Department of Health and Human Services

OFFICE OF

INSPECTOR GENERAL

HHS PUBLIC HEALTH AND 

MEDICAL SERVICES 

EMERGENCY SUPPORT 

PREPAREDNESS

 

Daniel R. Levinson 

Inspector General

November 2012

OEI-04-11-00260
EXECUTIVE SUMMARY: HHS PUBLIC HEALTH AND MEDICAL SERVICES 

EMERGENCY SUPPORT PREPAREDNESS

OEI-04-11-00260

WHY WE DID THIS STUDY 

In 2010, the Council of the Inspectors General on Integrity and Efficiency published An 

IG’s Guide for Assessing Federal Response Capabilities, which recommended that 

Federal agencies assess their emergency preparedness. Within the Department of Health 

and Human Services (HHS), the Office of the Assistant Secretary for Preparedness and 

Response (ASPR) organizes HHS’s resources and response as the Coordinator and 

Primary agency responsible for Emergency Support Function-8 (ESF-8), Public Health 

and Medical Services. HHS also has responsibilities as a Support agency for nine 

additional ESFs. 

HOW WE DID THIS STUDY

We reviewed ASPR’s and other Federal agencies’ documentation and information 

request responses regarding HHS participation in ESF preparedness activities. We 

determined the total number of incidents to which HHS deployed resources in 2010 and 

2011 and reported responses from ASPR and States regarding HHS’s response to three 

selected incidents.

WHAT WE FOUND

HHS has participated in preparedness activities to fulfill its Coordinator, Primary, and 

Support agency ESF responsibilities. However, other ESF Coordinator and Primary 

agencies did not always report having a clear understanding of HHS’s Support agency 

role and available resources during incident response. Further, HHS deployed resources 

for 28 incidents in 2010 and 2011 and demonstrated its ability to effectively fulfill its 

ESF-8 responsibilities for 3 incidents we reviewed in 2010 and 2011. However, States 

reported receiving multiple requests from HHS for the same information, which were

burdensome during incident response.

WHAT WE RECOMMEND

We recommend that ASPR: (1) continue to increase communication with the ESF 

Coordinator and Primary agencies it serves as a Support agency, and (2) coordinate HHS 

requests from HHS Staff Divisions and Operating Divisions to reduce the burden on 

States during incident response. ASPR concurred with both recommendations.
TABLE OF CONTENTS

Objectives ....................................................................................................1 

Background ..................................................................................................1 

Methodology ................................................................................................6 

Findings......................................................................................................10 

HHS has participated in preparedness activities to fulfill its 

Coordinator, Primary, and Support agency ESF responsibilities ..........10

HHS deployed resources to 28 incidents in 2010 and 2011 and 

demonstrated its ability to effectively fulfill its ESF responsibilities 

for 3 selected incidents we reviewed in 2010 and 2011 ......................17 

Conclusion and Recommendations ............................................................24 

Agency Comments and Office of the Inspector General Response .....26 

Appendixes ................................................................................................27 

A: Emergency Support Functions .......................................................27 

B: Seventeen Core Functional Areas of Emergency Support 

Function-8 ............................................................................................31 

C: National Planning Scenarios ..........................................................36 

D: The National Planning Scenario Playbooks and Emergency 

Support Function-8 ..............................................................................37 

E: Department of Health and Human Services Response to Three 

Selected Incidents in 2010 and 2011 ....................................................39 

F: 2010 and 2011 Incidents to Which the Department of Health and 

Human Services Deployed Resources .................................................50 

G: Agency Comments .........................................................................51 

Acknowledgments......................................................................................57 
1 

HHS Public Health and Medical Services Emergency Support Preparedness (OEI-04-11-00260)

OBJECTIVES 

1. To determine whether the Department of Health and Human Services 

(HHS) has prepared to provide public health and medical services to 

fulfill its emergency support responsibilities. 

2. To report the total number of emergencies and disasters (i.e., incidents) 

to which HHS deployed resources in 2010 and 2011 and describe 

HHS’s response to three selected incidents. 

BACKGROUND

In 2010, the Council of the Inspectors General on Integrity and Efficiency 

(CIGIE), a group of Inspectors General (IG) from agencies across the 

Federal Government, created An IG’s Guide for Assessing Federal 

Response Capabilities (IG’s Guide).1 The IG’s Guide recommends that

IGs assess their Federal agency’s emergency preparedness capabilities.2 It 

provides a framework for Offices of Inspectors General to conduct 

independent assessments of their department or agency’s (agency) incident

response capabilities. The IG’s Guide is based on the National Response 

Framework (NRF), Emergency Support Functions, and the National 

Planning Scenarios.3 Recent incidents such as Hurricane Sandy

emphasize the need for Federal agencies to assess their emergency 

response capabilities.

NRF

When an incident occurs that exceeds or is expected to exceed State, 

territory, tribal, or local resources, these entities may request Federal 

assistance.4 The Federal Government uses the NRF, which was developed 

through coordination of the Department of Homeland Security (DHS), to 

organize and coordinate its response and provide supplementary resources 

to affected areas. The NRF establishes a comprehensive, national, 

1 CIGIE comprises all Inspectors General whose offices are established under the Inspector 

General Act of 1978 (5 U.S.C. App.), those that are Presidentially appointed/Senate 

confirmed, and those that are appointed by agency heads (designated Federal entities). 

CIGIE, Mission and Organization. Accessed at http://www.ignet.gov/cigie1.html#mission on 

July 11, 2012. 

2 The IG’s Guide includes researchable questions that agencies can use as a starting point to 

frame their assessments. However, all questions included in the IG’s Guide may not be 

applicable to all agencies. CIGIE, An IG’s Guide for Assessing Federal Response 

Capabilities (August 2010). Accessed at 

http://www.ignet.gov/randp/igguidefederalresponse0810.pdf on April 12, 2011.

3 CIGIE, op. cit., pp. 7–8.

4 States include U.S. districts and territories.
HHS Public Health and Medical Services Emergency Support Preparedness (OEI-04-11-00260) 2

all-hazards approach to domestic incident responses.5 An all-hazards 

approach focuses on general capability-based planning that can be applied 

to a variety of incidents.6, 7 Federal agencies may also move resources 

close to an area or event where an incident may occur in anticipation of 

needs.

8

 For example, HHS deployed medical personnel to East Coast 

States in anticipation of Hurricane Irene’s landfall.

The NRF serves as a guide for organizing efforts of Federal, State, tribal, 

and local governments, as well as nonprofit and for-profit private-sector 

organizations (e.g., American Red Cross, private businesses). The NRF

outlines each Federal agency’s role during an incident and organizes 

agencies within 15 Emergency Support Functions (ESF).9

ESFs

The 15 ESFs within the NRF assign responsibilities to agencies.10 

Appendix A provides a listing of each ESF and identifies assigned 

responsibilities.

ESFs are activated by a declaration from the President or a Federal agency 

based on the needs resulting from an incident.11 Once ESFs are activated, 

agencies with ESF responsibilities can provide requested resources to 

affected States, territories, tribes, and localities.12 States, territories, tribes, 

and localities are not required to request or accept Federal resources 

during an incident response. If these entities request Federal resources, 

the ESF Coordinator and Primary agencies consider the requests and 

provide resources as they are available and necessary. 

5 DHS, National Response Framework, January 2008 (which superseded the National 

Response Plan, 2004), pp. 1, 28. Accessed at 

http://www.fema.gov/pdf/emergency/NRF/NRF-core.pdf on March 7, 2011.

6

 DHS, National Preparedness Guidelines, September 2007, p. 3. Accessed at 

http://www.fema.gov/pdf/emergency/NRF/NRF-core.pdf on June 21, 2011. DHS, National 

Response Framework, p. 31.

7 DHS, Presidential Policy Directive–8. Accessed at 

http://www.dhs.gov/xabout/laws/gc_1215444247124.shtm on November 7, 2011. In March 

2011, Presidential Policy Directive-8 (i.e., PPD-8) was released; it emphasizes integrated, 

risk-based preparedness planning for all agencies and organizations involved in incident 

response. The NRF is being revised as a result of PPD-8. 

8

 DHS, National Response Framework, p. 11.

9 DHS, National Response Framework, pp. 3–4.

10 Ibid., p. 29. The ESFs can be found at http://www.fema.gov/emergency/NRF/#. 11 Upon the advice of the Federal Emergency Management Agency (FEMA) Administrator, 

the President may declare a disaster. ESFs are activated on the basis of the needs caused by 

the incident. 42 U.S.C. §§ 5170, 5191. A Federal agency may also declare a disaster or 

emergency (e.g., the Secretary of HHS may declare a public health emergency) and activate 

ESFs to which the agency is assigned. Public Health Service Act, § 319 (42 U.S.C. § 247d); 

DHS, National Response Framework., p. 60.

12 Ibid., pp. 24–26.
HHS Public Health and Medical Services Emergency Support Preparedness (OEI-04-11-00260) 3

Each ESF divides Federal responsibilities among agencies on the basis of 

their capabilities. Federal agencies are designated as Coordinator, 

Primary, and/or Support agencies. Each ESF has one Coordinator agency, 

but may have one or more Primary agencies and multiple Support 

agencies and organizations.13 For example, ESF responsibilities require 

that, as a Coordinator and Primary agency, HHS provide medical 

personnel when an incident occurs. As a Support agency, the Department 

of Agriculture may provide food safety and inspection services for the 

same incident. For-profit and nonprofit private-sector organizations, 

hereinafter referred to as organizations, may also provide assistance as 

Support organizations in an ESF response. 

Throughout the preparedness, response, and recovery phases of an 

incident, the Coordinator agency is responsible for managing and 

organizing the resources provided by Primary and Support agencies and 

organizations.14 Primary agencies provide specific resources identified in 

the ESF (e.g., medical personnel to an affected area) and collaborate with 

other Federal, State, territory, tribal, and local governments and 

organizations that have other available resources. Support agencies and 

organizations are assigned ESF responsibilities on the basis of their ability 

to provide supplementary resources to the Primary agency responsible for 

the ESF.15 

Coordinator, Primary, and Support agencies and organizations engage in a 

variety of activities to prepare for an incident. Federal emergency 

preparedness guidance documents outline these five preparedness 

activities, which generally include: 

• developing written incident response plans (e.g., scenario 

playbooks, field operations guides, strategies to obtain and deploy 

staff and equipment); 

• participating in training and exercises;

16 

• purchasing equipment and procuring contracts to support incident 

response; 

13 The same agency within an ESF is often assigned to be both Coordinator and a Primary 

agency and leads ESF responses based on its capabilities. For example, HHS serves as a 

Coordinator and a Primary agency for ESF-8.

14 DHS, Emergency Support Function Annexes Introduction, pp. iii–v.

15 Ibid.

16 Exercises include tabletop and live exercises. Tabletop exercises use HHS plans and 

representations of people and resources to simulate incident response. Live exercises also use 

HHS plans but involve personnel and volunteer participants to simulate incident response.
HHS Public Health and Medical Services Emergency Support Preparedness (OEI-04-11-00260) 4

• coordinating internally as well as externally with other ESF 

agencies; and 

• conducting situational and readiness assessments.

17, 18 

These activities are referred to as preparedness activities hereinafter. 

HHS’s ESF Responsibilities 

HHS is the Coordinator and Primary agency for ESF-8, Public Health and 

Medical Services. As such, it manages the Federal response to an incident 

for activities in these areas. HHS also provides public health and medical 

services as a Support agency for nine additional ESFs (see Appendix A). 

ESF-8 is the “mechanism for coordinated Federal assistance to supplement 

State, tribal, and local resources in response to a public health and medical 

disaster.” 19 HHS conducts national situational and readiness assessments 

to prepare to respond to States’ public health and medical needs when 

incidents occur. Further, HHS may provide ESF support to States, 

territories, tribes, and localities in the form of technical and situational and 

readiness assessment assistance, when requested. Within HHS, the Office 

of the Assistant Secretary for Preparedness and Response (ASPR) 

organizes HHS’s preparedness resources and response activities.20 

Specifically, ASPR coordinates with HHS Staff Divisions (e.g., ASPR, 

Assistant Secretary for Health (ASH)) and Operating Divisions (e.g., 

Center for Disease Control and Prevention (CDC), Food and Drug 

Administration (FDA)) to ensure that HHS is prepared to provide public 

health and medical resources when incidents occur.21 

17 Information pertinent to this review was taken from the IG’s Guide and consolidated into 

the five prepared activities. CIGIE, loc. cit. 18 DHS, Emergency Support Function Annexes Introduction, pp. iii–v; DHS, National 

Response Framework; DHS, National Preparedness Guidelines.

19 DHS, ESF-8–Public Health and Medical Services Annex, p. 1. Accessed at 

http://www.fema.gov/pdf/emergency/NRF/NRF–esf–08.pdf on May 13, 2011.

20 HHS is made up of the Office of the Secretary, which is divided into 16 Staff Divisions, 

and 11 Operating Divisions. Operating and Staff Divisions perform tasks that include

research, public health work, food and drug safety, grants funding, and health insurance. Staff 

Divisions provide direct support to the Secretary of HHS. For example, ASPR supports the 

Secretary’s mission through its preparedness and response efforts. HHS, HHS Operating and 

Staff Divisions. Accessed at http://www.hhs.gov/about/ on May 15, 2012. 21 ASPR, Office of the Assistant Secretary for Preparedness and Response. Accessed at 

http://www.phe.gov/about/aspr/Pages/default.aspx on May 11, 2011.
HHS Public Health and Medical Services Emergency Support Preparedness (OEI-04-11-00260) 5

HHS’s ESF-8 responsibilities include 17 core functional areas of public 

health and medical services (e.g., assessment of public health and medical 

needs, health surveillance, and medical care personnel).

