 personnel to support the Emergency Response Team-Advance (ERT-A)^[10] to assess public health and medical needs. This function includes the assessment of the public healthcare system/facility infrastructure.
2. Health Surveillance: HHS coordinates with State, Tribal, and jurisdictional officials to do the following:
   1. Establish surveillance systems to monitor the health of the general population and special high-risk populations
   2. Conduct field studies and investigations
   3. Monitor injury and disease patterns and potential disease outbreaks
   4. Provide technical assistance and consultations on disease and injury prevention and precautions.
3. Medical Care Personnel:
   1. Medical response capabilities are provided by assets internal to HHS (e.g., USPHS Commissioned Corps, the National Disaster Medical System (NDMS)).
   2. DoD may be requested to provide support in casualty clearing/ staging and other missions as needed.
   3. HHS may seek individual clinical health and medical care specialists from the VA to assist State, Tribal, and local personnel.
4. Health/Medical Equipment and Supplies: HHS may request that agencies provide medical equipment and supplies, including Federal Medical Stations (FMSs) that provide low acuity medical care, pharmaceuticals, and biologic products (e.g., SNS), etc., in support of immediate medical response operations and for restocking healthcare facilities in an area.
5. Patient Evacuation:
   1. HHS may request that DHS/FEMA and ESF #1 provide support to DoD for patient movement in the evacuation of seriously ill or injured patients from the affected area to locations where hospital care or outpatient services are available.
   2. DoD is responsible for regulating and tracking these patients to appropriate treatment facilities (e.g., NDMS non-Federal hospitals, VA hospitals, and DoD military treatment facilities).
6. Patient Care: HHS may request available personnel to support in-hospital care and outpatient services for victims who become ill or injured.
7. Safety and Security of Human Drugs, Biologics, Medical Devices, and Veterinary Drugs, etc.: HHS ensures the safety, efficacy, and security of regulated foods, human and veterinary drugs, biologics (including blood and vaccines), medical devices (including radiation emitting and screening devices), and other HHS regulated products.
8. Food Safety and Security: HHS, in cooperation with ESF #11, ensures the safety and security of Federally regulated foods.
9. Blood and Blood Products: HHS establishes and maintains contact with the American Association of Blood Banks Inter-organizational Task Force on Domestic Disasters and Acts of Terrorism^[11] and, as necessary, its individual members, to determine:
   1. The need for blood, blood products, and the supplies used in their manufacture, testing, and storage
   2. The ability of existing supply chain resources to meet these needs
   3. Any emergency measures needed to augment or replenish existing supplies.
10. Agriculture Safety and Security: HHS, in coordination with ESF #11, ensures the safety and security of animal feed and therapeutics.
11. Worker Health/Safety:
    1. HHS requests Department of Labor (DOL) assistance to coordinate responder and worker safety and health using processes detailed in the Worker Safety and Health Support Annex.
    2. HHS requests support, as needed, to assist in monitoring the health and well-being of emergency workers; performing field investigations and studies addressing worker health and safety issues; and providing technical assistance and consultation on worker health and safety measures and precautions.
12. All-Hazard Consultation, Technical Assistance, and Support: HHS assesses public health and medical effects resulting from all hazards. Such tasks may include the following:
    1. Assessing exposures on the general population and on high- risk population groups
    2. Conducting field investigations, including collection and analysis of relevant samples
    3. Providing advice on protective actions related to direct human and animal exposures, and on indirect exposure through contaminated food, drugs, water supply, and other media
    4. Providing technical assistance and consultation on medical treatment and decontamination of injured/contaminated individuals.
13. Behavioral Health Care:
    1. Assessing mental health and substance abuse needs
    2. Providing disaster mental health training materials for disaster workers
    3. Providing liaison with assessment, training, and program development activities undertaken by Federal, State, Tribal, and jurisdictional mental health and substance abuse officials
    4. Providing additional consultation, as needed.
14. Public Health and Medical Information: HHS provides public health, disease, and injury prevention information that can be transmitted to members of the general public.
15. Vector Control:
    1. Assessing the threat of vector-borne diseases
    2. Conducting field investigations, including the collection and laboratory analysis of relevant samples
    3. Providing vector control equipment and supplies
    4. Providing technical assistance and consultation on protective actions regarding vector-borne diseases
    5. Providing technical assistance and consultation on medical treatment of victims of vector-borne diseases.
16. Potable Water/Wastewater and Solid Waste Disposal:
    1. Assessing potable water, wastewater, solid waste disposal issues, and other environmental health issues
    2. Conducting field investigations, including collection and laboratory analysis of relevant samples
    3. Providing water purification and wastewater/solid waste disposal equipment and supplies
    4. Providing technical assistance and consultation on potable water and wastewater/solid waste disposal issues.
17. Victim Identification/Mortuary Services:
    1. Providing victim identification and mortuary services
    2. Establishing temporary morgue facilities
    3. Performing victim identification by fingerprint, forensic dental, and/or forensic pathology/anthropology methods
    4. Processing, preparation, and disposition of remains.
18. Veterinary Services: HHS, in coordination with ESF #11, assists in delivering healthcare to injured or abandoned animals and performing veterinary preventive medicine activities, including conducting field investigations and providing technical assistance and consultation as required.

