# Presentation: 394466

## CDC Preparedness and Response Activities Prevent, Detect, Investigate, Control, Recover, Improve

## Presentation Outline

- CDC preparedness and response activities overview
- Description of basis and authority of CDC response
- CDC management structure
- Field management structure
- Overview of deployment process and supporting incident management structure

## DEOC 21    770-488-7100   24/7

## CENTERS FOR DISEASE

- Coordinating Center

- for Infectious

- Diseases

**OFFICE OF THE**** **

**DIRECTOR**

**CENTERS FOR DISEASE**
**CONTROL AND PREVENTION**

- CDC WASHINGTON

- OFFICE

- OFFICE OF CHIEF

- OPERATING OFFICER

- OFFICE OF CHIEF OF

- STAFF

- Coordinating Center for

- Health Information and

- Services

- OFFICE OF CHIEF

- SCIENCE OFFICER

- OFFICE OF CHIEF OF

- PUBLIC HEALTH

- PRACTICE

- OFFICE OF STRATEGY

- AND INNOVATION

- Coordinating Center

- for Health

- Promotion

- Coordinating Center for

- Environmental Health

- and Injury Prevention

- Coordinating Office

- of Global

- Health

- OFFICE OF

- ENTERPRISE

- COMMUNICATION

- National Center for

- Health Marketing

- OFFICE OF

- WORKFORCE

- AND CAREER

- DEVELOPMENT

- National Center for Public

- Health Informatics

- National Center for

- Health Statistics

- National Institute for

- Occupational Safety

- and Health

- National Center for

- Infectious Diseases

- National Center for HIV

- ,

- STD

- , &

- TD Prevention

- National Immunization

- Program

- National Center for

- Chronic Disease

- Prevention and Health

- Promotion

- National Center for Birth

- Defects and

- Developmental

- Disabilities

- Office of Genomics and

- Disease Prevention

- National Center for

- Environmental Health

- /

- Agency for Toxic

- Substances and Disease

- Registry

- *

- National Center for Injury

- Prevention and Control

- Coordinating Office For

- Terrorism Preparedness

- &

- Emergency Response

## Division of Emergency Operations 

## Preparedness Goals

| Pre –Event | Event | Post-Event |
| --- | --- | --- |
| Prevent
 Increase the use and development of interventions known to prevent human illness from chemical, biological, radiological agents and naturally occurring health threats.

Decrease the time needed to classify health events as terrorism or naturally occurring in partnership with other agencies | Detect
Decrease the time needed to detect chemical, biological, radiological agents in tissue, food or environmental sample that cause threats to the public’s health.

Improve the timeliness of information regarding threats to the public’s health as reported by clinicians and through electronic early event detection in real time | Recover
Decrease the time needed to restore health services and environmental safety to pre-event levels.

Increase the long-term follow-up provided to those affected by threats to the public’s health. |
|  | Investigate
Decrease the time to identify causes, risk factors, and appropriate interventions for those affected by threats to the public’s health. | Improve
Decrease the time needed to implement recommendation from after-action reports following threats to the public’s health. |
|  | Control
Decrease the time  needed to provide countermeasures and health guidance to those affected by threats to the public’s health |  |

**Preparedness Goals**

**Notes:**
Example #1

## Guiding References 

- _HSPD-5, 8 (2003):_ Established policies to strengthen the preparedness of the Unites States to prevent and respond to terrorist attacks, major disasters and all-hazards.
- _National Response Plan:_ An all-discipline, all-hazards plan that establishes a single, comprehensive framework for the management of domestic incidents.
- _National Incident Management System:_  The National Incident Management System (NIMS) provides a consistent approach for Federal, State, and local governments to work effectively and efficiently together to prepare for, prevent, respond to, and recover from domestic incidents, regardless of cause, size, or complexity .

