Emergency Support Function #8 Health and Medical Services Annex
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||Department of Health and Human Services
||Department of Agriculture
||Department of Defense
||Department of Energy
||Department of Justice
||Department of Transportation
||Department of Veterans Affairs
||Agency for International Development
||American Red Cross
||Environmental Protection Agency
||Federal Emergency Management Agency
||General Services Administration
||National Communications System
||U.S. Postal Service
Emergency Support Function (ESF) #8 — Health and Medical Services provides
coordinated Federal assistance to supplement State and local resources in
response to public health and medical care needs following a major disaster
or emergency, or during a developing potential medical situation. Assistance
provided under ESF #8 is directed by the Department of Health and Human Services
(HHS) through its executive agent, the Assistant Secretary for Health (ASH).
Resources will be furnished when State and local resources are overwhelmed
and public health and/or medical assistance is requested from the Federal
- ESF #8 involves supplemental assistance to State and local governments
in identifying and meeting the health and medical needs of victims of
a major disaster, emergency, or terrorist attack. This support is
categorized in the following functional areas:
- Assessment of health/medical needs;
- Health surveillance;
- Medical care personnel;
- Health/medical equipment and supplies;
- Patient evacuation;
- In-hospital care;
- Food/drug/medical device safety;
- Worker health/safety;
- Radiological/chemical/biological hazards consultation;
- Mental health care;
- Public health information;
- Vector control;
- Potable water/wastewater and solid waste disposal;
- Victim identification/mortuary services; and
- Veterinary services.
- HHS, in its primary agency role for ESF #8, coordinates the provision
of Federal health and medical assistance to fulfill the requirements
identified by the affected State and local authorities having jurisdiction.
Included in ESF #8 are overall public health response; triage, treatment,
and transportation of victims of the disaster; and evacuation of patients
out of the disaster area, as needed, into a network of Military Services,
Veterans Affairs, and pre-enrolled non-Federal hospitals located in the
major metropolitan areas of the United States. ESF #8 will utilize
resources primarily available from:
- Within HHS;
- ESF #8 support agencies;
- The National Disaster Medical System (NDMS), a nationwide medical
mutual aid network between the Federal and non-Federal sectors that
includes medical response, patient evacuation, and definitive medical
care. At the Federal level, it is a partnership between HHS, the
Department of Defense (DOD), the Department of Veterans Affairs (VA),
and the Federal Emergency Management Agency (FEMA); and
- Specific non-Federal sources such as major pharmaceutical suppliers,
hospital supply vendors, the National Foundation for Mortuary Care,
certain international disaster response organizations and international
- ESF #8 will be implemented upon the appropriate State-level request for
assistance following the occurrence of a major disaster or emergency and
after determination has been made by FEMA that a Federal response is warranted.
- The ASH is responsible for activating and coordinating the activities
of ESF #8. The lead policy official for ESF #8 supporting the ASH
is the Principal Deputy Assistant Secretary for Health (PDASH). The
HHS Office of Emergency Preparedness (HHS/OEP) is the action agent and is
responsible for coordinating the implementation of ESF #8 and providing
staff support to the HHS policy officials. The HHS Regional Health
Administrators (RHAs) are the operating agents and are responsible for directing
regional ESF #8 activities.
- The national HHS Emergency Operations Center (EOC)/NDMS Operations Support
Center (OSC) (HHS EOC/NDMSOSC) will provide liaison between the Federal
Government headquarters and appropriate regional officials in the response
structure at the disaster scene for the coordination of Federal health and
medical assistance to meet the requirements of the situation. The
HHS EOC will coordinate and facilitate the overall ESF #8 response.
- In accordance with assignment of responsibilities in ESF #8, and further
tasking by the primary agency, each support agency will contribute to the
overall response but will retain full control over its own resources and
- ESF #8 is the primary source of public health and medical response/information
for all Federal officials involved in response operations.
- All national and regional organizations (including other ESFs) participating
in response operations will report public health and medical requirements
to their counterpart level (national or regional) of ESF #8.
- To ensure patient confidentiality protection, ESF #8 will not release
medical information on individual patients to the general public.
- Appropriate information on casualties/patients will be provided to the
American Red Cross (ARC) for inclusion in the Disaster Welfare Information
(DWI) system for access by the public.
- Requests for recurring reports of specific types of public health and
medical information will be submitted to ESF #8. ESF #8 will develop
and implement procedures for providing these recurring Situation Reports
- The primary Joint Information Center (JIC), established in support of
the Federal Response Plan (FRP), will be authorized to release general medical
and public health response information to the public. Other JICs may
also release general medical and public health response information at the
discretion of the lead Public Affairs Officer.
- Disaster Condition
- A significant natural disaster or man-made event that overwhelms the
affected State would necessitate both Federal public health and medical
care assistance. Hospitals, nursing homes, ambulatory care centers,
pharmacies, and other facilities for medical/health care and special needs
populations may be severely structurally damaged or destroyed. Facilities
that survive with little or no structural damage may be rendered unusable
or only partially usable because of a lack of utilities (power, water,
sewer) or because staff are unable to report for duty as a result of personal
injuries and/or damage/disruption of communications and transportation
systems. Medical and health care facilities that remain in operation
and have the necessary utilities and staff will probably be overwhelmed
by the “walking wounded” and seriously injured victims who are transported
there in the immediate aftermath of the occurrence. In the face
of massive increases in demand and the damage sustained, medical supplies
(including pharmaceuticals) and equipment will probably be in short supply.
