CDC Preparedness and Response Activities Prevent, Detect, Investigate, Control, Recover, Improve

1. CDC Preparedness and Response ActivitiesPrevent, Detect, Investigate, Control, Recover, Improve

2. Presentation Outline • CDC preparedness and response activities overview • Description of basis and authority of CDC response • CDC management structure • Field management structure • Overview of deployment process and supporting incident management structure

3. DEOC 21 770-488-7100 24/7

4. CENTERS FOR DISEASE CONTROL AND PREVENTION CDC WASHINGTON OFFICE OF CHIEF OF OFFICE STAFF OFFICE OF OFFICE OF CHIEF ENTERPRISE OPERATING OFFICER COMMUNICATION OFFICE OF THE DIRECTOR OFFICE OF CHIEF OF OFFICE OF STRATEGY PUBLIC HEALTH AND INNOVATION PRACTICE OFFICE OF OFFICE OF CHIEF WORKFORCE SCIENCE OFFICER AND CAREER DEVELOPMENT Coordinating Center for Coordinating Office For Coordinating Center for Coordinating Center Coordinating Center Coordinating Office Health Information and Terrorism Preparedness Environmental Health for Health for Infectious of Global Services & Emergency Response Promotion and Injury Prevention Diseases Health National Center for National Center for Birth National Institute for Environmental Health / National Center for HIV , National Center for Defects and Occupational Safety Agency for Toxic STD , & TD Prevention Health Marketing Developmental and Health Substances and Disease Disabilities * Registry National Center for National Center for Injury National Center for Chronic Disease National Center for Prevention and Control Health Statistics Prevention and Health Infectious Diseases Promotion National Center for Public Office of Genomics and National Immunization Health Informatics Disease Prevention Program

5. Division of Emergency Operations

6. Preparedness Goals

7. Guiding References • HSPD-5, 8 (2003): Established policies to strengthen the preparedness of the Unites States to prevent and respond to terrorist attacks, major disasters and all-hazards. • National Response Plan: An all-discipline, all-hazards plan that establishes a single, comprehensive framework for the management of domestic incidents. • National Incident Management System: The National Incident Management System (NIMS) provides a consistent approach for Federal, State, and local governments to work effectively and efficiently together to prepare for, prevent, respond to, and recover from domestic incidents, regardless of cause, size, or complexity .

8. Guiding References cont. • Target Capabilities List (TCL): 36 essential capabilities that should be maintained and developed by government. • Universal Task List (UTL): A menu of tasks that may be performed during mitigation, preparedness, response and recovery from a major event. • National Planning Scenarios: A listing of 15 plausible terrorist attacks and natural disasters that would stretch the Nation’s prevention and response capability. • National Preparedness Goals: Planning, under uncertainty, to provide capabilities suitable for a wide range of threats and hazards by using risk-based target levels of capability, which enables entities to prioritize needs, update preparedness, allocate resources and deliver preparedness programs. • CDC Emergency Operations Plan with Annexes

9. National Response Plan: The Guiding Principles for Domestic Incidents • An all-discipline, all-hazards plan • Establishes a single, comprehensive framework for the management of domestic incidents • Provides the structure for Federal support • Consists of the Base Plan, Emergency Support Function Annexes (ESF), and Incident Annexes

10. National Incident Management System (NIMS) • A system that provides a consistent nationwide approach for incident management • Requires Federal, State, tribal, and local governments to work together before, during, and after incidents • Involves preparing for, preventing, responding to, and recovering from domestic incidents • All causes, sizes, and complexities ofincidents • Common terminology, structure, processes

11. The 15 ESFs

12. ESF 8: Public Health and Medical Services Primary Functional Agency: Department of Health and Human Services Purpose/Mission: Provide coordinated Federal assistance to Supplement State and local resources in response to public health and medical care needs following a major disaster or emergency Support Agencies: USDA, DOD, DOE, DOJ, DOT, VA, AID, ARC, EPA, DHS/FEMA/EPR, GSA, NCS, and USPS

