Action Steps/ Issues

Hurricane Response Action Steps/Issues

Introduction

These preparedness and response action steps complement the ESF #8 Hurricane Concept of Operations and provide decision support for coordinating and/or managing the Federal public health and medical assets required prior to and in the aftermath of a hurricane or tropical storm making landfall in the United States or its territories. It allows for a fully scalable approach for directing support operations that provide assistance to State, local and tribal authorities in responding to and initiating the recovery from a major tropical storm or hurricane. The table below highlights key activities and decision points and is not intended to be a comprehensive list of actions required in response to a hurricane landfall.

Structure of Action Steps

The emergency response phases in this playbook and its action steps are aligned with the phases and time sequence of actions in the DHS/FEMA National Hurricane Contingency Plan Execution Schedule. The ESF #8 response to the hurricane will occur in three phases. Some phases are continuous and all have a degree of overlap. They are as follows.

Phase I – Pre-Incident Phase (Heightened Situational Awareness, Preparedness and Alert) (TS-120 to Onset Tropical Storm Force Winds)
Phase II – Incident Response Phase (Activation, Deployment, Initial Response) (TS-96 thru L+120)
Phase III – Post-Incident Response Phase (Demobilization, Deactivation and Recovery)

The following table of action steps is organized by response phase and stage. Each stage is further segmented by functional area:

) Planning and Coordination;
) Healthcare, Emergency Response, and Human Services;
) Pharmaceuticals, Medical Supplies and Equipment;
) Patient Evacuation;
) Communication and Outreach

The ESF #8 Hurricane Response Trigger Events are highlighted in blue, the ESF #8 strategies are highlighted in purple.