(Most health care facilities usually maintain only a small inventory stock
to meet their short-term, normal patient load needs.) Disruptions
in local communications and transportation systems could also prevent
- Uninjured persons who require daily or frequent medications such as
insulin, antihypertensive drugs, digitalis, and dialysis may have difficulty
in obtaining these medications and treatments because of damage/destruction
of normal supply locations and general shortages within the disaster area.
- In certain other disasters, there could be a noticeable emphasis on
relocation, shelters, vector control, and returning water, wastewater,
and solid waste facilities to operation.
- A major medical and environmental emergency resulting from chemical,
biological, or nuclear weapons of mass destruction could produce a large
concentration of specialized injuries and problems that could overwhelm
the State and local public health and medical care system.
- Planning Assumptions
- Resources within the affected disaster area will be inadequate to clear
casualties from the scene or treat them in local hospitals. Additional
mobilized Federal capabilities will be urgently needed to assist State
and local governments to triage and treat casualties in the disaster area
and then transport them to the closest appropriate hospital or other health
care facility. Additionally, medical resupply will be needed throughout
the disaster area. In a major disaster, operational necessity may
require the further transportation by air of patients to the nearest metropolitan
areas with sufficient concentrations of available hospital beds, where
patient needs can be matched with the necessary definitive medical care.
- A terrorist release of weapons of mass destruction; damage to chemical
and industrial plants, sewer lines, and water distribution systems; and
secondary hazards such as fires will result in toxic environmental and
public health hazards to the surviving population and response personnel,
including exposure to hazardous chemicals, biologicals, radiological substances,
and contaminated water supplies, crops, livestock, and food products.
- The damage and destruction of a major disaster, which may result in
multiple deaths and injuries, will overwhelm the State and local mental
health system, producing an urgent need for mental health crisis counseling
for disaster victims and response personnel.
- Assistance in maintaining the continuity of health and medical services
will be required.
- Disruption of sanitation services and facilities, loss of power, and
massing of people in shelters may increase the potential for disease and
- Primary medical treatment facilities may be damaged or inoperable;
thus, assessment and emergency restoration to necessary operational levels
is a basic requirement to stabilize the medical support system.
- Concept of Operations
- Upon notification of a major disaster or emergency, HHS (as primary
agency) will alert the HHS EOC staff to assemble in the HHS EOC.
The ASH, PDASH, HHS Agency Emergency Coordinators (AECs), and appropriate
HHS RHAs, Regional Emergency Coordinators, and Regional Directors (RDs)
will be notified.
- The ASH will direct the activities of ESF #8 and will activate the
NDMS as needed.
- Pre-identified personnel will be alerted to meet requirements for representing
ESF #8 on the:
- Catastrophic Disaster Response Group (CDRG);
- Emergency Support Team (EST);
- National ESF #8 EOC;
- Regional ESF #8 Coordination Center;
- Regional Operations Center (ROC); and
- Emergency Response Team — Advance Element (ERT-A).
- All support agencies will be notified and tasked to provide 24-hour
representation as necessary. Each support agency is responsible
for ensuring that sufficient program staff is available to support the
HHS EOC and to carry out the activities tasked to its agency on a continuous
basis. Individuals representing agencies who are staffing the HHS
EOC will have extensive knowledge of the resources and capabilities of
their respective agencies and have access to the appropriate authority
for committing such resources during the activation.
- National ESF #8 will provide liaison and communications support to
regional ESF #8 to facilitate direct communications between them.
The national ESF #8 personnel will be deployed as necessary to assist
regional ESF #8 in establishing and maintaining effective coordination
within the disaster area.
- Regional ESF #8 will coordinate with the appropriate State medical
and public health officials and organizations to determine current medical
and public health assistance requirements.
- Regional ESF #8 will be supported by the Joint Regional Medical Planning
Office (JRMPO) or other entity designated by the DOD Defense Coordinating
Officer (DCO) to coordinate civil authority requests for military resource
support within the disaster area. Regional ESF #8 also will be assisted
by those other support agencies as contained in the regional ESF #8 appendices.
- Regional ESF #8 will utilize locally available health and medical resources
to the extent possible to meet the needs identified by State and local
authorities. National ESF #8 will meet the additional requirements
primarily from pre-arranged sources throughout the United States and Canada.
- During the response period, ESF #8 will evaluate and analyze medical
and public health assistance requests and responses, and develop and update
assessments of medical and public health status. ESF #8 will maintain
accurate and extensive logs to support after-action reports and other
documentation of the disaster conditions.
- In the early stages of a disaster response, it may not be possible
to fully assess the situation and verify the level of assistance required.
