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The Medical Surge Capacity and Capability (MSCC) handbook was published in August 2004 to describe a systematic approach for managing the medical and public health response to an emergency or disaster. Shortly after its publication, the Department of Homeland Security released the National Response Plan (NRP). In accordance with Homeland Security Presidential Directive (HSPD)-5, the NRP established the structure and process for a coordinated multidisciplinary and all-hazards approach to domestic incident management based on a National Incident Management System (NIMS).

The NRP was put to its first real-world test during Hurricane Katrina. Although incident response is a State and local responsibility, after action reviews from Katrina indicate the need to strengthen Federal support of State and local efforts and improve preparedness for the Federal response to a catastrophic event. Katrina was a stark reminder of the devastating consequences, especially among the medically fragile segments of society, when the local healthcare infrastructure fails. It also revealed that collaborative planning, information sharing, and incident management coordination—hallmarks of the MSCC handbook—apply not only to surge events, but also to maintaining normal healthcare operations and services, a concept known as medical system resiliency. The lessons learned from Katrina spurred changes to the NRP.^[1]

The impetus for updating the MSCC handbook was to describe recent changes to the Federal emergency response structure, particularly the Federal public health and medical response. The revision also expands on several concepts described in the first edition of the MSCC handbook to facilitate their implementation. While the tiered approach described in this handbook is consistent with NIMS and the NRP, this revision addresses terminology and concept descriptions to assure consistency with Federal guidance.

A subject matter expert panel was convened in August 2006 to identify areas of the MSCC handbook that should be expanded or updated. The panel was drawn primarily from the pool of experts that participated in the development of the original MSCC. Based on the panel's insights, HHS worked with the CNA Corporation and Drs. Joseph Barbera and Anthony Macintyre to prioritize areas for revision and complete the necessary changes.

In addition to promoting consistent terminology with the NRP and NIMS, the following is a list of key updates or revisions contained in this second edition of the MSCC handbook:

Tier 6 – Federal Support to State, Tribal, and Jurisdiction Management – has been rewritten to highlight changes to the Federal emergency response structure. The chapter focuses on the information that medical and public health planners need to know regarding the request, receipt, and integration of Federal public health and medical support under Emergency Support Function #8 of the NRP. At the time of this writing, the NRP is undergoing revision and may soon be known as the National Response Framework. However, the Emergency Support Function (ESF) structure as described in this handbook is not expected to change.^[2]
The handbook now emphasizes how MSCC concepts can be applied not only to medical surge, but also to maintain normal healthcare services and operations during a crisis (i.e., medical system resiliency).
Newly added ection 1.4.1 clarifies the role of Incident Command versus the regular administration of an organization during response and recovery operations. Included in this section is a description of the "Agency Executive" role in ICS.
In accordance with NIMS, the handbook describes the role of a Multiagency Coordination System (MACS), Multiagency Coordination Center (MACC), and Multiagency Coordination Group (MAC Group) in providing emergency operations support to incident command. The application of these concepts at Tiers 2 and 3 is particularly important.^[3]
Section 1.3.1 draws distinctions between the processes and structures that are used in preparedness planning and those used during incident response and recovery.
An important lesson learned from Hurricane Katrina and included in this update is the need at all levels of government to plan for the health services support needs of medically fragile populations.
The structure of the Emergency Operations Plan (EOP) has become increasingly standardized. Section 2.3 of the handbook provides a more detailed description of the requirements of an effective EOP for healthcare organizations.
The term "healthcare organization" has been substituted for "healthcare facility" to reflect the fact that many medical assets that may be brought to bear in an emergency or disaster are not facility-based.

U.S. Department of Homeland Security, Notice of Change to the National Response Plan, May 25, 2006. Available at: http://www.dhs.gov/dhspublic/interapp/editorial/editorial_0566.xml.
At the time of this writing, the NRP is undergoing revision and may soon be known as the National Response Framework. However, the Emergency Support Function (ESF) structure as described in this handbook is not expected to change. Additional information on the National Response Framework is available at http://www.fema.gov/emergency/nrf/.
As NIMS is updated, the terminology used to describe components of multiagency coordination systems may change, however, the general concepts remain the same.

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