22, 23 

Appendix B contains detailed descriptions of the 17 core functional areas

as they appear in the NRF. 

HHS as the ESF-8 Coordinator and Primary Agency. HHS is charged 

with continually assessing and coordinating its resources and capabilities 

to ensure that it is prepared to fulfill its responsibility for the 17 core 

functional areas of public health and medical services.24, 25 If HHS does 

not have the resources or capability to fulfill the 17 core functional areas, 

it can request assistance from designated Support agencies and 

organizations. Sixteen ESF Support agencies and organizations are tasked 

with providing supplementary resources to HHS, as needed.26, 27

HHS as an ESF Support Agency. When an incident occurs and HHS is not 

the Coordinator or Primary agency, it provides supplementary resources, 

as needed, for nine additional ESFs (see Appendix A). HHS provides 

public health and medical services as a Support agency similar to those 

that it provides as a Primary agency for ESF-8. For example, if ESF-10 

(Oil and Hazardous Materials Response) is activated, the Environmental 

Protection Agency (EPA), as the ESF-10 Primary agency, can request that

HHS provide supplementary medical personnel.

28, 29 Seven of the nine 

ESFs list which public health and medical services HHS must be prepared 

to provide as a Support agency.30

22 DHS, ESF-8 Annex, pp. 4–8.

23 ESF-8 includes a core functional area entitled Worker Safety and Health. The Department 

of Labor is the lead Federal agency for this core functional area, and HHS serves as a Support 

agency. Therefore, the Worker Safety and Health core functional area is not included in our 

list of HHS’s 17 core functional areas of ESF-8.

24 DHS, Overview: ESF and Support Annexes Coordinating Federal Assistance In Support of 

the National Response Framework. Accessed at 

http://www.fema.gov/pdf/emergency/NRF/NRF–overview.pdf on November 4, 2011.

25 DHS, ESF-8 Annex, p. 9.

26 Ibid., pp. iv, 10. 

27 ASPR, Response Coordination. Accessed at 

http://www.phe.gov/Preparedness/responders/soc/Pages/coordination.aspx on June 22, 2011. 

28 ASPR, Response Coordination; DHS, Emergency Support Function Annexes Introduction,

p. iv.

29 DHS, ESF-10 Oil and Hazardous Materials Response Annex. Accessed at 

http://www.fema.gov/pdf/emergency/NRF/NRF–esf–10.pdf on August 24, 2011.

30 DHS, NRF Resource Center. Accessed at http://www.fema.gov/emergency/NRF/# on 

August 24, 2011. The following ESFs list resources that HHS should be prepared to provide 

as a Support agency during an ESF response: ESF-3, - 6, - 7, - 9, -10, -11, and -14. ESF-5 

and -15 call for general HHS public health and medical support.
HHS Public Health and Medical Services Emergency Support Preparedness (OEI-04-11-00260) 6

National Planning Scenarios 

DHS created the 15 National Planning Scenarios to illustrate the potential 

scope, magnitude, and complexity of a range of major events for which the 

nation should be prepared. The 15 National Planning Scenarios are one of 

four parts of the National Preparedness Guidelines.31 DHS created the 

National Preparedness Guidelines to assist Federal, State, and local 

governments and organizations in coordinating incident preparedness and 

response. Agencies may also develop written plans to address incidents 

that may require unique plans and resources.32 

Similar to the NRF, the 15 National Planning Scenarios provide guidance 

on preparedness efforts for a range of potential incidents.33 The NRF 

provides general guidance regarding collaboration during incident 

response, and the scenarios provide guidance specifically regarding 

preparedness and response to incidents, such as a major hurricane. See 

Appendix C for a complete list of the 15 National Planning Scenarios. 

METHODOLOGY

Scope

We determined whether HHS has prepared to fulfill its Coordinator and 

Primary agency ESF-8 responsibilities. We also determined whether HHS 

addressed the 15 National Planning Scenarios through its participation in

preparedness activities. Further, we determined whether HHS participated 

in preparedness activities with other ESF Coordinator and Primary 

agencies for the nine additional ESFs it serves as a Support agency. 

We also reported the total number of incidents to which HHS deployed 

resources in 2010 and 2011. We then took an indepth look at three 

selected incidents to which HHS responded. 

We used the IG’s Guide as a framework for our evaluation and addressed 

categories from the guide that pertained to HHS’s responsibilities. We 

reviewed the following categories: participating in activities regarding the 

15 National Planning Scenarios, developing written plans, participating in 

training and exercises, purchasing equipment and procuring contracts, 

31 The four parts that make up the National Preparedness Guidelines are: National

Preparedness Vision, National Planning, Universal Task List, and Target Capabilities List. 

DHS, National Preparedness Guidelines, pp. iii, 31. Accessed at 

http://www.dhs.gov/files/publications/gc_1189788256647.shtm on June 25, 2012. DHS, 

National Response Framework, pp. 31, 73.

32 ASPR, Playbooks Introduction. Accessed at 

http://www.phe.gov/Preparedness/planning/playbooks/rdd/Pages/default.aspx on April 20, 

2012, p. 3. 33 DHS, National Preparedness Guidelines, p. 31.
HHS Public Health and Medical Services Emergency Support Preparedness (OEI-04-11-00260) 7

coordinating internally among HHS Staff and Operating Divisions and

externally with other ESF agencies, and conducting situational and 

readiness assessments. We did not include categories from the IG’s Guide

regarding financial accountability and recovery operations.34

Data Collection and Analysis

HHS as a Coordinator and Primary Agency. We requested information 

and collected documentation (e.g., After-Action Reports describing events 

that occurred in the National Level Exercise and service contracts 

procured by HHS for development of an Internet application) from ASPR

regarding participation in preparedness activities to fulfill HHS’s

Coordinator and Primary responsibilities for the 17 core functional areas 

of ESF-8. We also requested information and collected documentation 

from ASPR on HHS’s participation in preparedness activities to respond to 

the 15 National Planning Scenarios. ASPR coordinated with other HHS 

Staff Divisions and Operating Divisions, as needed, to fulfill our request.

We analyzed HHS’s responses and documentation to determine whether 

HHS participated in preparedness activities to fulfill the 17 core functional 

areas of ESF-8. If HHS had addressed a core functional area by 

participating in each of the five preparedness activities at least once (i.e., 

developing written incident response plans, participating in training and 

exercises, purchasing equipment and procuring contracts, coordinating 

internally and externally, and conducting situational and readiness 

assessments), we considered HHS as having prepared for that core 

functional area. We then report the number of core functional areas in 

which HHS had prepared. Further, we describe each of the five 

preparedness activities, how HHS engaged in them, and the core 

functional areas that correlated with them. 

We also analyzed HHS’s responses and documentation to determine 

whether HHS has participated in each of the five preparedness activities at 

least once to address the 15 National Planning Scenarios. 

HHS as a Support Agency. We coordinated with ASPR to identify 

appropriate points of contact for the ESF Coordinator and Primary 

agencies for the nine additional ESFs. We requested and received

information from these Coordinator and Primary agencies for all nine 

ESFs. We collected documentation from the ESF Coordinator or one or 

34 HHS OIG’s Office of Audit Services conducts audits specifically addressing financial 

accountability. In September 2011, DHS introduced the National Disaster Recovery 

Framework in which HHS has specific recovery responsibilities separate from what is 

included in the IG’s Guide. DHS, National Disaster Recovery Framework. Accessed at 

http://www.fema.gov/pdf/recoveryframework/ndrf.pdf on August 13, 2012. 
HHS Public Health and Medical Services Emergency Support Preparedness (OEI-04-11-00260) 8

more of the ESF’s Primary agencies regarding HHS’s involvement in 

planning and response activities as a Support agency.

35

We analyzed responses and documentation from HHS and the information 

provided by other ESF Coordinator and Primary agencies to determine 

whether HHS has prepared to fulfill its Support agency responsibilities. 

HHS’s Support to States During 2010 and 2011 Incidents. We requested 

and received from ASPR the total number of incidents to which HHS 

deployed resources in 2010 and 2011. We also requested that ASPR

identify selected incidents to which HHS deployed resources and to which 

it responded as an ESF-8 Coordinator and Primary agency in 2010 and 

2011. Because some incidents require resources from only a portion of the 

17 core functional areas, we asked that ASPR’s list include the smallest 

number of incidents that collectively required resources from all 17 core 

functional areas. ASPR identified three incidents: Red River flooding in 

North Dakota in March 2010; a tornado in Joplin, Missouri, in May 2011; 

and Hurricane Irene along the East Coast in August 2011. ASPR

identified 

17 States that were affected by these incidents.

36 We then requested 

information from State officials about their requests for and receipt of 

HHS support during these incidents. All 17 States responded to our 

request. 

We also analyzed State responses to open-ended questions about HHS’s 

response during incidents, the resources HHS provided, and any successes 

or challenges the States experienced in working with HHS. We report 

whether States indicated that HHS provided them resources and present

examples of the States’ experiences working with HHS. We also 

requested information from ASPR regarding the ESF-8 resources provided 

by HHS to States affected by these incidents. 

Limitations

We assessed HHS’s preparedness activities based on self-reported data

from Federal agencies and States. We did not independently verify HHS’s 

reported preparedness activities. We did not determine HHS’s capability 

to respond to an incident, or whether the reported response was sufficient. 

35 Each ESF may have more than one Coordinator and Primary agency. We requested 

information from all ESF Coordinator and Primary agencies for which HHS is a Support 

agency—a total of 18 points of contact. We received responses from at least one Coordinator

or Primary agency for each ESF that HHS supports. We received multiple responses from 

agencies for some ESFs. The total number of responses was 13.

36 The Red River flooding affected North Dakota. The Joplin tornado affected Missouri. 

States affected by Hurricane Irene were Connecticut, Delaware, the District of Columbia, 

Maryland, Massachusetts, New Jersey, New York, North Carolina, Pennsylvania, Puerto Rico, 

Rhode Island, South Carolina, U.S. Virgin Islands, Vermont, and Virginia.
HHS Public Health and Medical Services Emergency Support Preparedness (OEI-04-11-00260) 9

Standards

This study was conducted in accordance with the Quality Standards for 

Inspection and Evaluation issued by the Council of the Inspectors General 

on Integrity and Efficiency.
HHS Public Health and Medical Services Emergency Support Preparedness (OEI-04-11-00260) 10

FINDINGS

HHS has participated in preparedness activities to 

fulfill its Coordinator, Primary, and Support agency 

ESF responsibilities

The ESF framework within the NRF describes HHS’s responsibility to 

fulfill the 17 core functional areas of ESF-8 as a Coordinator, Primary, and 

Support agency. HHS has led and supported other agencies in five 

preparedness activities that Federal guidance documents describe as 

important to being prepared to respond to an incident. These five 

preparedness activities are developing written plans; participating in 

training and exercises; purchasing equipment and procuring contracts to 

support incident response; coordinating internally among HHS as well as 

externally with other ESF agencies; and conducting situational and 

readiness assessments. 

HHS has developed written incident response plans 

HHS has created incident 

response plans for all 17 core 

functional areas of ESF-8. 

Further, HHS’s National Planning 

Scenario playbooks and other 

written incident response plans 

address all the core functional 

areas. 

Specifically, HHS has developed 

playbooks for 14 of the 15 

National Planning Scenarios (see 

Appendix D). Although no 

playbook has been written for the 

cyber security National Planning 

Scenario, HHS included incident 

response plans for cyber security 

Photo provided by ASPR

The Hurricane Playbook describes HHS’s public 

health and medical services written incident 

response plans.
HHS Public Health and Medical Services Emergency Support Preparedness (OEI-04-11-00260) 11 

 

Photo provided by FEMA 

Health care workers rush to decontaminate a simulated victim 

during an exercise at the Center for Domestic Preparedness in 

Anniston, Alabama. These students were attending the 

Hospital Emergency Response Training for Mass Casualty 

Incidents course. 

in the 2010 Health Care and Public Health Sector Specific Plan and the 

2010 Sector Annual Report.37 

HHS has prepared other written incident response plans and technical and 

health care preparedness guidance documents that address topics 

including: the Hospital Preparedness Program, medical movement of 

evacuees, National Veterinary Response Teams, disaster behavioral health, 

and National Disaster Medical System (NDMS) (i.e., medical personnel). 

HHS has also published the National Health Security Strategy and 

Implementation Plan, which outline a national vision and actions 

regarding public health and medical preparedness, response, and recovery 

capabilities. 

HHS has participated in incident response training and 

exercises 

HHS has participated 

in at least one training 

activity and exercise 

to ensure it is 

prepared to fulfill its 

responsibilities in all 

17 core functional 

areas of ESF-8. 

Exercises in a 

realistic setting 

provide personnel 

opportunities to use 

training and hone 

skills they will need 

during incident 

response. For 

example, the U.S. Public Health Service (USPHS) has trained personnel to 

provide mass care (i.e., sheltering, feeding operations, emergency first aid, 

bulk distribution of emergency items, and collecting and providing 

information on victims to family members) to people affected by an 

incident. USPHS maintains teams of trained personnel that can address 

specific needs during a response. 