In such circumstances, national ESF #8, in consultation with regional
ESF #8, reserves the right to decide whether to authorize assistance.
In these cases, every attempt will be made to verify the need before providing
- ESF #8 will develop and provide medical and public health situation
reports to the CDRG, EST, ERT, primary JIC, and organizations with a need
for recurring reports of specific types of information including other
ESFs, Federal agencies, and the State upon request. Information
will be disseminated by all available means including fax, telephone,
radio, memoranda, display charts and maps, and verbal reports at meetings
- National-Level Response Structure
- ESF #8 response will be activated and directed by the ASH.
The HHS EOC will become operational. The HHS EOC will consist
of a core of Federal agencies that will be supplemented by other national-level
organizations, governmental and private, as the situation dictates.
During the initial activation, the principal core staff will consist
of a pre-designated HHS EOC staff and representatives from the Assistant
Secretary of Defense (Health Affairs), DOD; Under Secretary for Health,
VA; and Director, FEMA.
- Additional supporting agencies and organizations will be alerted
and will be tasked either to provide a representative to the HHS EOC
or to provide a representative who will be immediately available via
telecommunications (telephone, fax, conference calls, etc.) to provide
- HHS will identify and provide personnel to represent HHS and national
ESF #8 both on the CDRG and the EST. HHS also will dispatch, as
needed, emergency response coordinators and the national ESF #8 ERT
to the disaster area to support the lead RHA with responsibility for
the regional ESF #8.
- Coordination of ESF #8 will be centralized at the HHS EOC.
- Special advisory groups of health/medical subject matter experts
will be assembled and consulted by national ESF #8 as needed.
- Regional-Level Response Structure
- The RHA, the lead for the regional ESF #8 health and medical response,
will establish a regional ESF #8 Coordination Center (CC) and provide
administrative support to the regional response activities. The
HHS RD will assist the RHA by coordinating human services support required
from the other HHS operating divisions located within the region.
- The lead for regional ESF #8 will represent ESF #8 in its dealings
with the Federal Coordinating Officer (FCO) and will maintain liaison
with the FCO, the appropriate State and local health and medical officials,
national ESF #8, and the HHS RD.
- Regional ESF #8 will have appropriate representatives available to
rapidly deploy, with the ERT-A, to the affected State’s EOC or other
- Regional ESF #8 will have appropriate representative(s) present or
available by telephone or radio at the regional ESF #8 CC, and additionally
at the ROC and/or Disaster Field Office (DFO), as required by the FCO,
on a 24-hour basis for the duration of the emergency response period.
Other representatives of the lead/support agencies will be available
to staff the ROC and/or the DFO upon request of the lead of regional
- Upon the occurrence of a potential major disaster or emergency, the
FEMA National Emergency Coordination Center will notify the ESF #8 action
agent (HHS/OEP). The affected FEMA region will notify the HHS RHA.
Notification can be made via telephone, fax, or digital pagers.
Such notification could be to advise of the potential disaster, convene
the CDRG, request an ESF #8 representative to deploy as a regional ERT
member, establish the EST at FEMA Headquarters, or pass a request from
regional or State officials seeking activation of NDMS.
- HHS/OEP will notify the ASH and request activation of ESF #8. HHS/OEP
will alert its EOC staff, which in turn will notify the lead regional
ESF #8 by telephone or radio, if possible. If the RHA or the appropriate
representative cannot be contacted, the HHS RD will be notified and requested
to advise the regional ESF #8 lead. If the HHS RD cannot be contacted,
the ESF #8 lead of an adjacent region will be contacted and requested
to assist in notifying and establishing the regional ESF #8 in the disaster
- The HHS/OEP EOC staff also will notify all other national ESF #8 members
by the most expeditious communications method.
- Upon notification, ESF #8 members will notify their parent agencies.
ESF #8 members will report to the appropriate location(s) as directed
(such as HHS EOC, FEMA Headquarters, etc.) and regional ESF #8 members
will report to the appropriate location(s) as directed (such as the ROC
- Response Actions
- Initial Actions Following a Potential Major Disaster or Emergency
The HHS EOC will become operational within 2 hours of notification.
Until the regional ESF #8 becomes operational, the collection, analysis,
and dissemination of requests for medical and public health assistance will
be the responsibility of national ESF #8, with the assistance of the HHS
region. Upon declaration by the RHA that the regional ESF #8 CC is
operational, the major responsibilities for requests for medical and public
health assistance will be transferred to regional ESF #8. National
ESF #8 will conduct the following actions while bringing ESF #8 to a fully
- Federal health and medical assistance is generally categorized into
the major functions of prevention, medical services, mental health services,
and environmental health. Each of the 15 specific functional areas
is contained in one of these categories. Upon notification of
the occurrence of a potential major disaster or emergency, the lead
of the national ESF #8 (the ASH) will request HHS and support agencies
to initiate action immediately to identify and report the potential
need for Federal health and medical support to the affected disaster
area in the following functional areas:
- Assessment of Health/Medical Needs
Lead HHS Agency: Office of Public Health and Science/Office of Emergency
Preparedness/National Disaster Medical System (OPHS/OEP/NDMS):
Mobilize and deploy an assessment team to the disaster area to assist
in determining specific health/medical needs and priorities. The
composition of the assessment team will be jointly determined by the
action agent and the operating agent based on the type and location
of the emergency. This function includes the assessment of the
health system/facility infrastructure.