	Actions/Issues	Lead Agency/ Supporting Agency
Phase I – Pre-Incident (TS-120 thru onset tropical storm force winds) Normal Operations →Heightened Situational Awareness →Preparedness and Alert Trigger Event 1: Beginning Hurricane Season - June 1, – November 30, Trigger Event 2: NOAA/NHC Tropical Storm Advisory indicating development of potentially damaging tropical event Trigger Event 3: Formal Alert notification from FEMA/NRCC
ESF #8 Strategy: Closely Monitor Events and Begin Review of Advance Preparations Required to Facilitate an Effective and Timely Response
Normal Operations : HHS Secretary’s Operations Center (SOC) continually collects, analyzes and disseminates intelligence and information to allow the ASPR and DASOPEO to anticipate requirements and to react effectively.
Stage 1 - Heightened Situational Awareness Trigger: NOAA/NHC Tropical Storm Advisory
	A. Planning and Coordination
	Establish contact through the National Operations Center/National Response Coordination Center (NRCC) to maintain a heightened state of situational awareness	OPEO/SOC
	Review and validate ESF#8 Hurricane Playbook	OPEO/SOC
	Review and validate ESF #8 Essential Elements of Information (EEIs), information collection strategies and methodologies, and related decision points	All
	Ensure financial and acquisition personnel and systems are brought to and maintained at the highest state of readiness	HHS/ASPR/ASAM DoD/VA/FEMA
	Ensure pre-scripted activation Mission Assignments (PSMAs) and existing interagency and contractual vehicles are available for rapid implementation and execution	OPEO
	Review emergency personnel rosters and equipment in support of active and sustainable field response and recovery operations	All
	Establish and maintain required communication and coordination links via normal communication channels with ESF #8 Partners and appropriate Regional and State counterparts	All
	Establish and maintain additional lines of communication and coordination with non-collocated command and control entities (e.g., White House Situation Room, Homeland Security Council)	OPEO/SOC
	Review MOUs, MOAs and Mutual Aid Agreements with emergency management agencies, States, localities and other organizations in the potentially affected areas.	All
	Review plans to address surge capacity for medical functions such as: health care facility staff augmentation shelter in place vs. evacuation for health care facilities in path of storm	OPEO/OFRD
	Review plans to address surge capacity staffing for public health functions such as: public health needs assessment public health lab networks - testing public health nursing epidemiology and surveillance environmental health specialists injury prevention and control occupational safety and health risk communications mental/behavioral health At-Risk populations on-site technical assistance, consultation, and support for other ESF-8 functions veterinary support – injury and disease surveillance, investigation and control	OPEO/CDC/OFRD/ FDA/SAMSHA/HRSAACF/ OD
	Send as requested by DHS and FEMA, pre-identified representatives, authorized to coordinate and make decisions, to multi-agency and multi-jurisdictional groups.	HHS/DoD/VA/DOT/ ARC
	Test Government Emergency Telecommunications System (GETS) accounts and cards for their landline and cellular telephones and that all appropriate interagency Telecommunications Service Priorities (TSP) and Wireless Service Priorities (WSP) actions are coordinated with and ready for immediate post-incident implementation and execution	HHS/DoD/VA/DOT/ ARC
	Initiate tests of communications systems (i.e. VTC, emergency contact communications and cascading call-down lists)	All
	Direct rostered personnel to prepare for deployment by reviewing all deployment requirements, procedures and practices and review alert, activation, and deployment standard operating procedures, practices, and protocols	All
	Initiate information and data collection, analysis, and assessment based on available quantitative data and derived from the Hurricane Incident Essential Elements of Information Collection Plan (ICP)	All
	Determine preliminary staffing augmentation to FIRST, ERT-A, ERT-N, RNA, MNAT	OPEO/OPS
	Identify and verify key US Government executive structure and incident management structure contacts	OPEO/OPS
	Identify any specific medical materiel required for CDC/DSNS response to hurricanes and natural disasters.	HHS/CDC-DSNS
	Activate ESF #8 hurricane response planning for coordinated and parallel planning IAP development.	OPEO plans/All
	Include requirements of at-risk population in incident action plan	OPEO PLANS/ACF/ OD/OCR
	Initiate posting of operations to the Homeland Security Information Network (HSIN) to coordinate Federal/State/Local information sharing and development of a Common Operational Picture (COP) for response operations	OPEO/SOC
	Begin GIS Modeling/Gap Analysis	SOC
	Verify readiness of logistics requirements	OPEO/LOG
	B. Healthcare, Emergency Response, and Human Services
	1. Verify response posture of NDMS (all-inclusive)	OPEO
	2. Issue advisories to ESF#8 response teams (NDMS, Rapid Deployment Force (RDF), Applied Public Health (APHT), Mental Health (MHT), Human Services SME, Incident Coordination Response Team (IRCT) etc.)	OPEO/OFRD
	3. Verify response posture of SNS	CDC
	4. Issue advisories as appropriate to CDC for possible SNS response teams	CDC
	5. Verify FMS medical personnel staffing	OPEO/OFRD VA/DoD
	6. Predetermine logistics hubs for early forward placement of FMS equipment/supply sets	HHS/CDC OPEO/LOG
	7. Develop deployment plan for use during contra-flow evacuation	DOT
	8. Alert and ascertain preparedness for laboratories in Laboratory Response Network (LRN) (includes state/local and Federal public health labs and 25 DoD labs)	CDC/DoD
	9. Activate the Health Alert Network	CDC
	10. Determine procedures for uncompensated medical care	OPEO/CMS
	11. Identify medical and public health staff or other civilians as needed to augment medical facilities and mass care shelters	OPEO/OFRD/ OPDIVs/ ARC
	C. Surveillance, Investigation, and Protective Health Measures
	Ascertain preparedness status of laboratories with select agents	CDC
	Verify Public Health surge teams readiness for deployment (Public Health RNA Team, etc.)	CDC
	Verify that public health RNA surveillance tools and personnel are ready for deployment and implementation	CDC
	Review public health preparedness messages	CDC
	D. Pharmaceuticals, Medical Supplies and Equipment
	Verify readiness status of Federal Medical Stations	CDC/OPEO-Log
	Ascertain the status of vaccination/immunization supplies in the potentially affected areas.	HHS-CDC
	Ascertain essential medical material not in SNS including materials for special and emergency at-risk population needs.	VA/CDC/FDA/DoD/ OPEO-Log
	Verify readiness status of Public Health laboratories in the potentially affected areas. Address the following public health issues: Operational status Contingency Planning/Continuity of Operations for communications, transport of specimens, testing and staffing Surge capacity planning Testing water samples for potable water	CDC
	Ascertain the status of blood supplies in the potentially affected areas.	ASPR/AABBTF
	E. Patient Evacuation
	Identify potential receiving, distribution, and transportation network system	HHS/DOT/ DoD/VA
	Identify joint patient movement team (JPMT), aeromedical evacuation teams, and ground teams.	HHS/NDMS/DOT/ DoD/VA/FEMA
	Identify and synchronize planning with evacuation management jurisdictions	HHS/NDMS FEMA/ DOT/DoD
	Coordinate with States JFO/IRCT to pre-identify and prioritize potential evacuation routes, patient transport routes and patient tracking	OPEO/OPS/ OPEO PLANS
	Coordinate with ARC and other NGOs on identifying and assessing locations for congregate care shelters	OPEO/Human Services
	Coordinate public health, medical and support needs for at-risk populations and service animals	DHS/FEMA/ ACF/OPEO/OD/OCR
	Alert NDMS Federal Coordinating Centers (FCC) to be prepared to begin bed counts	HHS/NDMS VA/DoD
	Coordinate with the National Guard Bureau for potential evacuation support	HHS/NGB
	F. Communications and Outreach
	Coordinate public health messages through PAO communication channels	CDC/ASPA/ASPR
	Review and update Health Alert Network advisories	CDC/HHS-ASPA
	Review FDA guidance to regulated industry and public health and public service messages related to safety of FDA-related products – food, medication, medical devices, blood, and pet food.	FDA/AABB TF
	Review messages to ensure that outreach takes into account communication needs of at-risk populations	OD/OCR/ASPA
	Review messages to hospitals regarding cancelling elective surgeries.	ASPR/OPHS

