2.4: Disasters
Prepare for and respond to natural and manmade disasters. Other Information:
The Pandemic and All-Hazards Preparedness Act of 2006 (PAHPA; Public Law 109-417) codified the HHS Secretary’s role as lead
for the Federal public health and medical response to emergencies and incidents covered by the National Response Plan (NRP),
and authorizes HHS’s operational control of Federal public health and medical response assets during these events.8 In addition,
the development of the Homeland Security Council’s National Strategy for Pandemic Influenza has stressed the importance of
preparedness for natural and manmade disasters that have public health impact. Many of the strategies undertaken by HHS to
achieve preparedness and response capability are done in concert with or in support of other Federal departments and agencies,
State and local governments, and private sector entities. This collaborative approach is vital given that public health emergencies
have the potential to affect nearly every sector of society. One of HHS’s largest investments is to develop and stockpile
the countermeasures needed to respond to the most serious disasters. Consequently, a performance indicator listed at the end
of this chapter assesses the readiness of States to utilize these supplies. A second indicator focuses on the extent to which
State emergency management plans cover the broad array of individuals with special needs, specifically measuring plans for
those with disabilities. The Office of the Assistant Secretary for Preparedness and Response (ASPR) is the single office responsible
for preparedness and response activities within HHS. As the principal advisor to the Secretary on all matters related to public
health and medical preparedness and response emergencies, ASPR leads and promotes a collaborative approach with many partners,
including ACF, AoA, CDC, CMS, FDA, HRSA, OPHS, and SAMHSA. For additional information on this topic, see In the Spotlight:
Emergency Preparedness, Prevention, and Response. Key strategies that will be used to enhance public health and medical emergency
preparedness and response include: Developing the National Health Security Strategy, starting in 2009; * Awarding cooperative
agreements to States or other eligible entities to conduct the activities of the National Health Security Strategy; and *
Reintegrating the National Disaster Medical System within HHS. A major focus of preparedness activities will be the implementation
of the Biomedical Advanced Research and Development Authority (BARDA), and countermeasures development. The international
preparedness activities include the International Health Regulations, which will come into force in June 2007. These regulations
require members to develop, strengthen, and maintain core surveillance and response capacities to detect, assess, notify,
and report public health events to WHO and respond to public health risks and public health emergencies. WHO, in turn, will
evaluate members’ public health capacities, promote technical cooperation, offer logistical support, and facilitate the mobilization
of financial resources for building capacity in surveillance and response. Workforce Readiness: HHS will identify, put on
a roster, and train deployable teams of medical and public health providers, including HHS personnel (both commissioned officers
and civil service employees), other Federal employees, and voluntary staff. HHS meets regularly with its ESF-8 Federal partners
to identify missions, form teams with the skills needed to meet the missions, identify training and equipment requirements,
and initiate training. HHS has identified the logistical support needs for these teams and has developed specific tasks for
meeting these logistical needs. Examples of these needs include medical supplies, equipment, housing, and food requirements.
This activity builds upon the transformation activities of the Commissioned Corps of the USPHS (Commissioned Corps). The Commissioned
Corps provides a unique source of well-trained, highly qualified, dedicated public health professionals who are available
to respond rapidly to urgent public health challenges and health care emergencies. The Commissioned Corps’ response to Hurricane
Katrina is a powerful example of what its officers can do. In response to Hurricane Katrina, the Commissioned Corps deployed
more than 2,000 officers—the largest deployment in its history—and still has personnel in the field providing care in Louisiana
today. The transformation will facilitate force management improvements that are necessary for the Commissioned Corps to function
even more efficiently and effectively. The current activity using rosters is aimed at structuring officers into teams, and
then training them as a team. This approach defines clarity of roles and expectations, and assures that leadership and management
of the officers in the deployed situation are well understood and their roles are executable. These teams will interface with
the Disaster Medical Assistance Teams (DMATs) fielded under the National Disaster Medical System (NDMS). The greatest utility
of the DMATs is in immediate emergency response, and they are considered the initial responders for emergency medical needs
during the first 72 hours after an event. HHS and other Federal agencies will be responsible for the other requirements in
the continuum of health needs, including some aspects of health services delivery during evacuation, hospital care, low-intensity
facility-based care for populations with special needs (such as chronic diseases and disability), and other health outreach
activities. Threat Agent Identification: CDC and FDA will continue to develop and support laboratory capacity expansion to
improve analysis of biological or toxic substances that uses validated, proven methods for different sample matrices. CDC
and FDA will also support the development and validation of laboratory methods for priority biological and toxic substances
through the Laboratory Response Network. Emergency Preparedness: HHS administers two major grant programs that support State
and local capacities, as well as capabilities to prepare for and respond to public health emergencies. Over the next 5 years,
these programs will shift dramatically, from a focus on capacity building to improving targeted capabilities. ASPR administers
the National Bioterrorism Hospital Preparedness Program, which, through States, enhances the ability of the health care system,
including hospitals, to prepare for and respond to bioterrorism and other public health emergencies. Program priority areas
over the next 5 years include improving bed and personnel surge capacity, decontamination capabilities, isolation capacity,
and pharmaceutical supplies, as well as supporting training, education, drills, and exercises. CDC administers the Public
Health Emergency Preparedness Cooperative Agreement Program, which provides funds to States and localities for State and community-level
preparedness. Over the next 5 years, HHS will place increased emphasis on achieving benchmarks and standards for preparedness
by recipients of both funding streams as required by PAHPA. Countermeasures: HHS, through all of its operating divisions,
seeks to shape and execute a comprehensive medical countermeasures program to protect our citizens against the threats of
today and into the future. This mission encompasses the breadth of activities required to accomplish that goal, including
threat agent monitoring and disease surveillance and detection, as well as research, development, acquisition, storage, deployment,