## Guiding References cont.

- _Target Capabilities List (TCL):_ 36 essential capabilities that should be maintained and developed by government.
- _Universal Task List (UTL):_ A menu of tasks that may be performed during mitigation, preparedness, response and recovery from a major event.
- _National Planning Scenarios:_ A listing of 15 plausible terrorist attacks and natural disasters that would stretch the Nation’s prevention and response capability.
- _National Preparedness Goals:_ Planning, under uncertainty, to provide capabilities suitable for a wide range of threats and hazards by using  risk-based target levels of capability, which enables entities to prioritize needs, update preparedness, allocate resources and deliver preparedness programs.
- _CDC Emergency Operations Plan with Annexes_

## An all-discipline, all-hazards plan 

Establishes a single, comprehensive framework for the management of domestic incidents

Provides the structure for Federal support

Consists of the Base Plan, Emergency Support Function Annexes (ESF), and Incident Annexes

- Establishes a single, comprehensive framework for the management of domestic incidents
- Provides the structure for Federal support
- Consists of the Base Plan, Emergency Support Function Annexes (ESF), and Incident Annexes

- National Response Plan: The Guiding Principles for Domestic Incidents

## National Incident Management System (NIMS)

- A system that provides a consistent nationwide approach for incident management
- Requires Federal, State, tribal, and local governments to work together before, during, and after incidents
- Involves preparing for, preventing, responding to, and recovering from domestic incidents
- All causes, sizes, and complexities of incidents
- Common terminology, structure, processes

## The 15 ESFs

| 1: Transportation
Department of  Transportation | 6: Mass Care, Housing,
Human Services
Department of Homeland 
Security, American Red Cross | 11: Agriculture and Natural Resource
Department of Agriculture/ Food and Nutrition Service  |
| --- | --- | --- |
| 2: Telecommunications and TechnologyNational Communications System | 7: Resource Support
General Services Administration
 | 12: Energy
Department of Energy  |
| 3: Public Works and Engineering
Department of Defense/Army Corps of Engineers | 8: Public Health and
Medical Services
Department of Health and Human Services | 13: Public Safety and Security  |
| 4: Firefighting
Department of Agriculture/ Forest Service 

5: Emergency Management
Federal Emergency Management Agency | 9: Urban Search and Rescue
Federal Emergency Management Agency

10: Oil and Hazardous Materials Response
Environmental Protection Agency
 | 14: Community Recovery, Mitigation, and Economic Stabilization
US Small Business Administration 

15: Emergency Public Information and External Communications
 |
|  |  |  |

## ESF 8: Public Health and Medical Services

**Primary Functional Agency:**
- Department of Health and Human Services
**Purpose/Mission:**
- Provide coordinated Federal assistance to
- Supplement State and local resources in response to public health and medical care needs following a major disaster or emergency
**Support Agencies:**
- USDA, DOD, DOE, DOJ, DOT, VA, AID, ARC, EPA, DHS/FEMA/EPR, GSA, NCS, and USPS

**Notes:**
USDA, DOD, DOE, DOJ, DOT, VA, AID, ARC, EPA, FEMA, GSA, NCS, and USPS

## Assessment of public health/medical needs 
Medical care personnel 
Public health surveillance 
Medical equipment and supplies 
Patient evacuation 
Patient care 
Safety and security of human drugs, biologics, medical devices, veterinary drugs 
Food safety and security 
Agricultural safety and security 
Worker health/safety 

- Medical care personnel
- Public health surveillance
- Medical equipment and supplies
- Patient evacuation
- Patient care
- Safety and security of human drugs, biologics, medical devices, veterinary drugs
- Food safety and security
- Agricultural safety and security
- Worker health/safety

- All-hazards consultation and technical assistance and support
- Mental health care assistance
- Public health and medical information
- Vector control assistance
- Potable water/waste water and solid waste disposal, and other environmental health issues
- Victim identification / mortuary services
- Veterinary services
- Blood products and services

**ESF 8 Responsibilities**

## Director’s Critical Information Requirements (DCIR)

- Report disease outbreaks that are above the base line for the seasonal or geographic norm.
- Report H5N1 human to human transmission.
- Report any chemical, biological, nuclear threats or events.
- Report deaths from an infectious disease above normal base line.
- Report media interest for any accidental or intentional agent or toxin release/use.
- Report vaccine adverse affects resulting in death.
- Report food borne illness resulting in large numbers affected.
- Report accidental death/injury of CDC personnel.
- Report requests for use of CDC aircraft.