Stage 2 - Preparedness and Alert (Approximately: TS-120 (5 days) to TS-96 (4 days) Trigger: Formal Alert notification from FEMA/NRCC
	A. Planning and Coordination
	1. Upon receipt of the NOC/NRCC Operations Order: (Alert Notification) Perform assigned tasks commensurate with non-emergency position descriptions and operate within respective organization assignments. Maintain situational awareness and visibility of the common operating picture (COP) presented by the NHC Tropical Advisories and the HSIN Federal Operations portal. Prepare and distribute situation and spot reports using HSIN Review the current alert posture and readiness of emergency personnel and teams, to include equipment and facilities. Update pre-deployment checklists (medical, physical, legal, etc…) and rosters. Ensure personnel skill set list is matched with appropriate training. Identify administrative and logistical deployment requirements. Review standard operating procedures (SOP), practices, protocols and processes. Verify equipment lists and “fly-away” kits are on-hand, complete and available for deployment. Be prepared to activate and deploy resources when directed. Initiate contacts with Federal, Regional, State and local officials to include private sector representatives in accordance with statutory authorities.	ASPR/SOC All
	2. Ensure that the HHS Secretary is notified of the threat and is receiving regular updates.	ASPR
	3. Activate HHS Emergency Management Group	OPEO
	4. Alert OPDIVs and STAFFDIVs	OPEO
	5. Alert ESF #8 Partners	OPEO
	6. Issue warning order to ESF #8 Partners to be prepared to (BPT) staff SOC/HHS-EMG	OPEO
	7. Review staffing of EMG for potential augmentation	OPEO
	8. Activate the National Disaster Medical System	EMG
	8. Lead scheduled National ESF #8 Video Teleconferences to maintain situational awareness and to identify potential issues from the States and/or Regions	EMG Incident Manager
	9. Participate in video teleconferences and other conference calls with DHS/FEMA and ESF # 8 partners concerning the situation, mission, and objectives	All
	10. Map projected path established by National Weather Service – National Hurricane Center and impact on public health & medical infrastructure and Initiate pre-landfall geo-spatial imaging	SOC
	11. Check on status of FEMA Surge Account funding	EMG/A&F
	12. Perform pre-impact analysis of the likely consequences on the public health, human services, and medical critical infrastructures.	EMG plans/OD/ ACF/
	13. Activate logistics infrastructure. Identifies field lodging support for teams/personnel as required Be prepared to provide all non-medical logistics support	DHS/FEMA EMG/LOG
	14. Verify ability of FEMA logistics to handle ESF#8 logistics requirements	DHS/FEMA/ LOG EMG/LOG
	15. Notify CDC of likely locations for deployment of FMS and other SNS assets.	EMG
	16. Continue ESF #8 hurricane response planning for coordinated and parallel planning IAP development.	EMG plans/ All
	17. Provide clear guidance to CDC/DSNS for a hurricane or natural disaster response. This should include: Number of FMS(s) required, timeframe to deploy FMS and other materials. Medicines and medical supplies (other than what is in FMS and DSNS formulary) should be prepped and ready to ship in a hurricane or natural disaster response.	OPEO/EMG
	18. Identify HHS personnel in potentially affected areas and follow up with health and safety checks	HHS/OPDIVs
	19. Establish contact with coordinators of state-based volunteer registries (Emergency System for Advance Registration of Voluntary Health Professionals (ESAR-VHP)).	EMG plans
	20. Alert Medical Reserve Corps (MRC) units in the forecasted strike zone through MRC communication mechanisms.	OFRD/MRC
	21. Review/Update Incident Response Coordination Team (IRCT) Roster	OPEO/OPS
	22. Roster advance elements (ERT-A) to support applicable mission task force(s)	HHS/FEMA/VA/ DoD
	23. Begin capturing after-action comments	All
	24. Alert for deployment HHS pre-rostered teams (RDF, Public Health, Mental Health, NDMS, IRCT) and interagency ESF#8 teams for possible deployment	OPEO OPS/ OPEO PLANS/ OFRD/ NDMS
	25. Alert HHS Senior Health Officials (SHO)	OPEO
	B. Healthcare, Emergency Response, and Human Services
	1. Alert DSNS Team and CDC DEOC for heightened readiness posture.	EMG
	2. Place FMS in alert posture and prepare for deployment	EMG/CDC
	3. Pre-determine potential requirements for DoD or VA to staff FMS	OPEO OPS/ OPEO PLANS
	4. Alert medical and public health staff or other civilians as needed to augment Medical and Mass Care Shelters	OPEO/OFRD/ OPDIVs/ MRC/ARC
	5. Work with ERT-N/A, and RRCC/NRCC to pre-identify requirements which enable medical personnel to provide support (i.e. mental health)	OPEO/OPS-OPEO PLANS
	C. Surveillance, Investigation, and Protective Health Measures
	1. Ascertain the status of vaccination/immunization requirements in the potentially affected areas.	CDC
	2. Alert HHS OPDIVs with regard to potential deployments for response ops (e.g., Epidemiological, Food Inspection, Sanitation, etc.)	EMG
	3. Work with ERT-N/A, and RRCC/NRCC to pre-identify any potential personnel required which enable ESF #8 to identify public health hazards (e.g. food safety, water quality, wastewater, solid waste disposal, vector control, hygiene, and other environmental health support)	OPEO/CDC/ FDA/IHS DoD
	4. Refine plans for at-risk populations	OPEO/OPS-OPEO PLANS/OD/ ACF/OCR
	D. Pharmaceuticals, Medical Supplies and Equipment
	1. Notify CDC DEOC to begin preparations to load FMS on trucks for possible deployment.	OPEO-Log/CDC
	2. Work with ERT-N/A, and RRCC/NRCC to pre-identify and prioritize assembly areas of pre- deployment of medical supplies to strategic locations	OPEO/OPS- PLANS- LOG
	3. Pre-identify and prioritize assembly areas of pre-deployment of medical supplies to strategic locations	OPEO/OPS- PLANS – LOG/ DoD/VA
	4. Work with ERT-N/A, and RRCC/NRCC to pre-identify any potential DoD requirements to provide military medical logistics support (medical equipment/supplies, medical diagnostics/blood products)	OPEO/OPS- PLANS – LOG/DoD LNO
	E. Patient Evacuation
	1. Work with ERT-N/A, and RRCC/NRCC to pre-identify potential evacuation routes, patient transport routes, and patient tracking	OPEO/OPS- PLANS/NDMS
	2. Continue coordination with States to identify contra-flow, potential evacuation routes, patient transport routes, and patient tracking	DOT
	3. Request DoD assistance to prepare to provide support for the evacuation of seriously ill or injured patients to pre-identified locations.	HHS/NDMS/DoD
	4. In coordination with the ESF #8 EMG, issue Mission Assignment to place Joint Patient Movement Teams, AE Liaison Teams on be prepared to deploy status	DHS/FEMA DoD
	5. Alert Ambulance contract for medical transportation (ground, air and par transit ambulances)	FEMA/HHS/OPEO-OPS/NDMS
	6. Notify AABB TF of locations to which seriously ill or injured patients will be evacuated in case blood products are needed	EMG/OPHS
	F. Communications and Outreach
	1. Ensure ongoing coordination with the States’ health authorities	ASPA/CDC/-RHA
	2. Schedule and conduct a situation briefing for ESF partners and OPDIVS/STAFFDIVS	EMG ALL
	3. Invite delegates from the affected States to participate in ESF #8 Conference Calls as appropriate	EMG ALL

