Hurricane Season Concept of Operations (CONOPS)

Phase I – Pre-Incident Phase
Phase II – Incident Response Phase (Activation, Deployment, Initial Response)
Phase III – Post-Incident Phase (Demobilization, Deactivation and Recovery)

PURPOSE:
1. This document provides an Executive Summary of the concept of operations for coordinating Federal public health and medical assets necessary to support response efforts of expected hurricane landfalls for the 2009 season.

SITUATION: Scenario

MISSION:
1. The Department of Health and Human Services (HHS), with the help and support of its National Response Framework (NRF) partners will lead all Federal public health, medical and at-risk population support in the United States and its territories to prepare for, respond to, and recover from the effects of the hurricane season. HHS Operating and Staff Divisions and ESF #8 Partners will provide Federal assets and capabilities to support time-sensitive life-saving, life-sustaining, public health and medical infrastructure. Assets also include stabilization missions to supplement Local, State and tribal response and recovery capabilities.

CONCEPT OF OPERATIONS:
1. a. Intent: All response and recovery planning and operational activities will be initiated and executed in compliance with the NRF, National Incident Management System (NIMS), and the HHS ESF #8 Concept of Operations Plan for Public Health and Medical Emergencies. The hurricane response and recovery planning is focused on developing and coordinating collaborative, interagency and multi-jurisdictional operational activities and capabilities to provide for:
  1. Patient and At-Risk Population Evacuations
  2. Life-Saving Operations
  3. Life-Sustaining Operations
  4. Restoration of Public Health and Medical Infrastructure
  5. Human Services and At-Risk Population Needs
  6. Patient Return to Location of Origin
  7. Veterinary Assistance
  8. Fatality Management
  9. Worker Safety and Health
  ESF #8 response and initial recovery planning and operational activities will consider medical evacuation and shelter-in-place (SIP) options and resources for individuals with medical needs in hospitals, nursing homes, assisted living facilities, and persons living at home. Individuals with functional needs, including individuals with disabilities and individuals with limited English proficiency, that do not require medical support/intervention but do require other means of support such as the assistance of an interpreter, the assistance of a personal caregiver to accomplish activities of daily living or the assistance of a caregiver to provide guidance in daily decision-making, or other auxiliary aid or service is a shared responsibility between ESFs #6 and #8.
2. b. Phasing of Support: The ESF #8 Response to hurricane development will be in three phases, which correspond to the DHS/FEMA National Hurricane Contingency Plan (ConPlan). Details of the phase operations are contained in the ESF #8 Hurricane Response Operations Action Steps (Tab C). They are:
3. Phase I – Pre-Incident Phase
4. The purpose of the Pre-Incident Phase is to ensure that the Secretary of HHS, through the Assistant Secretary for Preparedness and Response (ASPR), Emergency Management Group (EMG) and ESF #8 partners receive the most current and accurate situational awareness information concerning communications relevant to emerging and potential threats and that ESF #8 response assets are postured to respond in a timely manner.
5. The strategy for this phase is to closely monitor events and begin review of advance preparations required to facilitate an effective and timely response; andto establish an alert posture for forward deployment of assets that may be required immediately after landfall to expedite a sustained response. Assets required may include Incident Response Coordination Teams (IRCTs,); NDMS teams; and Federal Medical Stations staffed by Rapid Deployment Force Teams, or ESF#8 supporting partners. During the alert stage the EMG ensures that HHS and other ESF #8 partners develop or maintain the capability to operate under austere conditions.
6. Following FEMA notification, the ESF #8 EMG will alert primary and support departments, agencies, team personnel, and sector support staff of a possible ESF# 8 activation.
7. Phase II – Incident Response Phase (Activation, Deployment, Initial Response)
8. Activation. It may be necessary to pre-deploy assets prior to declaration of an emergency or major disaster using FEMA surge account funds. HHS will coordinate with FEMA in pre-deploying response assets such as the IRCT-A, NDMS teams, Federal Coordinating Center (FCC) personnel and others, as appropriate. Following the receipt of an approved Mission Assignment (MA) activating ESF #8, activated team members and their associated equipment and caches will deploy to their designated field facilities as directed within 12 hours.
9. Deployment. ESF#8 assets will typically deploy under a FEMA MA. HHS and ESF#8 supporting agencies can operate under their statutory authorities if needed to provide timely and efficient access to the affected areas.
10. Initial Response. Once a Presidential emergency or major disaster declaration is made or a declaration of an Incident of National Significance is made by DHS, and a mission assignment is issued, HHS and ESF#8 partners will rapidly deploy and employ staged assets to begin providing public health, medical, human services, and veterinary support assistance where needed to save lives, minimize adverse health and medical effects, and stabilize the public health and medical infrastructures.
11. Post-landfall. Ongoing and accurate public health, medical, and at-risk population status assessments are necessary for the EMG and ESF #8 Support Agencies to plan for and sustain public health and medical response operations, to anticipate the need for follow-on personnel, supplies and equipment, and to provide other pertinent information as required to facilitate the response.
12. Phase III – Post-Incident Phase (Demobilization, Deactivation and Recovery)
13. Demobilization and Deactivation. The demobilization and deactivation phase, and the associated procedures, processes, practices, and protocols, begin when the Joint Field Office determines that sufficient progress has been made in restoring minimal functionality to the impacted area and that the critical life- and economy-sustaining critical infrastructures are able to support safe reentry and repopulation. A specific response asset is demobilized when its task or Mission Assignment is completed or when it is determined by the state/FEMA that the asset is no longer needed. The EMG will coordinate with the IRCT and with ESF #8 Support Agencies the demobilization of ESF #8 assets when all operational objectives are satisfied.