## Notification Process

**CDC**
**DEOC**

**Notification Process**

## CDC RESPONSE SYSTEM TIERED PHASES

**DEOC Opns Chief**
**DEOC Core Staff**
**Global Monitoring**

_**Response**_
**Incident Manager **
**Full DEOC IM Staffing**
**Deploy CDC Resources**
**Monitor Incident**
**Deploy SMO**
**IAP development**
**Gather intelligence**
**Report Information**
**On-Scene:**
**IRCT/SMO/ESF#8**
**SMO manage deployed resources**

_**Alert**_
**DEO Director:**
**CIO/ ATSDR SME Alerted**
**Mission Analysis Reviewed**
**Increased Activity:**
**Federal & State create COP**
**Conduct Planning-IAP**
**Deployment Preparation**

**HHS Response/ RL 0 - 5**

**CDC DCIR’s**

## STAFF IN DEOC

- EVENT INTENSITY

**TIER 0**
**3-7**

**TIER 1**
**30-45**

**TIER 2**
**60-100**

**TIER 3**
**100-232**

**WATCH**

**ALERT- RESPONSE**

## CDC / HHS Hurricane Phases to Tiers Chart

| Timeline |  | HHS Phases |  | CDC Phases |  | CDC Response |  |
| --- | --- | --- | --- | --- | --- | --- | --- |
| June 1, 2006 Hurricane Season Begins |  | Normal Operations |  | CDC Pre-Event Phase
Prepare for Hurricane Season |  | Watch Mode |  |
| H-168 to H-96 |  | Phase 0 |  | Phase 0 |  | Alert Mode |  |
|  |  |  |  |  |  | Response Mode |  |
|  |  |  |  |  |  |  | Tier 1 |
| H-96 to Landfall |  | Phase I |  | Phase I |  |  |  |
|  | H-96 to H-72 |  | Stage 1 |  | Stage 1 |  |  |
|  |  |  |  |  |  |  | Tier 2 |
|  | H-72 to H-48 |  | Stage 2 |  | Stage 2 |  |  |
|  | H-48 to Landfall |  | Stage 3 |  | Stage 3 |  |  |
|  |  |  |  |  |  |  | Tier 3 |
| Landfall to start of Phase III |  | Phase II |  | Phase II |  |  |  |
| Demobilization and Deactivation Phase  |  | Phase III |  | Phase III |  | Tailored to Requirements |  |

## Basic ICS Structure        

**       ****INCIDENT COMMANDER**

**SAFETY**

**PIO**

**LIAISON**

**OPERATIONS**

**PLANNING**

**LOGISTICS**

**FINANCE AND ADMISTRATION**

## CDC Event Management Challenges

- Stabilize management structure
- Core elements the same for all events
- CDC-wide NIMS training and education
- Reporting hierarchy
- Synthesizing information received from field
- Personnel accountability
- Refining and exercising the plans

## Command vs Management

- Incident Command (IC)
- On scene _control_ over resources
- _Authority_ to direct missions
- _Decision_ authority to resolve on scene issues
- _Accountable_ for success or failure
- Incident Management (IM)
- _Coordinate_, gather information, analyze and _recommend_
- _Provide_ technical assistance through SME’s to the IC
- _Provide_ resources as requested by the IC to the scene
- No direct authority over field resources
- _Monitor_ agency-provided resources in the field.
- Agency resources under the Operational Control (OPCON) of the IC.

