# Presentation: 815361

- The National Response Plan (NRP):
- HHS, CDC, and DHS Coordination
- CDC Public Health Preparedness Conference
- February 24, 2005

**By:  ****	****Brian Kamoie, JD, MPH**
**	****Special Assistant**
**	**

## Outline

- Role of HHS in Development and Implementation of the NRP
- NRP Coordination Structures
- Authorities of HHS Secretary
- Emergency Support Function (ESF) #8: Public Health and Medical Services
- Coordination between HHS Operating Divisions
- Coordination between ESF #8 Interagency Partners
- Concept of Operations
- Conclusion

## HHS Role in NRP Development and Implementation

- Full partner in NRP development and implementation
- Represented on the NRP Writing Team, led by DHS
- Drafted and circulated the NRP for review and comment by HHS operating divisions; DHS circulated to State/Local partners
- CDC and State/Local partners played an integral role in providing guidance on a wide range of public health and medical response issues
- Represented on the NRP Implementation Group, including evaluation and training sub-groups

## HHS Coordination with CDC and DHS

- NRP details Federal coordination structures for response to actual or potential Incidents of National Significance (e.g., Interagency Incident Management Group (IIMG))
- HHS represented on coordination structures
- HHS is the Coordinating and Primary Agency for two key NRP components:
- Emergency Support Function #8: Public Health and Medical Services
- Biological Incident Annex
- HHS carries out authorities and responsibilities by working closely with our operating divisions (including CDC) and interagency partners (including DHS)

## Authorities of the HHS Secretary

***(Unchanged by the NRP)***

- Declare a public health emergency
- Make and enforce regulations concerning isolation and quarantine
- Conduct and support research and investigations into the cause, treatment, or prevention of a disease or disorder
- Direct the deployment of the U.S. Public Health Service Commissioned Corps
- Provide public health and medical services
- Provide for the licensure of biological products

## Provides coordinated Federal assistance to supplement State, local, and Tribal resources in response to public health and medical care needs for potential or actual Incidents of National Significance and/or during developing potential health and medical situations

**Emergency Support Function #8:**
**Public Health and Medical Services**

## Coordinated by the Secretary of the Department of Health and Human Services (HHS) principally through the Assistant Secretary for Public Health Emergency Preparedness (ASPHEP)
ESF #8 resources can be activated through: 
the Robert T. Stafford Disaster Relief and Emergency Assistance Act or the Public Health Service Act for the purposes of Federal-to-State or Federal-to-Federal support; or 
the memorandum for Federal mutual aid included in the National Response Plan (NRP) Financial Management Support Annex (non-Stafford Act incidents)

- ESF #8 resources can be activated through:
- the Robert T. Stafford Disaster Relief and Emergency Assistance Act or the Public Health Service Act for the purposes of Federal-to-State or Federal-to-Federal support; or
- the memorandum for Federal mutual aid included in the National Response Plan (NRP) Financial Management Support Annex (non-Stafford Act incidents)

**ESF #8 - *****Continued***

**Notes:**
A basic premise of the NRP is that incidents are handled at the lowest level possible.  DHS becomes involved through the routine reporting and monitoring of threats and incidents, and/or when notified of an incident or potential incident of the severity, magnitude, complexity and/or threat to homeland security that it is considered an Incident of National Significance. 
DHS establishes multiagency structures at the headquarters, regional and field level to coordinate efforts and provide support to the on-scene incident command structures.  Other Federal agencies carry out their incident management and emergency response authorities within this overarching framework.
This framework is designed to accommodate the various roles the Federal Government plays during an incident, whether it is Federal support to State, local, or tribal governments; direct implementation of Federal incident management authorities and responsibilities; coordinating Federal-to-Federal support; or providing proactive Federal support in catastrophic incidents where it is clearly evident that aid is needed.
This framework also includes a national capability for incident management, and provides the ability to address impacts to the rest of the country, execute immediate nation-wide actions to avert or prepare for subsequent events, and manage multiple incidents. 

## ESF #8 - Continued

- Assessment of public health/medical needs;
- Public health surveillance;
- Definitive care and medical personnel; and
- Medical equipment and supplies.

