Aerosolized Anthrax Actions Steps/Issues

Trigger Event 1 - Credible Intelligence of a Plan to Conduct a Biological Attack Using Aerosolized Anthrax
Triggering Event 2 - Notification of a BioWatch Actionable Result (BAR)
Triggering Event 3 - Confirmed, Cases of Inhalation Anthrax
Triggering Event 4 – Decision to Demobilize

	Actions/Issues	Lead Agency/
	Actions/Issues	Supporting Agencies
Trigger Point #1 – Credible Intelligence of a Plan to Conduct a Biological Attack Using Aerosolized Anthrax
HHS Strategy: Begin preparation for a large-scale public health response in the event of widespread infection of the exposed populace.
Planning and Coordination
	1. Consider HHS transition from “normal” to coordinated Departmental emergency response operations.	ASPR
		OPDIVs/Agencies
	2. Begin structured planning process.	ASPR
	Situation update.
	Required tasks
	Available assets
	Determine constraints
	Identify critical facts and assumptions
	Determine critical information requirements
	Plan the use of time
	3. Prepare/Initiate response activities through ASPR.	ASPR
	Initiate notification roster.	OPDIVs/Agencies
	Determine additional EMG staffing requirements and OPDIV EOC activation requirements.
	Prepare daily or more frequent situation reports for the Secretary on preparedness efforts.
	Establish and maintain contact with appropriate RHAs
	4. Coordinate/Conduct meeting between ASPR and OSG to determine possible missions, deployments.	ASPR,/OSG
	POD Reinforcement/Augmentation/Establishment	OPDIVs
	Epidemiology Support
	Medical Treatment Support
	Subject Matter Expert Support
	5. Consider establishing HHS Emergency Management Group.	ASPR
	Designate Incident Manager.	OPDIVs/Agencies
	Begins response planning in coordination with relevant support agencies.
	Begin development of possible ESF #8 mission assignments in coordination with ESF #8 partners, Territory/Tribal/State/local officials and DHS.
	6. Begin coordination with the Interagency, including DHS and DOS, and the White House.	ASPR
	Prepare/Detail required liaison officers (DHS, SIOC, NCTC) and other agencies as requested.	OPDIVs/Agencies/
	Request appropriate agencies provide LNOs to HHS.	ESF #8 Supporting Agencies/Federal Partners
	Alert ESF #8 partners.
	Begin coordination with appropriate DHS/FEMA contacts (RRCC, RECs, etc)
	7. Establish and maintain contact with CDC DEOC.	ASPR
	7. Establish and maintain contact with CDC DEOC.	CDC
	8. Schedule/Convene meeting of the Emergency Preparedness and Response Group.	ASPR
	9. Support activation/deployment of advance elements of Federal Response Teams (FIRST, ERT-A, ERT-N, IRCT-A, DEST, etc.) as required. SMEs to consider:	ASPR
	Epidemiologist	OPDIVs/Agencies
	PODs expertise
	10. Alert/Deploy the Incident Response Coordination Team. Specific SMEs to consider:	ASPR
	Epidemiologist	OPDIVs/Agencies
	PODs expertise
	11. Formalize and distribute ESF #8 response structure, decisional authorities, and trigger points for health & medical interventions.	ASPR
		ESF #8 Supporting Agencies
	12. Determine readiness of local, Region, Tribal, Territory, State and Federal public health and emergency agencies to implement anthrax response measures (e.g. Receipt of SNS, PODs, etc.)	ASPR/OGC/CDC
	13. Review risk status (i.e., health screening and vaccination status) of all federal and contractor employees who could potentially deploy in support of ESF #8 anthrax response activities and provide additional screening and vaccination as needed and available.	ASPR
		ESF #8 Supporting Agencies
	14. Establish contact with key public health, healthcare, and community partners (e.g. Region/Tribe/ Territory/State Health Department, Region/Tribe/Territory/State OEM, Region/Tribe/Territory/State Hospital Association, etc.)	ASPR
		OPDIVs/Agencies
	15. Establish and publish schedule for recurring activities (Conference Calls, VTCs, etc.)	ASPR
		OPDIVs/Agencies/ESF #8 Supporting Agencies/Federal Partners

