Public Health Emergency - Leading a Nation Prepared
As the Primary Agency for ESF #8, HHS has developed a Concept of Operations Plan (CONOPS) that provides the framework for its management of the public health and medical response to an emergency or disaster. The HHS CONOPS is consistent with HSPD-5 and the NRP, and implements strategies to ensure a unified approach to all mitigation, preparedness, response, and recovery activities carried out by HHS. On behalf of the Secretary of HHS, the ASPR directs and coordinates all Federal public health and medical assistance provided under ESF #8. The ASPR also acts as the senior-level HHS liaison to DHS and other Federal departments and agencies.
Strategic coordination of the ESF #8 response
The ASPR coordinates the Federal ESF #8 response through the HHS Emergency Management Group or EMG, which operates from the SOC at HHS headquarters in Washington, D.C. By definition, the EMG is always operational at a baseline level and in times of non-response, it maintains a surveillance and monitoring posture. When preparing for or responding to an incident, the ASPR may raise the staffing level of the EMG and begin operations out of the SOC. The EMG's organizational structure is based on ICS principles.
The SOC is the focal point for command and control, communications, specialized technologies, and information collection, assessment, analysis, and dissemination for all HHS components under non-emergency and emergency conditions to support a common operating picture. It is continuously staffed and maintains operations 24 hours a day, 7 days a week (24/7). Because the SOC is always operational, it can rapidly enhance its services and staffing during times of crisis. When not in an emergency response mode, the SOC performs continuing surveillance of the following:
Watch Officers in the SOC maintain daily contact with other Federal operations centers to ensure situational awareness. Reports of incidents with potential public health or medical consequences are provided to the Duty Officer, who then alerts HHS senior staff as necessary. Critical public health and medical requirements are brought to the attention of the ASPR. During an event, the ASPR may deploy HHS liaisons to other Federal EOCs.
In addition to the SOC, some HHS OPDIVs, such as the CDC, maintain EOCs to manage their own assets. The OPDIV EOCs can be activated separately from the SOC when involved in a small-scale or "routine" response that does not require HHS department-wide coordination. However, when an OPDIV EOC is activated (only the SOC and the Director's EOC or DEOC at the CDC are operational 24/7), the EOC must notify the SOC and provide status updates of activities. During a department-wide response, the OPDIV EOCs coordinate their operational information with the SOC to establish a common operating picture. During response operations, staffing the SOC with experts from the HHS OPDIVs and Federal partners enhances ESF #8 coordination.
Operational coordination of the ESF #8 response
At the field level, the IRCT acts as the Secretary's agent on scene under the direction of the EMG. The IRCT consists of 10 pre-identified teams, with 30 multidisciplinary staff on each. The teams serve on a rotating call basis, with the on-call team capable of deploying within 12 hours of notification. The IRCT has a built-in command structure and is responsible for directing all ESF #8 response assets in the field. The IRCT is scalable to meet the demands of the incident. The IRCT coordinates the activities of all Federal ESF #8 resources deployed to assist States, Tribal Nations, jurisdictions, and other Federal agencies (see below). This includes teams deployed through HHS OPDIVs and the ESF #8 support agencies.
Key Roles of the IRCT
The IRCT is primarily responsible for supporting the public health and medical management of an incident. It does this by providing the field management component of the Federal public health and medical response. The IRCT is not designed to provide direct medical or mental-health care, decontamination, or public health services. Rather, the IRCT performs the following primary functions:
Consistent with NIMS, each IRCT has a team leader and other appropriate personnel to fill ICS positions (Figure 7-1). The IRCT Leader typically is an HHS Regional Emergency Coordinator (see description below); however, the ASPR maintains the right to appoint another qualified person to fill this position. To better coordinate all ESF #8 response components, the IRCT has liaisons from HHS OPDIVs and ESF #8 support agencies to integrate all ESF #8 activities under a single ICS. Any team from an OPDIV or ESF #8 support agency (e.g., VA, DoD) that is deployed during a disaster must report to that agency's liaison at the IRCT.
Figure 7-1. IRCT Organizational Chart
During large-scale or complex incidents, the Secretary of HHS may also deploy a Senior Health Official (SHO) to serve as his/her direct representative in the field. The SHO is typically an Admiral from the USPHS Commissioned Corps. When deployed, the SHO is responsible for overarching coordination of deployed HHS resources and provides guidance and leadership to the IRCT. The SHO essentially acts as an Agency Executive, as described in ICS, to the IRCT. The SHO serves in the JFO Coordination Group as the principal ESF #8 liaison to the PFO and other senior Federal, State, Tribal, and jurisdictional officials.
HHS has a cadre of regionally based personnel who work with State and local authorities on a variety of public health and medical initiatives, including preparedness and response to major events. It is important for public health and medical planners to understand the roles of these regionally-based personnel and to establish working relationships with them during preparedness planning to facilitate Federal support in a crisis. Brief descriptions of key regional personnel are provided below and their respective roles in preparedness, response, and recovery are summarized in Figure 7-2.