		Actions/Issues			Lead Agency/ Supporting Agency
Phase II – Incident Response (TS-96 (4 days) thru L+120 (5 days)) Activation → Deployment→ Initial Response Trigger Event 4: Receipt of FEMA/NRCC Activation Order for ESF#8 Trigger Event 5: Presidential Emergency or Major Disaster Declaration under the Robert T. Stafford Disaster Relief Act or the declaration of an Incident of National Significance and FEMA issues Mission Assignment to Deploy
ESF #8 Strategy: Rapidly Deploy ESF #8 Assets to Assist State, Tribal, or Local Officials by Providing Assistance Where Needed in Saving Lives, Minimizing Adverse Health and Medical Effects, and Stabilizing Public Health, Medical and Human Services Infrastructure
Stage 1 - Activation ( TS-96 (4 days) to TS-72 (3 days)) Trigger: Receipt of FEMA/NRCC Activation Order for ESF#8
			Increase EMG Staffing level to include selected liaisons and specialties - Expand Ops, Planning, Log, and SME cells as required - Initiate Administration/Finance section if not already activated - Request LNO from ESF #8 partners as required (e.g. DOT, DoD, VA, DHS/FEMA, ARC)	ASPR
			Operations Section Initiate daily HHS-EMG Coordination Call Deploy IRCT Alert advance elements of applicable mission task force(s) (MTF) Prepare to deploy rostered teams (RDF, APHT, MHT,NDMS IRCT, JFO, Human Services and Disability subject matter specialists)	EMG-OPS EMG/OFRD EMG/OFRD/ACF
			Planning Section Prepare Incident Action Plan and assure plans are coordinated with ESF #8 support agencies, OpDivs/Staff Divs and States. Analyze vulnerability of critical health care infrastructure in the expected impact zone.	EMG Plans/OPEO CIKR and FEMA recovery liaison
			Logistics Section Coordinate non-medical support with FEMA Refine medical supply concept support plan.	EMG LOG/DHS/FEMA EMG LOG/DoD
			Administration and Finance Ensure that funds are available to support pre-disaster operations BPT to develop RFA cost estimates BPT to track MA expenditures	EMG A&F
			Upon receipt of the NOC/NRCC Operations Order Amendment, Staff the ESF #8 desk at the NRCC Update situational awareness and ensure visibility of the common operating picture is maintained. Ensure that all essential functions can be performed and all related services can be provided following landfall. Initiate incident-specific information and data collection, analysis, and assessment. Perform pre-impact effects and consequences modeling and simulation analysis on the geography, demographics and population, and critical infrastructures. Ensure appropriate departmental and agency financial and acquisition personnel and systems are brought to and maintained at the highest state of readiness. Confirm essential communication and coordination links with Other Federal Agencies (OFA) and State partners to ensure optimal information sharing, and a common understanding of the expected mission and objectives. Initiate tests of emergency contact communications, cascading call-down lists and TTY devices. Initiate video teleconferences and other conference calls within ESF #8 emergency management community concerning the situation, mission and objectives Confirm lines of communication and coordination with non-collocated command and control entities. As required, activate senior managers’ and liaison officers’ Government Emergency Telecommunications System (GETS) accounts and cards. Confirm all essential Telecommunications Service Priorities (TSP) and Wireless Service Priorities (WSP) actions are coordinated and ready for immediate post-incident implementation and execution. Continue to review and validate internal and interagency senior officials’ “playbooks” and “checklists” including. (1) Essential Elements of Information (EEI) (2) Information collection requirements and capabilities (3) Information analysis and intelligence procedures (4) Reporting requirements (5) Initial response requirements post-landfall Prepare to execute Pre-Scripted Mission Assignments (PSMAs) and ensure existing interagency and contractual vehicles are available for rapid implementation and execution	EMG ALL
			3. Continue to map projected path of tropical storm as established by National Weather Service, National Hurricane Center (Continue pre-landfall GIS mapping)	EMG
			4. Review pre-impact analyses of the likely consequences to the public health, medical and human services critical infrastructures	EMG
			5. Verify readiness of rostered personnel teams, including PHS and NDMS.	EMG - OPS/A&F
			6. Provide all ESF8 partners (HHS and non-HHS) with specific reporting/requesting guidance for entry into the area of operations.	EMG OPS
			7. Prepare supplies and equipment packages (logistics support) for all HHS teams / personnel (note that CDC supports medical items FMS).	OPEO/LOG CDC/DSNS
			Convene Medical Interagency Coordinating Group (MIACG) to determine which FCCs will be activated for patient evacuation	OPEO/NDMS
			Activate NDMS patient movement as appropriate.	OPEO/OPS
			Maintain situational awareness of patient evacuation flow	HHS/NDMS
			Activate the American Association of Blood Banks Interagency Task Force on Domestic Disasters and Acts of Terrorism (AABB) to assess the current blood supply levels throughout the country	HHS/OPHS
			Coordinate with AABB Task Force to identify supply levels at the supporting medical facilities for the incident. Activate supply distribution plans for affected region(s).	HHS/OPHS
			Obtain approval for AABB Task Force coordinated public information assistance announcement re: the adequacy and safety of the nation’s blood supply.	HHS/OPHS
			Activate HaVBED system to track hospital bed capacity	EMG
			Provide assessment of healthcare infrastructure.	HHS/ASPR CIKR
Stage 2- Deployment (TS-72 (3 days) to TS-24 (1 day)) Trigger: Presidential Emergency or Major Disaster Declaration or declaration Incident of National Significance and FEMA issues Mission Assignment to deploy
	1. Initiate deployment actions for appropriate ESF #8 Regional and State resources Provide representative for ERT-A (usually the Regional Emergency Coordinator) Provide representative to State EOC and or Health Department. Staff the ESF #8 desks in the NRCC and RRCC			EMG
	2. Deploy IRCT(s) including SMEs if necessary, including Reps to State EOCs, etc.			EMG
	3. Stage public health, medical, mental health and human services personnel assets			HHS/DoD/VA
	4. Stage/Deploy NDMS teams and equipment caches as required to forward operating locations			NDMS/OPEO-LOG & NDMS
	5. Coordinate with ARC requirements for medical personnel augmentation at Red Cross shelters			HHS Human Services/ARC
	6. Coordinate with the potentially affected states to stage FMS and advance personnel to set-up and install - FMS Installation Team (FIT)			OPEO IRCT/CDC/JFO/ARC CDC/DSNS/OFRD
	7. Develop more detailed impact analysis 24 hours prior to an event that further defines the impact area based on detailed models. This analysis is refined on a 12, 8, and 4-hour basis, as determined by updated data.			EMG PLANS/ SOC
	8. Execute appropriate ESF-8 Pre-scripted Mission Assignments (PSMA) after receipt of FEMA tasking Issue ESF-8 sub-tasking as required Execute sub-tasking			DHS/FEMA/OPEO-EMG/ ESF #8 partners
	9. Test communications infrastructure			EMG LOG-IT
	10. If SNS assets required, deploy CDC TARU team and/or FMS teams as necessary			EMG/CDC/DSNS/OFRD
	11. Deploy SNS formulary items as directed			CDC/DSNS/OFRD
	12. Alert VA to be prepared to provide health and medical logistics/supply support via National Acquisition Center (NAC)			EMG- LOG/VA
	13. Support pre-landfall patient evacuation efforts - if initiated. Deploy AE components as required to support MA.			EMG /NDMS/DOD
	14. Deploy other logistics assets for ESF #8 teams/personnel to staging locations			EMG-LOG
	15. Determine Security Requirements for ESF #8 assets			EMG-OPS
	16. Stage rostered teams (RDF, APHT, MHT, NDMS IRCT, JFO, Human Services and Disability subject matter specialists) to designated FEMA logistics bases			EMG/OSG/OD/CDC/FDA/ ACF/AOA
	17. Verify security/destruction of select agent hazardous materials in the immediate pre-landfall period			CDC
	18. Activate the Ambulance Contract for medical transportation (ground, air and para-transit ambulances)			EMG/FEMA
	19. Develop a scaleable demobilization and deactivation plan for the release of appropriate ESF #8 components.			ALL
Stage 3 - Initial Response and Sustained Response (TS-48 (2 days) to L+120 (5 days) ) Trigger: Presidential Emergency or Major Disaster Declaration or declaration Incident of National Significance and FEMA issues Mission Assignment to deploy