37 DHS and HHS, 2010 Sector CIKR Protection Annual Report for the Health Care and 

Public Health Sector. Accessed at 

http://www.phe.gov/Preparedness/planning/cip/Documents/2010cikrannualreport.pdf on 

April 20, 2012; ASPR, Health Care & Pubic Health Sector Specific Plan. Accessed at 

http://www.phe.gov/Preparedness/planning/cip/Pages/ssp.aspx on April 20, 2012. 
HHS Public Health and Medical Services Emergency Support Preparedness (OEI-04-11-00260) 12

In 2010 and 2011, HHS reported that it conducted or participated in 

60 live and tabletop exercises.38 Three of the seven tabletop exercises that 

HHS conducted in 2011 focused on an anthrax dispersal scenario. These 

exercises did not require participants to simulate the incident response. 

Instead, using visual aids for illustration, participants were invited to 

discuss roles and responsibilities that would be needed during a response. 

Additionally, 11 live anthrax dispersal scenario exercises in 2010 and 2011 

included other Federal and State agencies and organizations. The 

exercises exposed gaps and demonstrated strengths in planning, training, 

and resources and allowed participants to examine policy and operational 

needs in responding to an aerosolized anthrax dispersal scenario.

HHS and other Federal, State, tribal, and local governments and 

organizations participated in the National Level Exercise, a live annual 

exercise in which participants

simulated incidents in real 

time. The 2011 National 

Level Exercise focused on an 

earthquake scenario in which 

participants simulated an 

appropriate response. For 

example, personnel used 

tangible resources and set up 

evacuation and alternative 

water supply stations. Local 

responders communicated 

their needs to State and 

Federal agencies, which 

collaborated to provide 

resources for the response. In 

addition, HHS communicated 

with private-sector partners 

and shared situational 

awareness information that assisted in rapid local response. For example,

HHS collaborated with organizations such as the American Red Cross to 

provide resources for medical surge response efforts.

Photo by SSG Brad Staggs

Missouri National Guard members participated in 

the 2011 National Level Exercise, which took place 

at Muscatatuck Urban Training Complex in

Butlerville, Indiana.

38 HHS conducted and participated in 27 live and 3 tabletop exercises in 2010 and 23 live and 

7 tabletop exercises in 2011. 
HHS Public Health and Medical Services Emergency Support Preparedness (OEI-04-11-00260) 13

HHS has purchased equipment and procured contracts to 

support incident response

HHS has purchased at least one piece of equipment and procured contracts 

to fulfill its responsibilities in each of the 17 core functional areas of 

ESF-8. Such equipment and contracts cover a wide range of areas. For 

example, HHS has purchased equipment and procured contracts to 

assemble and maintain Disaster Medical Assistance Team (DMAT) caches. 

Items needed for the caches include pharmaceuticals, ventilators, 

defibrillators, communications equipment, and electronic medical record 

software. Service contracts have been procured for the equipment in 

caches. Caches are prepackaged for rapid deployment and are also 

strategically stored around the country so that they are readily available 

when an incident response is required.39 

HHS also has procured contracts for services to ensure it is able to fulfill 

its ESF-8 responsibilities. For example, in 2011, HHS contracted with a 

vendor to develop an 

Internet-based 

application to help track 

medical care personnel. 

The application makes 

public health and 

medical volunteer 

credential information 

available to health care 

facilities when incidents 

occur. It allows States’ 

credential information to 

be linked, creating a 

single network for use 

nationwide. 

Further, HHS contracted with a vendor to conduct a national survey of 

medical equipment and supplies. This survey determined the number of 

ventilators in acute care hospitals that could be used in mass casualty 

scenarios, such as a pandemic. 

39 HHS has purchased equipment for caches in the following areas: Basic IT/Telecom Kit, 

Critical Care, Disaster Medical Assistance Team, Disaster Portable Morgue Unit, Electronic 

Medical Record Kit, Family Assistance Center Team, Federal Medical Station, Incident 

Response Coordination Team, International Surgical Response Team, Mobile Medical Kit, 

National Medical Response Team, National Special Security Event, National Veterinary 

Response Team, and Personnel Support Kit.

Photo provided by ASPR

A member of a DMAT sets up an NDMS cache with 

equipment and supplies needed to provide medical care. 
HHS Public Health and Medical Services Emergency Support Preparedness (OEI-04-11-00260) 14

HHS has coordinated its incident response efforts internally

and externally 

During 2010 and 2011, HHS provided internal and external coordination 

to fulfill its responsibilities in all 17 core functional areas of ESF-8. HHS

regularly coordinates internally with its Staff Divisions and Operating 

Divisions to ensure it is ready to respond when incidents occur. For 

example, the Office of the Surgeon General’s Office of Force and 

Readiness and Deployment coordinates with USPHS teams regarding 

ESF-8 response. USPHS has seven types of teams and the Office of the 

Surgeon General’s Office of Force and Readiness and Deployment 

frequently conducts meetings to update written incident response plans, 

training, and exercises regarding ESF-8 response responsibilities.

40 

HHS also coordinates externally with other Federal, State, tribal, and local

governments and organizations and participates in preparedness activities 

with them to 

ensure resources 

are provided 

through a 

coordinated 

response. For 

example, in 2011, 

HHS coordinated 

with other Federal 

agencies, State, 

and local 

governments, and 

organizations to 

establish procedures for joint delivery of veterinary services in preparation 

for an incident response through the Pets Multi-Agency Coordination 

System (Pets-MACS). Through its participation in Pets-MACS, HHS 

coordinates with other agencies, governments, and organizations to deploy 

National Veterinary Response Teams to treat animals in need. 

In many instances, HHS must coordinate internally and externally to cover

the same responsibility. For example, in 2011, HHS coordinated with

FEMA to develop the National Federal Ambulance Contract, which was 

developed to provide patient evacuation using private-sector ground and 

air ambulance services. Coordination internally within HHS and with 

40 The seven types of teams are Services Access, Rapid Deployment Force, Applied Public 

Health, Mental Health, Capitol Area Providers, National Incident Response, and Regional 

Incident Response.

Photo provided by FEMA

Ambulances departed from Stewart Air Force Base to evacuate 

patients from New York hospitals after Hurricane Irene in August 

2011 under the Federal National Ambulance Contract. 
HHS Public Health and Medical Services Emergency Support Preparedness (OEI-04-11-00260) 15

FEMA, and externally with private-sector ambulance service businesses, 

was necessary to develop this contract. 

HHS regularly conducts situational and readiness 

assessments to respond to an incident quickly

The HHS Secretary’s Operation Center (SOC) operates 24 hours a day, 

every day of the year, and maintains real-time situational and readiness 

assessments. Through these assessments, HHS monitors potential and 

actual incidents requiring public health and medical resources within all 

17 core functional areas of ESF-8. 

To provide 

comprehensive 

assessments, the 

SOC conducts

situational 

and readiness 

assessments 

before, during, 

and after an 

incident. 

Photo provided by 

ASPR

HHS’s Emergency Management Group staffs the SOC and maintains 

communication with Federal, State, territorial, tribal, and local 

governments, and other organizations.41 The Emergency Management 

Group provides real-time information to assist HHS Staff Divisions and 

Operating Divisions as they consider deploying resources before and 

during an incident. Examples of regular SOC situational and readiness 

assessment activities include: 

• identifying emerging threats through public health data for special 

topics (e.g., West Nile virus, influenza activity). When threats are 

identified, SOC personnel provide relevant information to HHS, other 

government agencies, and leaders of organizations; 

• tracking field reports received from Regional Emergency Coordinators 

(REC), HHS Operating Divisions, and other ESF-8 agencies that 

support State, territorial, tribal, and local incident response; 

41 The Emergency Management Group consists of liaisons from HHS Staff Divisions and 

Operating Divisions and other Federal agencies.
HHS Public Health and Medical Services Emergency Support Preparedness (OEI-04-11-00260) 16

• conducting conference and video calls to facilitate coordination and 

information sharing between HHS and deployed field personnel, such 

as the RECs, NDMS, and USPHS; and 

• preparing and coordinating situational assessments regarding HHS 

resources available for deployment in advance of and during 

prominent national events (e.g., Presidential inauguration, Super 

Bowl). 

HHS has participated in preparedness activities to fulfill its 

Support agency ESF responsibilities 

HHS has participated in preparedness activities for all nine of the 

additional ESFs it is required to support.42 Coordinator and Primary 

agencies from eight of the nine ESFs said that, as a Support agency, HHS 

is prepared to fulfill its responsibilities. One ESF-3 agency, DOD-U.S. 

Army Corps of Engineers, said that it has not communicated with HHS 

regarding its Support agency role. 

Many of the preparedness activities in which HHS has participated as a 

Coordinator and Primary agency are the same as those HHS provides in its 

Support agency role. For example, HHS participated in the 2011 National 

Level Exercise as an ESF-8 Coordinator and Primary agency and as a 

Support agency for nine additional ESFs. 

HHS also participated in exercises with Coordinator and Primary agencies 

for five of the nine ESFs for which it is a Support agency.43 For example, 

HHS participated as an ESF-7 Support agency in quarterly meetings of the 

Disaster Management Strategic working group with FEMA and the 

Government Services Administration. HHS also provided public health 

and medical services resources requested by these agencies. HHS 

provided many of the same core public health and medical services in each 

instance, with the distinction being who was responsible for leading the 

ESF response. 

Coordinator and Primary Agencies Did Not Always Report Having a 

Clear Understanding of HHS’s Support Agency Role and HHS’s Available 

Resources. 

Two of the eight ESF Coordinator and Primary agencies that reported

HHS participation in preparedness activities as a Support agency indicated 

42 Support agency preparedness activities include developing written incident response plans, 

conducting training and exercises, purchasing equipment and procuring contracts, and 

conducting situational and readiness assessments. Internal and external coordination are not 

considered Support agency preparedness activities in this report. 

43 ESF-5, -6, -7, -10, and -15 reported that HHS participated in exercises.
HHS Public Health and Medical Services Emergency Support Preparedness (OEI-04-11-00260) 17

that increased HHS communication regarding planning activities and 

available resources would improve its Support capabilities. The ESF-9 

agency (FEMA-Urban Search and Rescue) stated that better

communication of strategic information and preparedness planning and 

activities would improve HHS’s performance as a Support agency. The 

ESF-6 agency (FEMA-Individual Assistance Division) stated that

improved communication about resources that HHS is able to provide 

could improve incident response. For example, during an ESF-6 incident 

response, HHS can provide medical personnel as an ESF-6 Support 

agency. FEMA stated that it would be helpful for HHS to communicate, 

as soon as possible during an incident response, the number of available 

HHS-authorized medical facilities and medical personnel. Using this 

information, FEMA would be better able to determine whether additional 

facilities and medical personnel were needed. 

HHS deployed resources to 28 incidents in 2010 and 

2011 and demonstrated its ability to effectively fulfill 

its ESF responsibilities for 3 selected incidents we 

reviewed in 2010 and 2011 

HHS deployed resources to 15 incidents in 2010 and to 13 in 2011. The 

incidents varied from mudslides in Kentucky to humanitarian missions in 

Hawaii after the 2011 earthquake and tsunami (see Appendix F). HHS 

also provided resources for 20 prominent national events in 2010 and 

2011.44 These events ranged from the State of the Union address to the 

Cherry Blossom Festival. In preparing to provide public health and 

medical services, HHS may position resources prior to incidents and 

events. 

Of the 28 incidents, we reviewed 3 that affected 17 States. During these 

3 incidents, HHS demonstrated its ability to effectively fulfill all 17 core 

functional areas of its ESF-8 responsibilities. The incidents were: 

• Red River flooding in North Dakota in March 2010; 

• Tornado in Joplin, Missouri, in May 2011; and

• Hurricane Irene along the East Coast in August 2011. 

Public health emergencies were declared for all three incidents. For each, 

ASPR conducted situational and readiness assessments to determine what 

public health and medical services States might need. Through its 

Emergency Management Group, ASPR monitored the incident from the 

SOC. ASPR disseminated relevant information to HHS Staff Divisions 

44 HHS provided resources for 13 events in 2010 and for 7 in 2011.
HHS Public Health and Medical Services Emergency Support Preparedness (OEI-04-11-00260) 18

and Operating Divisions and coordinated with them to provide requested

HHS resources. 

HHS Operating Divisions outside of the Office of the Secretary also 

conducted situational and readiness assessments to ensure that resources 

were prepared for deployment in all three incidents. For example, CDC 

monitored State health department reports regarding vector control (i.e., 

eradicating mammals, birds, or insects that transmit diseases such as West 

Nile virus) and prepared to provide resources, such as products to 

eradicate insects, if needed. The Substance Abuse and Mental Health 

Services Administration (SAMHSA) assessed potential impact to 

behavioral health systems (i.e., networks of behavioral health services 

providers) and coordinated with stakeholders, assessed needs, and 

provided technical assistance to all three affected populations. SAMHSA 

and support organizations also distributed behavioral health materials. 

SAMHSA deployed behavioral health specialists and provided grants to 

restore behavioral health facilities and support services. 

The Administration for Children and Families (ACF) and FDA also 

participated in HHS’s response efforts. ACF assessed the impact the 

incidents had on services such as access to food and emergency housing. 

