1. ASPR: Resilient People. Healthy Communities. A Nation Prepared. ASPR CBRNE Branch Science & Response CBRNE Branch PREP Division Office of Emergency Management HHS/ASPR May 12, 2016 http://www.phe.gov/about/oem/cbrne

2. ASPR: Resilient People. Healthy Communities. A Nation Prepared. 2 Disclaimer The views and opinions expressed in this presentation are strictly that of the presenter and are not necessarily the views of ASPR, the Department of Health and Human Services, or the United States Government. No endorsement of products is implied.

3. ASPR: Resilient People. Healthy Communities. A Nation Prepared. 3 Goals

4. ASPR: Resilient People. Healthy Communities. A Nation Prepared. 4 What is ASPR?

5. ASPR: Resilient People. Healthy Communities. A Nation Prepared. 5 ASPR Organization

6. ASPR: Resilient People. Healthy Communities. A Nation Prepared. 6 HHS Role HHS, as the primary agency for ESF #8, coordinates with its Federal partners to provide assistance to state, local, tribal and territorial governments in identifying and meeting public health and medical requirements resulting from incidents of national significance. Assessment of public health/medical needs To include mental health Public health surveillance Medical personnel Medical equipment and supplies

7. ASPR: Resilient People. Healthy Communities. A Nation Prepared. 7 HHS/ASPR Capabilities

8. ASPR: Resilient People. Healthy Communities. A Nation Prepared. 8 Resources Compendium

9. ASPR: Resilient People. Healthy Communities. A Nation Prepared. 9 Resources (2)

10. ASPR: Resilient People. Healthy Communities. A Nation Prepared. 10 Resources (3)

11. ASPR: Resilient People. Healthy Communities. A Nation Prepared. 11 Example: Medical Care Personnel Capital Area Provider Teams Provide medical and public health resources and assistance during special events to augment the Office of the Attending Physician (OAP) medical staff supplying care during events at the United States Capitol. Disaster Medical Assistance Teams (DMAT) National Disaster Medical System (NDMS) assets are professional and para-professional medical personnel, supported by pharmacists, logistical and administrative staff that provide medical care during a disaster or other special events. Indian Health Services Resources Principal federal health care provider and health advocate for American Indians and Alaskan Natives (AI/AN) people. Comprehensive health service delivery system to members of 566 federally recognized Tribes located across 36 U.S. States. International Medical Surgical Response Teams (IMSuRT) Deployed at the request of the Department of State to treat United States (U.S.) citizens injured as a result of terrorism. A typical team configuration would consist of 50 members with flexible and mobile equipment, supplies, and pharmaceuticals. Medical Reserve Corps Program The Medical Reserve Corps (MRC) is a national network of MRC units comprised of volunteers, organized locally to improve the health and safety of their communities. The MRC network includes close to 1,000 community-based units and over 200,000 volunteers located throughout the United States and its territories Mobile Acute Care Response Teams (MAC-T) Provide critical care staging at a Disaster Aeromedical Staging Facility (DASF) in support of the Department of Defense (DoD) or Department of State (DoS). Secondary missions include patient evacuation using alternate methods of transport and ICU/PACU/ED decompression. Tactical Medicine Resources Provide direct operational medical support (Low Signature/Footprint Medical Capability, High Threat/Risk Medical Response), and Tactical Medical Education, Law Enforcement (LE) Medical Direction, LE Liaison/Force Protection Coordination, and Consultation. Rapid Deployment Forces Provides resources and assistance to State, Tribal and local health authorities throughout the United States. Like all Commissioned Corps response teams, they may be deployed in response to an ESF-8 or non- ESF-8 public health emergency.

12. ASPR: Resilient People. Healthy Communities. A Nation Prepared. 12 The Spectrum of Care & Phased Deployment

13. ASPR: Resilient People. Healthy Communities. A Nation Prepared. ESF #8 Operations Centers HHS Secretary’s Operations Center – Washington, DC ─Activated 24/7 since 2002. ─Used for oversight of all major operations. ─US hub for international health information reporting CDC Operations Center – Atlanta, GA ─Tracks and manages public health information. ─Serves as a centralized facility to gather and disseminate public health information.

14. ASPR: Resilient People. Healthy Communities. A Nation Prepared. 14 Response Personnel National Disaster Medical System (NDMS) ─1700+ Hospitals ─Patient movement ─Disaster Medical Assistance Teams (DMAT) ~5000 professionals Public Health Service ─~ 4200 deployable professionals Medical Reserve Corps (MRC) ─Primarily local / Community Based. Emergency System for Advance Registration of Volunteer Health Professionals (ESAR-VHP) ─National system of State-based programs for managing health professional volunteers

15. ASPR: Resilient People. Healthy Communities. A Nation Prepared. 15 CBRNE Branch Mission To provide medical and health-related CBRNE subject matter and operational expertise across the spectrum of ASPR preparedness and response; to recognize, anticipate and evaluate gaps in the Nation’s medical and public health response systems; and through cooperative professional interactions, to develop innovative, evidence-based interventions that strengthen the Nation’s medical and public health emergency response. Vision The Nation’s health and response systems and communities will be prepared, responsive and resilient to limit the adverse health impacts of CBRNE emergencies.