			A. Planning and Coordination
			1. Coordinate rapid needs assessments with FEMA (public health, medical and human services infrastructure)	EMG
			2. Make determination of and/or declare Public Health Emergency	Secretary HHS
			3. Increase HHS-EMG Staffing levels as required Expand Ops, Planning, Log, A&F and SME cells as required Request additional LNOs from ESF #8 partners as required (e.g. DOT, DoD, VA, DHS/FEMA, ARC)	EMG/OFRD/ESF #8 Partners
			4. Make necessary adjustments to pre-scripted Mission Assignments (MAs)	EMG -A&F
			5. Update situational awareness of hospital and healthcare infrastructure facilities (including power, water and debris) in the expected impact zone. Determine capability to continue operations, or whether rescue operations are required.	EMG-CIKR/FEMA recovery LNO
			6. Prepare tasks for USACE/ESF#3 to prioritize continuity of operations for hospital and healthcare infrastructure facilities (includes power, water and debris removal).	EMG-CIKR/USACE/DoD
			7. Review damage assessments and consult with FEMA regarding whether activation of ESF #14 is required.	EMG/ FEMA recovery LNO/ OPEO-CIKR
			8. Develop common operating picture for long-term recovery and establish a transition to recovery plan.	EMG plans/ FEMA recovery liaison/ OPEO-CIKR
			9. Produce ongoing and accurate public health, medical and human services status assessments post-landfall, including status of at-risk population and service animals	EMG/ /SOC/ ALL
			10. Determine need for Medicare/Medicaid waivers, human services and Federal benefits	EMG/CMS/ACF/AoA
			11. Prior to Phase III, as situation warrants, begin SNS redeployment/recovery/transition planning	EMG/CDC
			12. Capture after-action comments	ALL
			B. Healthcare, Emergency Response, and Human Services
			1. Deploy additional NDMS and PHS assets as required	EMG/NDMS/OFRD
			2. Deploy staged personnel in accordance with Mission Assignments Additional IRCTs as needed RDF, APHT, Mental Health, Human Services, etc. LNOs VA and DoD	EMG/OFRD/VA/DoD
			3. Implement necessary measures for at-risk persons with need for additional support(s)	EMG/OD/ACF/OCR/OPEO-Human Services
			4. Assess the need to use of Emergency System for Advance Registration of Voluntary Health Professionals (ESAR-VHP).	EMG /OPEO Hospital Program
			5. Assess need for MRC Federal-level activation	EMG/OPHS-MRC
			6. Receive, process, track and sub-task (as needed) MAs	EMG A&F
			7. Enter affected area and commence providing 24/7 support to State and Local authorities	IRCT/All
			8. Conduct and maintain Situational Awareness reporting	IRCT/SOC/EMG
			9. Deploy medical, public health, mental health, human services staff or other civilians as needed to augment Mass Care Shelters	EMG/All
			10. Determine if medical mass care procedures are required.	EMG/All
			11. Deploy assets in support of fatality management as requested.	EMG/NDMS
			12. Determine health and safety of deployed ESF #8 personnel in affected areas.	EMG/IRCT Safety Officer
			13. Deploy stress management teams as required.	HHS/SAMSHA
			C. Surveillance, Investigation, and Protective Health Measures
			1. Collect data from HRSA, ACF and, SAMHSA supported grantees. Impact on HRSA, ACF and SAMHSA funded services (Community Health Centers, Ryan White HIV/AIDS Clinics, Maternal and Child Health Clinics) Resources needed/future services Grantee/HRSA, ACF, AoA and SAMHSA attempts to address problem	HRSA/ ACF / SAMHSA/AoA
			2. Reach out to state epidemiologists to determine if assistance is needed	CDC- coordinated with IRCT
			3. Assist states with surveillance for outbreak/reports of abnormal disease or disease rates and “pockets” of at-risk population in the affected areas, including the community, medical facilities, and shelters.	CDC- coordinated with IRCT/OCR
			4. Assist states through direct or technical assistance in the collection and analysis of data from injury, illness and mortality surveillance activities	CDC- coordinated with IRCT
			5. Provide CDC staff to supplement state efforts to address identified public health issues/concerns	CDC- coordinated with IRCT
			6. Conduct inspections and assess damage to FDA-regulated industry in impacted areas	FDA- coordinated with IRCT
			7. Assist states with collection and/or analysis of FDA-regulated product samples	FDA- coordinated with IRCT
			8. Provide technical assistance or subject matter expertise to states related to FDA-regulated products (food, drug, medical device and biologics safety) and conduct assessment of food retail establishments in impacted area.	FDA- coordinated with IRCT
			9. Conduct active review all adverse event reports related to FDA-regulated products	FDA- coordinated with IRCT
			10. Assist States with surveillance efforts to determine product integrity of pharmaceuticals, medical supplies and equipment in aftermath of incident.	FDA- coordinated with IRCT
			11. Coordinate with state, local, and tribal environmental health departments to ascertain need for technical assistance, consultation, and support	CDC- coordinated with IRCT
			12. Conduct vector surveillance and be prepared to coordinate vector control measures (e.g. aerial spraying).	CDC- coordinated with IRCT
			D. Pharmaceuticals, Medical Supplies and Equipment
			1. Provide real time requirements for new pharmacy, medical supplies, and equipment to CDC/DSNS	IRCT
			As situation warrants, begin SNS redeployment/recovery/transition planning	EMG Plans/CDC
			3. Activate Emergency Prescription Assistance Program (EPAP)	IRCT/CMS
			E. Patient Evacuation
			1. Review and adjust patient evacuation/repatriation plans with ESF #8 partners.	EMG/ NDMS/ DOT/ DoD/ VA/ ACF/ OD
			2. NLT 12 hours prior to landfall, complete/hold on all patient evacuation operations until storm passes. Conduct last shelter-in-place assessment of medical facilities with patients remaining.	EMG-NDMS/DoD/DOT/VA/FEMA
			3. Post-landfall resume patient evacuation (as required).	EMG/DoD/DOT/VA/FEMA
			4. Consider movement of service animals in coordination with ESF#11.	EMG/USDA/DoD/DOT/VA
			5 Augment shelter in place facilities as required to sustain operations	EMG
			F. Communications and Outreach
			1. Continue situation briefing/conference calls for ESF partners and OPDIVS/STAFFDIVS	ALL
			2. Coordinate communications efforts with Local/State Public Health Departments	JIC/HHS-CDC/FDA/ADA /OD/ACF

