0. Regional Emergency Coordinator Program -Preparedness, Response and Recovery
Captain Kevin Sheehan, U.S. Public Health Service
Regional Emergency Coordinator/Field Supervisor
HHS Region IX

1. Federal Medical Preparedness & Response for Disasters and Special Events
Responses:
Haiti Earthquake
American Samoa Tsunami
President Obama Inauguration
Republican and Democratic National Conventions
G-8 and G-20 Meetings
North Dakota Floods
Gulf Oil Spill
Hurricane Katrina
Hurricane Ike & Gustav
Many other hurricanes
Preparedness
Southern California Earthquake Plan
New Madrid Earthquake Plan
Improvised Nuclear Plan for Nevada
Hurricane Plan for Hawaii
Typhoon Plan for Guam
Northern California Earthquake Plan
Cascadia Subduction Zone Plan – Northern California

2. HHS REC HPP RHA MRC RD ASPR OPEO ASH IGA REGIONS HEADQUARTERS
4/20/2017
HHS
Dept Health & Human Services
HEADQUARTERS
ASPR
Assistant Secretary for Preparedness & Response
OPEO
Office of Preparedness & Emergency Operations
ASH
Assistant Secretary
For Health
IGA
Intergovernmental Affairs
REGIONS
To quote Dr Yeskey “…the RECs are the lead for OPEO preparedness and response with the HPP FOs feeding into the REC program. FOs provide healthcare readiness info to the RECs and assist in assessing the healthcare impact during a response. They need to keep each other informed regarding exercises and issues of importance to both. While HPP FOs work in another program, their reason for existence is to ensure that hospitals are prepared to respond, so the RECs need to be kept informed by the FOs.”
Regional Emergency Coordinators (RECs) serve as ASPR’s primary representatives throughout the country at the regional level.
RECs work closely with State, local, tribal and private sector health, medical and emergency management officials to maintain high levels of preparedness throughout the country’s 10 disaster planning regions and integrate federal ESF 8 partners with state/local responders (EMS, LE, medical providers, hospitals). 
RECs participate in the development and implementation of regional and national policies, plans, and procedures that enhance local, state, tribal, federal and private sector preparedness and response capabilities. 
RECs collaborate with numerous partners to exercise and evaluate interdependent plans for preparedness and response to natural disasters, terrorist incidents, and other public health or medical emergencies.
ASPR HPP’s mission is to enhance the resiliency of healthcare systems to deliver coordinated and effective care during public health emergencies and mass casualty events.
HPP Regional Field Officers (FOs) assist HPP awardees better execute their cooperative agreement through enhanced monitoring, technical assistance, healthcare preparedness-related guidance and programmatic assistance to all awardees within their assigned region. 
HPP Regional FOs are the official regional liaison between the HPP headquarters staff (the HPP Project Officers) and the HPP award recipient (the states).
Regional HPP FO are also responsible for situational awareness, response support, integration across healthcare disciplines (hospitals, out pt providers), and verification of hospital reports and assessing healthcare exercises.
REC
Regional Emergency Coordinators
HPP
Hospital Preparedness Program staff
RHA
Regional Health Administrators
MRC
Medical Reserve Corps RD
Regional Directors

3. Today’s Agenda Role of the Emergency Support Function 8
Role of the Regional Emergency Coordinator Program
National Disaster Medical System (NDMS) Patient Movement
Federal Medical Service Access Teams and how they will interact with NDMS hospitals after a disaster
US Department of Health and Human Services role in Recovery

4. National Response Framework Emergency Support Functions (ESF)
4/20/2017
National Response Framework
Emergency Support Functions (ESF)
ESF #1
Transportation
ESF #2
Communications
ESF #3
Public Works & Engineering
ESF #4
Firefighting
ESF #5
Emergency Management
ESF #6
Mass care, housing, human services
ESF #7
Resource Support
ESF #8
Public Health & Medical Services
ESF #9
Urban Search & Rescue
ESF #10
Oil & HAZMAT Response
ESF #11
Agriculture & Natural Resources
ESF #12
Energy
ESF #13
Public Safety & Security
ESF #14
Long-term recovery
ESF #15
External Affairs
How the United States Government will respond
Coordination missions that are Federal responsibility
Selectively activated as needed
Provide staffing for incident management organizations
The NRP…..
The Basic Plan provides the structure and the processes for the national incident management approach. The Basic Plan includes the concept of operations, roles & responsibilities, implementation guidance, authorities, references, preparedness and plans maintenance.
Emergency Support Function Annexes group capabilities and resources into functions most likely needed during an incident. The ESF Annexes describe the responsibilities of primary and support agencies that are involved providing support to a State or other Federal agencies during Incidents of National Significance.
Within the National Response Plan Framework, HHS has a critical lead role to manage the public health and medical response and support the Department of Homeland Security in their role of overall domestic incident management and Federal coordination.

5. Emergency Support Function (ESF) # 8 Department of Health & Human Services (HHS)
4/20/2017
Medical Care
Medical Equipment & Supplies
Patient Evacuation
Behavioral Health Care
Vector Control/Potable Water & Sanitation
Mortuary Services
Public Health Veterinary Care

6. About National Disaster Medical System (NDMS)
The mission of the National Disaster Medical System to temporarily supplement Federal, Tribal, State and Local capabilities by funding, organizing, training, equipping, deploying and sustaining a specialized and focused range of public health and medical capabilities.