16. ASPR: Resilient People. Healthy Communities. A Nation Prepared. 16 CBRNE Program Organization Core SME Cadre (Where do SME’s come from?)

17. ASPR: Resilient People. Healthy Communities. A Nation Prepared. 17 Expertise and Response

18. ASPR: Resilient People. Healthy Communities. A Nation Prepared. 18 ASPR Science Response

19. ASPR: Resilient People. Healthy Communities. A Nation Prepared. 19 CBRNE Branch Mission ─Provide health-related CBRNE subject and operational expertise across the spectrum of ASPR preparedness and response ─To recognize, anticipate and evaluate gaps in the Nation’s medical and public health response systems; and ─Through cooperate professional interactions, to develop innovative; evidence- based interventions that strengthen the Nation’s medical and public health emergency response Who are our SME’s? ─Our SME’s are individuals who via education, training, and experience possess demonstrable specialized medical or scientific knowledge regarding the medical and public health aspects of CBRNE and technical hazards preparedness planning and response operations. What is their Role? ─Provide strategic advice to decision makers; ─Inform and develop evidence-based preparedness planning guidance and resources for planners and practitioners; and ─Come from federal and non-federal experts in various disciplines related to CBRNE and technical hazards medical response. CBRNE SMART Team Roles

20. ASPR: Resilient People. Healthy Communities. A Nation Prepared. 20 Synchronization with OEM & ASPR

21. ASPR: Resilient People. Healthy Communities. A Nation Prepared. 21 The vision is to engage the SMART Team in both preparedness planning and response activities. Expected responsibilities include: ─Collaboration and advise on CBRNE Branch analyses, other products and activities, and provide evidence-based support to CBRNE guidance; ─Direct support to ASPR (via CBRNE Branch, SOC, EMG, or other means) to inform planning and contingency operations; ─Review and analyze relevant science and information to enhance collaborative discussions; ─Utilize modeling data to link reality building dynamics to reflect population characteristics to help drive decision making; ─During an emergency, activation locally (home station) to provide evidence-based advice regarding the incident; and ─During an emergency, activation to incident location (TDY) to provide evidence-based advice regarding the incident. SMART Team Responsibilities

22. ASPR: Resilient People. Healthy Communities. A Nation Prepared. 22 SPiRIT Mission ─Improve the health and resilience of the nation through leadership and coordination of collaborative emergency science preparedness, response and recovery efforts that leverage a whole-of-community all-hazards approach before, during, and after large scale public health and medical emergencies and disasters. Who are our Research Responders? ─Our Research Responder’s are individuals who via education, training, and experience possess demonstrable specialized administrative or scientific knowledge regarding the aspects of emergency science research as applied throughout medical and public health preparedness, response and recovery operations. What is their Role? ─Utilize scientific methodologies to inform decision makers, responders and communities, before, during and after emergencies or disasters; ─Inform and develop evidence-based preparedness planning guidance and resources for planners and practitioners; and ─Derive from federal and non-federal experts in various disciplines related to an integrated all-hazards, whole-of-community, scientific, medical and public health preparedness approach. SPiRIT Research Responder Roles

23. ASPR: Resilient People. Healthy Communities. A Nation Prepared. 23 Tasks and Purpose As they applied to human health and response: ─Do a critical analysis of problem – Triage ─Characterize what is known - Evaluation ─Identify gaps in knowledge – Evaluation ─Assess potential public health impacts – Evaluation ─Develop recommendations – Provide Guidance & Decision Support ─Advise up to ASPR response considerations - Decision Support Subject Matter Advisory Resource (SMART) Team

24. ASPR: Resilient People. Healthy Communities. A Nation Prepared. 24 The vision is to engage the Research Responder in preparedness planning, response and recovery activities. Expected responsibilities would include: ─Collaboration and advise on scientific approach, other products and activities, and provide evidence-based support to ASPR and community guidance; ─Direct support to ASPR (via SPiRIT, SOC, EMG, or other means) to inform preparedness planning, response, recovery or contingency operations; ─Assist in the development, review and execution of pre-scripted research protocols, proposals, and dynamic or static funding mechanisms; ─Conduct scientific research before, during and after emergencies or disasters; ─Review and analyze relevant science and information to enhance informed decision making; ─During an emergency, activation locally (home station) to provide evidence-based advice regarding the incident; and ─During an emergency, activation to incident location (TDY) to provide evidence-based advice regarding the incident. SPiRIT Research Responder Responsibilities