- Health Surveillance
Lead HHS Agency: Centers for Disease Control and Prevention:
Assist in establishing surveillance systems to monitor the general population
and special high-risk population segments; carry out field studies and
investigations; monitor injury and disease patterns and potential disease
outbreaks; and provide technical assistance and consultations on disease
and injury prevention and precautions.
- Medical Care Personnel
Lead HHS Agency: OPHS/OEP/NDMS: Provide Disaster Medical
Assistance Teams (DMATs) and individual public health and medical personnel
to assist in providing care for ill or injured victims at the location
of a disaster or emergency. DMATs can provide triage, medical
or surgical stabilization, and continued monitoring and care of patients
until they can be evacuated to locations where they will receive definitive
medical care. Specialty DMATs can also be deployed to address
mass burn injuries, pediatric care requirements, chemical injury or
contamination, etc. In addition to DMATs, Active Duty, Reserve,
and National Guard units for casualty clearing/staging and other missions
will be deployed as needed. Individual clinical health and medical
care specialists may be provided to assist State and local personnel.
The VA is one of the primary sources of these specialists.
- Health/Medical Equipment and Supplies
Lead HHS Agency: OPHS/OEP/NDMS: Provide health and medical
equipment and supplies, including pharmaceuticals, biologic products,
and blood and blood products, in support of DMAT operations and
for restocking health and medical care facilities in an area affected
by a major disaster or emergency.
- Patient Evacuation
Lead HHS Agency: OPHS/OEP/NDMS: Provide for movement of seriously
ill or injured patients from the area affected by a major disaster or
emergency to locations where definitive medical care is available.
NDMS patient movement will primarily be accomplished utilizing fixed-wing
aeromedical evacuation resources of DOD; however, other transportation
modes may be used as circumstances warrant.
- In-Hospital Care
Lead HHS Agency: OPHS/OEP/NDMS: Provide definitive medical care
to victims who become seriously ill or injured as a result of a major
disaster or emergency. For this purpose, NDMS has established
and maintains a nationwide network of voluntarily pre-committed, non-Federal,
acute care hospital beds in the largest U.S. metropolitan areas.
- Food/Drug/Medical Device Safety
Lead HHS Agency: Food and Drug Administration: Ensure the safety
and efficacy of regulated foods, drugs, biologic products, and medical
devices following a major disaster or emergency. Arrange for seizure,
removal, and/or destruction of contaminated or unsafe products.
- Worker Health/Safety
Lead HHS Agency: Centers for Disease Control and Prevention:
Assist in monitoring health and well-being of emergency workers; perform
field investigations and studies addressing worker health and safety
issues; and provide technical assistance and consultation on worker
health and safety measures and precautions.
- Radiological/Chemical/Biological Hazards Consultation
Lead HHS Agency: Centers for Disease Control and Prevention:
Assist in assessing health and medical effects of radiological, chemical,
and biological exposures on the general population and on high-risk
population groups; conduct field investigations, including collection
and analysis of relevant samples; advise on protective actions related
to direct human and animal exposure, and on indirect exposure through
radiologically, chemically, or biologically contaminated food, drugs,
water supply, and other media; and provide technical assistance and
consultation on medical treatment and decontamination of radiologically,
chemically, or biologically injured/contaminated victims.
- Mental Health Care
Lead HHS Agency: Substance Abuse and Mental Health Services Administration:
Assist in assessing mental health needs; provide disaster mental health
training materials for disaster workers; and provide liaison with assessment,
training, and program development activities undertaken by Federal,
State, and local mental health officials.
- Public Health Information
Lead HHS Agency: Centers for Disease Control and Prevention: Assist
by providing public health and disease and injury prevention information
that can be transmitted to members of the general public who are located
in or near areas affected by a major disaster or emergency.
- Vector Control
Lead HHS Agency: Centers for Disease Control and Prevention:
Assist in assessing the threat of vector-borne diseases following a
major disaster or emergency; conduct field investigations, including
the collection and laboratory analysis of relevant samples; provide
vector control equipment and supplies; provide technical assistance
and consultation on protective actions regarding vector-borne diseases;
and provide technical assistance and consultation on medical treatment
of victims of vector-borne diseases.
- Potable Water/Wastewater and Solid Waste Disposal
Lead HHS Agency: Indian Health Service: Assist in assessing potable
water and wastewater/solid waste disposal issues; conduct field investigations,
including collection and laboratory analysis of relevant samples; provide
water purification and wastewater/solid waste disposal equipment and
supplies; and provide technical assistance and consultation on potable
water and wastewater/solid waste disposal issues.
- Victim Identification/Mortuary Services
Lead HHS Agency: OPHS/OEP/NDMS: Assist in providing victim identification
and mortuary services, including NDMS Disaster Mortuary Teams (DMORTs);
temporary morgue facilities; victim identification by fingerprint, forensic
dental, and/or forensic pathology/anthropology methods; and processing,
preparation, and disposition of remains.