FDA deployed food safety consultants to conduct risk assessments of food 

service and manufacturing facilities and of agricultural animals used for 

human consumption. 

For all three incidents, NDMS medical personnel were activated (i.e., 

instructed by the HHS Secretary to provide medical services) and hospital 

bed availability was continually assessed through the Hospital 

Preparedness Program’s Hospital Available Beds for Emergencies and 

Disasters system. This system reports available hospital beds in real time 

at the local and regional level. HHS also provided reports detailing

available blood resources and types to NDMS and other medical personnel 

for all three selected incidents.

Finally, after each of the three incidents, ASPR coordinated with all 

affected States to determine whether supplementary HHS resources were 

needed. Appendix E is a detailed list of ESF-8 resources provided to 

States by HHS during its response to three selected incidents in 2010 and 

2011. 

Red River flooding in North Dakota 

On March 21, 2010, the Red River crested at 36.99 feet—19 feet above 

flood level. Floodwaters destroyed homes, covered roadways, and closed

bridges. In an attempt to protect the city of Fargo from the floodwaters, 

Federal, State, and local governments and organizations coordinated 
HHS Public Health and Medical Services Emergency Support Preparedness (OEI-04-11-00260) 19

efforts to stack 700,000 sandbags around the city. At least 10 people were 

reportedly rescued from floodwaters.

45 

During the flood response, HHS provided North Dakota with resources in 

12 of the 17 core functional areas of ESF-8.46 (The State did not request 

resources for the other five core functional areas.) Throughout the 

response, HHS RECs monitored North Dakota’s requests for public health 

and medical equipment and technical assistance, and provided requested 

resources.

HHS deployed ESF-8 personnel to the North Dakota Emergency 

Operations Center to provide technical support. Specifically, an HHS 

Incident Response Coordination Team (IRCT) was deployed to assess 

flood damage. The 

IRCT interacted 

with State and local 

emergency 

response personnel 

to determine what 

additional ESF-8 

resources HHS 

could provide to 

support the State 

response. 

In addition to the 

IRCT, DMATs

were identified to 

assist in shelter 

operations, as needed. Health and medical caches containing mobile 

medical kits and prescription drugs were deployed to support response 

personnel. 

An HHS public affairs officer coordinated with State representatives to 

assess public health and medical communication needs. To provide 

further support, CDC posted information on its Web site to keep the public 

informed about the flooding. 

45 CNN, FEMA Chief to Survey Red River flooding. Accessed at 

http://www.cnn.com/2010/US/weather/03/22/severe.weather/index.html?iref=allsearch on 

June 22, 2012.

46 Core functional area resources not needed during the Red River flooding response were 

Patient Evacuation; Agricultural Safety and Security; Vector Control; Mass Fatality 

Management, Victim Identification, and Decontaminating Remains; and Veterinary Medical 

Support. 

Photo provided by FEMA

Burlington, North Dakota, was inundated during the Red River 

flood in March 2010.
HHS Public Health and Medical Services Emergency Support Preparedness (OEI-04-11-00260) 20

State representatives reported that HHS’s response was “efficient and 

effective,” and that all resources provided by HHS were sufficient, 

helpful, and appropriate. 

Tornado in Joplin, Missouri 

On May 23, 2011, a “monster tornado” struck Joplin, killing 116 people 

and injuring another 400.47 Measuring over a half-mile wide, the tornado 

destroyed an estimated 2,000 homes, schools, and businesses. One 

hundred eighty 

patients at St. 

John’s 

Regional 

Medical Center

attempted to 

find shelter as

the roof was 

ripped off by 

the tornado. 

Weather 

officials 

reported that 

the tornado was 

the single 

deadliest 

twister in the 

United States since 1947 and one of the nine deadliest in recorded 

history.48 

HHS provided Missouri with resources in 16 of the 17 core functional 

areas of ESF-8. (The State did not request resources for the other core 

functional area.49) HHS ESF-8 personnel deployed to Joplin assessed 

damage to the medical infrastructure, including hospitals and long-termcare facilities. An HHS IRCT and the Emergency Management Group 

collaborated with FEMA and State and local officials to determine the 

State’s need for Federal resources to repair the health care infrastructure. 

DMATs also assisted with patient care and emergency services. A 

Medical Strike Team was deployed to assess the impact on public health 

47 Reuters, Tornado devastates Joplin, Missouri, 116 dead. Accessed at 

http://www.reuters.com/article/2011/05/23/us–usa–weather–tornadoes–

idUSTRE74M08L20110523 on June 22, 2012.

48 Ibid.

49 Patient Evacuation core functional area resources were not needed during the Joplin 

tornado response.

Photo provided by FEMA

Damage to the front entrance of St. John’s Regional Medical Center in 

Joplin, Mo., after a deadly F-5 tornado struck. 
HHS Public Health and Medical Services Emergency Support Preparedness (OEI-04-11-00260) 21

and respond to chemical, biological, and radiological dispersals.50 RECs

collaborated with a hospital to set up a mobile medical unit. Health and 

medical caches containing prescription drugs and mortuary equipment and 

supplies were also deployed to Joplin. HHS personnel conducted family 

interviews to assist with victim identification.

SAMHSA deployed behavioral health specialists who provided 

psychological first aid and crisis counseling training to responders in 

Joplin. SAMHSA coordinated with the American Red Cross, which also 

provided mental health services to Joplin residents, as needed. SAMHSA

also managed the transport of patients, service providers, and drugs 

requiring additional security, such as methadone, during the response. 

ACF collaborated with ESF-6 personnel (e.g., DHS, FEMA), the Missouri 

State Division of Family Services, and the Child Care Development Fund 

to provide technical assistance and consultation to affected Joplin 

residents. FDA inspected and provided surveillance of retail food 

establishments and food manufacturing facilities. CDC assessed vaccine 

need and availability and animal control, and assessed needs for vector 

control resources. CDC worked with EPA to provide vector control 

resources to eradicate mosquitoes in Joplin. CDC also worked with 

Joplin’s health department to inform the affected population about the 

need to boil water before use. 

Public health emergency information was disseminated to the public 

through ASPR’s Web site. CMS published information regarding 

Medicare, Medicaid, and the Children’s Health Insurance Plan benefits 

during an incident response. SAMHSA also provided stress management 

information on its Web site. 

State representatives reported that all requested resources were sufficient, 

helpful, and appropriate. They stated that HHS provided technical support 

and “guidance in some very challenging circumstances.”

Hurricane Irene along the East Coast

On August 22, 2011, Hurricane Irene struck Puerto Rico. The storm 

downed trees, flooded streets, and left over a million people without 

electricity. Hurricane advisories were issued for most States along the 

50 A Medical Strike Team is prepared to assist with medical management and respond to the 

public health consequences of chemical, biological, and radiological incidents that result from 

accidental or deliberate acts. The team is designed to supplement the local hazardous 

materials and medical response to weapons of mass destruction by offering specialized 

equipment and knowledge, as well as additional fire and emergency personnel, physicians, 

and nurses.
HHS Public Health and Medical Services Emergency Support Preparedness (OEI-04-11-00260) 22

East Coast as Irene left Puerto Rico.

51 On August 26, the hurricane struck 

the East Coast and left millions of people without electricity for several 

days and, in some cases, several weeks. Homes, businesses, and crops 

were damaged or destroyed by high winds and heavy rains. The storm 

killed 45 people.52

Fifteen States on the East Coast were affected by Hurricane Irene.53 HHS 

reported that it provided affected States with resources in 16 of the 17 core 

functional areas 

of ESF-8. (States 

did not request 

resources for the

remaining core 

functional 

area.54) HHS 

began its 

response by 

deploying IRCTs, 

DMATs, 

Logistical 

Response 

Assistance 

Teams, and Rapid Deployable Force teams to affected States. 

Communications equipment was deployed to assist IRCTs in assessing 

States’ needs and the resources HHS could provide. Caches containing 

medical equipment had been strategically positioned along the East Coast 

to prepare them for rapid deployment during incident response. The 

Federal National Ambulance Contract was activated in New York to assist 

with patient evacuation from hospitals and other health care facilities.

CDC assessed the need for vector control resources and conducted 

epidemiology conference calls with affected States. CDC provided the 

Virginia Department of Health with technical assistance regarding vector 

control. The Health Resources and Services Administration assessed the 

51 CBS News, Hurricane Irene Slams Puerto Rico, Eyes U.S. Accessed at 

http://www.cbsnews.com/2100–201_162–20095323.html on June 22, 2012.

52 Associated Press, Hurricane Irene’s Impact, State by State. Accessed at 

http://www.nj.com/news/index.ssf/2011/08/hurricane_irenes_impact_state.html on June 22, 

2012.

53 The 15 States were Connecticut, the District of Columbia, Delaware, Massachusetts, 

Maryland, North Carolina, New Jersey, New York, Pennsylvania, Puerto Rico, Rhode Island, 

South Carolina, Vermont, Virginia, and the U.S. Virgin Islands.

54 Safety and Security of Drugs, Biologics, and Medical Devices core functional area 

resources were not needed during the Hurricane Irene response.

Photo provided by National Oceanic Atmospheric Administration

Hurricane Irene as it strikes the East Coast in August 2011.
HHS Public Health and Medical Services Emergency Support Preparedness (OEI-04-11-00260) 23

impact of Hurricane Irene on service providers and their ability to deliver

community-based services to patients. HHS provided critical 

infrastructure support to the American Red Cross in Baltimore to ensure 

that blood supplies were secure. 

Public health information regarding well water contamination was 

disseminated to the public through ASPR’s Web site. CDC also updated 

hurricane information on its Web site. 

Representatives from 10 of the 15 States reported that they received HHS 

resources, and that the resources provided were appropriate, based on their 

requests. Of the 10 States that reported receiving resources, 9 indicated 

that HHS resources were helpful. One State reported a neutral response 

about the resources it received.55

States Reported That Multiple Requests From HHS for the Same 

Information Were Burdensome During Incident Response. 

Five of the fifteen respondents reported that the same information was 

requested multiple times by different HHS Staff Divisions and Operating 

Divisions.56 States reported that it appeared HHS personnel did not 

communicate information among Staff Divisions and Operating Divisions 

and that each division made separate requests. States indicated that these 

multiple requests were burdensome. 

One State said that although it had established a regular, recurring 

reporting system during the Hurricane Irene response, HHS requested 

information that the State had already provided or intended to provide in 

the next reporting cycle.57 

55 The 10 States that received resources were Connecticut, Maryland, New Jersey, New York, 

North Carolina, Pennsylvania, Puerto Rico, Rhode Island, Vermont, and Virginia. The five 

States that did not receive resources were the District of Columbia, Delaware, Massachusetts, 

South Carolina, and the U.S. Virgin Islands. The only State that reported a neutral response 

about HHS resources received was Maryland.

56 The five States that reported receiving multiple requests for the same information were 

Maryland, New York, North Carolina, Rhode Island, and Virginia. 

57 Virginia.
HHS Public Health and Medical Services Emergency Support Preparedness (OEI-04-11-00260) 24

CONCLUSION AND RECOMMENDATIONS

In 2010, CIGIE published the IG’s Guide, which recommended that IGs 

assess their Federal agency’s emergency preparedness capabilities. Recent 

incidents such as the Sandy super storm emphasize the need for Federal 

agencies to assess their emergency response capabilities. HHS is charged 

with serving as the Coordinator and Primary agency for ESF-8 Public 

Health and Medical Services. Within HHS, ASPR organizes HHS

resources and response as the Coordinator and Primary agency for ESF-8. 

HHS also serves as the Support agency for nine additional ESFs. 

HHS has taken action in all five preparedness activities we reviewed to 

fulfill its ESF responsibilities as a Coordinator, Primary, and Support 

agency. However, HHS can improve communication of its Support 

agency role, responsibilities, and the resources it can provide during 

incident response. 

Further, HHS responded to 28 incidents in 2010 and 2011 and 

demonstrated its ability to respond to 3 incidents we reviewed that 

affected 17 States. Twelve of the seventeen States affected by these three 

incidents reported requesting HHS resources and stated that the resources 

they received were appropriate, based on their requests. However, internal

communication with Staff Divisions and Operating Divisions could be 

increased to reduce duplicative information requests to States. 

We recommend that HHS: 

Continue to Increase Communication with ESF Coordinator 

and Primary Agencies It Serves as a Support Agency

The NRF states that ESF Support agencies must be prepared to provide 

resources and participate in preparedness activities to support the ESF 

Coordinator and Primary agency’s mission. HHS should continue to work 

toward increasing its communication with the Coordinator and Primary 

agencies for the nine additional ESFs for which HHS serves as a Support 

agency. Specifically, HHS should increase communication regarding its 

Support agency role and the resources it can provide during incident 

response. 

Coordinate Requests for Information From HHS Staff Divisions 

and Operating Divisions To Reduce the Burden on States 

During an Incident Response 

Five of the fifteen States affected by Hurricane Irene indicated that HHS 

Staff Divisions and Operating Divisions made several requests for the 

same information. States found this burdensome and reported that the 

repeated requests slowed their incident response. HHS should coordinate 
HHS Public Health and Medical Services Emergency Support Preparedness (OEI-04-11-00260) 25

all requests for information during an incident response to ensure that 

States are not being unnecessarily burdened. For example, HHS could 

establish one point of contact per response area to communicate with State 

and local governments during the incident response. This point of contact 

could, in turn, disseminate information to HHS Staff Divisions and 

Operating Divisions. 
HHS Public Health and Medical Services Emergency Support Preparedness (OEI-04-11-00260) 26

AGENCY COMMENTS AND OFFICE OF INSPECTOR GENERAL

RESPONSE 

ASPR concurred with our recommendations and provided information 

regarding its efforts to fulfill its emergency support responsibilities. 