Surveillance, Investigation, and Protective Health Measures
	16. Provide updated information to medical providers and healthcare organizations seeking treatment and management guidance and algorithms for anthrax exposure.	CDC
		ASPR/ASPA/OPDIVs
	17. Coordinate lab surge capabilities with CDC and State/Region/Territory/Tribal/local authorities.	CDC
		OPDIVs
	18. Begin collecting and collating applicable information for the area.	ASPR
	GIS	OPDIVs/Agencies/Federal Partners
	Meteorological
	Transportation
	Intelligence
	Law Enforcement

Vaccine, Antibiotic, and Anthrax Immune Gloulin Utilization Policies
	19. Confirm vaccine and antibiotic availability vs. requirements.	ASPR
	Current inventories	OPDIVs/Agencies/ Federal Partners
	Current/Surge production capabilities
	20. Develop a plan to determine the use of scare resources (Vaccine, Antibiotic, and Anthrax Immune Gloulin)	ASPR
		OPDIVs/Agencies/ Federal Partners

Healthcare and Emergency Response
	21. Request/Review appropriate Region, Tribe, Territory, State, and local emergency management plans, focusing on:	ASPR
	Point of Dispensing (POD) operations	CDC
	City Readiness Initiative
	Patient regulating and movement processes
	High acuity care expansion capability
	22. Consider increasing the capacity of medical and emergency response systems to meet expected needs by identifying/alerting/deploying/distributing:	ASPR
	Federal healthcare assets, including NDMS, FMS and ESF #8 partner assets	OPDIVs/Agencies/ ESF #8 Supporting Agencies
	o Epidemiological support
	o Veterinary surveillance
	o Laboratory activities
	o Critical care capability
	o POD capabilities (augmentation/establishment)
	o Commissioned Officer Corps
	o Pharmacy activities
	o NDMS Teams
	SNS stockpile of antibiotics, vaccine, and other appropriate supplies and material
	Additional reagents and consumables for surge testing at appropriate LRN laboratories

Communications and Outreach
	23. Review Communications Plan.	ASPA
	o Mitigation	ASPR
	o Preparedness
	o Response
	o Recovery
	24. Review Media Campaign Plan.	ASPA
	Contacts	ASPR
	Information requirements
	Timelines
	25. Identify SMEs on medical and public health aspects of anthrax exposure	ASPA/CDC
		ASPR
	26. Identify HHS spokesperson(s).	ASPA
	26. Identify HHS spokesperson(s).	ASPR
	27. Identify public affairs liaison officer assignments and responsibilities.	ASPA
		ASPR

	Actions/Issues	Lead Agency
	Actions/Issues	Supporting Agency
Trigger Point #2 – Notification of a BioWatch Actionable Result (BAR)
HHS Strategy: Take aggressive actions to assist Region, Tribe, Territory, State and local officials in establishing an effective postexposure prophylaxis program (PEP) and in the management of inhalation anthrax cases.

Planning and Coordination
	1. If in combination with credible intelligence, HHS transitions from “normal” to coordinated Departmental emergency response operations.	ASPR
		OPDIVs/HHS Agencies
	2. If in combination with credible intelligence, establish HHS Emergency Management Group.	ASPR
	Designate Incident Manager.	OPDIVs/HHS Agencies
	Begins response planning in coordination with relevant support agencies.
	Begin development of possible ESF #8 mission assignments in coordination with ESF #8 partners, State/local officials and DHS.
	3. Begin/Continue supporting activation/deployment of advance elements of Federal Response Teams (FIRST, ERT-A, ERT-N, IRCT-A, DEST, etc.) as required. SMEs to consider:	ASPR
	Epidemiologist	OPDIVs/HHS Agencies
	PODs expertise
	4. If in combination with credible intelligence, deploy Incident Response Coordination Team (IRCT)	ASPR
		OPDIVs/HHS Agencies
	5. Review Federal BioWatch Conference Call Agenda.	EMG
	6. Identify Federal BioWatch Conference Call participants from HHS.	EMG
	7. Obtain BioWatch Area Profile for the affected regions.	EMG
	7. Obtain BioWatch Area Profile for the affected regions.	CDC
	8. Participate in Federal BioWatch Conference Call.	EMG
	9. Begin/Continue response activities	EMG
	Maintain contact with appropriate RHAs and other public health agencies	OPDIVs/HSS Agencies/ESF #8 Partners (DOD, VA, DHS, DOT, EPA, OSHA, DOJ, ARC, etc)
	Maintain communications with appropriate DHS/FEMA contacts (RRCC, RECs, etc)
	10. Establish contact with key public health, healthcare, and community partners (e.g., Region/Tribe/ Territory/State Health Department, Region/Tribe/Territory/State OEM, Region/Tribe/Territory/State Hospital Association, etc.)	EMG
		OPDIVs/HHS Agencies
	11. Monitor completion, assess quality of, and provide guidance to fill gaps in anthrax—related public health and medical preparedness and response plans at Federal, Region, Tribe, Territory, State, local, and private-sector levels	EMG
		OPDIVs/HHS Agencies/ESF #8 Partners (DOD, VA, DHS, DOT, EPA, OSHA, DOJ, ARC, etc)