13. ESF 8 Responsibilities • All-hazards consultation and technical assistance and support • Mental health care assistance • Public health and medical information • Vector control assistance • Potable water/waste water and solid waste disposal, and other environmental health issues • Victim identification / mortuary services • Veterinary services • Blood products and services • Assessment of public health/medical needs • Medical care personnel • Public health surveillance • Medical equipment and supplies • Patient evacuation • Patient care • Safety and security of human drugs, biologics, medical devices, veterinary drugs • Food safety and security • Agricultural safety and security • Worker health/safety

14. Director’s Critical Information Requirements (DCIR) • Report disease outbreaks that are above the base line for the seasonal or geographic norm. • Report H5N1 human to human transmission. • Report any chemical, biological, nuclear threats or events. • Report deaths from an infectious disease above normal base line. • Report media interest for any accidental or intentional agent or toxin release/use. • Report vaccine adverse affects resulting in death. • Report food borne illness resulting in large numbers affected. • Report accidental death/injury of CDC personnel. • Report requests for use of CDC aircraft.

15. Notification Process CDC DEOC

16. AWARENESS/ RESPONSE CDC RESPONSE SYSTEM TIERED PHASES HHS Response/ RL 0 - 5 • Response • Incident Manager • Full DEOC IM Staffing • Deploy CDC Resources • Monitor Incident • Deploy SMO • IAP development • Gather intelligence • Report Information • On-Scene: • IRCT/SMO/ESF#8 • SMO manage deployed resources • Alert • DEO Director: • CIO/ ATSDR SME Alerted • Mission Analysis Reviewed • Increased Activity: • Federal & State create COP • Conduct Planning-IAP • Deployment Preparation Watch DEOC Opns Chief DEOC Core Staff Global Monitoring CDC DCIR’s

17. CDC TIERED RESPONSE ALERT- RESPONSE TIER 3 100-232 TIER 2 60-100 STAFF IN DEOC TIER 1 30-45 WATCH TIER 0 3-7 EVENT INTENSITY

18. CDC / HHS Hurricane Phases to Tiers Chart

19. Basic ICS Structure PIO INCIDENT COMMANDER SAFETY LIAISON OPERATIONS PLANNING LOGISTICS FINANCE AND ADMISTRATION

20. CDC Event Management Challenges • Stabilize management structure • Core elements the same for all events • CDC-wide NIMS training and education • Reporting hierarchy • Synthesizing information received from field • Personnel accountability • Refining and exercising the plans

21. Command vs Management • Incident Command (IC) • On scene control over resources • Authority to direct missions • Decision authority to resolve on scene issues • Accountable for success or failure • Incident Management (IM) • Coordinate, gather information, analyze and recommend • Provide technical assistance through SME’s to the IC • Provide resources as requested by the IC to the scene • No direct authority over field resources • Monitor agency-provided resources in the field. • Agency resources under the Operational Control (OPCON) of the IC.

22. Sample Transition from Functional Organization to IMS

23. Transition from Current Organization to IM for Task Accountability, Authority, and Responsibility TASKS RESPONSE PLANNING WHO Phases IMS Coordinating Centers and CIOs = Authority Accountable Team Leads and members are responsible for coordination, planning and execution of tasks Provide Team Resources Coordinated by Chief Health Officer (Jim Leduc) Accountability remains with CC/CO/NIOSH Guidance Responsibility and authority for coordination and execution transitions to Team leads and Incident Management System

24. CDC Incident Management Structure

25. Operations Section

26. Planning Section

27. Logistics/F&A Sections

28. DHS (ESF # 8) PFO & JFO DHHS (ESF # 8) SOC/EMG CDC ESF # 8 Senior Health Official & IRCT States Dr. J L Gerberding CDC Senior Mgmt Officials (SMO) DEOC Incident Manager (Phil Navin) Chief Health Officer (Steven Redd) Deputy IM Officer (Mr. Bruce Burney) Deputy Health Officer (Toby Merlin) Chief OPNS & Science OPS Chief PLANS & Science PLANS Public Health Information Integration Center Chief LOG Chief FINANCE

29. Potential CDC Missions • Conduct PH needs assessments and environmental assessments. • Disseminate risk communication messages. • Provide vaccinations and medical supplies. • Conduct disease surveillance. • Provide mental health assessments and response. • Deployment of pharmaceuticals and medical supplies.