7. Disaster Medical Assistance Teams (DMAT)
locally sponsored and community based.
ready to deploy within 12 hours of notification and then remain self-sufficient for 72 hours
consists of approximately individuals in each deployable unit
ER docs, nurses, paramedics, coms, command & control
deploy for 14 days

8. Medical Response Surgical Teams Mortuary Teams
Haiti
Mortuary Teams
Buffalo Plane Crash
US Public Health Service Officers
Public Health Teams
Mental Health Teams
Environmental Health

9. Health and Human Service Partners for Medical Response

10. Agenda continued, Role of the Emergency Support Function 8
Role of the Regional Emergency Coordinator Program
Health and Human Services in the Region
National Disaster Medical System (NDMS) Patient Movement
Federal Medical Service Access Teams and how they will interact with NDMS hospitals after a disaster
US Department of Health and Human Services role in Recovery

11. Information Analysis and Performance Measurement
4/20/2017
Regional Emergency Coordinators (RECs) HHS/ASPR REGIONAL OFFICE RESPONSIBILITIES
Event Occurs
Goal: Community Resiliency
Goal: Effective Field Operations
Risk Management
Mitigation
Prevention
Integration
Preparedness and Readiness Planning (Ready to Act)
Response and Transition
to Recovery
Training and Exercises
ICS
NRF/NIMS/Health Security
Intergovernmental/Agency Coordination
and Integration
Manage Response Teams
Improve Response Times/Effectiveness
Logistics
After Action Lessons Learned
Information Analysis and Performance Measurement
RECs daily jobs span the spectrum of the Emergency Management cycle
A majority of time and effort are spend on preparedness and readiness planning
This requires significant investments of time and attention to relationship building, developing partnerships, and information sharing
During disasters/public health emergencies within the region or responding outside the region, RECs step in to ASPR response leadership roles.
ESF 8 Leader – directs the overall strategic direction of the federal public health and medical response effort in coordination with the State. Responsible for mission development and coordination with EMG and IRCT commander for mission execution
ASPR Incident Response Coordination Team (IRCT) Commander – provides overall coordination and direction of the IRCT and HHS response teams based on broad strategic direction from the EMG and JFO.
ESF 8 Liaison - involved in mission generation and sit in positions at the State Emergency Operations Center (EOC), RRCCs; JFOs, Joint Operations Centers (JOCs), etc. These LNOs report directly to the ESF-8 lead.
All of the positions the RECs assume during a response include developing situational awareness and managing information.
For responses within the region, RECs are responsible for communicating with regional HHS OPDIVs/STAFFDIVs (usually through the RAC) details about HHS response activities, priorities and requests for information.

12. HHS/ASPR Region Spheres of Influence
4/20/2017
Local Health Officials
State Health Officers
Tribes
Community Volunteer Based Organizations
Faith Based Organizations
RHA
Universities
Private Industry
FEMA
Local Elected Officials
DHS VA
ASPR Regional
Executive
Leadership
Network
Congress
State EMA
Governor’s Offices
DoD
REC RD
ESF #8 Response Assets
1. RECs are part of the larger executive leadership team that ensure a significant cross section of the ESF 8/public health and medical stakeholders are engaged and active in preparedness planning and response. This takes considerable coordination, work and collaboration. It truly exemplifies a team approach to regional planning and response.
Other Federal Agencies
Public Affairs
Public Health Preparedness
Directors
HHS/ASPR Region Spheres of Influence

13. In-Transit Visability Not Used In-Transit Visability
4/20/2017
Patient Movement Schematic
“The Continuum of Patient Movement”
FEMA Ambulance Contract
(Ambulances and Care Flight)
NGB – EMAC / Title 32
Local
Federal ESF#8
State
DoD Mil Air
NDMS
Origination /
Disaster
Area
Ground /
Air Transport
NDMS
Destination
Site
Hospital / FMS
DoD Air Transport
Patient Transport Begins
APOE
APOD
FCC
Traditional
EMR Encounter
* Initial JPATS Entry /
EMR Encounter
* Notional / Desired Entry of Pt Info
Enters
TRAC2ES
Exits
TRAC2ES
In-Transit Visability
Origination /
Disaster
Area
Federal ESF#8
Destination
Site
Click to start the overlay of functional areas. Click once to start the direction from left to right (top portion of the diagram), and click a second time to overlay the functional areas over the bottom portion of the diagram, right to left.
APOD
APOE
DoD Air Transport
DoD Mil Air
NDMS
FCC
Not Used
Patient Reentry Transport Begins
FEMA Ambulance Contract
(Ambulances and Care Flight)
NGB – EMAC / Title 32
JPATS / EMR
In-Transit Visability
NoTRAC2ES
Hand-Off to Final Destination Facility