- Veterinary Services
Lead HHS Agency: OPHS/OEP/NDMS: Assist in delivering health care
to injured or abandoned animals and performing veterinary preventive
medicine activities following a major disaster or emergency, including
conducting field investigations and providing technical assistance and
consultation as required.
- National ESF #8 also will initiate the following alerting actions:
- Alert and deploy national ESF #8 representative(s) to the EST;
- Alert national ESF #8 representative(s) to be on standby to deploy
to the disaster area as a member of the national ESF #8 ERT;
- Alert and deploy national ESF #8 Management Support Unit (MSU)
to the disaster area to provide liaison and support to regional ESF
#8. The MSU will be self-contained as much as possible (tents, sleeping
bags, food, etc.) and will provide some long-distance communications
support for direct connectivity between the regional and national
- Request HHS EOC to alert NDMS Response Resources to be on a standby
- Through its DOD representative, alert the Global Patient Movement
Requirements Center (GPMRC) to prepare to receive hospital bed availability
reports. GPMRC will establish an appropriate reporting window;
- Through VA, DOD representatives, and appropriate VA and Military
Services command and control systems, alert local NDMS Federal Coordinating
Centers (FCCs) to obtain bed availability reports from the participating
non-Federal hospitals and report bed status to GPMRC;
- Alert HHS Supply Service Center, Defense Logistics Agency, and
other pre-identified sources of medical supplies to be on a standby
- Alert national-level communications and transportation support
agencies to be on a standby basis; and
- Determine from ESF #5 — Information and
Planning the geographic area affected by the disaster and obtain
weather information for the disaster area, including present conditions,
the 24-hour forecast, and the long-range forecast.
- National ESF #8 primary and support agency members will report to
the HHS EOC and convene within 2 hours following notification.
Alternatively, ESF #8 members may be directed to report to their usual
offices within 2 hours and thereafter maintain continuous telephone
communication with national ESF #8.
- The HHS EOC DOD representative will activate the national-level DOD
support network as required. This alerting may include, but not
be limited to, the Director of Military Support (DOMS); Surgeons General
of the Army, Navy, and Air Force; U.S. Transportation Command (USTRANSCOM);
Air Mobility Command (AMC); National Guard Bureau (NGB); GPMRC; Forces
Command (FORSCOM); U.S. Atlantic Command (USACOM); U.S. Pacific Command
(USPACOM); U.S. Southern Command (USSOUTHCOM); Office of Civilian Health
and Medical Program of the Uniformed Services (OCHAMPUS); Medical Readiness
Division, Office of the Joint Chiefs of Staff (J-4/JCS); and other appropriate
DOD components. DOMS, in coordination with the Services and JCS
executive agents (i.e., Headquarters U.S. Air Force (HQUSAF) Surgeon
General for GPMRC) will, in turn, notify Service FCCs and other Service
components as appropriate.
- Continuing Actions
- Situation Assessment
- The national ESF #8 staff will continuously acquire and assess
information about the disaster situation. The staff will continue
to attempt to identify the nature and extent of health and medical
problems, and establish appropriate monitoring and surveillance of
the situation to obtain valid ongoing information. National
ESF #8 will primarily rely on information from the disaster area that
is furnished by regional ESF #8. Other sources of information
may include national ESF #8 support agencies, various Federal officials
in the disaster area, State health officials, State emergency medical
services (EMS) authorities, State disaster authorities, or the responsible
jurisdiction in charge of the disaster scene. Information also
may be acquired from Federal officials outside the disaster area,
such as local NDMS FCCs, FEMA Regional Offices, and HHS Regional Offices.
- Because of the potential complexity of the health and medical response
issues/situations, conditions may require special advisory groups
of subject matter experts to be assembled by national ESF #8 to review
health/medical intelligence information and advise on specific strategies
to most appropriately manage and respond to a specific situation.
- Activation of Health/Medical Response Teams
- By direction of the ASH, health personnel/teams from HHS will be
deployed as needed, and appropriate medical and public health (including
environmental health) assistance will be provided. NDMS DMATs
will be activated and deployed as needed. The HHS EOC will respond
to the direction by arranging for alerting, activation, appointment
to Federal status (where appropriate), and deployment of NDMS DMATs.
The HHS EOC, in cooperation with the MSU (when established), will
coordinate and arrange for the necessary transportation and logistic
support for the DMATs. DMATs may be activated for provision
of patient reception, patient staging, casualty clearing, or other
medical care activities in meeting the needs of the situation.
- Certain military medical units, including Active Duty, Reserve,
and National Guard, may be tasked to deploy to support ESF #8 requirements.
These requirements will be coordinated with the NDMSOSC DOD representative,
who will coordinate with DOMS to activate and deploy the necessary
military units. VA assets that are available for response activities
include the Medical Emergency Radiological Response Teams (MERRTs)
and the Emergency Medical Response Teams (EMRTs). The VA is
also able to mobilize health professionals who are not necessarily
part of a formal “team,” depending on ESF #8 requirements.