Specifically, ASPR will continue to include all appropriate Coordinator 

and Primary agencies in any planning endeavors as well as routine 

collaboration with partner agencies. 

Regarding our second recommendation, ASPR will continue to improve 

information collection from States concerning multiple agency requests 

during incident response. Although ASPR makes every effort to ensure 

that requests to States are well-coordinated and minimally burdensome, it

recognizes that during a response communication breakdowns may occur

at the Federal and State levels. ASPR acknowledges this challenge and 

places a high priority on building and enhancing communications with all 

of its partners and stakeholders. 

We support ASPR’s efforts to address and continue to make progress in 

these areas. For the full text of ASPR’s comments, see Appendix G.
HHS Public Health and Medical Services Emergency Support Preparedness (OEI-04-11-00260) 27

APPENDIX A 

Emergency Support Functions 

 The National Response Framework assigns 15 Emergency Support Functions (ESF) to various Federal agencies. Each 

ESF divides Federal responsibilities among Coordinator (C), Primary (P), and Support (S) agencies and organizations. 

The chart below indicates which Federal agencies and organizations are assigned responsibilities within each ESF. The 

highlighted column and row indicate the Department of Health and Human Services’ ESF-8 responsibilities. 

Table A-1 Selected Federal Agencies With Coordinator, Primary, and Support Roles for Emergency Support Functions

Agencies and 

Organizations

#1 #2 #3 #4 #5 #6 #7 #8 #9 #10 #11 #12 #13 #14 #15 Transportation Communications Public 

Works and 

EngineeringFirefightingEmergency ManagementMass Care, Emer. Assist., Housing, and Human Svs.Logistics Management and Resource SupportPublic Health and Medical ServicesSearch and RescueOil and Hazardous Materials ResponseAgriculture and Natural ResourcesEnergyPublic Safety and Security Long-Term Community RecoveryExternal Affairs

American 

Council on

Historic 

Preservation

S 

American Red 

Cross S S S S S S 

Corporation for 

National & 

Community 

Service

S S S 

Department of 

Homeland 

Security (DHS)

S C/P/S P/S S C/P/S C/P/S C/P/S S C/P/S P/S S S S C/P C/P

Department of 

Commerce S S S S S S S S S S S S S S 

Department of 

Defense S S C/P/S S S S S S P/S S S S S S S 

Department of 

Energy S S S S S S S C/P S S S 

continued on next page
HHS Public Health and Medical Services Emergency Support Preparedness (OEI-04-11-00260) 28

Table A-1 Selected Federal Agencies With Coordinator, Primary, and Support Roles for Emergency Support Functions, Continued

Agencies and 

Organizations

#1 #2 #3 #4 #5 #6 #7 #8 #9 #10 #11 #12 #13 #14 #15 Transportation Communications Public 

Works and 

EngineeringFirefightingEmergency ManagementMass Care, Emer. Assist., Housing, and Human Svs.Logistics Management and Resource SupportPublic Health and Medical ServicesSearch and RescueOil and Hazardous Materials ResponseAgriculture and Natural ResourcesEnergyPublic Safety and Security Long-Term Community RecoveryExternal Affairs

Department of the 

Interior S S S S S S S S P S P/S S S S S 

Department of 

Justice S S S S S S S C/P S 

Department of 

Labor S S S S S S S S S S S 

Department of 

State S S S S S S S S S 

Department of 

Transportation C/P S S S S S S S S S S 

Delta Regional 

Authority S 

Department of 

Education S S 

Environmental 

Protection Agency S S S S C/P S S S S S 

Federal 

Communications 

Commission

S S S 

General Services 

Administration S S S S S C/P S S S S 

Heritage 

Emergency 

National Task 

Force

S 

Department of 

Health and 

Human Services

S S S S C/P S S S S S 

continued on next page
HHS Public Health and Medical Services Emergency Support Preparedness (OEI-04-11-00260) 29

Table A-1 Selected Federal Agencies With Coordinator, Primary, and Support Roles for Emergency Support Functions, Continued

Agencies and 

Organizations

#1 #2 #3 #4 #5 #6 #7 #8 #9 #10 #11 #12 #13 #14 #15 Transportation Communications Public 

Works and 

EngineeringFirefightingEmergency ManagementMass Care, Emer. Assist., Housing, and Human Svs.Logistics Management and Resource SupportPublic Health and Medical ServicesSearch and RescueOil and Hazardous Materials ResponseAgriculture and Natural ResourcesEnergyPublic Safety and Security Long-Term Community RecoveryExternal Affairs

Department of 

Housing and 

Urban 

Development

S S P S 

National 

Archives and 

Records 

Administration

S 

National 

Aeronautics and 

Space 

Administration

S S S S S 

Nuclear 

Regulatory 

Commission

S S S S S 

National 

Voluntary 

Organizations 

Active in 

Disaster

S S 

Office of 

Personnel 

Management

S S S 

Small Business 

Administration S S P S 

Social Security 

Administration S S S 

continued on next page
HHS Public Health and Medical Services Emergency Support Preparedness (OEI-04-11-00260) 30

Table A-1 Selected Federal Agencies With Coordinator, Primary, and Support Roles for Emergency Support Functions, Continued

Agencies and 

Organizations

#1 #2 #3 #4 #5 #6 #7 #8 #9 #10 #11 #12 #13 #14 #15 Transportation Communications Public 

Works and 

EngineeringFirefightingEmergency ManagementMass Care, Emer. Assist., Housing, and Human Svs.Logistics Management and Resource SupportPublic Health and Medical ServicesSearch and RescueOil and Hazardous Materials ResponseAgriculture and Natural ResourcesEnergyPublic Safety and Security Long-Term Community RecoveryExternal Affairs

Department of 

the Treasury S S S S S 

Tennessee 

Valley Authority S S S S 

Agency for 

International 

Development

S S S 

Department of 

Agriculture S S S C/P S S S S S C/P/S S P S 

Postal Service S S S S S S S 

Veterans 

Administration S S S S S S S 

Source: DHS, National Response Framework. Accessed at http:// www.fema.gov/pdf/emergency/NRF/NRF-core.pdf on March 7, 2011. DHS, ESF-8–Public Health and Medical 

Services Annex. Accessed at http://www.fema.gov/pdf/emergency/NRF/NRF–esf–08.pdf on May 13, 2011.
HHS Public Health and Medical Services Emergency Support Preparedness (OEI-04-11-00260) 31

APPENDIX B 

Seventeen Core Functional Areas of Emergency Support 

Function-8 

Emergency Support Function-8 (ESF-8) describes Federal public health 

and medical services that can be provided to assist States, tribes, and 

localities when an incident occurs. The Department of Health and Human 

Services (HHS), in conjunction with Federal Support agencies and 

organizations, fulfills the responsibilities within ESF-8. The 17 core 

functional areas of ESF-8, as quoted in the National Response Framework

are:58, 59

1. Assessment of Public Health/Medical Needs. HHS, in collaboration with 

the Department of Homeland Security (DHS), mobilizes and deploys 

ESF-8 personnel to support national or regional teams to assess public 

health and medical needs, including the needs of at-risk population 

groups, such as language assistance services for limited Englishproficient individuals and accommodations and services for individuals 

with disabilities. This function includes the assessment of the health care 

system/facility infrastructure. 

2. Health Surveillance. HHS, in coordination with supporting departments 

and agencies, enhances existing surveillance systems to monitor the 

health of the general and medical needs population; carries out field 

studies and investigations; monitors injury and disease patterns and 

potential disease outbreaks, blood and blood product bio-vigilance, and 

blood supply levels; and provides technical assistance and consultations 

on disease and injury prevention and precautions. 

3. Medical Care Personnel. Immediate medical response capabilities are 

provided by assets internal to HHS (e.g., U.S. Public Health Service 

Commissioned Corps (PHSCC), National Disaster Medical System 

(NDMS), and Federal Civil Service employees) and from ESF-8 

supporting organizations. 

ESF-8 may request Department of Defense (DOD) support for casualty 

clearing and staging, patient treatment, and support services such as 

surveillance and laboratory diagnostics. 

58 DHS, ESF-8–Public Health and Medical Services Annex. Accessed at 

http://www.fema.gov/pdf/emergency/NRF/NRF–esf–08.pdf on May 13, 2011.

59 ESF-8 includes a core functional area entitled Worker Safety and Health. The Department 

of Labor is the lead Federal agency for this core functional area, with HHS serving as a 

Support agency. Therefore the Worker Safety and Health core functional area is not included 

in our list of HHS’s 17 core functional areas of ESF-8.
HHS Public Health and Medical Services Emergency Support Preparedness (OEI-04-11-00260) 32

ESF-8 may seek individual clinical public health and medical care 

specialists from the Department of Veterans Affairs (VA) to assist State, 

tribal, and local public health and medical personnel. 

ESF-8 may engage civilian volunteers, such as Medical Reserve Corps 

(MRC), to assist State, tribal, and local public health and medical 

personnel. 

4. Health/Medical/Veterinary Equipment and Supplies. In addition to 

deploying assets from the Strategic National Stockpile (SNS), ESF-8 

may request DOD or the VA to provide medical equipment, durable 

medical equipment, and supplies, including medical, diagnostic, and 

radiation-detecting devices, pharmaceuticals, and biologic products in 

support of immediate medical response operations and for restocking 

health care facilities in an area affected by a major disaster or emergency. 

When a veterinary response is required, assets may be requested from the 

National Veterinary Stockpile (NVS), which is managed by the 

Department of Agriculture (USDA) Animal and Plant Health Inspection 

Service (APHIS). 

5. Patient Evacuation. ESF-8 is responsible for transporting seriously ill 

(i.e., seriously ill describes persons whose illness or injury is of such 

severity that there is cause for immediate concern, but there is not 

imminent danger to life) or injured patients, and medical needs 

populations from casualty collection points in the impacted area to 

designated reception facilities. ESF-8 coordinates the Federal response 

in support of emergency triage and pre-hospital treatment, patient 

tracking, and distribution. This effort is coordinated with Federal, State, 

tribal, and local emergency medical services officials. 

ESF-8 may request DOD, VA, and DHS/Federal Emergency 

Management Agency (FEMA), via the national ambulance contract, to 

provide support for evacuating seriously ill or injured patients. Support 

may include providing transportation assets, operating and staffing 

NDMS Federal Coordination Centers, and processing and tracking 

patient movements from collection points to their final destination 

reception facilities. 

DOD is the only recognized Federal partner responsible for regulating 

and tracking patients transported on DOD assets to appropriate treatment 

facilities (e.g., NDMS hospitals). 

6. Patient Care. ESF-8 may task HHS components to engage civil service 

personnel, the PHSCC, the regional offices, and States to engage civilian 

volunteers and request the VA and DOD to provide available personnel 

to support pre-hospital triage and treatment, inpatient hospital care, 
HHS Public Health and Medical Services Emergency Support Preparedness (OEI-04-11-00260) 33

outpatient services, pharmacy services, and dental care to victims who 

are seriously ill, injured, or suffer from chronic illnesses who need 

evacuation assistance, regardless of location. 

ESF-8 may assist with isolation and quarantine measures and with point 

of distribution operations (mass prophylaxis and vaccination). Health 

care providers and support staff will ensure appropriate patient 

confidentiality is maintained, including Health Insurance Portability and 

Accountability Act privacy and security standards, where applicable.

7. Safety and Security of Drugs, Biologics, and Medical Devices. ESF-8 

may task HHS components to ensure the safety and efficacy of and 

advise industry on security measures for regulating human and 

veterinary drugs, biologics (including blood and vaccines), medical 

devices (including radiation emitting and screening devices), and other 

HHS-regulated products. 

8. Blood, Organs, and Blood Tissues. ESF-8 may task HHS components 

and request assistance from other ESF-8 partner organizations to monitor 

and ensure the safety, availability, and logistical requirements of blood, 

organs, and tissues. This includes the ability of the existing supply chain 

resources to meet the manufacturing, testing, storage, and distribution of 

these products. 

9. Food Safety and Security. ESF-8, in cooperation with ESF-11, may task 

HHS components and request assistance from other ESF-8 partner 

organizations to ensure the safety and security of federally regulated 

foods. (Note: HHS, through the Food and Drug Administration (FDA), 

has statutory authority for all domestic and imported food except meat, 

poultry, and egg products, which are under the authority of the USDA 

Food Safety and Inspection Service. The Environmental Protection 

Agency (EPA) establishes tolerance levels for pesticide residues.) 

10. Agriculture Safety and Security. ESF-8, in coordination with ESF-11, 

may task HHS components to ensure the health, safety, and security of 

food-producing animals, animal feed, and therapeutics. (Note: HHS, 

through the FDA, has statutory authority for animal feed and for the 

approval of animal drugs intended for both therapeutic and nontherapeutic use in food animals as well as companion animals.) 