## Sample Transition from Functional Organization to IMS

## Transition from Current Organization to IM for Task Accountability, Authority, and Responsibility

- Responsibility  and authority for coordination and execution transitions to Team leads and Incident Management System

**TASKS**

| 0 | 1 | 2 | 3 | 4 | 5 | 6 |
| --- | --- | --- | --- | --- | --- | --- |

**Coordinated by Chief Health Officer (Jim Leduc)**

**Provide Team Resources**

**Guidance**

- Coordinating Centers and CIOs

**Accountable**

- Team Leads and members are  responsible for coordination, planning and execution of tasks

- = Authority

**WHO Phases**

**IMS**

**PLANNING**

**RESPONSE**

- Accountability remains with CC/CO/NIOSH

##  CDC Incident Management Structure

##  Operations Section

## Planning Section

## Logistics/F&A Sections

**Logistics/F&A Sections**

## DHHS

- (ESF # 8)

- SOC/EMG

- CDC

- Dr. J L Gerberding

- DEOC

- Deputy Health
- Officer
- (Toby Merlin)

- Chief OPNS
- &
- Science OPS

- Incident
- Manager
- (Phil Navin)

- Chief Health
- Officer
- (Steven Redd)

- Chief PLANS
- &
- Science PLANS

- Chief LOG

- Chief FINANCE

- Deputy IM
- Officer
- (Mr. Bruce Burney)

- States

- ESF # 8
- Senior Health Official &
- IRCT

- PFO
- &
- JFO

- Public Health
- Information Integration
- Center

- CDC
- Senior Mgmt Officials
- (SMO)

- DHS
- (ESF # 8)

## Conduct PH needs assessments and environmental assessments.

Disseminate risk communication messages.

Provide vaccinations and medical supplies.

Conduct disease surveillance.

Provide mental health assessments and response.

Deployment of pharmaceuticals and medical supplies.

- Disseminate risk communication messages.
- Provide vaccinations and medical supplies.
- Conduct disease surveillance.
- Provide mental health assessments and response.
- Deployment of pharmaceuticals and medical supplies.

- Potential CDC Missions

## How is Assistance Deployed?The Mission Assignment Process

- How is Assistance Deployed?The Mission Assignment Process

## Hurricane Single-State 

- Hurricane Single-State
- Command Structure

## CDC Senior Management Official: Role in Emergency Response

## SMO - Primary Emergency Response Functions

**Oversight of CDC resources in ****the state during an emergency event**
**Provide ****technical assistance**** to the state**

**Notes:**
Slide of Steve Boedigheimer (right) CDC SMO for Arkansas briefing Dr. William Mason (left) Arkansas Department of Health and Human Services on CDC assets committed to Katrina response in Arkansas. Location is the Arkansas ESF-8 Emergency Operations Center. 
.

## SMO - Primary Emergency Response Functions

**Provide ****situational awareness**** for both the state and CDC **
**Act as a ****point of connection**** for state and federal response systems and interact with other response partners**** **

**Notes:**
The SMO supports the State Health command structure by providing situational awareness in both directions.....informing the State of CDC/HHS response status and by informing the CDC/HHS of State needs.
Slide of part of the FEMA transported Katrina evacuees arriving in Arkansas at Fort Smith. Buses and aircraft delivered over 8,500 people at one location in less than 24 hours.

## Oversight of CDC Resources

**Responsible for CDC resources and personnel activated or deployed to state under the IRCT**
**Assure maximum coordination of CDC resources with DHHS and State Health Official to support  State requirements**

**Notes:**
Kristin Brusuelas, CDC Senior Management Official for Florida with CDC deployed field team members in Florida along with state public health responders.