	12. Initiate/Increase deployment activities	EMG
	Roster personnel	OPDIVs/HHS Agencies/ESF #8 Partners (DOD, VA, DHS, DOT, EPA, OSHA, DOJ, ARC, etc)
	Conduct any necessary fit testing, health screening and/or vaccination (as applicable and available)
	Confirm logistical capability to support deployments, including transportation
	Ensure that laboratories in support of the LRN are operational and verify their analytical capability
	Expand Interagency/Intergovernmental coordination
	Identify and coordinate medical credentialing requirements as required
	13. Request interagency representatives to staff the ESF#8 EMG branches.	EMG
	Unified Planning Branch	ESF #8 Partners (DOD, VA, DHS, DOT, EPA, OSHA, DOJ, ARC, etc)
	Unified Logistics Branch (includes Private Sector Assistance, and Mortuary Affairs)
	Unified Operations Branch
	Unified Administration and Finance Branch
	Combined International Assistance Branch (OMSPH, OGHA) for possible reception of international relief effort assets
	Patient Movement Branch


Surveillance, Investigation, and Protective Health Measures
	14. Maintain situational awareness public health activities ongoing in the affected area.	EMG
	Laboratory Analysis	CDC
	Public Health Surveillance
	o Environmental Surveillance
	o Human Surveillance
	o Veterinary Surveillance
	15. Support Event Reconstruction and Plume Modeling efforts.	EMG
		OPDIVs/HHS Agencies/ESF #8 Partners (DOD, VA, DHS, DOT, EPA, OSHA, DOJ, ARC, etc)/Federal Partners
	16. Monitor Intelligence Analyses and Law Enforcement efforts.	EMG
		DHS, FBI, NCTC

Vaccine, Antibiotic, and Anthrax Immune Globulin Utilization Policies
	17. Begin/Continue to confirm vaccine and antibiotic availability vs. requirements.	EMG
	Current inventories	OPDIVs/HHS Agencies/ESF #8 Partners (DOD, VA, DHS, DOT, EPA, OSHA, DOJ, ARC, etc)/Federal Partners
	Current/Surge production capabilities
	18. Begin developing estimates of possible requirements	EMG
	o Vaccines	OPDIVs/HHS Agencies/ESF #8 Partners (DOD, VA, DHS, DOT, EPA, OSHA, DOJ, ARC, etc)/Federal Partners
	o Antibiotics

Healthcare and Emergency Response
	19. Begin to alert, roster and deploy Federal medical and public health personnel.	EMG
	Activate Occupational Safety and Health Plan.	OPDIVs/HHS Agencies/ESF #8 Partners (DOD, VA, DHS, DOT, EPA, OSHA, DOJ, ARC, etc)/Federal Partners
	If needed, use HHS Intermittent Hiring Authorities to roster and redirect available civilian volunteers to areas most in need.
	Coordinate requirements with appropriate Region, Tribe, Territory, State and local public health officials.