11. All-Hazards Public Health and Medical Consultation, Technical 

Assistance, and Support. ESF-8 may task HHS components and regional 

offices and request assistance from other ESF-8 partner organizations in 

assessing public health, medical, and veterinary medical effects resulting 

from all hazards. Such tasks may include assessing exposures on the 

general population and on high-risk population groups; conducting field 
HHS Public Health and Medical Services Emergency Support Preparedness (OEI-04-11-00260) 34

investigations, including collection and analysis of relevant samples; 

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; and providing technical assistance 

and consultation on medical treatment, screening, and decontamination 

of injured or contaminated individuals. While State, tribal, and local 

officials retain primary responsibility for victim screening and 

decontamination operations, ESF-8 can deploy the National Medical 

Response Teams (NMRT) to assist with victim decontamination.

12. Behavioral Health Care. ESF-8 may task HHS components and request 

assistance from other ESF-8 partner organizations in assessing mental 

health and substance abuse needs, including emotional, psychological, 

psychological first aid, behavioral, or cognitive limitations requiring 

assistance or supervision; providing disaster mental health training 

materials for workers; providing liaison with assessment, training, and 

program development activities undertaken by Federal, State, tribal, or 

local mental health and substance abuse officials; and providing 

additional consultation as needed. 

13. Public Health and Medical Information. ESF-8 provides public health, 

disease, and injury prevention information that can be transmitted to 

members of the general public who are located in or near areas affected 

in languages and formats that are understandable to individuals with 

limited English proficiency and individuals with disabilities. 

14. Vector Control. ESF-8 may task HHS components and request 

assistance from other ESF-8 partner organizations, as appropriate, in 

assessing the threat of vector-borne diseases; conducting field 

investigations, including the collection and laboratory analysis of 

relevant samples; providing vector control equipment and supplies; 

providing technical assistance and consultation on protective actions 

regarding vector-borne diseases; and providing technical assistance and 

consultation on medical treatment of victims of vector-borne diseases. 

15. Public Health Aspects of Potable Water/Wastewater and Solid Waste. 

ESF-8 may task HHS components and request assistance from other 

ESF-8 organizations to assist in assessing potable water, wastewater, 

solid waste disposal, and other environmental health issues related to 

public health in establishments holding, preparing, and/or serving food, 

drugs, or medical devices at retail and medical facilities, as well as 

examining and responding to public health effects from contaminated 

water; conducting field investigations, including collection and 

laboratory analysis of relevant samples; providing equipment and 

supplies as needed; and providing technical assistance and consultation. 
HHS Public Health and Medical Services Emergency Support Preparedness (OEI-04-11-00260) 35

16. Mass Fatality Management. ESF-8, when requested by State, tribal, or 

local officials, in coordination with its partner organizations, will assist 

the jurisdictional medico-legal authority and law enforcement agencies 

in the tracking and documenting of human remains and associated 

personal effects; reducing the hazard presented by chemically, 

biologically, or radiologically contaminated human remains (when 

indicated and possible); establishing temporary morgue facilities; 

determining the cause and manner of death; collecting ante mortem data 

in a compassionate and culturally competent fashion from authorized 

individuals; performing postmortem data collection and documentation; 

identifying human remains using scientific means (e.g., dental, 

pathology, anthropology, fingerprints, and, as indicated, DNA samples); 

and preparing, processing, and returning human remains and personal 

effects to the authorized person(s) when possible; and providing 

technical assistance and consultation on fatality management and 

mortuary affairs. In the event that caskets are displaced, ESF-8 assists in 

identifying the human remains, recasketing, and reburial in public 

cemeteries. 

ESF-8 may task HHS components and request assistance from other 

ESF-8 partner organizations, as appropriate, to provide support to 

families of victims during the victim identification mortuary process. 

17. Veterinary Medical Support. ESF-8 will provide veterinary assistance to 

ESF-11. Support will include the amelioration of zoonotic disease and 

caring for research animals where ESF-11 does not have the requisite 

expertise to render appropriate assistance. 

ESF-8 will assist ESF-11 as required to protect the health of livestock 

and companion and service animals by ensuring the safety of the 

manufacture and distribution of foods and drugs given to animals used 

for human food production. ESF-8 supports DHS/FEMA together with 

ESF-6 – Mass Care, Emergency Assistance, Housing, and Human 

Services, ESF-9 – Search and Rescue, and ESF-11 to ensure an 

integrated response to provide for the safety and well-being of household 

pets and service and companion animals. 
HHS Public Health and Medical Services Emergency Support Preparedness (OEI-04-11-00260) 36

APPENDIX C 

National Planning Scenarios

Fifteen National Planning Scenarios describe specific incidents that may 

occur, ranging from hurricanes and influenza pandemics to biological 

attacks. Agencies with Emergency Support Function responsibilities can 

use the 15 National Planning Scenarios as a guide to developing 

preparedness plans and participating in activities for these specific 

incidents that may require unique plans and resources beyond all-hazards 

plans. The 15 National Planning Scenarios are: 60

1. Biological Attack—Aerosolized Anthrax

2. Biological Attack—Botulinum Food Contamination 

3. Biological Attack—Pandemic Influenza

4. Biological Attack—Pneumonic Plague 

5. Biological Attack—Foreign Animal Disease

6. Chemical Attack—Blister Agent 

7. Chemical Attack—Chlorine Tank Explosion

8. Chemical Attack—Toxic Industrial Chemicals

9. Chemical Attack—Nerve Agent

10. Cyber Attack—Cyber Security 

11. Explosives Attack—Bombing Using Improvised Explosive 

Devices

12. Explosives Attack—Improvised Nuclear Device 

13. Natural Disaster—Major Earthquake

14. Natural Disaster—Major Hurricane

15. Radiological Attack—Radiological Dispersal Devices and 

Radiological Explosive Devices 

60 Federal Emergency Management Agency, National Preparedness Guidelines, pp. 4–5. 

Accessed at 

http://www.fema.gov/pdf/emergency/NRF/National_Preparedness_Guidelines.pdf on June 21, 

2011.
HHS Public Health and Medical Services Emergency Support Preparedness (OEI-04-11-00260) 37

APPENDIX D

The National Planning Scenario Playbooks and Emergency Support Function-8 

The 15 National Planning Scenario (NPS) playbooks contain written guidance that addresses Federal agencies’ 

responsibilities when an incident (i.e., emergency or disaster) occurs. The Department of Health and Human Services 

(HHS) is assigned public health and medical services responsibilities for Emergency Support Function #8 (ESF-8). 

Within ESF-8 are 17 core functional areas for which HHS is responsible when an incident occurs. The chart below 

indicates which of the 17 core functional areas are addressed in the HHS’s 14 NPS playbooks. 

Table D-1 The 17 Core Functional Areas of ESF-8 and the 15 NPS Playbooks

Core Functional Areas

#1 #2 #3 #4 #5 #6 #7 #8 #9 #10 #11 #12 #13 #14 #15 Aerosolized Anthrax Botulinum Food Contamination Pandemic Influenza Pneumonic Plague Foreign Animal Disease Blister Agent Chlorine Tank Explosion Toxic Industrial Chemical Nerve Agent Cyber Security* Improvised Explosive Device Improvised Nuclear Device Major Earthquake Major Hurricane Radiological Dispersal Device and Radiological 

Explosive Device

Assessment of public 

health and medical needs x x x x x x x x x x x x x x 

Health surveillance x x x x x x x x x x x x x x 

Medical care personnel x x x x x x x x x x x x x x 

Health/medical/veterinary 

equipment and supplies x x x x x x x x x x x x x x 

Patient evacuation x x x x x x x x x x x x x x 

Patient care x x x x x x x x x x x x x x 

Safety and security of 

drugs, biologics, and 

medical devices

x x x x x x x x x x x x x x 

Blood and blood products x x x x x x x x x x x x x 

Food safety and security x x x x x x x x x x x x x x 

Agriculture safety and 

security x x x x x x x x x x x x x x 

continued on next page
HHS Public Health and Medical Services Emergency Support Preparedness (OEI-04-11-00260) 38

Table D-1 The 17 Core Functional Areas of ESF-8 and the 15 NPS Playbooks, Continued

Core Functional Areas

#1 #2 #3 #4 #5 #6 #7 #8 #9 #10 #11 #12 #13 #14 #15 Aerosolized Anthrax Botulinum Food Contamination Pandemic Influenza Pneumonic Plague Foreign Animal Disease Blister Agent Chlorine Tank Explosion Toxic Industrial Chemical Nerve Agent Cyber Security* Improvised Explosive Device Improvised Nuclear Device Major Earthquake Major Hurricane Radiological Dispersal Device and Radiological 

Explosive Device

All-hazard public health 

and medical consultation, 

technical assistance, and 

support

x x x x x x x x x x x x x x 

Behavioral health care x x x x x x x x x x x x x x

Public health and 

medical information x x x x x x x x x x x x x x 

Vector control x x x x x x x x x x x 

Potable 

water/wastewater and 

solid waste disposal

x x x x x x x x x x x x x x 

Mass fatality 

management, victim 

identification, and 

decontamination of 

remains

x x x x x x x x x x x x x x 

Veterinary medical 

support x x x x x x x x x x x x x 

* No NPS playbook has been written for cyber security. Gray-shaded boxes indicate that planning for the listed core functional area was not found in the playbooks. However, HHS has written incident response 

plans to address these areas. Source: Federal Emergency Medical Agency, ESF-8-Public Health and Medical Services Annex. Accessed at http://www.fema.gov/pdf/emergency/nrf/nrf-esf-08.pdf, on May 15, 

2011. DHS, National Preparedness Guidelines, September 2007, p. 3. Accessed at http://www.fema.gov/pdf/emergency/NRF/National_Preparedness_Guidelines.pdf on June 21, 2011.
HHS Public Health and Medical Services Emergency Support Preparedness (OEI-04-11-00260) 39

APPENDIX E

Department of Health and Human Services Response to Three Selected Incidents in 2010 and 2011 

The Department of Health and Human Services (HHS) provides resources to States when an incident (i.e., emergency or 

disaster) occurs. HHS is assigned public health and medical services responsibilities as the lead for the Emergency 

Support Function 8 (ESF-8), Public Health and Medical Services. Within ESF-8 are 17 core functional areas for which

HHS is responsible. The chart below describes three selected incidents—Red River flooding in North Dakota, March 

2010; a tornado in Joplin, Missouri, May 2011; and Hurricane Irene along the East Coast, August 2011—and the resources 

HHS provided, or was prepared to provide, to these States during incident response. 

Table E-1 HHS Resources Provided to Affected States in 2010 and 2011

Core Functional Area Incident State(s) HHS Resource(s) Provided

Objective Strategy Response

1. Assessment of Public 

Health/Medical Needs

Red River 

flooding North Dakota

To evaluate the 

need for public 

health and 

medical support

Assess public health 

and medical 

infrastructure 

threatened by 

flooding

• ESF-8 personnel deployed to North Dakota 

Emergency Operations Center (EOC) and 

assessed potential damage from flooding

• National Disaster Medical System (NDMS) 

activated

• Incident Response Coordination Team 

(IRCT)/Logistics Response Assessment Team 

(LRAT) deployed

• Administration for Children and Families (ACF) 

assessed impact to human services

• Centers for Disease Control (CDC) monitored 

reports from state health departments, assessed 

need for technical assistance on vector control 

(i.e., eradicating mammals, birds, or insects that 

transmit diseases such as West Nile virus)

• Food and Drug Administration (FDA) conducted 

risk assessments

• Substance Abuse and Mental Health Services

Administration (SAMHSA) assessed impact to 

behavioral health systems

continued on next page
HHS Public Health and Medical Services Emergency Support Preparedness (OEI-04-11-00260) 40

Table E-1 HHS Resources Provided to Affected States in 2010 and 2011, Continued

Core Functional Area Incident State(s) HHS Resource(s) Provided

Objective Strategy Response

Joplin tornado Missouri

Ensure the 

integrity of the 

public health 

and medical 

infrastructure

Assess potential

damage to health 

care and long-termcare facilities and 

other infrastructure 

that may have 

resulted from 

damage because of

winds, flooding, etc.

