Action Steps/Issues

1. HHS transition from “normal” to “Coordinated Departmental Emergency Response Operations” 

2. Begin structured planning process. Brief the Secretary/Deputy Secretary

• Situation update.
• Required tasks
• Available assets
• Determine constraints
• Identify critical facts and assumptions
• Determine critical information requirements

3. Activate the EMG 

•  Initiate notification roster
• Determine additional EMG staffing requirements and OPDIV EOC activation requirements
• Prepare daily or more frequent situation reports for the Secretary on preparedness efforts
• Designate Incident Manager (IM)
• Begins response planning in coordination with relevant support agencies
• Begin development of possible ESF #8 mission assignments in coordination with ESF #8 partners, State/local officials and DHS
• Establish and maintain contact with OPDIVS  and ESF#8 Federal partners
• Establish and maintain contact with appropriate RECs
• Develop initial Incident Action Plan (IAP)

 4. Coordinate/Conduct meeting to determine possible missions, deployments

• Consider the requirement to establish PODs
• Epidemiology Support
• Medical Treatment Support
• Subject Matter Expert Support

5. Begin coordination with the Interagency, including DHS and DOS, and the White House

• Prepare/Detail required liaison officers to DHS and other agencies as requested
• Alert ESF #8 partners
• Begin coordination with appropriate DHS/FEMA contacts (RRCC, RECs, etc)
• Alert/Deploy the Incident Response Coordination Team

SEC HHS/ASPR/ESF #8 Supporting Agencies

ASPR/IM 

6. Formalize and distribute ESF-8 response structure, decisional authorities, and trigger points for public health & medical interventions. 

7. Review risk status (i.e., health screening and countermeasure status) of all federal and contractor employees who could potentially deploy in support of ESF-8 response activities. 

8. Establish contact with key public health, healthcare, and community partners (i.e., State Health Department, State OEM, State Hospital Association, etc.) 

9. Establish and publish schedule for recurring activities (Conference Calls, VTCs, etc.)

10. Request/Review appropriate State, Tribal and local emergency management plans, focusing on:

• Point of Dispensing (POD) operations\
• City Readiness Initiative
• Patient regulating and movement processes
• High acuity care expansion capability 

11. Consider increasing the capacity of medical and emergency response systems to meet expected needs by identifying/alerting/pre-staging/deploying/distributing:

• Federal healthcare assets, including NDMS, FMS and ESF #8 partner assets
• Epidemiological support
• Veterinary surveillance
• Laboratory activities
• Critical care capability
• POD capabilities (augmentation/establishment)
• Commissioned Officer Corps Teams
• Pharmacy activities
• NDMS Teams
• Medical/Surgical/Burn Nurse teams
• SNS counter measures and other appropriate supplies and material
• Additional reagents and consumables for surge testing at appropriate LRN laboratories  

12. Provide updated information to medical providers and healthcare organizations seeking treatment and management guidance and algorithms for RDD/RED exposure. 

13. Coordinate lab surge capabilities with CDC and State/Tribal/local authorities. 

14. Begin collecting and collating applicable information for the area.

• GIS
• Meteorological\
• Transportation
• Intelligence
• Law Enforcement
   

15. Decisions to pre stage or deploy medical countermeasures need to be made based on the credibility of the intelligence and the threat 

16. Decisions on hospitalized patient evacuation need to be made based on the credibility of the intelligence and the threat 

17. Review Communications Plan.

• Mitigation
• Preparedness
• Response
• Recovery 

18. Review Media Campaign Plan.

• Contacts
• Information requirements
• Timelines

19. Identify SMEs on medical and public health aspects of RDD/RED exposure

20. Identify HHS spokesperson(s).

21. Identify public affairs liaison officer assignments and responsibilities.

1. Activate Emergency Support Functions (ESF)s in support of the even

2. Consider declaring a public health emergency

3. Activate all components of the EMG to include selected liaisons and specialties

• Expand Ops, Planning, Log, and SME cells as required
• Request LNO from ESF #8 partners as required (e.g. DOT, DoD, VA, DHS/FEMA, ARC, DOE, EPA, OSHA, FEMA Recovery LNO)
• Request LNO from operating/staff divisions
• Working with State & Local Authorities and DHS  determine the event as an RDD/RED and the type of radiological agent to determine the appropriate countermeasures