	20. Review appropriate Emergency Management Assistance Compacts (EMAC).	EMG
		CDC
	21. Support Region, Tribe, Territory, State and local public health activities ongoing in the affected area.	EMG
	Epidemiological support	OPDIVs/HHS Agencies/ESF #8 Partners (DOD, VA, DHS, DOT, EPA, OSHA, DOJ, ARC, etc)/Federal Partners
	Veterinary surveillance
	Laboratory activities
	Critical care capability
	POD capabilities (augmentation/establishment)
	Commissioned Officer Corps
	Pharmacy activities
	NDMS Teams
	22. Consider increasing the capacity of medical and emergency response systems to meet expected needs by identifying/alerting/deploying/distributing:	EMG
	Federal healthcare assets, including NDMS, FMS and ESF #8 partner assets	OPDIVs/HHS Agencies/ESF #8 Partners (DOD, VA, DHS, DOT, EPA, OSHA, DOJ, ARC, etc)/Federal Partners
	o Epidemiological support
	o Veterinary surveillance
	o Laboratory activities
	o Critical care capability
	o POD capabilities (augmentation/establishment)
	o Commissioned Officer Corps
	o Pharmacy activities
	o NDMS Teams
	SNS stockpile of antibiotics, vaccine, and other appropriate supplies and material
	Additional reagents and consumables for surge testing at appropriate LRN laboratories

Communications and Outreach
	23. Begin/Continue review and update of Communications Plan.	ASPA
		EMG
	24. Begin/Continue review and update of Media Campaign Plan.	ASPA
		EMG
	25. Review BioWatch Area Communications Plan.	ASPA
	25. Review BioWatch Area Communications Plan.	EMG
	26. If a JIC is established at the local and/or Region, Tribe, Territory, State level, coordinate communications and media activities as appropriate.	ASPA
		EMG
	27. Coordinate communications plan with local and Region, Tribe, Territory, State Public Information Officers.	ASPA
		EMG
	28. Coordinate press releases with local and Region, Tribe, Territory, State Public Information Officers.	ASPA
		EMG


	Actions/Issues	Lead Agency
	Actions/Issues	Supporting Agency
Trigger Point #3 – Confirmed Cases of Inhalation Anthrax Identified in a U.S. City
HHS Strategy: Take aggressive actions to assist Region, Tribe, Territory, State, and local officials in providing surge capacity and continued recommendations and assistance in the management of inhalation anthrax cases.


