1. 1 ESF 8 Organizational Structure Federal Support Teams and Assets DHHS/ASPR Regional Emergency Coordinators CDR Mick Cote, CAPT Louis “Skip” Lightner, CDR Mark Byrd, CDR Amy O. Taylor

2. 2 To describe the Organization of ESF 8 To explain the scope of health and medical support services potentially available from the Federal Government during an emergency event To define specific skills of teams and clinical personnel To reinforce the process of defining the needs vs. asking for a particular asset Purpose

3. 3 Lead - Department of Health and Human Services Supporting Departments and Agencies – Homeland Security – Veterans Affairs – Defense – Transportation – Agriculture – Energy – Justice – Environmental Protection Agency – General Services Administration – American Red Cross – National Communications System – Office of U.S. Foreign Disaster Assistance – U.S. Postal Service Federal ESF 8

4. 1. Assessment of Public Health and Medical Needs 2. Health Surveillance 3. Medical Care Personnel 4. Health/Medical Equipment and Supplies 5. Patient Evacuation 6. Patient Care 7. Safety and Security of Human Drugs, Biologics, Medical Devices, and Veterinary Drugs 8. Blood and Blood Products 9. Food Safety and Security ESF 8 Response Capabilities

5. 5 ESF 8 Response Capabilities con’t: 10. Agriculture Safety and Security 11. Worker Health/Safety 12. All-Hazards Public Health and Medical Consultations, Technical Assistance, and Support 13. Behavioral Health Care 14. Public Health and Medical Information 15. Vector Control 16. Potable Water/Wastewater & Solid Waste Disposal 17. Victim Identification/Mortuary Services 18. Protection of Animal Health

6. 6  Emergency Management Group – Strategy and Resource Allocation  ESF 8 Lead – Incident Command and Mission Generation  Incident Response Coordination Team – Mission Execution and Tactics ESF 8 Response Structure EMGFEMA HQ JFO/RRCC IRCT State ESF 8 Assets ESF 8 Lead

7. 7 Applied Public Health Teams –consists of 47 Public Health Service Officers –deploy within 36 hours to augment the state/local public health –provide health needs assessment, disease surveillance, epidemiology and laboratory investigations, and environmental health hazard identification and control measures Epidemiological Surveillance Teams –2-person team –monitor conditions with local and state authorities –provide guidance and implement procedures to reduce the possibility of disease outbreaks –monitor health care facilities –assist local authorities to determine current status and capability of health care facilities to conduct out patient treatment, inpatient treatment and surgical care Public Health Assets

8. 8 Consumer Safety Officers –augment state and local staff to perform inspections of establishments serving food for conformance to appropriate food safety standards FDA Analysts –augment state and local staff to analyze samples of foods, drugs, medical devices and cosmetics to determine fitness for use Environmental Health Teams –two person teams –conduct vector surveillance –advise vector control measures and techniques –evaluate and assist in re-establishing safe water systems Worker Health and Safety Teams –two person teams to coordinate worker safety guidelines and distribute information and to monitor occupational health effects to ensure safety of federal responders

9. 9 Federal Medical Stations (FMS) –Cache of medical supplies and equipment that can be used to set up a temporary non-acute medical care facility –Each FMS has beds, supplies, and medicine to treat 250 people for up to three days FIT (FMS Installation Team) 2-3 person team –Provides technical assistance for FMS set up Rapid Deployment Force Team (RDF) –105 Public Health Service Officers –provide primary medical care, pharmacy, mental health and public health services for sheltered populations –medical staff augmentation at FMS –distribution operations for mass prophylaxis or vaccinations Medical Care and Equipment

10. 10 Laboratory Cache –Basic Lab Cache v i-STAT and Lifescan One Touch Glucometers v reagents, controls, and cartridges –Lab Plus Cache v all temperature sensitive reagents transported in climate controlled packages v includes the Beckman-Coulter ACT10, the Clinitek 50, the Piccolo chemistry analyzer v cardiac markers, pregnancy tests, urine drug screens, occult blood screens v additional laboratory tests

11. 11 Strategic National Stockpile (SNS) –12-hour Push Package - Pharmaceuticals and Medical Supplies v Shotgun approach when threat is poorly defined (med surge supplies, antibiotics, nerve agent antidote) –Vendor Managed Inventory v Tailored approach when threat is defined (PPE, antivirals) –TARU (Technical Advisory Response Unit): v team of six subject matter experts that assist local areas in receiving pharmaceuticals/supplies from the SNS

12. 12 National Disaster Medical System (NDMS) –Evacuation support of seriously ill or injured patients from casualty collection staging areas or hospitals in the disaster impacted areas. Patients will be taken to designated patient reception medical facilities where they can receive the appropriate level of care –Support may include: v transportation assets (FEMA and DoD) v medical regulating assistance and patient tracking support (DoD and VA) v en-route medical care (DoD and HHS) v medical personnel movement (DoD) v patient reception operations at Federal Coordinating Centers (DoD and VA) Patient Evacuation

13. 13 Disaster Medical Assistance Team (DMAT) –consists of 35 persons; it includes physicians, nurses, medical technicians, and ancillary support personnel –provide primary and acute care, triage of mass casualties –initial resuscitation and stabilization, advanced life support and preparation of sick or injured for evacuation –Emergency Department decompression –Self-sufficient for 72 hours National Veterinary Response Team (NVRT) –assess medical needs of animals –medical treatment and stabilization of animals –animal disease surveillance, zoonotic disease surveillance –public health assessments, technical assistance to assure food and water quality –animal decontamination –composed of clinical veterinarians, veterinary pathologists, animal health technicians, and other specialties Emergency Medical Assistance

14. 14 Disaster Mortuary Operational Response Team (DMORT) –work under the guidance of local authorities –provide technical assistance and personnel to recover, identify, and process deceased victims –Team composed of funeral directors, medical examiners, coroners, pathologists, forensic anthropologists, medical records technicians and transcribers, finger print specialists, forensic odontologists, dental assistants, x-ray technicians, and other personnel National Medical Response Team (NMRT) –provide medical care following a nuclear, biological, and for chemical incident –capable of providing mass casualty decontamination, medical triage, and primary and secondary medical treatment Specialized Medical Teams –Burn –Pediatric –Crush Medicine –International Medical / Surgical –Mental Health

15. 15 Federal Ambulance Support –FEMA contract w AMR; HHS is COTR –Provides ground and air ambulances, para-transit vehicles –300/25/3500 seats per zone; 2 zones currently Emergency Prescription Assistance Program (EPAP) –Inter-Agency Agreement between FEMA and HHS –Provides local pharmacists with prescription reimbursement for uninsured patients –One 30-day prescription –Tracked by patient zip code Additional Support Programs

16. 16 ESF 8: The Spectrum of Care & Federal Medical Resources NDMS DMATs Medical Reserve Corps Volunteers NDMS Hospitals NDMS DMORT USPHS APHT USPHS MHT USPHS RDF Basic First Aid Outpatient Care Hospital Inpatient Care Nursing Home Care Pre-hospital Care Fatalities Management Emergency Departments Food / Water Safety Drug / Blood Safety Mental Health Health Surveillance ICU/ Trauma Critical Care Individual Resources

17. 17 Locals request support State determines need and submits ARF –LNOs can provide technical assistance FEMA and ESF 8 Lead evaluate need FEMA generates MA ESF 8 determines best resource to meet need Access to ESF 8 Resources