4. Provide representative to ERT-A and Deploy IRCT –A, IRCT (including SHO)

1. Operations Section
   •  Initiate regular HHS-EMG Coordination Call
   • Alert rostered teams (RDF, APHT, MHT, NDMS IRCT, HHS Human Services  technical assistance team and subject matter expert assessment team) 
2. Planning Section
   • Prepare Incident Action Plan and assure plans are coordinated with ESF #8 support agencies, IRTC, OpDivs/Staff Divs and DHS/FEMA.
   • Analyze vulnerability of critical health care infrastructure in the expected impact zone.
3. Logistics Section
   • Coordinate medical support within HHS
   • Coordinate non-medical support with FEMA 
4. Administration and Finance
   • Ensure that funds are available to support operations
   • Process Mission Assignments and Sub Tasks
   • Track mission assignments
   • Institute tracking of deployed personnel 

EMG
EMG-OPS

EMG/OFRD
EMG/HSC liaison

EMG Plans/OPEO CIKR and FEMA recovery liaison

EMG LOG/DHS/FEMA
EMG LOG/DoD
EMG A&F

5. Upon receipt of the NOC/NRCC Activation Order

1. Update situational awareness and ensure visibility of the common operating picture is maintained.
2. Staff the ESF #8 desks at the NRCC, IMPT, NOC, as requested
3. Ensure that all essential functions can be performed and all related services can be provided.
4. Initiate incident-specific information and data collection, analysis, and assessment
5. Perform effects and consequences modeling and simulation analysis on the geography, demographics, and population, including the at-risk population and critical infrastructures. Coordinate with IMAAC.
6. Confirm essential communication and coordination links with Other Federal Agencies (OFA) to ensure optimal information sharing, and a common understanding of the expected mission and objectives.
7. Establish initial Battle Rhythm video teleconferences and other conference calls within ESF #8 emergency management community concerning the situation, mission and objectives
8. Confirm lines of communication and coordination with non-collocated command and control entities.
9. Continue to review and validate internal and interagency senior officials’ “playbooks” and “checklists” including:
   • Essential Elements of Information (EEI)
   • Information collection requirements and capabilities;
   • Information analysis and intelligence procedures; and
   • Reporting requirements
10. Prepare to execute Pre-Scripted Statements of Work (PSOWs) and Sub Tasks to ESF#8 partner departments and agencies and HHS OpDivs/StaffDivs and ensure existing interagency and contractual vehicles are available for rapid implementation and execution
11. Disseminate IMACC products as appropriate

6. Compare pre-impact with initial post-impact of the likely consequences to the public health, medical and human services critical infrastructures

7. Provide all ESF#8 partners with specific reporting/requesting guidance on dosimetry and personal protective equipment for entry into the area of operations.

8. Deploy supplies and equipment packages (logistics support) for all ESF #8 teams / personnel deployed in support of ESF #8 missions

9. Coordinate with the potentially deployed IRCTs to stage FMS and advance personnel to set-up and install FMS Installation Team

10. Establish and maintain contact with key public health, healthcare, and community partners, including partners serving the at-risk population

11. Develop, release and communicate guidance to public health officials and community partners, EMS for response, including counter-measures, concepts of operations, protective action guidelines, triage information, food safety, shelter in place, water safety, etc.

12. Upon receipt of Mission Assignment from FEMA execute the appropriate sub tasks as required.

13. Deploy other logistics assets for ESF #8 teams/personnel to staging locations

EMG-LOG

14. Assess and coordinate  Security Requirements for ESF #8 assets

15. Activate and deploy NDMS teams and patient movement components as appropriate.

16. Request NDMS , HaVBED and BARTs bed counts

17. Activate the American Association of Blood Banks Interagency Task Force on Domestic Disasters and Acts of Terrorism (AABB) to assess the current blood supply levels throughout the country

18. Coordinate with AABB Task Force to identify supply levels at the supporting medical facilities for the incident.  Activate supply distribution plans for affected region(s).

19. Obtain approval for AABB Task Force coordinated public information assistance announcement re: the adequacy and safety of the nation’s blood supply.