Planning and Coordination
	1. Confirm clinical cases of inhalation anthrax.	EMG
	1. Confirm clinical cases of inhalation anthrax.	CDC
	2. Declare a Public Health Emergency	Sec HHS
	3. Recommend the Secretary of DHS declare an Incident of National Significance	Sec HHS/Sec DHS
		EMG/NOC
	4. Participate in establishment of US Government executive structure for management of the incident.	EMG
		OPDIVs/HHS Agencies/ESF #8 Partners (DOD, VA, DHS, DOT, EPA, OSHA, DOJ, ARC, etc)
	5. Begin/Continue to coordinate response efforts with ESF #8 Partners (DOD, VA, DHS, DOT, EPA, OSHA, DOJ, ARC, etc), DHS, other Federal Partners, and the White House.	EMG
	Provide appropriate LNOs	OPDIVs/HHS Agencies/ESF #8 Partners (DOD, VA, DHS, DOT, EPA, OSHA, DOJ, ARC, etc)
	6. Begin/Continue monitoring the completion of, assessing the quality of, and providing guidance to fill gaps in anthrax—related public health and medical preparedness and response plans at Federal, Region, Tribe, Territory, State, local and private-sector levels.	EMG
		OPDIVs/HHS Agencies/ESF #8 Partners (DOD, VA, DHS, DOT, EPA, OSHA, DOJ, ARC, etc)
	7. Begin/Continue deployment activities of appropriate response capabilities.	EMG
		OPDIVs/HHS Agencies/ESF #8 Partners (DOD, VA, DHS, DOT, EPA, OSHA, DOJ, ARC, etc)
	8. Establish/Sustain ongoing communication with ESF #8 partners regarding logistical and operational planning.	EMG
		ESF #8 Partners (DOD, VA, DHS, DOT, EPA, OSHA, DOJ, ARC, etc)
	9. Grant OPHS/OSG the authority to activate all PHS CC and deploy as needed	Sec HHS
		OPHS/OSG
	10. Coordinate with FBI to provide support for any criminal investigation.	EMG
		OPDIVs/HHS Agencies/ESF #8 Partners (DOD, VA, DHS, DOT, EPA, OSHA, DOJ, ARC, etc)
	11. Convene Medical Interagency Coordination Group (MIACG) to determine medical regulating policy as well as which FCC PRAs should be alerted and/or activated.	EMG
		OPDIVs/HHS Agencies/ESF #8 Partners (DOD, VA, DHS, DOT, EPA, OSHA, DOJ, ARC, etc)
	12. Establish/Maintain communications with CDC DEOC.	EMG
	12. Establish/Maintain communications with CDC DEOC.	CDC
	13. Maintain contact with key public health, healthcare, and community partners (e.g., Region/Tribe/ Territory/State Health Department, Region/Tribe/Territory/State OEM, Region/Tribe/Territory/State Hospital Association, etc.)	EMG
		OPDIVs/HHS Agencies
	14. Process required mission assignments.	EMG
	14. Process required mission assignments.	ESF #8 Partners (DOD, VA, DHS, DOT, EPA, OSHA, DOJ, ARC, etc)
	15. Complete ESF #8 Mission Assignment Subtasking Requests.	EMG
	15. Complete ESF #8 Mission Assignment Subtasking Requests.	ESF #8 Partners (DOD, VA, DHS, DOT, EPA, OSHA, DOJ, ARC, etc)
	16. HHS Incident Response Coordination Team (IRCT)	IRCT
	o Deploy to designated area.	EMG/OPDIVs/HHS Agencies/
	o Conduct/Submit situation assessments.	ESF #8 Partners (DOD, VA, DHS, DOT, EPA, OSHA, DOJ, ARC, etc)
	o POD operations
	o Epidemiology investigations
	o Critical care capabilities
	o Establish liaison with appropriate Federal management and support centers (RRCC/JFO, JOC, JIC, DEST, etc.).
	o Establish “trouble desk” to facilitate coordination of HHS functions with local/State officials.
	o Coordinate with HHS regional personnel and other Federal assets (e.g. PFO and/or FCO).
	o Provide Federal field management/coordination for deployed HHS assets.
	o Participate in appropriate conference calls/VTCs.
	o Track and monitor all missions approved by the Incident Manager and ESF #8 Support Agencies.


Surveillance, Investigation, and Protective Health Measures
	17. Maintain situational awareness public health activities ongoing in the affected area.	EMG
	Laboratory Analysis	CDC
	Public Health Surveillance
	o Environmental Surveillance
	o Human Surveillance
	o Veterinary Surveillance
	18. Track/map inhalation anthrax cases in coordination with CDC and Region, Tribe, Territory, State and local health officials.	EMG
		CDC
	19. Use available models and applicable data to assist in the identification of potentially exposed people.	EMG
		CDC
	20. Continue to prepare and distribute reagents. CDC will develop, produce, and disseminate confirmatory laboratory tests/reagents to the Laboratory Response Network (LRN), if applicable.	CDC
		EMG
	21. Issue updated case definitions and guidance for specimen management, laboratory testing, and enhanced surveillance.	CDC
		EMG
	22. Issue guidance in decontamination and secondary exposure	CDC
		EMG

Vaccine, Antibiotic, and Anthrax Immune Globulin Utilization Policies
	23. Consult with FDA to ascertain the regulatory status, current data on safety and efficacy, and availability of products (in the SNS, vendor inventories, etc.) such as Anthrax Vaccine Adsorbed (AVA) and antibiotics appropriate for the treatment of inhalation anthrax patients.	EMG
		OPDIVs/HHS Agencies/
		ESF #8 Partners (DOD, VA, DHS, DOT, EPA, OSHA, DOJ, ARC, etc)/Federal Partners
	24. Assess candidate vaccines for licensure	EMG
	Explore the rapid development, licensure, and production of new anthrax vaccines.	OPDIVs/HHS Agencies/
	Evaluate dose-optimization strategies to maximize the use of limited vaccine stocks.	ESF #8 Partners (DOD, VA, DHS, DOT, EPA, OSHA, DOJ, ARC, etc)/Federal Partners