- Coordination of Requests for Medical Transportation
Arrangements for medical transportation should be made at the lowest levels
possible. Normally, local transportation requirements are to be
handled by local authorities. If it is determined by regional ESF
#8 that local or regional resources are inadequate to meet the requirements,
a request for Federal medical transportation assistance will be worked
at the national ESF #8 level by use of the patient evacuation component
of NDMS. Patient regulation will be the responsibility of GPMRC.
- Coordination of Requests for Medical Facilities
Arrangements for medical facilities are primarily a local function.
Requests for additional assistance should first be referred to State authorities.
Requests by State officials for Federal aid for NDMS hospital support
should be routed through regional ESF #8 to the NDMSOSC. The NDMSOSC
will verify the request and refer it to the DOD and VA representatives.
The VA and DOMS, through their Service representatives, will notify NDMS
FCCs to activate area operations/patient reception plans. HQUSAF
will alert GPMRC regarding NDMS activation. GPMRC will establish
and disseminate appropriate bed reporting instructions to the FCCs.
Further, the 375th Aeromedical Evacuation Squadron/Aeromedical Evacuation
Control Center (AECC), Scott Air Force Base, IL (formerly the Patient
Airlift Center), will provide appropriate patient reception/patient arrival
information to GPMRC and local FCCs. Local FCCs, through their patient
reception teams, will distribute arriving patients to specific NDMS-participating
hospitals based on the patients’ needs and facility capability.
- Coordination of Requests for Aeromedical Evacuation of Patients
from the Disaster Area
- State and local health/medical authorities identify the need for
patient evacuation support from the disaster area. The requirement
for aeromedical evacuation (AE) is communicated through regional ESF
#8 to the NDMSOSC. The DOD representative in the NDMSOSC, in
turn, will coordinate with the appropriate commands, such as FORSCOM,
USTRANSCOM, USACOM, USPACOM, USSOUTHCOM, and/or HQAMC Command Centers.
The agency contacted will then coordinate with the appropriate supporting
command to obtain the needed support.
- The concept of operation is for local authorities to operate Casualty
Collection Points (CCPs) that will feed into State-operated Regional
Evacuation Points (REPs). ESF #8 will coordinate the hand-off
of patients from the REPs into the NDMS patient evacuation system.
- Patient regulating is the responsibility of GPMRC. Because
the movement of patients is based upon the availability of hospital
beds, GPMRC will receive patient requirements from the disaster area
and regulate patients to destination reception areas that report available
beds. Regional ESF #8 will establish a Patient Reporting Activity
(PRA) to report the number of patients requiring movement out of the
area to GPMRC. Patients will be reported in the specified contingency
categories. FCCs will likewise report available beds in the
same contingency categories. Once the regulating decision is
made, GPMRC will pass it to the PRA and the receiving FCCs.
After receipt by the PRA, regional ESF #8 will coordinate with the
State to have the patients moved. GPMRC can provide Joint Patient
Movement Team(s) (JPMTs) that can manage patient regulating activities
from the disaster site.
- AE resources will be deployed based on the nature of the disaster
or emergency and estimated length of support requirement. In
a limited operation, support may be restricted to providing Aeromedical
Evacuation Crew Members (AECMs), airlift, and/or liaison personnel,
with centralized management remaining with the AECC, Scott Air Force
Base. In a larger or more prolonged event that may require sustained
support, elements of the Tactical Aeromedical Evacuation System (TAES),
to include an Aeromedical Evacuation Control Element (AECE), Mobile
Aeromedical Staging Facility (MASF), Aeromedical Evacuation Liaison
Team (AELT), and AECMs, may be deployed to the region. When
deployed, the AECE will provide regional control for the AE elements,
with overall responsibility for continental United States (CONUS)
AE operations remaining with the AECC, Scott Air Force Base.
Outside the continental United States (OCONUS), overall responsibility
will rest with the appropriate military command — Commander-in-Chief
Atlantic (CINCLANT), Commander-in-Chief Pacific (CINCPAC), or USSOUTHCOM
— having military support responsibility for the geographic area of
Coordination for Obtaining, Assembling, and Delivering Medical
Equipment and Supplies to the Disaster Area
- An AELT could deploy to the REPs to provide a direct high frequency
radio communications link and immediate coordination between the
REP originating the requirements for aeromedical evacuation and
the AECC. The primary mission of the AELT is to coordinate
patient movement requests and the movement schedule between the
AECC and the REP.
- The AECC is the operations center responsible for mission planning,
coordinating, and management of the disaster area AE operations.
The AECC establishes and is the focal point for communications and
provides the source of direction and control for disaster area AE
- The MASF is a mobile, tented, temporary staging facility deployed
to provide supportive care and administration. It does not
have beds or cots. Since it has no organic patient-carrying
vehicles, it is normally located near runways, taxiways, or airfields.