14. Recovery. HHS may continue providing technical expertise or guidance to state and local authorities as they rebuild their public health and medical infrastructures. In this role HHS supports ESF#14. The goal is to effect a smooth and transparent transition to long-term recovery.
15. c. Medical Care
16. ESF #8 coordinates and provides the appropriate level and quantity of federal medical care based on the type, extent, nature, and severity of the incident. ESF #8 will coordinate and oversee the following support functions: field stabilization and treatment, primary healthcare, inpatient care, extended care, medically-supported patient movement, and medical care compensation.
17. d. Mass Patient Movement and Return
18. 1) Mass patient movement includes medical regulating processes and patient transportation systems to evacuate ill or injured patients from a disaster area to facilities where they may receive medical care. The ESF#8 National Disaster Medical System (NDMS) will regulate patients to designated transportation hubs and coordinate all lift support for patients in route to definitive care.
19. 2) HHS may establish a Patient Movement Section as part of the EMG to liaison with, Department of Transportation (DOT), Department of Defense (DoD), and Department of Veterans Affairs (VA); with participation from the American Red Cross (ARC), local, state, and tribal agencies; to move patients by air or by ground from locally operated patient reception centers to destination medical facilities outside the anticipated impact area.
20. 3) HHS will coordinate with Federal partners return of patients and family members that have been transported by NDMS.
21. e. Mission Assignment Subtaskings
22. HHS will request ESF #8 Support Agencies, HHS OPDIV and STAFFDIVs to provide available assets in support of tasks outlined in FEMA Mission Assignments. If HHS determines that the services of an ESF #8 Support Agency are needed, HHS will provide the Support Agency with a copy of the Mission Assignment, funding limitations, and other documents that will be necessary for the subtasked agency to perform the mission. HHS will use an appropriate mission assignment subtasking request form when seeking the assistance of ESF #8 Support Agencies. Support agencies must submit breakdowns of costs by sub-object class code to HHS/ASPR. ASPR must review and approve all MA and related sub tasking documentation before forwarding it to DHS/FEMA for reimbursement.
1. LOGISTICS:
  1. HHS and ESF #8 Support Agencies will use the structures and processes described in National Incident Management System (NIMS) to sustain ESF #8 deployed assets. HHS will coordinate medical and non-medical logistics support with FEMA Logistics. FEMA Logistics will be expected to provide support and facilities management at FEMA managed sites such as the Joint Field Office (JFO), marshalling sites, advance staging bases, and base camps. Examples of the support include:
    1. Lodging
    2. Food
    3. Local ground transportation
    4. Fuel
    5. Potable water
    6. Site security
  2. The IRCT Logistics Section will provide a one-stop shop for logistical support, medical resupply and non-medical support (transport, food, security, etc) for deployed HHS/ESF #8 assets. The IRCT Logistics Section will coordinate activities with the appropriate FEMA logistics section for the current phase of staging or response (e.g., RRCC, ERT-A, JFO, Area Field Office).
1. COMMAND AND MANAGEMENT:
2. The Secretary, HHS is responsible for interagency coordination of the public health and medical response under ESF #8. All public health and medical response efforts will be coordinated for the Secretary by the ASPR. Operations in preparation for, or in response to, a public health or medical emergency are managed and coordinated by the Emergency Management Group (EMG) under the direction of the ASPR. The EMG will typically operate out of the HHS Secretary’s Operations Center (SOC) in Washington, DC, but may relocate to designated alternate facilities. The EMG’s organizational structure has its foundation in the Incident Command System (ICS) structure with Operations, Planning, Logistics, and Administration / Finance Sections; but remains flexible in order to accommodate the functional requirements of headquarters and ESF operations. The Deputy Assistant Secretary/Director, Office of Preparedness and Emergency Operations (DAS OPEO) (or his or her designee) is designated as the EMG Manager.
3. At the field level, HHS operational actions are coordinated through the Incident Response Coordination Team (IRCT). In accordance with ICS concepts, the response operations of teams and personnel from ESF-8 partners and HHS divisions are coordinated through the Operations Branch of the IRCT. The IRCT coordinates HHS actions into the larger Federal response via liaisons at the Federal JFO, Regional Response Coordination Center (RRCC), or the Regional ERT-A location as appropriate. One member of the IRCT will be designated as the ESF-8 lead at the JFO,RRCC or ERT-A. The liaisons are integrated into the JFO organizational structure and relay information and assignments back to the EMG via the IRCT. It is through these liaisons that HHS fulfils its role in the integrated Federal response by processing and executing FEMA MAs.
  1. Note: The IRCT-Advance (IRCT-A) teams are pre-designated regional teams, designed to set up initial response operations and provide rapid situational assessments up through the EMG at HHS headquarters. Utilizing their established contacts with State, local, and tribal officials, they can help determine the level and type of Federal public health, medical and human services support and follow-on resources that may be required and requested. An IRCT-A is prepared to rapidly deploy and conduct operations up to the first 72 hours of response; after which, they will be augmented by the full IRCT. The Regional Emergency Coordinators (RECs) serve as the lead for their regional IRCT-As.
  2. In large scale or complex response operations, an HHS Senior Health Official (SHO) will deploy to function as the Secretary’s representative in the field. When deployed, the SHO is the primary liaison to the DHS Principal Federal Official (PFO) for public health and medical issues. The HHS SHO is responsible for coordinating deployed HHS resources and provides guidance and leadership to the IRCT.

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