	25. Work with manufacturers to expedite public-sector vaccine/antibiotic-purchasing.	EMG
		OPDIVs/HHS Agencies/
		ESF #8 Partners (DOD, VA, DHS, DOT, EPA, OSHA, DOJ, ARC, etc)/Federal Partners
	26. Provide regulatory guidance to vaccine/antibiotic manufacturers for the manufacture and shipment of anthrax vaccines and antibiotics.	EMG
		OPDIVs/HHS Agencies/
		ESF #8 Partners (DOD, VA, DHS, DOT, EPA, OSHA, DOJ, ARC, etc)/Federal Partners
	27. Mobilize healthcare partners and request activation of State-based plans for distributing and administering vaccines and antibiotics.	CDC
		EMG/OPDIVs/HHS Agencies/
		ESF #8 Partners (DOD, VA, DHS, DOT, EPA, OSHA, DOJ, ARC, etc)/Federal Partners
	28. Allocate vaccines and antibiotics.	CDC
		EMG/OPDIVs/HHS Agencies/
		ESF #8 Partners (DOD, VA, DHS, DOT, EPA, OSHA, DOJ, ARC, etc)/Federal Partners
	29. Monitor vaccine use.	CDC
	Monitor that vaccine distribution follows existing plans for priority groups.	EMG/OPDIVs/HHS Agencies/
	Assist with implementation of a call-back system or immunization registry that would accomplish the goals of vaccination.	ESF #8 Partners (DOD, VA, DHS, DOT, EPA, OSHA, DOJ, ARC, etc)/Federal Partners
	Monitor anthrax disease outcomes among vaccinated persons
	Monitor reported adverse events associated with vaccine use.
	Implement protocols and databases for monitoring vaccine safety, and for tracking vaccine usage, including second and third dose uptake.
	Use existing vaccine-monitoring systems to conduct population-based surveillance for adverse events.
	30. Monitor antibiotic use.	CDC
	Support data-collection efforts on the distribution of State or Federal supplies of antibiotic, the occurrence of adverse events following administration of antibiotics.	EMG/OPDIVs/HHS Agencies/
	Implement existing drug-monitoring systems to allow population-based surveillance for adverse events following the use of antibiotics for treatment and/or prophylaxis.	ESF #8 Partners (DOD, VA, DHS, DOT, EPA, OSHA, DOJ, ARC, etc)/Federal Partners
	Use existing antibiotic use-monitoring systems to conduct population-based surveillance for adverse events.

	31. Anthrax Immune Globulin (AIG) use.	CDC
	Mobilize healthcare partners and request activation of State-based plans for distributing and administering AIG.	EMG/OPDIVs/HHS Agencies/
	Allocate AIG.	ESF #8 Partners (DOD, VA, DHS, DOT, EPA, OSHA, DOJ, ARC, etc)/Federal Partners
	HHS to determine use of scarce resources
	Monitor AIG use.
	Monitor that AIG distribution follows existing plans for priority groups.
	Monitor reported adverse events associated with AIG use.


Healthcare and Emergency Response
	32. Continue to alert, roster and deploy Federal medical and public health personnel.	EMG
	Support hospital augmentation in affected communities to offload low-acuity patients from hospitals.	OPDIVs/HHS Agencies/ESF #8 Partners (DOD, VA, DHS, DOT, EPA, OSHA, DOJ, ARC, etc)/Federal Partners
	If needed, use HHS Intermittent Hiring Authorities to roster and redirect available civilian volunteers to areas most in need.
	Deploy and track Federal mass fatality response assets (NDMS, DoD).