**ESF #8 - *****Continued***

## Office of the Secretary
Assistant Secretary for Public Health Emergency Preparedness (ASPHEP), Assistant Secretary for Health, Office of the Surgeon General, U.S. Public Health Service Commissioned Corps
Centers for Disease Control and Prevention (CDC)/Office of Terrorism Prevention and Emergency Response
Agency for Toxic Substances and Disease Registry (ATSDR)
Food and Drug Administration (FDA) 
Health Resources and Services Administration
Indian Health Service (HRSA)
Substance Abuse and Mental Health Services Administration 
National Institutes of Health (NIH) 
Agency for Healthcare Research and Quality (AHRQ)
Administration on Aging (AoA)
Centers for Medicare and Medicaid Services (CMS)
Administration for Children and Families (ACF) 

**Assistant Secretary for Public Health Emergency Preparedness (ASPHEP), Assistant Secretary for Health, Office of the Surgeon General, U.S. Public Health Service Commissioned Corps**
**Centers for Disease Control and Prevention (CDC)/Office of Terrorism Prevention and Emergency Response**
**Agency for Toxic Substances and Disease Registry (ATSDR)**
**Food and Drug Administration (FDA) **
**Health Resources and Services Administration**
**Indian Health Service (HRSA)**
**Substance Abuse and Mental Health Services Administration **
**National Institutes of Health (NIH) **
**Agency for Healthcare Research and Quality (AHRQ)**
**Administration on Aging (AoA)**
**Centers for Medicare and Medicaid Services (CMS)**
**Administration for Children and Families (ACF) **

**ESF #8 – HHS Operating Divisions**

**Notes:**
A basic premise of the NRP is that incidents are handled at the lowest level possible.  DHS becomes involved through the routine reporting and monitoring of threats and incidents, and/or when notified of an incident or potential incident of the severity, magnitude, complexity and/or threat to homeland security that it is considered an Incident of National Significance. 
DHS establishes multiagency structures at the headquarters, regional and field level to coordinate efforts and provide support to the on-scene incident command structures.  Other Federal agencies carry out their incident management and emergency response authorities within this overarching framework.
This framework is designed to accommodate the various roles the Federal Government plays during an incident, whether it is Federal support to State, local, or tribal governments; direct implementation of Federal incident management authorities and responsibilities; coordinating Federal-to-Federal support; or providing proactive Federal support in catastrophic incidents where it is clearly evident that aid is needed.
This framework also includes a national capability for incident management, and provides the ability to address impacts to the rest of the country, execute immediate nation-wide actions to avert or prepare for subsequent events, and manage multiple incidents. 

## ESF #8 Roles: HHS Operating Division Examples

- Centers for Disease Control and Prevention (CDC)
- Conducts disease surveillance activities, detects and investigates disease outbreaks and other health conditions, and develops strategies for dealing with the public health aspects of an emergency
- Components within CDC have roles in evaluating chemical spills and environmental contamination and providing safety and health recommendations to responders (e.g., personal protective equipment)

## ESF #8 Roles: HHS Operating Division Examples

- Office of the Secretary/Office of the Surgeon General (OSG)
- OSG is responsible for coordinating the deployable element of the U.S. Public Health Service Commissioned Corps and officers who are called to duty in the Inactive Reserve Corps during deployment in support of the ASPHEP.
- The U.S. Public Health Service Commissioned Corps has the ability to deploy physicians, nurses, pharmacists, engineers, environmental health officers, dentists, mental health providers, scientists, therapists, dieticians, epidemiologists, health educators, food safety inspectors, and other public health professionals.

## Department of Agriculture
Department of Defense
Department of Energy
Department of Homeland Security
Department of the Interior
Department of Justice
Department of Labor
Department of State
Department of Transportation
Department of Veterans Affairs
Environmental Protection Agency
General Services Administration
U.S. Agency for International Development
U.S. Postal Service
American Red Cross

**Department of Defense**
**Department of Energy**
**Department of Homeland Security**
**Department of the Interior**
**Department of Justice**
**Department of Labor**
**Department of State**
**Department of Transportation**
**Department of Veterans Affairs**
**Environmental Protection Agency**
**General Services Administration**
**U.S. Agency for International Development**
**U.S. Postal Service**
**American Red Cross**

**ESF #8 – Partners/Support Agencies**

## ESF #8 Roles:  Interagency Partner Examples

- Department of Homeland Security
- Directs the activation of the National Disaster Medical System (NDMS) as necessary to support incident response operations
- In coordination with HHS, deploys NDMS health/medical personnel, equipment, and supplies in a phased regional approach, and coordinates the provision of hospital care and outpatient services, veterinary services, and mortuary services
- HHS, VA, and DOD assist in coordinating NDMS operations
- Coordinates NDMS to assist in establishing priorities with HHS and ESF #8 partners for application of health and medical support
- Assists in providing information/liaison with emergency management officials in NDMS Federal Coordinating Center (FCC) area

