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The Health Center Program: Program Information Notice 2007-15: Health Center Emergency Management Program Expectations
 

PURPOSE

This Policy Information Notice (PIN) provides guidance to health centers (i.e., section 330 funded grantees and Federally Qualified Health Center (FQHC) Look-Alikes) on emergency management expectations related to planning and preparing for future emergencies. For purposes of this document, an “emergency” or “disaster” is defined as an event affecting the overall target population and/or the community at large, which precipitates the declaration of a state of emergency at a local, State, regional, or national level by an authorized public official such as a governor, the Secretary of the Department of Health and Human Services, or the President of the United States. Examples include, but are not limited to: hurricanes, floods, earthquakes, tornadoes, wide-spread fires, and other natural/environmental disasters; civil disturbances; terrorist attacks, collapses of significant structures within the community (e.g., buildings, bridges); and infectious disease outbreaks and other public health threats.

At the core of emergency management planning and preparation are three key elements: safeguarding human resources, protecting physical resources, and ensuring business continuity. For health centers, this translates to protecting health center staff and patients as well as safeguarding its ability to deliver health care. Emergencies can disrupt the environment of care or change the demand for the health center’s services making it essential for health centers to ensure that emergency management is integrated into its daily functions and values.

The expectations outlined in this guidance are intended to be broad to ensure applicability to the diverse range of health centers and ease in integrating them into what health centers are already doing related to emergency and risk management.[1] They are not intended to be an all inclusive guide but rather to provide guidance so that health centers can develop and maintain an effective and appropriate emergency management strategy. For health centers, building on existing relationships with natural partners at the local level, such as hospitals and health departments, is critical for engaging in emergency management. At the State level, health centers are strongly encouraged to work with their Primary Care Association (PCA). PCAs are expected to provide State level leadership, where appropriate, for the (a) integration of health centers into Statewide and community preparedness and response plans and (b) direct assistance in the area of emergency preparedness planning to health centers. At the national level, health centers can also seek technical assistance on emergency management from the HRSA’s Bureau of Primary Health Care (BPHC) as well as from BPHC’s national technical assistance partners.

 

APPLICABILITY

This PIN applies to FQHC Look-Alikes and all health centers funded under the Health Center Program authorized in section 330 of the Public Health Service (PHS) Act (42 U.S.C. 254b), as amended, specifically:

  • Community Health Center (CHC) Programs, funded under section 330(e);
  • Migrant Health Center (MHC) Programs, funded under section 330(g);
  • Health Care for the Homeless (HCH) Programs, funded under section 330(h); and
  • Public Housing Primary Care (PHPC) Programs, funded under section 330(i).

For the purposes of this document, the term “health center” refers to the diverse types of health centers that are supported under section 330 of the PHS Act (i.e., CHC, MHC, HCH, and PHPC) and FQHC Look-Alikes.

 

BACKGROUND

The Federal government has established a Federal emergency management plan, referred to as the National Response Plan or the NRP. The NRP is a national, all-discipline, all-hazards plan that provides the framework and mechanisms to coordinate Federal, State, local, Tribal, private sector, and non-governmental entities during national emergencies. The NRP establishes a single, comprehensive approach to prevent, prepare for, respond to, and recover from major events, including natural disasters, terrorist attacks, and other public health emergencies. It applies to all incidents requiring a coordinated Federal response as part of an appropriate combination of Federal, State, local, Tribal, and community entities.

The NRP is constructed on the framework established by the National Incident Management System (NIMS). At the request of the President of the United States, the Department of Homeland Security developed NIMS to provide a consistent, comprehensive, and nationally recognized framework for incident management. NIMS is designed to help emergency managers and responders from different jurisdictions and disciplines work together more effectively in the management of domestic incidents at all jurisdictional levels regardless of the cause, size, or complexity of the incident. NIMS provides an integrated process towards incident management, standard command and management structures, and emphasis on preparedness, mutual aid, and resource management. National capabilities are strengthened to prevent, prepare for, respond to, and recover from any incident through the adoption and implementation of NIMS across all jurisdictions—Federal, State, local, Tribal, private sector, and non-governmental entities.

The NIMS standard incident command structures are based on preparedness through implementation of a general chain of command, efficient personnel and resource management, and effective communications and information management. The Incident Command System or ICS is a component of the NIMS. ICS is scalable to address large and small incidents; it is also interdisciplinary and organizationally flexible. ICS includes a unified approach for controlling personnel, facilities, equipment, and communications. In general, health centers are strongly encouraged to use ICS in context of their emergency management strategy, understand the NIMS and NRP framework, and move toward full NIMS compliance. Since October 1, 2005, all 56 States and Territories were required to meet NIMS implementation requirements to be eligible to receive Federal preparedness assistance in the form of grants, cooperative agreements and direct contracts. While it is not a requirement for health centers at this time, compliance with NIMS is strongly encouraged. Health centers should visit the Department of Homeland Security’s web site training.fema.gov for NIMS training information and resources.

The NRP and NIMS are companion strategies designed to improve the Nation’s incident management capabilities and overall efficiencies—integrating the capabilities and resources of various governmental jurisdictions, incident management and emergency response disciplines, non-governmental organizations, and the private sector into a cohesive, coordinated, and seamless national framework for domestic incident management. An underlying tenet of the NRP is that, in general, most emergencies are limited in scope and range and, therefore, the response to such events is managed at the local level. The NRP also recognizes that private sector entities have a key role related to critical infrastructure protection and restoration as well as contributing necessary resources and services in an emergency event. In this context, health centers are a vital part of an effective emergency response in the communities they serve.

Health centers can support the NRP by being prepared to handle emergencies—whether man made or natural. This means having a plan in place to prevent, prepare for, respond to, and recover from emergencies. Health centers can also support the NRP by working collaboratively at the State, local, and community levels in identifying risks, performing vulnerability assessments, maximizing effective use of available resources, and enhancing overall readiness. For additional information on NRP, see the Department of Homeland Security’s Web site.

 

Footnotes

[1] This PIN is not intended to address issues associated with the applications of the Federal Tort Claims Act to health centers’ activities during emergencies or disasters. Please refer to the BPHC PIN 98-23, Health Center Program Expectations and PIN 2007-16, Federal Tort Claims Act (FTCA) Coverage for Health Center Program Grantees Responding to Emergencies.