30. How is Assistance Deployed?The Mission Assignment Process

31. Hurricane Single-State Command Structure

32. CDC Senior Management Official:Role inEmergency Response

33. SMO - Primary Emergency Response Functions • Oversight of CDC resources in the state during an emergency event • Provide technical assistance to the state

34. SMO - Primary Emergency Response Functions • Provide situational awareness for both the state and CDC • Act as a point of connection for state and federal response systems and interact with other response partners

35. Oversight of CDC Resources • Responsible for CDC resources and personnel activated or deployed to state under the IRCT • Assure maximum coordination of CDC resources with DHHS and State Health Official to support State requirements

36. Incident Response Coordination Team (IRCT) Joint Field Office (JFO) CDC Field Teams CDC Field Response Structure State DOH CDC Senior Management Official (SMO) Locally conducts incident management and Federal Assistance coordination Provides on-site information from all sources to Secretary's Command Center for passing to other Operating Divisions, Agencies, etc

37. When a CDC Mission is Over…. • Rotation, every two to three weeks • Containment or mitigation of the event • State reassumes roles • SOC returns to normal operations • RRCC returns to normal operations

38. CDC Event Management Challenges • Stabilize management structure • Core elements the same for all events • Reporting hierarchy • Synthesizing information received from field • Personnel accountability • Refining and exercising the plans • CDC-wide NIMS training and education

39. Additional Resources Federal Emergency Management Agency (FEMA)www.fema.gov ICS • IS-100 Introduction to Incident Command System, I-100 http://training.fema.gov/EMIWeb/IS/is100.asp • IS-200 Basic Incident Command System, I-200, for Federal Disaster Workers http://www.training.fema.gov/EMIWeb/IS/is200.asp NIMS • IS-700 National Incident Management System (NIMS), An Introduction http://training.fema.gov/EMIWeb/IS/is700.asp NRP • IS-800 National Response Plan (NRP), An Introduction http://www.training.fema.gov/EMIWeb/IS/is800.asp National Emergency Management Association (NEMA) http://www.nemaweb.org • NEMA-CDC Incident Command System for Executives: Training Packagehttp://www.nemaweb.org/?1100

40. Additional Resources National Wildfire Coordinating Group (NWCG)www.nwcg.gov/default.htm There are six courses in the NWCG ICS curriculum: • I-100  ICS Orientation (Self-study; Module 1) http://www.nwcg.gov/pms/forms/ics_cours/i100/I100text.pdf •    I-200  Basic ICS (Modules 2-6) http://www.nwcg.gov/pms/forms/ics_cours/i200/i200.pdf •    I-300  Intermediate ICS (Modules 7-11) http://www.nwcg.gov/pms/forms/ics_cours/i300/i300.pdf •    I-400  Advanced ICS  (Module 12-15) http://www.nwcg.gov/pms/forms/ics_cours/i400/i400.pdf •    I-401  Multi-Agency Coordination  (Module 16) http://www.nwcg.gov/pms/forms/ics_cours/i401/i401.pdf •    I-402  ICS for Executives  (Module 17) http://www.nwcg.gov/pms/forms/ics_cours/i402/i402.pdf

41. Director’s Emergency Operations Center • Operational 24/7/365 • Uses Incident Command - FLOP • Conducts Information Management • Space for Agency LNOs • Complete Logistics • Redundant Communications • Functional Area Action Officers 770-488-7100

42. Questions? Success for the future….

43. Acronyms • HSPD: Homeland Security Presidential Directive • NIOSH National Institute of Occupational Safety and Health • OWCD: Office of Workforce and Career development • OSEP: Office of Security and Emergency Preparedness • CCHP: Coordinating Center for Health Promotion • CCID: Coordinating Center for Infectious Disease • CCEHIP: Coordinating Center for Environmental Health and Injury Prevention • ATSDR: Agency for Toxin Substances and Disease Registry • DSNS: Division of Strategic National Stockpile • OD/OCOO: Office of the Director/ Office of Chief Operation Officer • CCHIS : Coordinating Center for Health Information Service • SME: Subject Matter Expert • ESF: Emergency Support Function • ICS: Incident Command System • NIMS: National Incident Management System • OPEO: Office of Preparedness and Emergency Operations • FLOP: Finance, Logistics, Operations, and Planning (Sections of ICS ) • IRCT: Incident Response Coordination Team • LNO: Liaison