20. Request assessment of healthcare infrastructure from the IRCT(s).

21. Identify sites of opportunity for RTR 1-3,and MC and AC sites (as needed)

22. Obtain evacuation and patient transportation routes

23. Obtain decontamination sites for support at extraction points and/or at Triage locations.

24. Obtain receiving, distribution and transportation Hubs (logistics Stand-up)

25. Stage/Deploy ESF #8 teams and equipment caches as required in support of MC sites.

26. Coordinate with FEMA requirements for medical personnel augmentation at general/mass care shelters

27. Activate the Ambulance Contract for medical transportation (ground, air and para-transit ambulances)

28. Activate Radiation Injury Treatment Network to potentially receive patients with Acute Radiation Syndrome.

29. Activate the Rapid Response Victim Registry

30. Request DOJ to establish missing persons HOTLINE or integrate with the National Center for Missing and Exploited Children for tracking of patients, persons looking for family members

31. Deploy the Interagency Advisory Team (A Team)

32. Provide recommendations regarding decontamination and medical management

33. If SNS assets required, deploy CDC TARU team and/or FMS teams as necessary

34. Deploy SNS radiation countermeasures as indicated by type of radionuclide and types of injury

35. Alert VA to be prepared to provide health and medical logistics/supply support via National Acquisition Center (NAC).

36. Submit EUA /IND for countermeasures that are not FDA approved. (EUA Playbook)

37. Convene Medical Interagency Coordinating Group (MIACG) to evaluate and make recommendations regarding the medical need and patient evacuation, including evacuation of members of the at-risk population.

38. Participate in the National Incident Communications Conference Line (NICCL) composed of Federal public affairs officers as well as local and state public affairs officers.  The goal of the NICCL is to develop and implement a coordinated communications plan that ensures the provision of timely and accurate information across all levels of government (“one voice”).

39. Provide information on medical and public health response activities with as much granularity as possible

40. Provide anticipatory guidance on how the public health and medical response (including mass fatality management) will unfold over time

41. Explain the rationale for difficult decisions that must be made due to overwhelming need in the context of resource scarcity (e.g., first priority is to save as many lives as possible)

42. Provide behavioral health expertise to help craft messages

43. Provide talking points that give protective guidance (“Protective Action Guidelines” (PAG) e.g., worker health and safety; decontamination, evacuation vs. shelter-in-place); information on the zone of exclusion, and where/how to seek care

44. Provide information (when available) for Medical Providers seeking treatment and management guidance and algorithms.(REMM)

45. Identify SMEs on medical and public health aspects of radiation health

46. Identify HHS spokesperson(s)

47. Ensure that in communicating with the public, the needs of at risk, such as individuals with disabilities and individuals with limited English proficiency, are taken into account

48. Ensure communication with the at risk population, including limited English proficient individuals and individuals with disabilities

1. Coordinate rapid needs assessments with FEMA (public health, medical and human services infrastructure) 

 2. Adjust HHS-EMG Staffing levels as required

1. Expand Ops, Planning, Log, A&F and SME cells as required
2. Request additional LNOs from ESF #8 partners as required (e.g., DOT, DoD, VA, DHS/FEMA, ARC, DOE, EPA, OSHA)

3. Make necessary adjustments to pre-scripted Sub Tasks 

4. Update situational awareness of hospital and healthcare infrastructure facilities (including power, water and debris) in the impact zone. Determine capability to continue operations.

5. Prepare tasks for USACE/ESF#3 to prioritize continuity of operations for hospital and healthcare infrastructure facilities (includes power, water and debris removal).  

6. Review damage assessments and consult with FEMA regarding whether activation of ESF #14 is required

7. Develop common operating picture for long-term recovery and establish a transition to recovery plan

8. Produce ongoing and accurate public health, medical and human services status assessments, including status of at-risk population and service animals

9. Coordinate the requirement for Medicare/Medicaid and other statutory waivers for health, human services and other Federal benefits

10. Expedite new or re-enrollment into health and human services Federal Benefits

11. Capture after-action comments

12. Deploy additional NDMS and PHS assets as required

13. Deploy staged personnel in accordance with Mission Assignments

• Additional IRCTs as needed
• ESF #8/HHS Teams (MERT, NMRT, DMORT-WMD, etc)
• LNOs
• Federal and non Federal partners

14. Make necessary recommendations for at-risk persons regarding support needed

15. Assess the need to use the Emergency System for Advance Registration of Voluntary Health Professionals (ESAR-VHP). 

16. Assess need for MRC Federal-level activation

17. Receive, process, track and sub-task (as needed) MAs

18. Conduct and maintain Situational Awareness reporting, including reporting regarding the at-risk population

19. Deploy ESF #8 medical and public health and HHS human services teams to augment shelters

20. Coordinate medical care support for mass care requirements

21. Deploy assets in support of fatality management as requested.

22. Update dose rate data for responders and for potential reentry into safe regions

23. Assist states with surveillance for outbreak/reports of abnormal disease or disease rates and “pockets” of at-risk population in the affected areas, including the community, medical facilities, and shelters.