14. Agenda Role of the Emergency Support Function 8
Role of the Regional Emergency Coordinator Program
Health and Human Services in the Region
National Disaster Medical System (NDMS) Patient Movement
Federal Medical Service Access Teams and how they will interact with NDMS hospitals after a disaster
US Department of Health and Human Services role in Recovery

15. Service Access Teams Overview
Involves returning patients who were evacuated through Federal ESF#8
Destination locations could include home, originating facilities, intermediate care facilities
HHS Service Access Teams (SATs) shall ensure proper services afforded medical evacuees
SAT will serve as patient advocates and provide medical and human services case management
Patients will be tracked through the system using Joint Patient Assessment Tracking System (JPATS)

16. Service Access Team (SAT)
SAT will coordinate all aspects of patient return to ensure smooth transition from host State to final destination. Scope of services will include:
Work with FCCs, sending and receiving facilities, as well as State EOCs and health departments to identify/track patients
Ensure transportation, human services (language translation, food, lodging, etc) and arrangements for discharged patients and attendants
Coordinate return of patients and attendants to home state
Facilitate communication between attending physician and accepting physician in home state for those requiring follow-on care

17. # 1 - Coordination of Evacuee Return
SAT Primary Functions
# 1 - Coordination of Evacuee Return
Desired end state is return to home or appropriate placement
Medical evacuees are allowed to return when:
They are well enough to travel
The evacuated state has declared it is safe to return
There is an appropriate receiving facility

18. #2 – Medical Case Management
SAT Primary Functions
#2 – Medical Case Management
Coordinate services with facility discharge planners, receiving facilities, others as required
Communicates clearly to patients, families, providers, and staff of receiving facility
Arranges for medical transportation/ equipment

19. # 3 – Coordinate Evacuee Travel
SAT Primary Functions
# 3 – Coordinate Evacuee Travel
SAT communicates with patient movement contractor or the ASPR Response travel Section to arrange transportation
Movement may be through a variety of modes: air, train, ground
Arrange transportation services for non-medical attendants and/or family members who accompanied patient

20. # 4 – Coordinate Human Services
SAT Primary Functions
# 4 – Coordinate Human Services
HHS through the SAT will coordinate lodging and human services needs for all discharged patients until transportation to their final destination can be facilitated
Note: Family members that accompany patients or non-medical attendants will likely re-enter with patient and will require transportation that matches the patient

21. Service Access Teams (SAT)
#5 – Data Collection
SAT works with medical facilities, nursing homes, rehabilitative services units who are providing care to evacuees
SAT personnel will have access to the Joint Patient Tracking System (JPATS). Once operational, the SAT will be responsible for updating JPATS until patients are returned to their home state
Coordination with appropriate local and state agencies

22. In Case of Death
If a patient dies during response operations- SAT will coordinate with local or State medical examiner’s office and patient’s family for disposition of remains

23. JPATS Concept of Operations
Joint Patient Assessment Tracking System (JPATS) Team Basics:
Deployed as 2-person strike teams
Deployment locations:
Aerial Port of Embarkation (APOE)
Aerial Port of Debarkation (APOD) / FCC
Deployed within 24 hours of notification
Will remain until host unit (i.e., FCC) able to use JPATS

24. Agenda Role of the Emergency Support Function 8
Role of the Regional Emergency Coordinator Program
Health and Human Services in the Region
National Disaster Medical System (NDMS) Patient Movement
Federal Medical Service Access Teams and how they will interact with NDMS hospitals after a disaster
U.S. Department of Health and Human Services role in Recovery

25. Health and Human Services during Recovery
HHS Roles during Recovery
Lead for Recovery in Region – Regional Health Administrator
Disaster Response Framework (in progress)
~ National Response Framework
Recovery Support Functions (in progress)
~ Emergency Support Functions

26. Health and Human Services Recovery
4/20/2017
Health and Human Services Recovery
Recovery Issues
Restoration of Clinical Care Facilities (HHS/FEMA)
Patient Discharge/Placement (HHS/ASPR)
Patient Care for Uninsured (HHS/CMS)
Long term population surveillance (HHS/CDC)
Environmental Health (HHS/EPA)
Restoration of Essential Social Services (HHS/ACF/AOA)
Kids outside shelter in American Samoa after the tsunami.

27. Health & Human Services Recovery
4/20/2017
Health & Human Services Recovery
Laboratory Capacity (HHS/ASPR/CDC)
Coordination of Social Services / Disaster Case Management (FEMA/HHS/ACF)
Behavioral Health (HHS/SAMHSA)
Long term responder, occupational health issues (HHS/CDC/NIOSH & DOL/OSHA)
Fatality Management (HHS/ASPR)
Injured resident in American Samoa after the tsunami (Reuters)

28. Review Role of the Emergency Support Function 8
Role of the Regional Emergency Coordinator Program
Health and Human Services in the Region
National Disaster Medical System (NDMS) Patient Movement
Federal Medical Service Access Teams and how they will interact with NDMS hospitals after a disaster
U.S. Department of Health and Human Services role in Recovery

29. Haiti Hospital Site Gheskio University in Port-Au-Prince Haiti
Health and Human Services Surgical Team deployment

30. Contact Info
Region IX Regional Emergency Coordinators
Kevin Sheehan