## ESF #8 Roles:  Interagency Partner Examples

**Department of Veterans Affairs**
**Coordinates with participating non-Federal NDMS hospitals to provide incident-related medical care to authorized NDMS beneficiaries affected by a major disaster or emergency;**
**Furnishes available VA hospital care and medical services to individuals responding to, involved in, or otherwise affected by a major disaster of emergency, including members of the Armed Forces on active duty;**
**Designates and deploys available medical, surgical, mental health, and other health service support assets; and**
**Provides a Medical Emergency Radiological Response Team for technical consultation on the medical management of injuries and illnesses due to exposure to or contamination by ionizing radiation.**
***	******(Subject to the availability of resources and funding, and consistent with the VA mission to provide priority services to veterans)***

## ESF #8: Concept of Operations      

- Upon notification, the ASPHEP alerts identified HHS personnel to represent ESF #8, as required, on the NRP Coordination Structures
- National Response Coordination Center (NRCC);
- Interagency Incident Management Group (IIMG);
- Regional Response Coordination Center (RRCC)/Joint Field Office (JFO);
- National Emergency Response Team;
- Emergency Response Team–Advance Element (ERT-A); and
- Joint Information Center
- HHS notifies and requests partner organizations to participate in headquarters coordination activities, including providing liaisons to the HHS Secretary’s Operations Center

**Notes:**
A basic premise of the NRP is that incidents are handled at the lowest level possible.  DHS becomes involved through the routine reporting and monitoring of threats and incidents, and/or when notified of an incident or potential incident of the severity, magnitude, complexity and/or threat to homeland security that it is considered an Incident of National Significance. 
DHS establishes multiagency structures at the headquarters, regional and field level to coordinate efforts and provide support to the on-scene incident command structures.  Other Federal agencies carry out their incident management and emergency response authorities within this overarching framework.
This framework is designed to accommodate the various roles the Federal Government plays during an incident, whether it is Federal support to State, local, or tribal governments; direct implementation of Federal incident management authorities and responsibilities; coordinating Federal-to-Federal support; or providing proactive Federal support in catastrophic incidents where it is clearly evident that aid is needed.
This framework also includes a national capability for incident management, and provides the ability to address impacts to the rest of the country, execute immediate nation-wide actions to avert or prepare for subsequent events, and manage multiple incidents. 

## ESF #8: Concept of Operations      

- Headquarters ESF #8 staff provide liaison and communications support to regional ESF #8 groups to facilitate direct communications.
- Headquarters ESF #8 personnel are deployed as necessary to assist regional ESF #8 personnel in establishing and maintaining effective coordination within the impacted area.
- ESF #8 coordinates with the appropriate State, local, and tribal medical and public health officials and organizations to determine current medical and public health assistance requirements.
- Public health and medical subject-matter experts from HHS and ESF #8 organizations are consulted as needed.

**Notes:**
A basic premise of the NRP is that incidents are handled at the lowest level possible.  DHS becomes involved through the routine reporting and monitoring of threats and incidents, and/or when notified of an incident or potential incident of the severity, magnitude, complexity and/or threat to homeland security that it is considered an Incident of National Significance. 
DHS establishes multiagency structures at the headquarters, regional and field level to coordinate efforts and provide support to the on-scene incident command structures.  Other Federal agencies carry out their incident management and emergency response authorities within this overarching framework.
This framework is designed to accommodate the various roles the Federal Government plays during an incident, whether it is Federal support to State, local, or tribal governments; direct implementation of Federal incident management authorities and responsibilities; coordinating Federal-to-Federal support; or providing proactive Federal support in catastrophic incidents where it is clearly evident that aid is needed.
This framework also includes a national capability for incident management, and provides the ability to address impacts to the rest of the country, execute immediate nation-wide actions to avert or prepare for subsequent events, and manage multiple incidents. 

## Conclusion

- HHS fully supports the NRP and has been instrumental in its development and implementation
- NRP provides coordination structures that will enhance domestic incident prevention, preparedness, response, and recovery.
- HHS is the Coordinating and Primary Agency for ESF #8 and the Biological Incident Annex (which builds upon ESF #8 and details additional steps for biological incidents)
- HHS looks forward to implementing the plan with our State and Local Partners

## 	
DEPARTMENT OF HEALTH AND 
HUMAN SERVICES
Office of the Assistant Secretary for 
Public Health Emergency PreparednessHubert H. Humphrey Building, Room 638G200 Independence Avenue, S.W.Washington, D.C.  20201(202) 205-2882  www.hhs.gov/asphep

**DEPARTMENT OF HEALTH AND **
**HUMAN SERVICES**
- Office of the Assistant Secretary for
- Public Health Emergency PreparednessHubert H. Humphrey Building, Room 638G200 Independence Avenue, S.W.Washington, D.C.  20201(202) 205-2882  www.hhs.gov/asphep

**Questions?**