	Actions/Issues	Lead Agency/Supporting Agency
Phase III- Post-Incident Demobilization, Deactivation and Recovery Trigger Event 6: Unified Command determines that sufficient progress has been made in restoring minimal functionality to affected and impacted area and that the critical life- and economy-sustaining critical infrastructures are able to support reentry and repopulation
ESF #8 Strategy: To Effect a Smooth and Transparent Transition to Long-Term Recovery
	A. Planning and Coordination
	1. Determine with FEMA and local authorities that sufficient progress has been made in restoring minimal functionality to affected and impacted area and that the medical and public health infrastructures are able to support reentry and repopulation.	EMG/ FEMA recovery liaison/OPEO CIKR/DHS
	2. At the direction of the JFO/NRCC, implement demobilization and deactivation plan for the release of appropriate ESF #8 components.	ALL
	3. Scale IRCT to reduced staffing to ensure (a) continued visibility on the execution of longer term Mission Assignments and (b) maintain situational awareness to support additional response operations.	EMG
	4. Complete draft of after-action report	ALL
	5. Demobilize and deactivate specific response assets when its specific task or Mission Assignment is completed or when it is determined the magnitude of the event does not warrant continued use of the asset	EMG/DHS/FEMA
	6. Scale down HHS-EMG operations commensurate with field activities including all LNOs	EMG
	7. Provide briefings on public health and medical sector needs to Chamber’s Business Civic Leadership Center (BCLC), top 20 donors, NGOs, and non-profits that contribute/support our sector. Schedule subsequent briefings as necessary.	OPEO-CIKR, FEMA recovery liaison
	8. Coordinate with IRCT and ESF#8 supporting agencies, the demobilization of ESF#8 resources when all operational objectives contained in the ESF#8 Incident Action Plan have been met or affected State, or DHS determines that resources are no longer needed.	EMG-OPEO-CIKR
	B. Healthcare, Emergency Response, and Human Services
	1. Transition response to State and local authorities	ALL
	2. Demobilize personnel as required in accordance with MAs completion	ALL
	3. Transition to routine operations for OPDIVs as appropriate.	EMG
	C. Surveillance, Investigation, and Protective Health Measures
	1. Determine requirements for long-term post-event surveillance or investigation.	CDC
	2. Continue assistance to States regarding surveillance efforts including outbreak reports of abnormal disease/injury or disease/injury rates in the affected areas and surveillance of “pockets” of at-risk populations.	CDC//OD/ACF/SAMHSA OCR
	3. Continue to coordinate with state, local, and tribal environmental health department to ascertain ongoing and/or anticipated need for technical assistance, consultation, and support	IHS/CDC/other OPDIVS
	4. Continue to monitor worker safety and physical and mental health	EMG/CDC-NIOSH/OSHA
	5. Continue inspections of FDA regulated industry and work with states as needed to assess retail food establishments in impacted areas	FDA
	6. Continue to assist states through collection and/or analysis of FDA-regulated product samples.	FDA
	7. Continue to provide states technical assistance or subject matter expertise related to FDA-regulated products food, drug, medical device and biologics safety; water safety as it affects FDA-regulated products; informed consent; clinical trials	FDA
	8. Continue to review all adverse event reports related to FDA-regulated products	FDA
	D. Pharmaceuticals, Medical Supplies and Equipment
	1. Establish procedures for follow on shipments of necessary pharmaceuticals, medical supplies, and equipment to affected area.	EMG/DHS/FEMA
	2. Inventory and return non-essential equipment for reconstitution	ALL
	3. Continue to assist states as needed with surveillance efforts to determine product integrity	FDA
	E. Patient Evacuation
	1. Assist with return of patients to intermediate and final locations (and family and caregivers as feasible)	EMG/CMS/DHS/ FEMA/ DOT/ACF/OD
	F. Communications and Outreach
	1. Continue situation briefing/conference calls for ESF partners and OPDIVS/STAFFDIVS until demobilization complete.	HHS-EMG
	2. Continue coordination with State Health Officials until demobilization.	IRCT