• NDMS activated

• ESF-8 Lead/Regional Emergency Coordinator 

(REC) to MO—Conducted assessments of 

medical infrastructure damage to hospitals and 

long-term-care facilities

• CDC monitored reports from State health 

departments, provided technical assistance on 

vector control 

• Regional Incident Support Team (RIST)/IRCT 

deployed

• ACF assessed impact to human services

• At-Risk Behavioral Health Coordination (ABC)/ 

ACF monitored child care support to ESF-6 

• SAMHSA assessed impact on behavioral health 

systems 

Hurricane Irene

CT, DC, DE, 

MA, MD, NC, 

NJ, NY, PA, 

PR, RI, SC, VT, 

VA, USVI

Ensure the 

integrity of the 

public health 

and medical 

infrastructure

Support Local Public 

Health Agency

• NDMS activated 

• ACF assessed impact to human services 

• CDC monitored reports from State health 

departments, technical assistance on vector 

control

• FDA conducted risk assessments

• SAMHSA assessed impact on behavioral health 

systems

2. Health Surveillance

Red River 

flooding North Dakota

Maintain 

situational 

awareness

Monitor public health 

surveillance reports 

and systems

• Hospital Preparedness Program (HPP)/ Hospital 

Available Beds for Emergencies and Disasters 

(HAvBed) bed status reports reviewed

Joplin tornado Missouri

Maintain 

situational 

awareness

Monitor public health 

surveillance reports 

and systems; report 

on anomalies

• HPP/HAvBed bed status reports reviewed

Hurricane Irene

CT, DC, DE, 

MA, MD, NC, 

NJ, NY, PA, 

PR, RI, SC, VT, 

VA, USVI

Evaluate the 

need to provide 

public health 

and medical 

support

CDC Epidemiology 

team (CDC EPI) 

responds under its

own authorities, 

conducts interviews, 

and records abstract

reviews

• HPP/HAvBED bed status reports reviewed

continued on next page
HHS Public Health and Medical Services Emergency Support Preparedness (OEI-04-11-00260) 41

Table E-1 HHS Resources Provided to Affected States in 2010 and 2011, Continued

Core Functional Area Incident State(s) HHS Resource(s) Provided

Objective Strategy Response

3. Medical Care 

Personnel

Red River 

flooding North Dakota

Evaluate the 

need to provide 

public health 

and medical 

support

Evaluate the need 

for NDMS support 

and identify Medical 

Strike Team (MST) 

and IRCT on the 

basis of capability

• Six on-call Disaster Medical Assistance Team 

(DMAT) identified to support potential emergency 

decompression and shelter operations; plus 2 

24-person teams identified, if needed

• One IRCT deployed

Evaluate the 

need to provide 

public health 

and medical 

support

Prepare safety 

briefing for alerted 

teams

• Health and Safety Plan (HASP) used

Evaluate the 

need to provide 

public health 

and medical 

support

Be prepared to 

provide mental 

health and stress 

management 

technical assistance

• ABC coordinated behavioral health stakeholders to 

identify needs/materials and provide technical 

assistance

Joplin tornado Missouri

Provide lifesaving medical 

capability

Monitor public health 

surveillance reports 

and systems; report 

on anomalies

• Two standard DMATs determined whether the

State was unable to handle health care 

infrastructure damage; each team had capability to 

perform emergency decompression, as required

Provide force 

protection for 

deployed 

personnel

Provide necessary 

communication 

equipment, training, 

Personnel Protective 

Equipment, and 

medical 

countermeasures, if 

required

• MST deployed for force protection

• Behavioral health specialist deployed to support 

responders

• HASP used

Hurricane Irene

CT, DC, DE, 

MA, MD, NC, 

NJ, NY, PA, 

PR, RI, SC, VT,

VA, USVI

Evaluate the 

need to provide 

public health 

and medical 

support and 

ensure the 

integrity of the 

health and 

medical 

infrastructure

Evaluate the need 

for public health and 

medical resources in 

support of the State

• Three IRCT deployed

• Five DMAT deployed to support States

• One LRAT deployed 

• One Rapid Deployable Force (RDF) deployed

• HASP used

continued on next page
HHS Public Health and Medical Services Emergency Support Preparedness (OEI-04-11-00260) 42

Table E-1 HHS Resources Provided to Affected States in 2010 and 2011, Continued

Core Functional Area Incident State(s)

HHS Resource(s) Provided

Objective Strategy Response

4. Health/Medical/

Veterinary Equipment 

and Supplies

Red River 

flooding North Dakota

Provide lifesaving medical 

capability

Augment local health 

care with medical 

personnel or logistical

support to minimize 

patient care shortfalls

• One IRCT cache deployed

• One DMAT cache deployed

• Two Federal Medical Station caches deployed

• Seven MST team kits deployed

• Three Lab caches deployed

• Seven Pharmacy caches deployed

• Seven Electronic Medical Record kits deployed

• Seventeen IT/Telecom kits deployed

• Three Medical Mobile Kits (MMK) deployed

Joplin tornado Missouri

Provide lifesaving medical 

capability

Augment local health 

care with medical 

personnel or logistical

support to minimize 

patient care shortfalls

• Two IRCT caches deployed

• One Deployable Portable Morgue Unit (DPMU) 

deployed

• One DMPU Family Assistance Center Team 

(FACT) cache deployed

• Two Electronic Medical Record kits deployed

• Three MMKs deployed

• Two IT/Telecom kits deployed

Hurricane Irene

CT, DC, DE, 

MA, MD, NC, 

NJ, NY, PA, PR, 

RI, SC, VT, VA, 

USVI

Provide lifesaving medical 

capability

Augment local health 

care with medical 

personnel or logistical

support to minimize 

patient care shortfalls

• One IRCT cache deployed

• Two DMAT caches deployed 

• Two Pharmacy caches deployed

• Two Lab caches deployed

• Five MMKs deployed

• Twelve Electronic Medical Record kits deployed

• Thirteen IT/Telecom kits deployed

5. Patient Evacuation

Red River 

flooding North Dakota

Evaluate the 

need to provide 

public health 

and medical 

support

Assess the need for 

patient movement

• No State requests or HHS actions

Joplin tornado Missouri

Provide lifesaving medical 

capability

Support patient 

movement either by 

Federal Emergency 

Medical Agency

(FEMA) ambulance 

contract or NDMS 

evacuation

• No State requests or HHS actions

Hurricane Irene

CT, DC, DE, 

MA, MD, NC, 

NJ, NY, PA, PR, 

RI, SC, VT, VA, 

USVI

None noted None noted

• National Ambulance Contract activated in NY

continued on next page
HHS Public Health and Medical Services Emergency Support Preparedness (OEI-04-11-00260) 43

61 When a public health emergency is declared, the Centers for Medicare & Medicaid Services (CMS) is permitted to temporarily waive or modify 

Medicare, Medicaid, and the Children’s Health Insurance Program benefit requirements to assist in incident response efforts. This is commonly referred 

to as the 1135 waiver request and is submitted by affected States. ASPR, Public Health Emergency Declarations Q&A. Accessed at 

http://www.phe.gov/Preparedness/legal/Pages/phe-qa.aspx on May 31, 2012.

Table E-1 HHS Resources Provided to Affected States in 2010 and 2011, Continued

Core Functional Area Incident State(s)

HHS Resource(s) Provided

Objective Strategy Response

6. Patient Care

Red River 

flooding North Dakota

Evaluate the 

need to provide 

public health 

and medical 

support

None noted

• Public Health Emergency (PHE) declared by the 

Secretary of HHS

• CMS 1135 waiver requests61

Joplin tornado Missouri

Provide lifesaving medical 

capability

Provide medical 

support teams with 

strike team kits and 

logistic support

• PHE declared by the Secretary of HHS

• CMS 1135 waiver requests

• Four DMAT alerted for emergency 

decompression/augmentation

Provide lifesaving medical 

capability

Augment local health 

care with medical 

personnel or logistic 

support to minimize 

patient care 

shortfalls

• No State requests or HHS actions

Hurricane Irene

CT, DC, DE, 

MA, MD, NC, 

NJ, NY, PA, 

PR, RI, SC, VT, 

VA, USVI

None noted None noted

• PHE declared by the Secretary of HHS

• CMS 1135 waiver requests

• Five DMAT shelter support teams deployed

• Three IRCT deployed to affected regions

7. Safety and Security of 

Drugs, Biologics, and 

Medical Devices

Red River 

flooding North Dakota

Evaluate the 

need to provide 

public health 

and medical 

support

Initiate actions to 

deploy and deliver 

appropriate Strategic 

National Stockpile 

(SNS) material to a 

Federal Mobilization 

Center or other 

designated reception 

location, if requested

• REC monitored potential Durable Medical 

Equipment (DME) requests

continued on next page
HHS Public Health and Medical Services Emergency Support Preparedness (OEI-04-11-00260) 44

Table E-1 HHS Resources Provided to Affected States in 2010 and 2011, Continued

Core Functional Area Incident State(s) HHS Resource(s) Provided

Objective Strategy Response

Joplin tornado Missouri

Ensure the 

integrity of the 

public health 

and medical 

infrastructure

Assess risk to the 

public health and 

medical assets, 

including safety of 

human, biologics, 

veterinary drugs, 

and medical devices

• SAMHSA monitored methadone movement and 

security 

Hurricane Irene

CT, DC, DE, 

MA, MD, NC, 

NJ, NY, PA, 

PR, RI, SC, VT, 

VA, USVI

None noted None noted

• No State requests or HHS actions

8. Blood, Organs, and Blood 

Tissues

Red River 

flooding North Dakota None noted None noted • Blood supply reports for area provided to State

Joplin tornado Missouri

Provide lifesaving medical 

capability

Assess blood and 

blood product 

availability and 

mitigate shortages

• Blood supply reports for area provided to State

Hurricane Irene

CT, DC, DE, 

MA, MD, NC, 

NJ, NY, PA, 

PR, RI, SC, VT, 

VA, USVI

None noted None noted

• Blood supply reports for area provided to States

9. Food Safety and Security

Red River 

flooding North Dakota

Assess integrity 

of public health 

infrastructure

Perform 

assessments of 

needs for vector 

control, food and 

water safety, and 

sanitation. Support 

State requests for 

assistance

• REC monitored State actions and requests

Joplin tornado Missouri

Provide lifesaving medical 

capability

Assess blood and 

blood product 

availability and 

mitigate shortages

• Blood supply reports for area provided to State

Hurricane Irene

CT, DC, DE, 

MA, MD, NC, 

NJ, NY, PA, 

PR, RI, SC, VT, 

VA, USVI

None noted None noted

• Blood supply reports for area provided to States

continued on next page
HHS Public Health and Medical Services Emergency Support Preparedness (OEI-04-11-00260) 45

Table E-1 HHS Resources Provided to Affected States in 2010 and 2011, Continued

Core Functional Area Incident State(s)

HHS Resource(s) Provided

Objective Strategy Response

10. Agriculture Safety and 

Security

Red River 

flooding North Dakota None noted None noted • No State requests or HHS actions

Joplin tornado Missouri

Ensure the

integrity of the 

public health and 

medical 

infrastructure

Provide technical 

assistance for 

protection of animal 

life in coordination 

with ESF-11

• CDC assessed vaccine and animal control efforts

Hurricane Irene

CT, DC, DE, 

MA, MD, NC, 

NJ, NY, PA, 

PR, RI, SC, VT, 

VA, USVI

None noted None noted

• FDA food safety consultants deployed

• Technical assistance provided to ESF-11

11. All-Hazards Public 

Health and Medical 

Consultation, Technical 

Assistance, and Support

Red River 

flooding North Dakota None noted None noted • REC monitored State actions and requests

• PHS subject matter expert (SME) deployed

Joplin tornado Missouri

Provide force 

protection for 

deployed 

personnel

Provide necessary 

communication 

equipment, training, 

personnel protective 

equipment (PPE), 

and medical 

countermeasures, if 

required

• REC assisted hospital in setup of mobile medical 

unit

• ACF collaborated with ESF-6 and MO Division of 

Family Services, Child Care and Development 

Fund

• CDC vaccine and animal control efforts assessed

• DMORT needs assessed

• FACT engaged

• SAMHSA psychological first aid training provided

• SAMHSA crisis counseling training provided

Hurricane Irene

CT, DC, DE, 

MA, MD, NC, 

NJ, NY, PA, 

PR, RI, SC, VT, 

VA, USVI

Provide technical 

assistance

Technical 

assistance provided

• Monitored State health departments, water 

supplies, and technical assistance for vector 

control

• CDC EPI conducted conference calls with States

• Health Resources and Services Administration 

(HRSA) contacted grantees and partners to 

determine impact to community-based services 

delivery

• HHS Critical Infrastructure support to American 

Red Cross Blood HQ in Baltimore

• SAMHSA provided behavioral health technical 

assistance 

continued on next page
HHS Public Health and Medical Services Emergency Support Preparedness (OEI-04-11-00260) 46

Table E-1 HHS Resources Provided to Affected States in 2010 and 2011, Continued

Core Functional Area Incident State(s) HHS Resource(s) Provided

Objective Strategy Response

12. Behavioral Health Care

Red River 

flooding North Dakota

Monitor 

transition to 

recovery

Be prepared to 

provide mental 

health and stress 

management 

technical assistance

• REC monitored State actions and requests

• ABC coordinated behavioral health stakeholders to 

identify needs/materials and provided technical 

assistance

• SAMHSA provided technical assistance, crisis 

counseling program grants, and monitored impact 

on behavioral health systems 

Monitor 

transition to 

recovery

Plan for recovery 

operations, 

including mental 

health support

• ABC coordinated behavioral health stakeholders to 

ensure that behavioral health was included in 

recovery efforts

Joplin tornado Missouri

Monitor 

transition to 

recovery

Plan for recovery 

operations 

including, mental 

health support

• Deployed behavioral health specialist to DPMU

• ABC coordinated behavioral health stakeholders to 

ensure that behavioral health was included in 

recovery efforts

Ensure the 

integrity of the 

public health and 

medical 

infrastructure

Provide behavioral 

health and stress 

management 

technical assistance

• SAMHSA assessed and monitored the relocation 

of methadone, patients, and service providers

• SAMHSA provided crisis counseling program and 

SAMHSA emergency response grants (SERG)