and utilization of medical countermeasures. NIH leads the effort for medical countermeasure basic research, early stage product
development, and clinical research. FDA is committed to facilitating the development and availability of safe and effective
medical countermeasures. CDC has responsibilities including disease monitoring through its infectious disease surveillance
program and medical countermeasure storage and deployment through its Strategic National Stockpile (SNS) program. The SNS
procures and stores large quantities of medicine and medical supplies to protect the American public if there is an emergency
(e.g., terrorist attack, influenza pandemic, or earthquake) severe enough to cause local supplies to run out. HHS will continue
to invest in research and development of medical countermeasures, procure safe and effective materials for the SNS, and work
with States to ensure that they are prepared to request, receive, and utilize SNS materials in the case of a public health
emergency. Pandemic Influenza: HHS pandemic influenza implementation activities support the larger National Strategy for Pandemic
Influenza, and many are conducted in concert with or in support of other Federal departments and agencies. The key strategies
for pandemic influenza preparedness focus on international activities; domestic surveillance; public health interventions;
medical response; vaccines, antivirals, diagnostics, and personal protective equipment; passive and active surveillance for
vaccine safety; communication; and support for State, local, and tribal preparedness. HHS, primarily through ASPR, CDC, FDA,
NIH, and OPHS, will continue to support the National Strategy by completing actions in these strategy areas. One major area
of focus will be building the prepandemic and pandemic influenza vaccine production capacity and vaccine supply. In April
2007, FDA approved the first U.S. vaccine for humans against the H5N1 influenza virus. FDA will continue to facilitate advanced
product development of both seasonal and pandemic influenza medical countermeasures, including novel vaccines, antivirals,
and rapid diagnostics. This will be accomplished by providing assistance to industry partners on domestic manufacturing capabilities,
accelerating the reviews of seasonal and pandemic influenza related products, and issuing guidance to external stakeholders
on various regulatory subjects, including clinical requirements for licensure of seasonal and pandemic influenza vaccines.
HHS agencies also will work closely with other Federal agencies and international partners, such as WHO and the ministries
of health in target countries. HHS has forward deployed a quantity of Tamiflu in Asia for the purposes of mounting a containment
operation to attempt to halt a potential influenza pandemic. In addition, HHS is engaged in a number of international pandemic
preparedness activities, through the International Partnerships on Avian and Pandemic Influenza, the Security and Prosperity
Partnership of North America, and the Global Health Security Initiative. People With Disabilities: Under Executive Order 13347,
all Federal emergency preparedness efforts must address the needs of individuals with disabilities and other vulnerable populations.
HHS has taken a leadership role in engaging the disability community and providing guidance to partners to address the unique
health needs of individuals with disabilities and other vulnerable populations, including children and youth with special
health care needs. In 2006, HHS and the U.S. Department of Homeland Security cosponsored a working conference for State emergency
preparedness, public health, aging, and disability agencies to facilitate dialog and collaboration among these organizations
toward the common goal embodied in the Executive Order. The result has been a living laboratory for State and Federal cooperation
and shared learning around the issue of emergency preparedness for vulnerable populations. OD and ASPR will implement and
monitor the use of the disability-based preparedness toolkit and public health staff training modules— developed by a broad-based
HHS workgroup—to ensure that the needs of children, youth, and adults with disabilities and chronic conditions are fully understood
by first responders and other emergency response providers at the Federal, tribal, State, and local levels during all emergency
situations. ASPR, OD, and OCR are working with the American Red Cross to develop an intake and assessment tool that will be
used at shelters to evaluate the functional needs of all individuals, including individuals with disabilities. This tool will
help ensure that individuals with disabilities have equal access to shelter services and are served in the most integrated
setting appropriate. On the local level, OCR’s 10 regional offices are working with other offices in HHS and States to provide
technical assistance and resources to plan for and respond to needs of individuals with disabilities in the event of an emergency.
Protected Health Information. In its review of State and local emergency plans issued in the summer of 2006, the U.S. Department
of Homeland Security identified misunderstanding and confusion surrounding the application of the HIPAA Privacy Rule protections
to information sought for emergency response planning purposes. OCR has implemented a new Web-based interactive decision tool
designed to assist emergency preparedness and recovery planners in determining how to access and use health information consistent
with the HIPAA Privacy Rule. The tool guides emergency preparedness and recovery planners through a series of questions regarding
how to apply the HIPAA Privacy Rule. The tool is available on OCR’s Web site along with bulletins containing information for
emergency providers on the disclosure of protected health information to assist with disaster relief efforts. Equal Access:
OCR has taken steps, consistent with a Federal Governmentwide effort, to help ensure that individuals with Limited English
Proficiency (LEP) have equal access to information, shelters, and other evacuation and relief efforts. For example, OCR is
working with ASPR and the American Red Cross to develop an intake and assessment tool that will be used at shelters to identify
and address communication needs of individuals with LEP. On the local level, OCR’s regional offices are working with HHS partners
and States to provide technical assistance and resources to plan for and respond to the needs of individuals with LEP in the
event of an emergency. Information Technology Support: HHS will be developing a deployable, interoperable first responder
electronic health record system. The electronic health record system for disasters will maintain the security and confidentiality
of health information. The intention is to field test possible platforms during the 2007 hurricane season to gain insight
into their benefits and limitations. There are few existing systems and standards in the broader health environment to interact
with at this time, so the expected benefits are to ensure quality of care and continuity of information sharing during a public
health emergency and its aftermath. Wider health sector standards development and endorsement by the Health Information Technology
Standards Panel and the Secretary will be completed to capitalize on the desired benefits of this approach toward continuity
and quality of care.
Indicator(s):
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