- The AECMs provide in-flight supportive medical care aboard AE
- Control teams will be deployed to identify the closest appropriate
hub site to the REP that can handle the AE aircraft, which is normally
a C-9 or C-130. Aeromedical staging capability (utilizing
a joint operation between military MASFs and NDMS DMATS) will be
established near the runways or taxiways of the designated airfield
or forward operating base. The regulated patients are then
moved from the REP to the aeromedical staging location for entrance
into the AE system and movement to the regulated destination.
- The AELT, AECC, and MASF have equipment and personnel to establish
a communications network in support of the system. The AECC
functions as the net control for the various elements.
- If AE elements are not deployed to the disaster area, personnel/medical
facilities reporting patient movement requirements should be prepared
to provide as much medical information on patients as is known,
e.g., current condition, diagnosis, vital signs, any special equipment
requirements. A point of contact should be provided
so the AECC can obtain any additional information needed to prepare
for the mission.
- If State or local authorities request patient evacuation but
are unable to establish REPs and/or CCPs, ESF #8 will deploy the
necessary additional medical force structure to facilitate the lowest
echelon level of care required to accomplish the mission successfully.
Representatives of HHS, VA, DOD, Department of Transportation (DOT), and
General Services Administration will coordinate arrangements for the procurement
and transportation of medical equipment and supplies to the disaster area.
A “push” concept will be employed when feasible to expedite medical resupply
to the disaster area from pre-identified medical supply caches.
Included in this response will be the HHS-requested support, as needed,
of certain medical supplies.
National ESF #8 will establish communications necessary to effectively
Requests for information may be received at ESF #8 from various sources,
such as the media and the general public, and they will be referred to
the appropriate agency or JIC for response.
The HHS/OEP will, upon completion of the emergency, prepare a summary
after-action report. The after-action report, which summarizes the
major activities of ESF #8, will identify key problems, indicate how they
were solved, and make recommendations for improving response operations
in subsequent activations. Support agencies will assist in the preparation
of the after-action report and endorse the final report.
- Primary Agency: Department of
Health and Human Services
- Provide leadership in directing, coordinating, and integrating overall
Federal efforts to provide medical and public health assistance to the
- Direct the activation of NDMS and the staffing of the HHS EOC as necessary
to support the emergency response operations;
- Direct the activation and deployment of health/medical personnel, equipment,
and supplies in response to requests for Federal health/medical assistance;
- Coordinate the evacuation of patients from the disaster area when evacuation
is deemed appropriate by State authorities;
- Coordinate the provision of definitive health care through NDMS; and
- Provide human services assistance under the direction of the HHS RD.
- Support Agencies
- Department of Agriculture, Forest Service
Provide appropriate personnel, equipment, food, and supplies, coordinated
through the National Fire Suppression Liaison Officer or representative,
Fire and Aviation Management Office (located in Washington, DC), and the
National Interagency Coordination Center (NICC) located in Boise, ID.
Support will be primarily for communications and aircraft and the establishment
of base camps for deployed Federal health and medical teams in the disaster
- Department of Defense
- Alert GPMRC to provide DOD NDMS FCCs (Army, Air Force, and Navy)
and VA NDMS FCCs reporting/regulating instruction to support disaster
- Alert DOD NDMS FCCs to activate NDMS area operations/patient reception
plans; initiate bed reporting based on GPMRC instructions;
- In coordination with NDMSOSC, evacuate and manage patients as required
from the disaster area to NDMS patient reception areas;
- In coordination with DOT and other transportation support agencies,
transport medical personnel, equipment, and supplies into the disaster
- Provide logistical support to health/medical response operations;
- Provide Active Duty medical units for casualty clearing/staging and
other missions as needed, including aeromedical evacuation; mobilize
and deploy Reserve and National Guard medical units, when authorized
and necessary to provide support;
- Coordinate patient reception and management in NDMS areas where military
treatment facilities serve as local NDMS FCCs;
- Provide military medical personnel to assist HHS in activities for
the protection of public health (such as food, water, wastewater, solid
waste disposal, vectors, hygiene, and other environmental conditions);
- Provide available DOD medical supplies for distribution to mass care
centers and medical care locations being operated for disaster victims;
- Provide available emergency medical support to assist State and local
governments within the disaster area. Such services may include
triage, medical treatment, and the utilization of surviving DOD medical
facilities within the disaster area;
- Provide assistance in managing human remains, including victim identification
- Provide technical assistance, equipment, and supplies through the
U.S. Army Corps of Engineers, as required, in support of HHS to accomplish
temporary restoration of damaged public utilities affecting public health;
- Immediately notify the Surgeons General of the Army, Air Force, and
Navy if there is a likelihood that their support may be required; and
- Provide technical facility and clerical expertise to assess the physical
condition of the medical treatment facilities.
- Department of Energy
- Through the Radiation Emergency Assistance Center/Training Site (REAC/TS):
- Provide 24-hour direct and/or consulting assistance in assessing
and treating the health and medical effects of radiological exposure
and contamination involving general and high-risk populations;
- Offer intensive training to health professionals in medical management
for radiological accidents;
- Provide counseling to victims of radiological accidents; and
- Provide technical advice and assistance regarding the handling
disposition of radiologically contaminated remains.