• SAMHSA provided technical assistance and 

consulted with State regarding behavioral health 

programs

• American Red Cross provided disaster mental 

health services 

• SAMHSA administered crisis counseling program 

and SERG grants

• SAMHSA provided communication materials for 

State and local dissemination and ABC technical 

assistance to HHS recovery personnel

Maintain 

situational 

awareness

Monitor potential 

behavioral health 

concerns of affected 

populations

• ABC coordinated behavioral health stakeholders 

and ensured recovery needs were addressed and 

emergent needs were identified

• SAMHSA communicated with local, regional, and 

State stakeholders 

Hurricane Irene

CT, DC, DE, 

MA, MD, NC, 

NJ, NY, PA, 

PR, RI, SC, VT, 

VA, USVI

None noted None noted

• SAMHSA and ABC monitored and coordinated

• SAMHSA grant funding info passed to VA DOH

• SAMHSA provided crisis counseling grants 

• SAMHSA provided communication materials for 

statewide and local dissemination

continued on next page
HHS Public Health and Medical Services Emergency Support Preparedness (OEI-04-11-00260) 47

Table E–1 HHS Resources Provided to Affected States in 2010 and 2011, Continued

Core Functional Area Incident State(s) HHS Resource(s) Provided

Objective Strategy Response

13. Public Health and 

Medical Information

Red River 

flooding North Dakota

Assess the 

integrity of the 

public health 

infrastructure

Provide subject 

matter expertise on 

risk communication 

for the public 

regarding health 

concerns after 

flooding

• REC monitored State actions and requests

• CDC assisted in posting public messages on Web 

site

• Public affairs officer (PAO) contacted State officials

• SAMHSA provided communication materials for 

State and local dissemination

Joplin tornado Missouri

Ensure the

integrity of the 

public health 

and medical 

infrastructure

Coordinate public 

messaging with local 

health officials

• Public health emergency information published on 

the Assistant Secretary for Preparedness and 

Response’s Web site 

• SAMHSA published stress management 

information on Web site

• CMS provided information to beneficiaries 

regarding Children’s Health Insurance Program 

(CHIP) and other CMS services on Web site and 

printed materials

• SAMHSA provided communication materials for 

State and local dissemination

Hurricane Irene

CT, DC, DE, 

MA, MD, NC, 

NJ, NY, PA, 

PR, RI, SC, VT, 

VA, USVI

Assess the 

integrity of the 

public health 

infrastructure

Coordinate potential 

requests or public 

messaging

• PAO worked with States on public messaging 

regarding well water contamination

• CDC updated information about hurricanes on 

disaster Web sites

• SAMHSA provided communication materials for 

State and local dissemination

continued on next page
HHS Public Health and Medical Services Emergency Support Preparedness (OEI-04-11-00260) 48

Table E-1 HHS Resources Provided to Affected States in 2010 and 2011, Continued

Core Functional Area Incident State(s)

HHS Resource(s) Provided

Objective Strategy Response

14. Vector Control (i.e., 

eradicating mammals, 

birds, or insects that 

transmit diseases, such 

as West Nile virus)

Red River 

flooding North Dakota

Assess the 

integrity of the 

public health 

infrastructure

Perform 

assessments of 

needs for vector 

control, food and 

water safety, and 

sanitation; support 

State requests for 

assistance

• No State requests or HHS actions

Joplin tornado Missouri

Ensure the 

integrity of the 

public health 

and medical 

infrastructure

Provide vector 

control and 

surveillance of food 

safety

• CDC vector control efforts and fogging operations 

assessed

Hurricane Irene

CT, DC, DE, 

MA, MD, NC, 

NJ, NY, PA, 

PR, RI, SC, VT, 

VA, USVI

Ensure the 

integrity of the 

public health 

and medical 

infrastructure

Conduct vector 

control survey and 

provide 

recommendations 

for long-term control 

and followup 

activities

• REC monitored Virginia Department of Health 

request for technical assistance for vector control

15. Public Health Aspects of 

Potable 

Water/Wastewater 

and Solid Waste

Red River 

flooding North Dakota

Assess the 

integrity of the 

public health 

infrastructure

Perform 

assessments of 

needs for vector 

control, food and 

water safety and 

sanitation. Support 

State requests for 

assistance

• CDC/FDA monitored State and local requests for 

assistance

Joplin tornado Missouri

Ensure the 

integrity of the 

public health 

and medical 

infrastructure

Provide technical 

assistance for 

potable 

water/wastewater 

assessment

• CDC/FDA monitored State and local requests for 

assistance 

• CDC worked with local health department advisory 

assistance regarding handwashing and boil-water 

order

• REC monitored needs regarding biowaste handling

Hurricane Irene

CT, DC, DE, 

MA, MD, NC, 

NJ, NY, PA, 

PR, RI, SC, VT, 

VA, USVI

None noted None noted

• CDC/FDA monitored State and local requests for 

assistance 

continued on next page
HHS Public Health and Medical Services Emergency Support Preparedness (OEI-04-11-00260) 49

Table E-1 HHS Resources Provided to Affected States in 2010 and 2011, Continued

Core Functional Area Incident State(s)

HHS Resource(s) Provided

Objective Strategy Response

16. Veterinary Medical 

Support

Red River 

flooding North Dakota None noted None noted • No State requests or HHS actions

Joplin tornado Missouri

Ensure the 

integrity of the 

public health 

and medical 

infrastructure

Provide technical 

assistance for 

protection of animal 

life in coordination 

with ESF-11

• Discussed potential for veterinary support on 

ESF-8 national calls

Hurricane Irene

CT, DC, DE, 

MA, MD, NC, 

NJ, NY, PA, 

PR, RI, SC, VT, 

VA, USVI

None noted None noted

• Discussed potential for veterinary support on 

ESF-8 national calls 

17. Mass Fatality 

Management, Victim 

Identification, and 

Decontaminating 

Remains

Red River 

flooding North Dakota None noted None noted • No State requests or HHS actions

Joplin tornado Missouri

Ensure the 

integrity of the 

public health 

and medical 

infrastructure

Provide fatality 

management 

capability

• DMORT support requested and sent to MO; 

processed over 120 remains

Ensure the 

integrity of the 

public health 

and medical 

infrastructure

Provide victim 

identification and 

mortuary services

• FACT conducted family interviews and collection of 

data to support victim identification

Hurricane Irene

CT, DC, DE, 

MA, MD, NC, 

NJ, NY, PA, 

PR, RI, SC, VT, 

VA, USVI

Ensure the 

integrity of the 

public health 

and medical 

infrastructure

Provide fatality 

management 

capability

• Provided two fatality management SME to VT and 

advised State on recovery of remains

Ensure the 

integrity of the 

public health 

and medical 

infrastructure

Support the local 

coroner, provide 

identification of 

human remains

• Provided two fatality management SME to VT and 

advised State on recovery of remains

Ensure the 

integrity of the 

public health 

and medical 

infrastructure

Provide victim 

identification and 

mortuary services

• Provided two fatality management SME to VT and 

advised State on recovery of remains

Source: The Office of the Assistant Secretary for Preparedness and Response (ASPR)
HHS Public Health and Medical Services Emergency Support Preparedness (OEI-04-11-00260) 50 

2010 Incidents 2011 Incidents 

Biomedical Advanced Research and Development 

Authority H1N1 Vaccine Support Mission 2011 Hawaii Humanitarian Mission 1 

H1N1 Outbreak (On-Call) Earthquake and Tsunami Response 

Haiti Earthquake Japan Earthquake/Tsunami Nuclear Accident 

Vaccination Team Support Pennsylvania Severe Winter Storms 

Chile Earthquake North Dakota Red River Flooding 

North Dakota Red River Flooding South Dakota Flooding 

New England Flooding Alabama Severe Storms, Tornadoes, and 

Straight-Line Winds 

Tennessee Severe Storms, Flooding, and 

Straight-Line Winds New York State Flooding 

Tropical Storm and Hurricane Alex Federal Emergency Management Agency 

(FEMA) Region II Flooding (Multiple States)62 

Hurricane Earl Hurricane Irene/Tropical Storm Lee 

Louisiana BP Oil Spill New England Severe Weather 

2010 Hawaii Humanitarian Mission 1 Tropical Storm Maria 

Rocky Boy Indian Reservation Montana Flooding Missouri Severe Storms, Tornadoes, and 

Flooding 

Kentucky Severe Storms, Flooding, and 

Mudslides 

2010 Hawaii Humanitarian Mission 2 

Total = 15 Total = 13 

APPENDIX F 

Table F-1 2010 and 2011 Incidents to Which the Department of 

Health and Human Services Deployed Resources* 

* Incidents include emergencies and disasters. Resources may be provided for international incidents. 

Source: The Office of the Assistant Secretary for Preparedness and Response. 

62 FEMA provides resources to affected areas in States, territories, and tribes and divides its 

service area into regions. Region II is composed of New York, New Jersey, Puerto Rico, and 

the U.S. Virgin Islands. FEMA, Region II. Accessed at 

http://www.fema.gov/about/regions/regionii/ on June 22, 2012. 
HHS Public Health and Medical Services Emergency Support Preparedness (OEI-04-11-00260) 51

APPENDIX G

Agency Comments 
HHS Public Health and Medical Services Emergency Support Preparedness (OEI-04-11-00260) 52
HHS Public Health and Medical Services Emergency Support Preparedness (OEI-04-11-00260) 53
HHS Public Health and Medical Services Emergency Support Preparedness (OEI-04-11-00260) 54
HHS Public Health and Medical Services Emergency Support Preparedness (OEI-04-11-00260) 55
Response to OEI-04-11-00260 

Page6 

the single point of contact with the states. Further, we will add an item to the agenda for our 

incident coordination calls, reminding HHS Staff Divisions and Operating Divisions of the need 

tor a coordinated approach to information exchange with our state partners. Finally, we will 

stress to the StatTDivisions and Operating Divisions that questions can be forwarded to the SOC 

and the SOC can engage states, and then push summary reports out internally ASPR is 

identifying pre-existing federal reports and information sources to establish protected sharing 

capabilities with all our ESF partners prior to an incident response. These collaborations have 

improved situational awareness and planning efforts while similarly reducing the number of 

requests from the federal level to the states. These measures should alleviate multiple requests 

for information and help to ensure that states are not unnecessarily overburdened. 

Thank you for carrying out your study and providing us with a report highlighting how HHS has 

prepared to provide public health and medical services to fulfill its emergency support 

responsibilities, and has carried out those responsibilities in selected responses. We appreciate 

the opportunity to review your report and respond to your recommendations. Please direct any 

questions to Jessica Tytel by telephone at 202.205.4369, or by e-mail at Jessica.Tytel@hhs.gov. 

Nicole Lurie, MD, MSPH 

Assistant Secretary for Preparedness and Response 

HHS Public Health and Medical Services Emergency Support Preparedness (OEI-04-11-00260) 56 
HHS Public Health and Medical Services Emergency Support Preparedness (OEI-04-11-00260) 57

ACKNOWLEDGMENTS

This report was prepared under the direction of Dwayne Grant, Regional 

Inspector General for Evaluation and Inspections in the Atlanta regional 

office, and Jaime Durley, Deputy Regional Inspector General. 

Sarah McLaulin served as the team leader for this study. Other Office of 

Evaluation and Inspections staff from the Atlanta regional office who 

conducted the study include Hannah Spell. Central office staff who 

provided support include Kevin Farber, Debra Roush, and Talisha Searcy. 
Office of Inspector General

http://oig.hhs.gov

The mission of the Office of Inspector General (OIG), as mandated by Public Law 95-452, as 

amended, is to protect the integrity of the Department of Health and Human Services 

(HHS) programs, as well as the health and welfare of beneficiaries served by those 

programs. This statutory mission is carried out through a nationwide network of audits, 

investigations, and inspections conducted by the following operating components:

Office of Audit Services

The Office of Audit Services (OAS) provides auditing services for HHS, either by conducting 

audits with its own audit resources or by overseeing audit work done by others. Audits 

examine the performance of HHS programs and/or its grantees and contractors in carrying 

out their respective responsibilities and are intended to provide independent assessments of 

HHS programs and operations. These assessments help reduce waste, abuse, and 

mismanagement and promote economy and efficiency throughout HHS.

Office of Evaluation and Inspections

The Office of Evaluation and Inspections (OEI) conducts national evaluations to provide 

HHS, Congress, and the public with timely, useful, and reliable information on significant 

issues. These evaluations focus on preventing fraud, waste, or abuse and promoting 

economy, efficiency, and effectiveness of departmental programs. To promote impact, OEI 

reports also present practical recommendations for improving program operations. 

Office of Investigations

The Office of Investigations (OI) conducts criminal, civil, and administrative investigations 

of fraud and misconduct related to HHS programs, operations, and beneficiaries. With 

investigators working in all 50 States and the District of Columbia, OI utilizes its resources 

by actively coordinating with the Department of Justice and other Federal, State, and local 

law enforcement authorities. The investigative efforts of OI often lead to criminal 

convictions, administrative sanctions, and/or civil monetary penalties.

Office of Counsel to the Inspector General 

The Office of Counsel to the Inspector General (OCIG) provides general legal services to 

OIG, rendering advice and opinions on HHS programs and operations and providing all 

legal support for OIG’s internal operations. OCIG represents OIG in all civil and 

administrative fraud and abuse cases involving HHS programs, including False Claims Act, 

program exclusion, and civil monetary penalty cases. In connection with these cases, OCIG 

also negotiates and monitors corporate integrity agreements. OCIG renders advisory 

opinions, issues compliance program guidance, publishes fraud alerts, and provides other 

guidance to the health care industry concerning the anti-kickback statute and other OIG 

enforcement authorities.