1. To provide leadership and services for San Antonio and Bexar County to prevent illness and injury, promote healthy behaviors, and protect against health hazards. Key Services City of San Antonio (COSA) Metropolitan Health Mission Mitigation-Preparedness-Response-Recovery Federal Partners: (SAMMC, DHS, CDC): Receive the SNS from CDC. Coordinate with partners to identify pandemics and disease. Distribute SNS to all regional partners. Conduct lessons learned with public health assets. State Partners: (TDPS, TDSHS) Coordinate medical volunteers. Enforce state public health code and laws. Conduct lessons learned with state partners. Ensure rebuilding is IAW health zoning laws. Local Partners: (City of San Antonio & Bexar County) Community engagement and education. Community health. Disease control. Food and water inspection. Mental health. Coordination and Role in National Response Framework National Incident Management System Incidents begin locally, are managed locally on a daily basis, preferably at the local level (organizational and geographically). Lessons Learned from 9/11 Basic Response Action Plan Women/ Children Health Promotion Healthcare enforcement, free clinics, screenings, school presentations, young parent classes, family planning Immunizations Social work services, mental health Venereal disease mitigation Environmental Protection Inspections: Food, water, livestock, restaurants Disease Control: Quarantine, confinement measures Disinfestation (vector control) Emergency Preparedness Strategic National Stockpile Decontamination Mitigation: Identification of at risk areas of the city, underserved populations. Response: Collaboration with neighboring jurisdictions, mental health considerations/assets. Management of Response Personnel: In aftermath of 9/11, overflow of well intended volunteers that frustrated efforts of rescue workers. Metro Health mission positive outlet for this manpower. Primary emergency response responsibilities Coordinates health and medical care and EMS support. Disseminates public health information and education. Inspection of food and water supplies. Develops and publishes emergency public health regulations and orders. Coordinates collection, identification, and interment of deceased victims. Coordinates disaster mental health services to disaster victims, emergency workers, and/or others suffering trauma due to the emergency incident/disaster. Responsibilities to be done in conjunction with San Antonio Fire Department HAZMAT team Maintains inventory of radiological equipment. Provides response forces to include personnel with current training in radiological monitoring and decontamination. Assists in response to radiological incidents and terrorist incidents involving radiological materials. Makes notifications concerning radiological incidents to state and federal authorities. US Department of Homeland Security. (2008) National incident management system. Washington, D.C. City of San Antonio Metro Health District. (n.d.). Retrieved from https://www.sanantonio.gov/Health.aspxhttps://www.sanantonio.gov/Health.aspx FEMA. (2014, July 14). Federal Emergency Management Agency. Retrieved from http://www.fema.gov/media-library/assets/documents/32230?id=7371http://www.fema.gov/media-library/assets/documents/32230?id=7371 Office of Emergency Management San Antonio. (2014). Basic Plan. Retrieved from www.saoemprepare.comwww.saoemprepare.com

2. San Antonio Metro Health Coordination Phase 1 Coordination Phase 1 COA/Action Plan Phase 1 COA/Action Plan Phase 1 Coordination Phase 2 Coordination Phase 2 COA/Action Plan Phase 2 COA/Action Plan Phase 2 Coordinate with SAMMC to determine requirements and identify shortfalls. Coordinate with DHS and immigration officials to determine location of children who have left Lackland AFB. Coordinate with TDSHS and TDPS to request support to fill short-falls. Coordinate with CDC to acquire SNS assets. Pre-test all Metro Health personnel for TB, review testing procedures. Deploy Public Health assets to Lackland AFB to contain outbreak of TB. Pre-stage testing equipment at local clinics and hospitals. Communicate with community partners to include: hospitals, community leaders. Deploy epidemiologist to explore any/all outbreak scenarios. Request the Mayor of San Antonio to request the state governor to assign Bexar County Health Authority powers in accordance with state code. Powers include: testing, quarantine, and decontamination. San Antonio Emergency Operation Cell begins coordination with all local agencies: pandemic/ communicable disease. Openly discuss TB mitigation and screening plans with all local organizations, media outlets, and community leaders. Prepare emergency screening clinics and quarantine facilities for use. Deploy SNS to Federal and Bexar County partners. Activate clinics and quarantine facilities are fully operational. Conduct selective compulsory TB testing (schools, government organizations) as well encourage use of free testing clinics throughout San Antonio area. Utilize volunteers to perform screenings, follow-up on no show re- screening. US Department of Homeland Security. (2008) National incident management system. Washington, D.C. City of San Antonio Metro Health District. (n.d.). Retrieved from https://www.sanantonio.gov/Health.aspx https://www.sanantonio.gov/Health.aspx FEMA. (2014, July 14). Federal Emergency Management Agency. Retrieved from http://www.fema.gov/media-library/assets/documents/32230?id=7371 http://www.fema.gov/media-library/assets/documents/32230?id=7371 Office of Emergency Management San Antonio. (2014). Basic Plan. Retrieved from www.saoemprepare.com www.saoemprepare.com US Department of Homeland Security. (2008) National incident management system. Washington, D.C. City of San Antonio Metro Health District. (n.d.). Retrieved from https://www.sanantonio.gov/Health.aspx https://www.sanantonio.gov/Health.aspx FEMA. (2014, July 14). Federal Emergency Management Agency. Retrieved from http://www.fema.gov/media-library/assets/documents/32230?id=7371 http://www.fema.gov/media-library/assets/documents/32230?id=7371 Office of Emergency Management San Antonio. (2014). Basic Plan. Retrieved from www.saoemprepare.com www.saoemprepare.com

3. PHASE I: Incident SAMMC San Antonio Metro Health Texas Dept. Public Safety Texas Dept. State Health Services Northern Command Lackland AFB CDC Department of Homeland Security International Communities WHO Mayor DP US Department of State TX GOV DP President DP Legend Communication Notification Decision Point DHHS SOC

4. PHASE II: Response Plan SAMMC Northern Command US Department of State CDC San Antonio Metro Health STRAC DHS (Lead Agency) President International Communities WHO SEC DEF TX GOV Texas Dept. Public Safety Texas Dept. State Health Services SOC Media Legend Communication Notification Decision Point STRAC Group AFB