25. ASPR: Resilient People. Healthy Communities. A Nation Prepared. 25 Technical Resources, Assistance Center, and Information Exchange (TRACIE) “Created to meet the information and technical assistance needs of regional ASPR staff, healthcare coalitions, healthcare entities, healthcare providers, emergency managers, public health practitioners, and others working in disaster medicine, healthcare system preparedness, and public health emergency preparedness.” TRACIE

26. ASPR: Resilient People. Healthy Communities. A Nation Prepared. 26 Technical Resources (TR) ─Compilation of resources from numerous contributors, including existing databases from the National Library of Medicine and other government agencies. It contains up-to-date disaster medical, healthcare system preparedness, and public health preparedness materials. Assistance Center (AC) ─Technical Assistance Specialists are available to assist with specific requests related to disaster medicine, healthcare system preparedness, and public health preparedness. Information Exchange (IE) ─Connect with your peers and participate in near-real time conversations about pending and actual health threats, share plans and other materials, and discuss promising practices and other information in a password-protected environment. TRACIE Components

27. ASPR: Resilient People. Healthy Communities. A Nation Prepared. CBRNE Branch on PHE.gov

28. ASPR: Resilient People. Healthy Communities. A Nation Prepared. 28 Radiation Emergency Medical Management (REMM)

29. ASPR: Resilient People. Healthy Communities. A Nation Prepared. 29 Chemical Hazards Emergency Medical Management (CHEMM)

30. ASPR: Resilient People. Healthy Communities. A Nation Prepared. 30 CBRNE Field Information Guide (FIG 1) Provides the user with medical management and medical treatment solutions to inform preparedness and response decisions. Provide swift and concise assistance to patients, officials, and leadership. A quick guide to provide: Descriptions of common CBRN agents Health effects and treatment information Operational response considerations Unique Organization Section 1 – Resources/References, includes teams & SNS. Section 2 – General Information for quick reference “at-a-glance” ─Basic CBRN facts and terminology. ─1-page summaries of common agents. Section 3 – includes more in-depth information for each of the agents in a rapid reference format.

31. ASPR: Resilient People. Healthy Communities. A Nation Prepared. 31 CBRNE Field Information Guide (FIG 2)

32. ASPR: Resilient People. Healthy Communities. A Nation Prepared. 32 CBRNE Field Information Guide (FIG 3)

33. ASPR: Resilient People. Healthy Communities. A Nation Prepared. 33 CBRNE Toolkit App for iOS and Android Portable media CBRNE Field Information Guide CHEMM/WISER REMM ExEMM IND Decision-Makers Guide Key peer-reviewed publications Other resources User-driven navigation

34. ASPR: Resilient People. Healthy Communities. A Nation Prepared. 34 CBRNE Toolkit (2)

35. ASPR: Resilient People. Healthy Communities. A Nation Prepared. 35 CBRNE Toolkit (3)

36. ASPR: Resilient People. Healthy Communities. A Nation Prepared. 36 IND Decision Maker’s Guide Planners, administrators, emergency managers, government officials, and other upper-level decision-makers Federal, State, local, tribal, and territorial public health and health-sector agencies and institutions Informational resource and practical guide ─presents essential background information ─provides the “why” behind the critical issues and decisions The Sections - Primers with key points and concise information The Guides - More detailed information Checklist and reference IT IS NOT ─tactical operations guide ─response plan or playbook ─substitute for preparedness efforts

37. ASPR: Resilient People. Healthy Communities. A Nation Prepared. 37 What is in it?

38. ASPR: Resilient People. Healthy Communities. A Nation Prepared. 38 Dynamic Navigation

39. ASPR: Resilient People. Healthy Communities. A Nation Prepared. 39 Section Contents

40. ASPR: Resilient People. Healthy Communities. A Nation Prepared. 40 Guide Contents

41. ASPR: Resilient People. Healthy Communities. A Nation Prepared. 41 Peer-reviewed Papers Biodosimetry: Medicine, Science, and Systems to Support the Medical Decision-maker Goal: To describe advances in radiation biodosimetry for massive radiation response and how data and expertise can be integrated into an systems approach to operational response. IND Fatality Management Goal: To better refine and define the actual anticipated number of accessible fatalities following an IND by time and location. Radiation TRiage, TRansport, & Treatment Goal 1: To provide a common lexicon between Civilian EMS; DoD “Roles of Medical Care”; RTR – compare and contrast. Goal 2: To better define owners, roles, functions, levels of care, resource requirements for operations in various RTR locations.

42. ASPR: Resilient People. Healthy Communities. A Nation Prepared. 42 QUESTIONS?