Figure 7-2. Roles of HHS Regional Personnel in Emergency Management
Primary POC for elected officials
Coordinates overall recovery efforts
Facilitates acquisition of necessary Federal resources
Work with State Health Directors
Serves as a liaison for Assistant Secretary of Health to State health
Serves in public health advisory role as requested and in support of the REC
Liaison with State Health Directors
May serve as SHO
Facilitates recovery effort with State Health Directors
Maximize HHS invest-ment in region
Regional lead for preparedness
Works will all State health officials and State emergency managers
Lead for ESF #8 regional response
IRCT Team Leader
POC for recovery but triages requests for support to the appropriate office
Liaison and advisor to the REC
Participates in regional planning activities to plan for human service programs
ACF is responsible for HHS ESF#6 related activities
Assesses and coordinates ACF response
Provides a liaison to the IRCT
Provides support to program recipients
Coordinates human services support
Recommends program areas which may need support during recovery
Works in the State health department and represents CDC
Advises States on the use of CDC assets and provides technical assistance
Deploys as needed at direction of Secretary
Oversees IRCT field activities
Provides strategic level decision making and liaison between the PFO/FCO and HHS field activities
The EMG deploys liaisons to field operations centers (e.g., JFO) to represent the Federal public health and medical response effort. Following the lessons learned from Hurricane Katrina, the JFO has been restructured along ICS lines, with ESF #8 liaisons within each ICS Section. The senior HHS liaison at the JFO is the SHO (if deployed).
The framework by which HHS responds to threats or public health emergencies is characterized by three general stages: notification and alert, deployment and operational management, and transition and disengagement. Each of these stages is described in detail below.
Notification and Alert
HHS learns about credible threats to the public's health, as well as potential or actual emergencies, from public health and emergency management authorities at all levels of government, disease surveillance systems, law enforcement agencies, intelligence channels, agricultural, industrial, and environmental agencies, and the media. The SOC is the notification point within HHS for public health threats and emergencies, and it should be contacted immediately (via established local to State to Federal communications channels) with any information regarding a threat or emergency.
Once notified, the SOC performs a series of pre-determined notifications within HHS, including the ASPR, the Secretary, the Deputy Secretary, and key members of the EMG staff. Depending on the nature of the incident, the ASPR may notify other senior Departmental officials, OPDIV EOCs or Heads, key Federal EOCs, and the relevant RHA, RD, and REC. As situational awareness is gained, the ASPR directs further actions, which may include activation of the EMG, which deploys liaisons to other Federal EOCs and/or places ESF #8 response teams or personnel on alert status.
The EMG also convenes an ESF #8 conference call to assess the situation and determine the appropriate actions. The EMG alerts pre-designated HHS personnel to represent ESF #8 on the following:
Deployment and Operational Management
The Secretary of HHS, through the ASPR and the ESF #8 EMG, directs the activation and deployment of ESF #8 assets in support of State, Tribal, or jurisdictional incident management. The EMG activates an IRCT as required to coordinate locally the activities of all deployed ESF #8 assets and to represent ESF #8 in interactions with the affected local, State, or regional response structure. If there are multiple incidents, or one incident with widespread implications, the EMG may deploy multiple IRCTs. As stated earlier, the Secretary may also deploy a SHO to serve as the senior ESF #8 advisor in the JFO Coordination Group and to provide overarching field-level guidance and leadership to the IRCT.
At the request of the EMG, HHS OPDIVs and ESF #8 support agencies provide liaisons to the SOC to ensure a common operating picture and a coordinated ESF #8 response. Similarly, HHS may be asked to provide liaisons to other operations centers. The SOC schedules video and/or audio conferences at regular intervals to facilitate communi-cations between the different components of the ESF #8 response and affected State, Tribal, and local authorities.
During incident operations, HHS oversees and coordinates appropriate missions under ESF #8 in accordance with FEMA mission assignments (if the Stafford Act has been invoked). EMG staff review each mission assignment received from FEMA to determine the most appropriate resource to meet the identified need. In some cases this may be an asset within HHS; in others, the EMG tasks its ESF #8 support agencies to provide the necessary resource(s). Through regular communications with the IRCT Leader, the EMG assesses the status of all ESF #8 mission assignments and anticipated future public health and medical needs.
Transition and Disengagement
The Secretary of HHS, through the ASPR, decides when to demobilize ESF #8 assets based on the successful completion of ESF #8 mission assignments and assessments of the overall public health and medical response. The demobilization of ESF #8 assets, including those from HHS OPDIVs and ESF #8 support agencies, is coordinated with the IRCT. With the demobilization of the IRCT, full responsibility for coordination with incident authorities transitions back to the regional staff and to any OPDIVs with regional assets stationed on a day-to-day basis in the region.
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