24. Assist states through direct or technical assistance in the collection and analysis of data from injury, illness and mortality surveillance activities

25. Provide CDC staff to supplement state efforts to address identified public health issues/concerns

26. Conduct  inspections and  assess damage to FDA-regulated industry in impacted areas

27. Assist states with collection/analysis of FDA-regulated product samples

28. Provide technical assistance or subject matter expertise to states related to FDA-regulated products (food, drug, medical device and biologics safety) and conduct assessment of food retail establishments in impacted area.

29. Conduct active review all adverse event reports related to FDA-regulated products

30. Assist States with surveillance efforts to determine product integrity of pharmaceuticals, medical supplies and equipment in aftermath of incident.

31. Identify updated countermeasures, medical supplies and equipment

32. Establish procedures for SNS shipments of necessary countermeasures, medical supplies, and equipment to affected area

33. Activate Emergency Prescription Assistance Program (EPAP)

34. Review and adjust patient evacuation/repatriation plans with ESF #8 partners.

35. Continue situation briefing/conference calls for ESF partners and OPDIVS/STAFFDIVS

36. Continue to participate in NICCL.

• Continue providing information and anticipatory guidance to the public, including the at-risk population.
• Reiterate rationale for difficult decisions that must be made due to overwhelming need in the context of resource scarcity (e.g. first priority is to save as many lives as possible).
• Continue providing talking points on worker health and safety; decontamination, evacuation vs. shelter-in-place); information on the zone of exclusion, and where/how to seek care.
• Maintain hotline capacity for medical and behavioral health questions.
• Disseminate information on volunteer opportunities and rostering mechanisms (phone line, internet) decontamination, evacuation vs. shelter-in-place); information on the radiation zone, and where/how to seek care.

1. Report to FEMA and local authorities on progress development in restoring minimal functionality to the medical and public health infrastructures 

2. At the direction of the JFO/NRCC, implement demobilization and deactivation plan for the release of appropriate ESF #8 components. 

3. Adjust  ESF #8 assets to ensure (a) continued visibility on the execution of longer term Mission Assignments and (b) maintain situational awareness to support additional response operations. 

4. Capture items for the draft after-action report 

5. Coordinate with IRCT and ESF#8 supporting agencies, the demobilization of ESF#8 resources when all operational objectives contained in the ESF#8 Incident Action Plan have been met or affected State, or DHS determines that resources are no longer needed. 

6. Deactivate and demobilize specific response assets when its specific task or Mission Assignment is completed. 

7. Adjust HHS-EMG operations commensurate with field activities including all LNOs 

8. Develop a demobilization plan 

9. Coordinate the transition to recovery activities with OPDIV/STAFFDIVS 

 10. Transition response to State and local authorities

11. Demobilize personnel as required in accordance with MAs completion 

12. Transition to routine operations for OPDIVs as appropriate. 

13. Determine need and requirements for long-term post-event surveillance or investigation, including surveillance of at risk population. 

14. Continue assistance to States regarding surveillance efforts, including surveillance of at risk population. 

15. Continue to coordinate with state, local, and tribal environmental health department to ascertain ongoing and/or anticipated need for technical assistance, consultation, and support 

16. Continue to monitor worker safety and physical and mental health 

17. Continue inspections of FDA regulated industry and work with states as needed to assess retail food establishments in impacted areas 

18. Continue to assist states through collection and/or analysis of FDA-regulated product samples. 

19. Continue to provide states technical assistance or subject matter expertise related to FDA-regulated products food, drug, medical device and biologics safety; water safety as it affects FDA-regulated  products; informed consent; clinical trials 

20. Continue to review all adverse event reports related to FDA-regulated products 

21. Establish procedures for follow on shipments of necessary countermeasures, medical supplies, and equipment to affected area.

22. As situation warrants, begin SNS redeployment/recovery/transition planning

23. Inventory and return non-essential equipment for reconstitution

24. Continue patient evacuation

25. Continue situation briefing/conference calls for ESF partners and OPDIVS/STAFFDIVS until demobilization complete.

26. Continue coordination with IRCT until demobilization.