7.4 HHS Concept of Operations for ESF #8

As the Primary Agency for ESF #8, HHS has developed a Concept of Operations Plan (CONOPS) that provides the framework for its management of the public health and medical response to an emergency or disaster. The HHS CONOPS is consistent with HSPD-5 and the NRP, and implements strategies to ensure a unified approach to all mitigation, preparedness, response, and recovery activities carried out by HHS. On behalf of the Secretary of HHS, the ASPR directs and coordinates all Federal public health and medical assistance provided under ESF #8. The ASPR also acts as the senior-level HHS liaison to DHS and other Federal departments and agencies.

Strategic coordination of the ESF #8 response

The ASPR coordinates the Federal ESF #8 response through the HHS Emergency Management Group or EMG, which operates from the SOC at HHS headquarters in Washington, D.C. By definition, the EMG is always operational at a baseline level and in times of non-response, it maintains a surveillance and monitoring posture. When preparing for or responding to an incident, the ASPR may raise the staffing level of the EMG and begin operations out of the SOC. The EMG's organizational structure is based on ICS principles.

The SOC is the focal point for command and control, communications, specialized technologies, and information collection, assessment, analysis, and dissemination for all HHS components under non-emergency and emergency conditions to support a common operating picture. It is continuously staffed and maintains operations 24 hours a day, 7 days a week (24/7). Because the SOC is always operational, it can rapidly enhance its services and staffing during times of crisis. When not in an emergency response mode, the SOC performs continuing surveillance of the following:

• Public health data for special topics (e.g., West Nile virus, influenza activity)
• Reports from Regional Emergency Coordinators (RECs), HHS OPDIVS and other ESF #8 agencies that support State, Tribal, and jurisdictional incident management
• Media reports and other mass public information sources
• Natural disasters (e.g., earthquake activity, hurricanes).

Watch Officers in the SOC maintain daily contact with other Federal operations centers to ensure situational awareness. Reports of incidents with potential public health or medical consequences are provided to the Duty Officer, who then alerts HHS senior staff as necessary. Critical public health and medical requirements are brought to the attention of the ASPR. During an event, the ASPR may deploy HHS liaisons to other Federal EOCs.

In addition to the SOC, some HHS OPDIVs, such as the CDC, maintain EOCs to manage their own assets. The OPDIV EOCs can be activated separately from the SOC when involved in a small-scale or "routine" response that does not require HHS department-wide coordination. However, when an OPDIV EOC is activated (only the SOC and the Director's EOC or DEOC at the CDC are operational 24/7), the EOC must notify the SOC and provide status updates of activities. During a department-wide response, the OPDIV EOCs coordinate their operational information with the SOC to establish a common operating picture. During response operations, staffing the SOC with experts from the HHS OPDIVs and Federal partners enhances ESF #8 coordination.

Operational coordination of the ESF #8 response

At the field level, the IRCT acts as the Secretary's agent on scene under the direction of the EMG. The IRCT consists of 10 pre-identified teams, with 30 multidisciplinary staff on each. The teams serve on a rotating call basis, with the on-call team capable of deploying within 12 hours of notification. The IRCT has a built-in command structure and is responsible for directing all ESF #8 response assets in the field. The IRCT is scalable to meet the demands of the incident. The IRCT coordinates the activities of all Federal ESF #8 resources deployed to assist States, Tribal Nations, jurisdictions, and other Federal agencies (see below). This includes teams deployed through HHS OPDIVs and the ESF #8 support agencies.

Key Roles of the IRCT

The IRCT is primarily responsible for supporting the public health and medical management of an incident. It does this by providing the field management component of the Federal public health and medical response. The IRCT is not designed to provide direct medical or mental-health care, decontamination, or public health services. Rather, the IRCT performs the following primary functions:

• Provides liaisons in the field to coordinate with jurisdictional, Tribal, or State incident management
• Provides the field management and coordination for deployed HHS and other ESF #8 assets to integrate those assets with the State and local response
• Assesses the requirements or potential needs for HHS and ESF #8 assistance
• Provides continuous assessment of the adequacy of the HHS and ESF #8 response to the Secretary through the ASPR
• Represents ESF #8 in the JFO and the RRCC
• Provides data management and information processing services for ESF #8. This includes the development of incident action plans and situational reports for the ESF #8 response
• Acts as the conduit for incident information exchange between the SOC and the field (via the IRCT Leader).

Consistent with NIMS, each IRCT has a team leader and other appropriate personnel to fill ICS positions (Figure 7-1).^[13] The IRCT Leader typically is an HHS Regional Emergency Coordinator (see description below); however, the ASPR maintains the right to appoint another qualified person to fill this position. To better coordinate all ESF #8 response components, the IRCT has liaisons from HHS OPDIVs and ESF #8 support agencies to integrate all ESF #8 activities under a single ICS. Any team from an OPDIV or ESF #8 support agency (e.g., VA, DoD) that is deployed during a disaster must report to that agency's liaison at the IRCT.

Figure 7-1. IRCT Organizational Chart

During large-scale or complex incidents, the Secretary of HHS may also deploy a Senior Health Official (SHO) to serve as his/her direct representative in the field. The SHO is typically an Admiral from the USPHS Commissioned Corps. When deployed, the SHO is responsible for overarching coordination of deployed HHS resources and provides guidance and leadership to the IRCT. The SHO essentially acts as an Agency Executive, as described in ICS, to the IRCT. The SHO serves in the JFO Coordination Group as the principal ESF #8 liaison to the PFO and other senior Federal, State, Tribal, and jurisdictional officials.

HHS has a cadre of regionally based personnel who work with State and local authorities on a variety of public health and medical initiatives, including preparedness and response to major events. It is important for public health and medical planners to understand the roles of these regionally-based personnel and to establish working relationships with them during preparedness planning to facilitate Federal support in a crisis. Brief descriptions of key regional personnel are provided below and their respective roles in preparedness, response, and recovery are summarized in Figure 7-2.

