This Policy Information Notice (PIN)
provides guidance to health centers (i.e.,
section 330 funded grantees and Federally
Qualified Health Center (FQHC) Look-Alikes)
on emergency management expectations related
to planning and preparing for future emergencies.
For purposes of this document, an “emergency”
or “disaster” is defined as
an event affecting the overall target
population and/or the community at large,
which precipitates the declaration of
a state of emergency at a local, State,
regional, or national level by an authorized
public official such as a governor, the
Secretary of the Department of Health
and Human Services, or the President of
the United States. Examples include, but
are not limited to: hurricanes, floods,
earthquakes, tornadoes, wide-spread fires,
and other natural/environmental disasters;
civil disturbances; terrorist attacks,
collapses of significant structures within
the community (e.g., buildings, bridges);
and infectious disease outbreaks and other
public health threats.
At the core of emergency management planning
and preparation are three key elements:
safeguarding human resources, protecting
physical resources, and ensuring business
continuity. For health centers, this translates
to protecting health center staff and
patients as well as safeguarding its ability
to deliver health care. Emergencies can
disrupt the environment of care or change
the demand for the health center’s
services making it essential for health
centers to ensure that emergency management
is integrated into its daily functions
and values.
The expectations outlined in this guidance
are intended to be broad to ensure applicability
to the diverse range of health centers
and ease in integrating them into what
health centers are already doing related
to emergency and risk management.[1]
They are not intended to be an all inclusive
guide but rather to provide guidance so
that health centers can develop and maintain
an effective and appropriate emergency
management strategy. For health centers,
building on existing relationships with
natural partners at the local level, such
as hospitals and health departments, is
critical for engaging in emergency management.
At the State level, health centers are
strongly encouraged to work with their
Primary Care Association (PCA). PCAs are
expected to provide State level leadership,
where appropriate, for the (a) integration
of health centers into Statewide and community
preparedness and response plans and (b)
direct assistance in the area of emergency
preparedness planning to health centers.
At the national level, health centers
can also seek technical assistance on
emergency management from the HRSA’s
Bureau of Primary Health Care (BPHC) as
well as from BPHC’s national technical
assistance partners.
This PIN applies to FQHC Look-Alikes
and all health centers funded under the
Health Center Program authorized in section
330 of the Public Health Service (PHS)
Act (42 U.S.C. 254b), as amended, specifically:
- Community Health Center (CHC) Programs,
funded under section 330(e);
- Migrant Health Center (MHC) Programs,
funded under section 330(g);
- Health Care for the Homeless (HCH)
Programs, funded under section 330(h);
and
- Public Housing Primary Care (PHPC)
Programs, funded under section 330(i).
For the purposes of this document, the
term “health center” refers
to the diverse types of health centers
that are supported under section 330 of
the PHS Act (i.e., CHC, MHC, HCH, and
PHPC) and FQHC Look-Alikes.
The Federal government has established
a Federal emergency management plan, referred
to as the National Response Plan or the
NRP. The NRP is a national, all-discipline,
all-hazards plan that provides the framework
and mechanisms to coordinate Federal,
State, local, Tribal, private sector,
and non-governmental entities during national
emergencies. The NRP establishes a single,
comprehensive approach to prevent, prepare
for, respond to, and recover from major
events, including natural disasters, terrorist
attacks, and other public health emergencies.
It applies to all incidents requiring
a coordinated Federal response as part
of an appropriate combination of Federal,
State, local, Tribal, and community entities.
The NRP is constructed on the framework
established by the National Incident Management
System (NIMS). At the request of the President
of the United States, the Department of
Homeland Security developed NIMS to provide
a consistent, comprehensive, and nationally
recognized framework for incident management.
NIMS is designed to help emergency managers
and responders from different jurisdictions
and disciplines work together more effectively
in the management of domestic incidents
at all jurisdictional levels regardless
of the cause, size, or complexity of the
incident. NIMS provides an integrated
process towards incident management, standard
command and management structures, and
emphasis on preparedness, mutual aid,
and resource management. National capabilities
are strengthened to prevent, prepare for,
respond to, and recover from any incident
through the adoption and implementation
of NIMS across all jurisdictions—Federal,
State, local, Tribal, private sector,
and non-governmental entities.
The NIMS standard incident command structures
are based on preparedness through implementation
of a general chain of command, efficient
personnel and resource management, and
effective communications and information
management. The Incident Command System
or ICS is a component of the NIMS. ICS
is scalable to address large and small
incidents; it is also interdisciplinary
and organizationally flexible. ICS includes
a unified approach for controlling personnel,
facilities, equipment, and communications.
In general, health centers are strongly
encouraged to use ICS in context of their
emergency management strategy, understand
the NIMS and NRP framework, and move toward
full NIMS compliance. Since October 1,
2005, all 56 States and Territories were
required to meet NIMS implementation requirements
to be eligible to receive Federal preparedness
assistance in the form of grants, cooperative
agreements and direct contracts. While
it is not a requirement for health centers
at this time, compliance with NIMS is
strongly encouraged. Health centers should
visit the Department of Homeland Security’s
web site training.fema.gov for NIMS training
information and resources.
The NRP and NIMS are companion strategies
designed to improve the Nation’s
incident management capabilities and overall
efficiencies—integrating the capabilities
and resources of various governmental
jurisdictions, incident management and
emergency response disciplines, non-governmental
organizations, and the private sector
into a cohesive, coordinated, and seamless
national framework for domestic incident
management. An underlying tenet of the
NRP is that, in general, most emergencies
are limited in scope and range and, therefore,
the response to such events is managed
at the local level. The NRP also recognizes
that private sector entities have a key
role related to critical infrastructure
protection and restoration as well as
contributing necessary resources and services
in an emergency event. In this context,
health centers are a vital part of an
effective emergency response in the communities
they serve.
Health centers can support the NRP by
being prepared to handle emergencies—whether
man made or natural. This means having
a plan in place to prevent, prepare for,
respond to, and recover from emergencies.
Health centers can also support the NRP
by working collaboratively at the State,
local, and community levels in identifying
risks, performing vulnerability assessments,
maximizing effective use of available
resources, and enhancing overall readiness.
For additional information on NRP, see
the Department
of Homeland Security’s Web site.
Footnotes
[1] This PIN is not intended to address
issues associated with the applications
of the Federal Tort Claims Act to health
centers’ activities during emergencies
or disasters. Please refer to the BPHC
PIN 98-23, Health Center Program Expectations
and PIN 2007-16, Federal Tort Claims Act
(FTCA) Coverage for Health Center Program
Grantees Responding to Emergencies.
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