- Through the Radiological Assistance Program (RAP):
- Provide regional resources (personnel, specialized equipment, and
supplies) to evaluate, control, and mitigate radiological hazards
to workers and the public;
- Assist in the decontamination of victims; and
- Assist State and local authorities in the monitoring and surveillance
of the accident area.
- Through the Atmospheric Release Advisory Capability (ARAC), provide
real-time transport, dispersion, and dose predictions of atmospheric
releases of radioactive and hazardous materials that can be used by
authorities in taking protective actions related to sheltering and evacuation
- Through the Federal Radiological Monitoring and Assessment Center
(FRMAC), to assist health and medical authorities in determining
radiological dose information, provide coordinated gathering of radiological
information and data; consolidated data sample analyses, evaluations,
assessments, and interpretations; and technical information.
- Department of Justice
- Assist in victim identification, coordinated through the Federal
Bureau of Investigation (FBI) Headquarters in Washington, DC;
- Provide State and local governments with legal advice concerning
the identification of the dead;
- Provide HHS/OEP with relevant intelligence information of any credible
threat or other situation that could potentially threaten public health.
This support will be coordinated through FBI Headquarters in Washington,
- Provide communication, transportation, and other logistical support
to the extent possible. This support is provided through the FBI.
- Department of Transportation
- Assist in identifying and arranging for all types of transportation,
such as air, rail, marine, and motor vehicle;
- Assist in identifying and arranging for utilization of U.S. Coast
Guard (USCG) aircraft in providing urgent airlift support when not otherwise
required by ESF #1 — Transportation or the
- Provide casualty distribution assistance from DOT resources subject
to DOT statutory requirements; and
- Coordinate with the Federal Aviation Administration for air traffic
control support for priority missions.
- Department of Veterans Affairs
- Alert VA NDMS FCCs to activate NDMS area operations/patient reception
plans, initiate bed reporting based on GPMRC instructions, and coordinate
patient reception, management, and the provision of inpatient care through
NDMS hospitals in areas where VA medical centers serve as local NDMS
- Assist in providing medical support to State and local governments
within the disaster area. Such services may include triage, medical
treatment, and the utilization of surviving VA medical centers within
the disaster area;
- Provide available medical supplies for distribution to mass care
centers and medical care locations being operated for disaster victims;
- Provide assistance in managing human remains, including victim identification
- Agency for International Development, Office of Foreign Disaster
Provide assistance in coordinating international offers for health/medical
- American Red Cross
- Provide emergency first aid, supportive counseling, health care for
minor illnesses and injuries to disaster victims in mass care shelters,
DFOs, selected disaster cleanup areas, and other sites deemed necessary
by the primary agency;
- Assist community health personnel subject to the availability of
- Provide supportive counseling for the family members of the dead
- Provide available personnel to assist in temporary infirmaries, immunization
clinics, morgues, hospitals, and nursing homes;
- Acquaint families with available health resources and services, and
make appropriate referrals;
- Provide blood and blood products through regional blood centers at
the request of the appropriate agency; and
- Provide coordination for uploading appropriate casualty/patient information
from ESF #8 into the DWI system.
- Environmental Protection Agency
Provide technical assistance and environmental information for the assessment
of the health/medical aspects of situations involving hazardous materials.
- Federal Emergency Management Agency
- Assist NDMS in establishing priorities for application of health
and medical support;
- Assist in providing NDMS communications support;
- Assist in providing information/liaison with emergency management
officials in NDMS FCC areas; and
- Provide logistics support as appropriate.
- General Services Administration
Provide facilities, equipment, supplies, and other logistical support, including
the acquisition of private sector ground and air transportation.
- National Communications System
Provide communications support for medical command and control. This
support will be coordinated through the Office of the Manager.
- U.S. Postal Service
Assist in the distribution and transportation of medicine and pharmaceuticals
to the general public affected by a major disaster or emergency as needed.
Updated: June 3, 1999
- DOD Directive 6010.17, National Disaster Medical System, December 28,
- DOD Directive 3025.1, Military Support to Civil Authorities, January
- 55 FR 2885, Office of the Assistant Secretary for Health; Statement of
Organization, Functions, and Delegations of Authority, January 29, 1990.
- 55 FR 2879, Office of the Secretary; Statement of Organizations, Functions,
and Delegations of Authority, January 29, 1990.
- Public Health Service Disaster Response Guides, May 1987.
- Facts on the National Disaster Medical System, February 1995.
- National Disaster Medical System — Concept of Operations, January 1991.
- National Disaster Medical System — Operations Support Center Manual,
- National Disaster Medical System — Federal Coordinating Center Guide,
- National Disaster Medical System — Disaster Medical Assistance Team Organization
Guide, May 1992.
- The Public Health Consequences of Disasters, Centers for Disease Control,
U.S. Public Health Service, September 1989.
- 61 FR 21470, Office of the Secretary; Statement of Organization, Functions,
and Delegations of Authority, May 10, 1996.
- 60 FR 56605, Office of the Secretary and Public Health Services; Statement
of Organization, Functions, and Delegations of Authority, November 9, 1995.