• Regional Director (RD): An HHS political appointee at the regional level, the RD is the Secretary's regional representative and the primary spokesperson for HHS in his/her region, except in times of emergency. During normal daily operations, the RD reports pertinent information on regional issues and implications to HHS leadership. The RD promotes preparedness by coordinating regional resources through a Regional Advisory Council. During a response, the RD serves as the point of contact (POC) for elected officials and consults with an IRCT deployed to his/her region.
• Regional Health Administrator (RHA): Oversees HHS public health programs at the regional level and coordinates with State Health Directors. The RHA builds relationships with State and local public health officials as well as other Federal departments in their region. During a response, the RHA may serve in a public health advisory role supporting the REC, and as a liaison to State Health Directors. The HHS Secretary may also call on the RHA to serve as the SHO, if needed.
• Regional Emergency Coordinator (REC): Leads the HHS regional preparedness effort in his/her region by working with medical and public health planners to determine precisely what their response capability is, when they might need to ask for Federal support, and how they would integrate Federal assets into their ICS. The REC also is the HHS lead for regional response and typically serves as the IRCT Leader.
• Regional Administrator (ACF): Serves as the liaison and advisor to the REC for coordination of Human Services (ESF #6) issues and participates in regional planning activities. During an event, the ACF RA assesses and coordinates the ACF response and provides a liaison to the IRCT.
• Senior Management Official (CDC): Represents CDC in the State health department and coordinates technical support to local and State public health agencies. During a response, the SMO advises the State on the effective use of CDC assets and provides technical assistance and guidance.

Figure 7-2. Roles of HHS Regional Personnel in Emergency Management

The EMG deploys liaisons to field operations centers (e.g., JFO) to represent the Federal public health and medical response effort. Following the lessons learned from Hurricane Katrina, the JFO has been restructured along ICS lines, with ESF #8 liaisons within each ICS Section. The senior HHS liaison at the JFO is the SHO (if deployed).

The framework by which HHS responds to threats or public health emergencies is characterized by three general stages: notification and alert, deployment and operational management, and transition and disengagement. Each of these stages is described in detail below.

Notification and Alert

HHS learns about credible threats to the public's health, as well as potential or actual emergencies, from public health and emergency management authorities at all levels of government, disease surveillance systems, law enforcement agencies, intelligence channels, agricultural, industrial, and environmental agencies, and the media. The SOC is the notification point within HHS for public health threats and emergencies, and it should be contacted immediately (via established local to State to Federal communications channels) with any information regarding a threat or emergency.

Once notified, the SOC performs a series of pre-determined notifications within HHS, including the ASPR, the Secretary, the Deputy Secretary, and key members of the EMG staff. Depending on the nature of the incident, the ASPR may notify other senior Departmental officials, OPDIV EOCs or Heads, key Federal EOCs, and the relevant RHA, RD, and REC. As situational awareness is gained, the ASPR directs further actions, which may include activation of the EMG, which deploys liaisons to other Federal EOCs and/or places ESF #8 response teams or personnel on alert status.

The EMG also convenes an ESF #8 conference call to assess the situation and determine the appropriate actions. The EMG alerts pre-designated HHS personnel to represent ESF #8 on the following:

• National Response Coordination Center (NRCC)
• Regional Response Coordination Center (RRCC)
• Emergency Response Team – National (ERT-N)
• Emergency Response Team – Advance (ERT-A)
• Joint Field Office/Joint Information Center.

Deployment and Operational Management

The Secretary of HHS, through the ASPR and the ESF #8 EMG, directs the activation and deployment of ESF #8 assets in support of State, Tribal, or jurisdictional incident management. The EMG activates an IRCT as required to coordinate locally the activities of all deployed ESF #8 assets and to represent ESF #8 in interactions with the affected local, State, or regional response structure. If there are multiple incidents, or one incident with widespread implications, the EMG may deploy multiple IRCTs. As stated earlier, the Secretary may also deploy a SHO to serve as the senior ESF #8 advisor in the JFO Coordination Group and to provide overarching field-level guidance and leadership to the IRCT.

At the request of the EMG, HHS OPDIVs and ESF #8 support agencies provide liaisons to the SOC to ensure a common operating picture and a coordinated ESF #8 response. Similarly, HHS may be asked to provide liaisons to other operations centers. The SOC schedules video and/or audio conferences at regular intervals to facilitate communi-cations between the different components of the ESF #8 response and affected State, Tribal, and local authorities.

During incident operations, HHS oversees and coordinates appropriate missions under ESF #8 in accordance with FEMA mission assignments (if the Stafford Act has been invoked). EMG staff review each mission assignment received from FEMA to determine the most appropriate resource to meet the identified need. In some cases this may be an asset within HHS; in others, the EMG tasks its ESF #8 support agencies to provide the necessary resource(s). Through regular communications with the IRCT Leader, the EMG assesses the status of all ESF #8 mission assignments and anticipated future public health and medical needs.

Transition and Disengagement

The Secretary of HHS, through the ASPR, decides when to demobilize ESF #8 assets based on the successful completion of ESF #8 mission assignments and assessments of the overall public health and medical response. The demobilization of ESF #8 assets, including those from HHS OPDIVs and ESF #8 support agencies, is coordinated with the IRCT. With the demobilization of the IRCT, full responsibility for coordination with incident authorities transitions back to the regional staff and to any OPDIVs with regional assets stationed on a day-to-day basis in the region.

13. In the event of multiple incidents, or one incident with widespread implications (e.g., Hurricane Katrina), multiple IRCTs may be mobilized at the discretion of the ASPR.

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