Medical Care Personnel is a key functional area of the ESF #8 response. The USPHS Commissioned Corps provides public health, humanitarian, and clinical services and personnel during an emergency, disaster, or other urgent public health need. Based on lessons learned from Hurricane Katrina, the USPHS adopted a tiered response posture of rapidly deployable, well-trained, and well-equipped teams. Below is a brief description of the USPHS teams currently available. Other USPHS teams may be phased in across coming years as the USPHS continues to examine and enhance its response capability.

Overview of USPHS Commissioned Corps teams

• Rapid Deployment Force (RDF): The RDF consists of five pre-identified teams, each with 105 multidisciplinary staff. The teams serve on a rotating call basis, with the on-call team capable of deploying within 12 hours of notification. RDF teams have a built-in command structure and can provide mass care at shelters (including FMSs), staff Points of Distribution, and Casualty Collection Points. The RDF can also conduct community outreach and assessments, among other functions.
• Applied Public Health Team (APHT): The APHT is composed of experts in applied public health and can function as a "public health department in a box." An APHT can deploy within 36 hours of notification and provide assistance in public health assessments, environmental health, infrastructure integrity, food safety, vector control, epidemiology, and surveillance.
• Mental Health Team (MHT): The MHT consists of mental and behavioral health experts who assess stress and suicide risks within the affected population, manage responder stress, and provide therapy, counseling, and crisis intervention. The MHT can deploy within 36 hours of notification.

USPHS active duty officers who are not members of the aforementioned teams comprise supporting personnel who can deploy as teams or individuals within 72 hours of notification. Beyond the 72-hour mark, the USPHS Inactive Reserve Corps may be called on to augment the Active Duty Corps.

The National Disaster Medical System (NDMS) is another source of public health and medical personnel under ESF #8. The NDMS helps maintain our national capability to deliver quality medical care during domestic incidents that challenge or exceed normal medical capabilities or infrastructure in an affected area. NDM can provide assistance in three areas—field care, casualty evacuation, and definitive care—to support HHS under ESF #8 of the NRP.

Overview of NDMS teams

The NDMS is a nationwide partnership designed to deliver quality medical care to the victims of, and responders to, a domestic disaster. NDMS provides state-of-the-art medical care under any conditions at a disaster site, in transit from the impacted area, and into participating definitive care facilities. The main NDMS teams consist of the following:

• Disaster Medical Assistance Team (DMAT): DMATs provide primary and acute care, triage of mass casualties, initial resuscitation and stabilization, advanced life support and preparation of sick or injured for evacuation. The basic deployment configuration of a DMAT consists of 35 persons; it includes physicians, nurses, medical technicians, and ancillary support personnel. They can be mobile within 6 hours of notification and are capable of arriving at a disaster site within 48 hours. They can sustain operations for 72 hours without external support. DMATs are responsible for establishing an initial (electronic) medical record for each patient, including assigning patient unique identifiers in order to facilitate tracking throughout the NDMS.
• Disaster Mortuary Operational Response Team (DMORT): DMORTs work under the guidance of local authorities by providing technical assistance and personnel to recover, identify, and process deceased victims. Teams are composed of funeral directors, medical examiners, coroners, pathologists, forensic anthropologists, medical records technicians and transcribers, finger print specialists, forensic odontologists, dental assistants, x-ray technicians, and other personnel. HHS also maintains several Disaster Portable Morgue Units (DPMU) that can be used by DMORTs to establish a stand-alone morgue operation.
• Veterinary Medical Assistance Team (VMAT): VMATs provide assistance in assessing the extent of disruption and need for veterinary services following major disasters or emergencies. These responsibilities include: Assessing the medical needs of animals, medical treatment and stabilization of animals, animal disease surveillance, zoonotic disease surveillance and public health assessments, technical assistance to assure food and water quality, and animal decontamination. Teams are composed of clinical veterinarians, veterinary pathologists, animal health technicians (veterinary technicians), microbiologist/virologists, epidemiologists, toxicologists and various scientific and support personnel. Deployment configurations depend on the nature and scope of the incident.
• National Medical Response Team (NMRT): NMRTs provide medical care following a nuclear, biological, and/or chemical incident. This team is capable of providing mass casualty decontamination, medical triage, and primary and secondary medical care to stabilize victims for transportation to tertiary care facilities in a hazardous material environment. The basic deployment configuration of an NMRT consists of 50 personnel.

Additional medical care personnel are available through ESF #8 support agencies, such as the VA and DoD, and through the Medical Reserve Corps. During Hurricanes Katrina and Rita, the VA and DoD played significant roles in supporting ESF #8 missions. The VA (both facilities and personnel) was prominently involved in the operation of FMSs, while the DoD supplied aircraft, equipment, and personnel to facilitate the evacuation of patients and persons with special medical needs to facilities where they could receive appropriate care.

The Federal Government can also provide public health and medical equipment to support local response efforts during a public health emergency or disaster. One such deployable asset is the FMS, which can be used as a healthcare platform for stable patients with low acuity or primary healthcare needs. Below is a basic description of the FMS and its operating requirements.^[12]

The Federal Medical Station (FMS) is an HHS deployable healthcare platform that can deliver large-scale primary healthcare services anywhere in the U.S. A team of approximately 100 personnel is needed to staff the FMS, with personnel provided primarily by the USPHS. Each FMS contains a three-day supply of medical and pharmaceutical resources to sustain 250 stable primary care based patients who require bedding services. Additional roles for the FMS may include the following:

• Mass ambulatory vaccination services (using vaccination inventory from the SNS)
• Ambulatory prophylactic medication administration (using medication inventory from the SNS)
• Pre-hospital triage and initial stabilization for up to 250 mass casualty patients.

The FMS must be housed inside a structurally intact building that has roughly 40,000 square feet of space, a 10-person set up team, electricity, heating, air conditioning, ventilation, and clean water services. Reduced bed requirements can be accommodated in smaller facilities. Other operational requirements include bathroom and showering facilities, billeting for staff, and contracted support for food, potable water, laundry, ice, medical oxygen filling, and biomedical waste disposal. The FMS requires 48-96 hours from the time of request to delivery inside the continental U.S. and a 12-hour assembly time.

To address primary healthcare service needs far forward in a disaster area, HHS has a community outreach capability ("Go Bag") that is a rapidly deployable light strike team-based platform. Staffed primarily by the USPHS, each platform has basic medical and pharmaceutical resources to sustain 50 to 100 stable primary care based ambulatory patients. 

10. The DHS/FEMA-led ERT-A is the principal interagency group that conducts assessments and initiates coordination with the State and initial deployment of Federal resources.
11. Members of the Task Force include AdvaMed, American Association of Blood Banks, American Association of Tissue Banks, American Hospital Association, American Red Cross, America's Blood Centers, Armed Services Blood Program Office, Blood Centers of America, CDC, College of American Pathologists, FDA, Plasma Protein Therapeutics Association.
12. Readers are encouraged to work with their regional emergency coordinators to learn more about the FMS and state/local responsibilities for its operations.

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