	33. Support Region, Tribe, Territory, State use of Emergency Management Assistance Compacts (EMAC) to direct available medical and public health personnel to the affected areas.	EMG

	34. Continue to gather data on bed counts and other critical resources.	EMG
		OPDIVs/HHS Agencies/ESF #8 Partners (DOD, VA, DHS, DOT, EPA, OSHA, DOJ, ARC, etc)/Federal Partners
	35. If required, deploy medical materiel and pharmaceuticals from the SNS. Prepare to requisition/deploy additional vaccine/antibiotics through VMI.	CDC
		EMG/OPDIVs/HHS Agencies/
		ESF #8 Partners (DOD, VA, DHS, DOT, EPA, OSHA, DOJ, ARC, etc)/Federal Partners
	36. Trigger the healthcare community to implement protocols related to the allocation of scarce healthcare resources.	EMG
	Protocols that triage patients’ access to hospitalization, intensive care, and ventilators.	OPDIVs/HHS Agencies/ESF #8 Partners (DOD, VA, DHS, DOT, EPA, OSHA, DOJ, ARC, etc)/Federal Partners
	Develop/Issue guidance on allocation of scarce Federal healthcare assets (personnel, equipment, supplies).
	Implement alternative staffing plans to leverage scarce local health and medical personnel.

	37. Begin coordinating patient transportation plan to move patients to definitive care facilities nationwide, FCCs, NDMS, VA, DOD (GPMRC), etc.	EMG
		OPDIVs/HHS Agencies/ESF #8 Partners (DOD, VA, DHS, DOT, EPA, OSHA, DOJ, ARC, etc)/Federal Partners
	38. Conduct patient movement requests as required.	EMG
	38. Conduct patient movement requests as required.	OPDIVs/HHS Agencies/ESF #8 Partners (DOD, VA, DHS, DOT, EPA, OSHA, DOJ, ARC, etc)/Federal Partners
	39. Support/Conduct behavioral health operations.	EMG
	39. Support/Conduct behavioral health operations.	OPDIVs/HHS Agencies/ESF #8 Partners (DOD, VA, DHS, DOT, EPA, OSHA, DOJ, ARC, etc)/Federal Partners
	40. Begin National Hospital Surge Capacity Activities	EMG
	• Contact affected States and Region to determine remaining public health and medical infrastructure and assets (HHS Regional Emergency Coordinator).	DOD, VA, DHS
	- Establish medical communications with affected area.	National Guard
	- Encourage use of Emergency Management Assistance Compacts (EMAC) for emergency medical services (EMS), other medical and medical support assets.
	• Contact all HHS Regional Emergency Coordinators to determine and coordinate:
	- Deployable medical assets; and
	- Receiving facilities for patient transport.
	• Request receiving facilities to activate surge plans augment their capacity (e.g., canceling elective surgery, implementing early discharge of patients to nursing facilities / home, etc.)	AHA, ASTHO

Communications and Outreach
	41. Continue execution of Communications Plan.	ASPA
	Provide information on medical and public health response activities.	EMG
	Provide anticipatory guidance on how the public health and medical response (including mass fatality management) will unfold over time.
	o Points of Dispensing Sites
	o Post Exposure Prophylaxis
	o City Readiness Initiative
	Provide regular public updates.
	Provide regular public health updates to Congress, Governors, Mayors, State, local, and tribal health departments, local officials, other stakeholders, and the media regularly.

	42. Continue execution Media Campaign.	ASPA
	Instruct the public on preventive measures.	EMG
	Instruct the public on response measures.
	Conduct "desk-side briefings" and editorial roundtables with news media decision-makers.

	43. Provide behavioral expertise to help craft messages.	ASPA
	43. Provide behavioral expertise to help craft messages.	EMG
	44. Coordinate communications plan with local and Region, Tribe, Territory, State Public Information Officers.	ASPA
		EMG/State and local JICs
	45. Coordinate press releases with local and Region, Tribe, Territory, State Public Information Officers.	ASPA
		EMG/State and local JICs
	46. Participate in the National Incident Communications Conference Line (NICCL) composed of Federal public affairs officers as well as local and state public affairs officers.	ASPA
		EMG
	47. Participate in coordinated interagency communications campaign.	ASPA
		EMG
	48. Activate and surge hotline capacity for medical and behavioral health questions.	ASPA
		EMG
	49. Update appropriate HHS websites (HHS, CDC, NIH, FDA).	ASPA
	49. Update appropriate HHS websites (HHS, CDC, NIH, FDA).	EMG
	50. Activate the CDC-INFO telephone line to provide relative information to the public.	CDC
		ASPA/EMG
	51. Provide healthcare providers clinical management guidelines for hospitals, long-term care facilities, and outpatient settings.	CDC
	Assess and resolve clinical issues related to inhalation anthrax treatment.	ASPA/EMG
	Distribute sample model protocols for early detection and treatment of inhalation anthrax and provide healthcare facilities with these protocols.