Summary

Phase I – Pre-Incident (TS-120 hours to Onset of Tropical Storm Force Winds)

The purpose of the Pre-Incident Phase is to ensure that the Secretary of HHS, through the ASPR, and all the ESF #8 partners receive the most current and accurate situational awareness information concerning emerging and potential threats and that ESF #8 response assets are alert and postured to respond in a timely manner. The strategy for this phase is to closely monitor events and begin review of advance preparations required to facilitate an effective and timely response. Phase I- Pre-Incident addresses all the actions taken before a severe tropical storm or hurricane makes landfall. This phase transitions from normal operations on the June 1^st start of the hurricane season, through Heightened Situational Awareness, Preparedness and Alert stages. The priority efforts during the Pre-Incident Phase are focused on awareness, preparedness and protection.

The HHS-EMG and ESF #8 Partners will review the readiness and deployment posture of personnel and resources in preparation to support active and sustainable field response and recovery operations; ensure US Government financial, acquisition, and personnel systems are brought to, and maintained at, the highest state of readiness; establish and maintain required communication and coordination links with other Federal agency representatives to ensure optimal situational awareness and resource visibility, in preparation for the anticipated mission and objectives.

Playbook Action Steps in Phase1 are sub-divided into two stages:

Stage 1: Heightened Situational Awareness

Stage 2: Preparedness and Alert (TS-120 hours to TS-96 hours )

Stage 1- Heightened Situational Awareness. The transition from normal operations to the heightened situational awareness stage is triggered bythe receipt of a US Department of Commerce’s National Oceanographic and Atmospheric Administration, National Weather Service, National Hurricane Center/Tropical Prediction Center (USDOC/NOAA/NWS/NHC/TPC) tropical advisory indicating the development of a potentially damaging tropical event (i.e., tropical storm or hurricane).

Stage 2- Preparedness and Alert. The next key trigger event is the formal alert to the US Government’s Federal Executive Branch emergency management community and its State, local, tribal, and private sector partners by FEMA, via the FEMA NRCC to be prepared to activate and deploy at a specific time in support of a major hurricane or tropical storm making landfall in the United States or its territories. Following the receipt of a FEMA notification to assume an alert posture, the HHS-EMG will issue an alert notification to primary and support departments, agencies, team personnel, and sector support staff that may be required to forward deploy assets, directing them to assume an alert status in preparation for possible activation. Assets required immediately may include IRCT, NDMS teams, and Federal Medical Stations (FMS) with personnel support.

Phase II – Incident Response (TS-96 hours thru L+120 hours)

The key strategy in Phase 2 – Incident Response Phase is to activate and deploy highly capable, incident-specific, interagency public health, medical, and at-risk population response and recovery teams and resources to support State, local, tribal, and private sector partners in saving lives, minimizing adverse public health and medical effects, stabilizing the public health and medical infrastructures and addressing medical special needs. This Phase addresses initial response actions immediately prior to and immediately after a severe tropical storm or hurricane makes landfall and the subsequent activities required to deal with the immediate effects of the events.

Playbook Action Steps in Phase II are sub-divided into three stages:

Stage 1: Activation (TS-96 to TS-72)

Stage 2: Deployment (TS-72 to TS-24)

Stage 3: Initial Response and Sustained Response (TS-12 to TS +120) Presidential Declaration/ MA thru Landfall)

Activation (Stage 1). It may be necessary to pre-deploy enabling assets prior to declaration of an emergency or major disaster using FEMA surge account funds. The EMG may pre-deploy response assets such as the IRCT-A, NDMS personnel, Federal Coordinating Center (FCC) points of contact, and others as appropriate to support patient evacuation activities, or to have teams positioned forward in order to begin operations soon after landfall. Following the receipt of an approved mission assignment activating the ESF #8 desk in the NRCC, team members and their associated equipment caches will deploy to their designated field facilities as directed within 12 hours.

