The following example demonstrates how the concepts presented in this chapter may be applied during an actual incident response. The various phases of response (as described in Chapter 1) highlight when critical actions should occur; however, the example extends only as far as incident operations, as this is the focus of the MSCC Management System.
Background and Incident Description
- A large, 7.0-magnitude earthquake occurs, with the epicenter near a metropolitan area on the New Madrid Fault in the central United States.
- The earthquake occurs at dusk. Widespread loss of electrical power in the affected area limits the effectiveness of aerial flyovers for initial assessment. Early reports indicate that multiple cities and towns across the region are severely affected, with hundreds of structures reported to be collapsed, partially collapsed, or unusable.
- Initial reports indicate that hundreds of people may be dead.
- Given the severity of the event, the early response stages unfold fairly rapidly as follows:
- Incident recognition at the Federal level occurs almost immediately, as the REC in the affected area rapidly contacts the SOC Watch Officer to report that a major earthquake has occurred. The SOC is also notified of the event from the DHS NOC. At the same time, the SOC Watch Officer receives initial media reports from national news agencies describing the incident. It becomes immediately obvious that Federal public health and medical assistance are indicated.
- The SOC immediately notifies the ASPR, who alerts the Secretary of HHS. The ASPR activates the EMG, which establishes operations in the SOC, and notifies and briefs senior managers at HHS headquarters and at the OPDIVs.
- Notification/activation of Federal public health and medical assistance occurs in anticipation of the Governor's request for a Presidential disaster declaration and implementation of the Stafford Act (in accordance with the Catastrophic Incident Annex of the NRP). An IRCT and RDF are placed on alert and prepare for deployment to the affected area. In addition, HHS convenes a call with ESF #8 support agencies to discuss the situation and possible assets that may be needed to provide public health and medical assistance.
Meanwhile, the REC establishes contact with local public health and medical officials, and the RD establishes contact with elected officials of the affected States, Tribal Nations, and jurisdictions. This initiates the process for potential Federal public health and medical assistance under ESF #8 once a disaster declaration is made and specific missions have been authorized. HHS also deploys personnel on the ERT-A to gain better situational awareness of potential public health and medical needs.
- Mobilization at the national level is marked by an increase in staffing at the SOC, and by the deployment of HHS liaisons to staff other Federal operations centers, such as the DHS NOC and FEMA NRCC. In addition, the EMG deploys an IRCT and RDF to the disaster area. As the presumptive IRCT Leader, the REC begins the initial assessment of public health and medical needs and relays this information to the EMG. In addition, the Secretary of HHS appoints a SHO to serve in the JFO Coordination Group, once it is established.
- RHA and regional ESF #8 staff coordinates with DHS through the EMG.
- REC reports to the RRCC to begin coordinating requests for public health and medical assistance.
- HHS OPDIVs and ESF #8 support agencies mobilize their EOCs, enhance staffing, and provide liaisons to the SOC to coordinate response activities.
- In anticipation of requests for Federal public health and medical assistance, ESF #8 assets are forward deployed to mobilization centers on Federal property.
Incident operations activities are closely coordinated among jurisdictional, State, Tribal, and Federal officials. A JFO is established locally to bring together all key Federal, State, and jurisdictional stakeholders with incident management responsibility. Once on scene, the IRCT integrates into the JFO and the IRCT Leader coordinates all Federal ESF #8 resources that have been deployed. The IRCT Leader interacts with the State public health official(s) and emergency managers at the State EOC and relays information back to the SOC for accurate real-time situational awareness. The State EOC has activated its preplanned procedure for centralizing requests for public health and medical assistance from jurisdictional and State authorities and determines whether requests can be met using State resources or assets immediately available through mutual aid arrangements with neighboring States.
Once it is determined that Federal assistance for resources or assets is indicated, the State submits the request to the DHS request process through the JFO. Once the JFO has the request, DHS/FEMA distributes a mission assignment to the Primary Agency of the appropriate ESF. For public health and medical requests (ESF #8), HHS is tasked and has the responsibility to fulfill the mission assignment in coordination with its OPDIVs and ESF #8 support agencies.
The IRCT Leader provides situation reports to the EMG on a regular schedule, and all HHS response actions at the scene are coordinated with the EMG and other Federal operation centers (e.g., JFO, NOC-NRCC). Based on information contained in these situation reports, the ASPR, on behalf of the Secretary, coordinates the following ESF #8 functions:
- Coordinates the deployment of immediate medical care (e.g., NDMS and USPHS Commissioned Corps) to help provide required public health and medical services in heavily affected communities
- Coordinates the deployment of FMSs to serve low acuity patients and persons with special medical needs
- Coordinates patient movement with DoD and the VA
- Coordinates with the Medical Reserve Corps to support personnel requirements
- Deploys healthcare personnel from the USPHS Commissioned Corps and NDMS to support hospitals that are short-staffed
- Engages with HRSA to assist in evaluating affected Community Health Centers
- Deploys experts from FDA to provide consultation regarding safe feeding of displaced populations
- Tasks CDC to provide technical assistance on injury prevention and public health missions
- Tasks CDC to assist in monitoring the health of emergency workers, and to provide technical assistance on worker health and safety measures and precautions
- Tasks CMS to assist in monitoring and enforcing or waiving/suspending HCF regulations
- Tasks SAMHSA to assist in providing mental health crisis counseling
- Tasks IHS and other relevant Federal agencies to assess potable water and waste-water/solid waste disposal issues resulting from loss of power and water utilities.
The HHS Assistant Secretary of Public Affairs collaborates with the DHS Public Affairs Office on all public affairs aspects of the response. Public affairs response teams are deployed to address media inquiries, to develop public information materials, and to provide public information liaison officers to the IRCT and to other Federal operations centers. The primary Joint Information Center (JIC), established in support of the NRP, provides general health and medical information to the public after consultation with HHS.
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