	52. Update and disseminate national guidelines on diagnostic testing and use of antibiotics and vaccines	CDC
		ASPA/EMG/HHS Agencies
	53. Assist the Department of State (primary agency) in coordinating international activities related to chemical, biological, radiological, and nuclear incidents and events that pose transborder threats. Cooperate with DOS to assist in communicating real-time actions taken by the United States and U.S. projections of the international consequence of the event (e.g., disease spread, travel restrictions, pharmaceutical supply and distribution, and displaced persons).	DOS
		ASPA/EMG/OMSPH
	54. Coordiante with DOS (primary agency) in coordination with foreign states concerning offers of support, gifts, offerings, donations, or other aid. This includes establishing coordination with partner nations to identify the U.S.-validated immediate support in response to an Incident of National Significance.	DOS
		ASPA/EMG/OMSPH

	Actions/Issues	Lead Agency
	Actions/Issues	Supporting Agency
Trigger Point #4 – Demobilization (Upon Release from Region, Tribe, Territory, State and Local Authorities)
HHS Strategy: Establish effective policies and processes to allow Federal public health response personnel and equipment to rapidly and efficiently redeploy to their homestation.
Planning and Coordination
	1. Review PHS section 319 declaration. (It expires automatically after 90 days, but can be renewed for 90 day periods based on the same or additional facts).	Sec HHS
		EMG/OPDIVs/HHS Agencies/ ESF #8 Partners (DOD, VA, DHS, DOT, EPA, OSHA, DOJ, ARC, etc)
	2. Coordinate with Local and State incident management commands to facilitate a timely and orderly movement and redeployment of Federal assets.	EMG
		OPDIVs/HHS Agencies/ ESF #8 Partners (DOD, VA, DHS, DOT, EPA, OSHA, DOJ, ARC, etc)/Federal Partners/State and local Officials
	3. Determine Demobilization decision (EMG)	Sec HHS
	3. Determine Demobilization decision (EMG)	EMG/OPDIVs/HHS Agencies/ ESF #8 Partners (DOD, VA, DHS, DOT, EPA, OSHA, DOJ, ARC, etc)
	4. Notify Federally deployed Units / Entities of pending demobilization and redeployment of personnel and equipment	EMG
		OPDIVs/HHS Agencies/ ESF #8 Partners (DOD, VA, DHS, DOT, EPA, OSHA, DOJ, ARC, etc)/Federal Partners
	5. Coordinate for Transportation	EMG
	5. Coordinate for Transportation	OPDIVs/HHS Agencies/ ESF #8 Partners (DOD, VA, DHS, DOT, EPA, OSHA, DOJ, ARC, etc)/Federal Partners
	6. Close out financial accounts at the incident area, if required	EMG
		GSA, DHS
		(FEMA funds all Incidents of national Significance)

	7. Request / Coordinate for SNS Redeployment	EMG
	Inventory (SNS and other Federal entities)	CDC/ Federal Partners
	Repack / Load configuration (SNS)
	Secure SNS (IAW ESF 13)
	Transport SNS and Federal entities (IAW ESF 1)

	8. Plan/Coordinate Post Deployment Occupational Health and Safety screening	EMG, USPHS
		Federal Agencies
	9. Coordinate for post deployment debrief at home station	Federal Entities

Surveillance, Investigation, and Protective Health Measures
	9. Coordinate for post deployment debrief at home station	Federal Entities	10. Conduct Post deployment health screening

Vaccine and Antibiotic Utilization Policies
	11. Begin reconstitution of medical countermeasure supplies	CDC
	11. Begin reconstitution of medical countermeasure supplies	ASPR

Healthcare and Emergency Response
	12. Establish/Conduct Post Deployment Occupational Health and Safety screening program.	EMG, USPHS
		Federal Agencies

Communications and Outreach
	13. Evaluate communications plan and media plan	ASPA
	13. Evaluate communications plan and media plan	ASPR

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Anthrax Playbook

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