The receipt of a mission assignment activating the ESF #8 desk in the NRCC authorizes the deployment of additional personnel and assets, and provides for the possibility, but not the guarantee of (per HSPD-5), reimbursement for travel costs (i.e., transportation, billeting, and meals and incidental expenses) and disaster-related overtime under the FEMA Surge Account or the Fund Code 6 DRF.

In order to fully be prepared to respond to ESF#8 requests for DoD support for aeromedical evacuation and DoD/VA FCC support it may be necessary to pre-deploy enabling assets such as aeromedical evacuation liaison teams, aeromedical staging facilities, and patient movement teams.

Key actions include activation of the NDMS patient movement system (if needed), deploying ESF#8 field elements (IRCT) and integrating HHS operations with the FEMA JFO including deploying a SHO (if the HHS Secretary deems the event to be large enough to warrant deployment of a SHO), and maintaining situational awareness and readiness of pre-positioned assets.

Deployment (Stage 2). The triggering event for this stage is a Presidential Emergency Disaster Declaration under the Robert T. Stafford Disaster Relief and Emergency Assistance Act or the Declaration of an Incident of National Significance by DHS under Homeland Security Presidential Directive (HSPD) 5, Management of Domestic Incidents. When landfall of a major hurricane or Incident of National Significance, occurs or is imminent, FEMA will notify the appropriate Federal Agencies’ response components if and when they can deploy under a MA. Until such time, HHS and ESF #8 partners will operate under their statutory authorities in order to pre-position or deploy personnel and resources in locations favorable to providing timely and efficient access to the affected area.

When notified, the HHS-EMG, primary and support agencies, and supporting facilities will need to rapidly decide on the initial level of their deployment to include whether a rapid advance deployment is needed. Key actions involve staging/deploying NDMS teams, other pre-rostered public health, medical, and mental health personnel assets to forward operating locations; stage/deploy FMSs, and other pharmaceuticals and supplies from the Strategic National Stockpile (SNS) as necessary to begin caring for and evacuating critical patients out of affected area to NDMS receiving hospitals. EMG is at full-staffing Level 3 with LNOs from ESF#8 partners as required.

Initial and Sustained Response (Stage 3). Once an emergency declaration has been made under the Stafford Act, and/or a determination has been made that an event is a public health emergency, and a mission assignment is issued, HHS and ESF #8 partners will rapidly deploy staged personnel and assets and enter the affected area to commence providing 24/7 support to State, local, and tribal authorities. All patient evacuation operations must cease 12 hours prior to landfall and will resume post-landfall as required by damage to the health care infrastructure in the impacted area.

During sustained response and recovery, activated personnel in the SOC and other EOCs will maintain comprehensive situational awareness of the national-level domestic operating picture as well as the specific incident or incidents in order for them to make informed operational employment and resource allocation decisions.

The IRCT is fully functional managing ESF#8 missions in the field. Requirements for augmentation personnel will be assessed and expanded. Volunteers through the Medical Reserve Corps (MRC) and in state-based registries (ESAR-VHP) will be considered in an extended response.

Phase III – Post-Incident (Demobilization, Deactivation and Recovery)

The triggering event for the demobilization and deactivation phase, and the associated procedures, processes, practices, and protocols, is initiated when the Joint Field Office determines that sufficient progress has been made in restoring minimal functionality to the affected and impacted area(s) and that the critical life and economy-sustaining critical infrastructures are able to support safe reentry and repopulation. The demobilization and deactivation of a specific response asset is initiated when its specific task or mission assignment is completed or when it is determined by the state/FEMA the magnitude of the event does not warrant continued use of the asset.

Ongoing and accurate public health, medical, veterinary, human services and at risk group status assessments are necessary for the HHS-EMG and ESF #8 support agencies to plan for and sustain medical response operations; to anticipate the need for follow-on personnel, supplies and equipment; and provide other pertinent information to aid demobilization decision making. The HHS-EMG will coordinate with the IRCT and with ESF #8 support agencies the demobilization of ESF #8 assets when all operational objectives contained in the ESF #8 Incident Action Plan (IAP) have been met or the affected State, or DHS determines that assets are no longer needed.

At the direction of the Federal Coordinating Officer (FCO) the various planning sections develop a scaleable demobilization and deactivation plan for the release of appropriate components. As the need for full-time interagency coordination at the JFO ceases, the IRCT plans for selective release of federal resources, demobilization, deactivation, and closeout. Federal agencies then work directly with their grantees from their regional or HQ offices to administer and monitor individual recovery programs, support, and technical services.

As response operations begin to diminish, Incident Commanders demobilize Federal agencies from their respective operations. The IRCT may remain operational at reduced staffing to maintain continued visibility on the execution of longer term mission assignments and maintain situational awareness to support additional response operations.

When the Federal response effort is deactivated, specific procedures for deactivation will be followed to ensure proper record keeping and handling of contracts as well as recovery of deployed equipment, materials, and medical records. Demobilization and deactivation activities are planned, coordinated, and executed to ensure that Federal, State, local, tribal, and private sector response and recovery personnel are maintained at the highest state of readiness commensurate wtih operational field response and recovery operations.

These activities are also planned to ensure that a smooth and transparent transition to long-term recovery can be sustained. Demobilization and deactivation activities ensure that the appropriate government jurisdiction, and private sector components, under local government regulation and oversight, resume direct authority for operations and administration as soon as effectively possible.

Hurricane Playbook

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