## CDC Field Response Structure

**CDC Senior**
**Management Official**
**(SMO)**

- Locally conducts incident management and Federal Assistance coordination

- Provides on-site information from all sources to Secretary's Command Center for passing to other Operating Divisions, Agencies, etc

**State DOH**

## When a CDC Mission is Over....

- Rotation, every two to three weeks
- Containment or mitigation of the event
- State reassumes roles
- SOC returns to normal operations
- RRCC returns to normal operations

## CDC Event Management Challenges

- Stabilize management structure
- Core elements the same for all events
- Reporting hierarchy
- Synthesizing information received from field
- Personnel accountability
- Refining and exercising the plans
- CDC-wide NIMS training and education

## Additional Resources

_**Federal Emergency Management Agency (FEMA)**__** **__** **__www.fema.gov_
***ICS***
**IS-100 Introduction to Incident Command System, I-100 **
- 		http://training.fema.gov/EMIWeb/IS/is100.asp
**IS-200 Basic Incident Command System, I-200, for Federal Disaster Workers** 	http://www.training.fema.gov/EMIWeb/IS/is200.asp
***NIMS***
**IS-700 National Incident Management System (NIMS), An Introduction **
- 		http://training.fema.gov/EMIWeb/IS/is700.asp
***NRP***
**IS-800 National Response Plan (NRP), An Introduction **
- 		http://www.training.fema.gov/EMIWeb/IS/is800.asp
_**National Emergency Management Association (NEMA)**_** **
- http://www.nemaweb.org
**NEMA-CDC Incident Command System for Executives: Training Package** 	http://www.nemaweb.org/?1100

## Additional Resources

_**National Wildfire Coordinating Group (NWCG**__**)**__** **__www.nwcg.gov/default.htm_
**There are six courses in the NWCG ICS curriculum:**
-    **I-100  ICS Orientation (Self-study; Module 1)**
**	****	**** **http://www.nwcg.gov/pms/forms/ics_cours/i100/I100text.pdf
**   ****I-200  Basic ICS (Modules 2-6)**
- 		http://www.nwcg.gov/pms/forms/ics_cours/i200/i200.pdf
**   ****I-300  Intermediate ICS (Modules 7-11)**
- 		http://www.nwcg.gov/pms/forms/ics_cours/i300/i300.pdf
**   ****I-400  Advanced ICS  (Module 12-15)**
- 		http://www.nwcg.gov/pms/forms/ics_cours/i400/i400.pdf
**   ****I-401  Multi-Agency Coordination  (Module 16)**
- 		http://www.nwcg.gov/pms/forms/ics_cours/i401/i401.pdf
**   ****I-402  ICS for Executives  (Module 17)**
- 		http://www.nwcg.gov/pms/forms/ics_cours/i402/i402.pdf

## Director’s Emergency Operations Center

- Operational 24/7/365
- Uses Incident Command - FLOP
- Conducts Information Management
- Space for Agency LNOs
- Complete Logistics
- Redundant Communications
- Functional Area Action Officers
- 770-488-7100

## Questions?

- Success for the future....

## Acronyms

- HSPD: Homeland Security Presidential Directive
- NIOSH National Institute of Occupational Safety and Health
- OWCD: Office of Workforce and Career development
- OSEP: Office of Security and Emergency Preparedness
- CCHP: Coordinating Center for Health Promotion
- CCID: Coordinating Center for Infectious Disease
- CCEHIP: Coordinating Center for Environmental Health and Injury Prevention
- ATSDR: Agency for Toxin Substances and Disease Registry
- DSNS: Division of Strategic National Stockpile
- OD/OCOO: Office of the Director/ Office of Chief Operation Officer
- CCHIS : Coordinating Center for Health Information Service
- SME: Subject Matter Expert
- ESF: Emergency Support Function
- ICS: Incident Command System
- NIMS: National Incident Management System
- OPEO: Office of Preparedness and Emergency Operations
- FLOP: Finance, Logistics, Operations, and Planning (Sections of ICS )
- IRCT: Incident Response Coordination Team
- LNO: Liaison