Planners: Preparedness and Response
Introduction
- Disaster response plans describe how various governmental and private sector entities are supposed to function individually and collaboratively during a disaster in order to protect the public and key infrastructure and continue to perform their missions.
- Hospitals, public health agencies and other health entities also have response plans specific for their missions.
- Planning details
- Some plans are appropriate for all types of incidents: "all hazard" plans.
- Some plans are hazard-specific e.g., chemical, biological, radiological, nuclear, natural disasters
- Hazard-specific response plans typically contain the critical elements of "all hazard" plans but also include modifications that address hazard-specific features
- Effective plans are
- Developed collaboratively by all potential participants
- Integrated into plans that will be used by others participating in the response
- Communicated to all those who will perform activities specified by the plan
- Practiced in formal drills or exercises
- Updated regularly to reflect lessons learned in formal exercises
- The nature, scope, and location of a mass casualty disaster will significantly affect the implementation of any response plan
- The documents featured below provide an overview of some of the current key documents relevant to medical response planning. The list is not exhaustive.
- If you are new to the planning process, please refer to pre-existing documents for your jurisdictions and workplace
- In 2009, the Institute of Medicine published a detailed document (purchase required) reviewing US medical preparedness to respond to a terrorist nuclear event.
- In 2011, the Nuclear Detonation Scarce Resources Working Group published a series of manuscripts about medical and public health planning and response to a nuclear disaster with scarce resources. (DMPHP, March 2011)
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Key Federal Disaster Response Planning Documents
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From the President of the United States
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Guidance for communities developing Emergency Operations Plans
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Comprehensive Preparedness Guide (CPG) 101, Version 2, Developing and Maintaining Emergency Operations Plans: (PDF - 1.86 MB) (FEMA, Nov 2010)
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Foundation for state, territorial, tribal, and comprehensive local emergency planning in the United States.
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Comprehensive Preparedness Guide (CPG) 201, Comprehensive Preparedness Guide 201: Threat and Hazard Identification and Risk Assessment Guide
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Five-step process for developing an understanding of its risks from natural, technological, and human-caused threats and hazards,
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Allows a community to make informed decisions about how to manage risk and develop needed capabilities
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National Response Framework (NRF)
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National Incident Management System (NIMS)
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"Systematic, proactive approach to guide departments and agencies at all levels of government, nongovernmental organizations, and the private sector to work seamlessly to prevent, protect against, respond to, recover from, and mitigate the effects of incidents, regardless of cause, size, location, or complexity, in order to reduce the loss of life and property and harm to the environment."
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National Health Security Strategy (HHS, December 2009)
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Comprehensive strategy focused on protecting people's health during a large-scale emergency
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Represents a national — not just federal — strategy, and therefore it requires the commitment of a broad range of stakeholders: all levels of government, as well as individuals, families, and communities (including the private sector, non-governmental organizations, and the academic and research sectors).
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Designed to achieve two goals
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Build community resilience: healthy individuals, families, and communities with
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access to health care and with
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the knowledge and resources to know what to do to care for themselves and others in both routine and emergency situations
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Strengthen and sustain health and emergency response systems.
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Reflects current approaches and priorities for improving our Nation's ability to prevent, prepare for, respond to, and recover from a major health incident
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Sets priorities for government and non-government activities over the next four years
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Interagency Board (IAB)
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Standardized equipment list (SEL)
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Provided to the local, state and federal responder communities for equipment standardization, enhanced ease of interoperability and common terminology across all responder groups
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The SEL has traditionally contained a list of generic equipment recommended by the IAB to local, state, and federal government organizations in preparing for and responding to all Chemical, Biological, Radiological, Nuclear, and Explosive (CBRNE) events.
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This 2009 version edition continues the transition to a broader "all-hazards" SEL, while maintaining an emphasis on CBRNE events.
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The SEL is a guideline, and its use is voluntary.
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The document mentions of a variety of items useful in a radiation emergency.
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National Infrastructure Protection Plan (PDF - 4.5 MB) (DHS, 2009)
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HHS: Explaining Federal Declaration of Public Health Emergency
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HHS: Explaining Food and Drug Administration's Emergency Use Authorization
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Key US Radiation-specific Response Plans
- Approach to Optimizing Decision Making for Late-Phase Recovery from Nuclear or Radiological Terrorism Incidents, SC 5-1 (NCRP draft in progress), National Council on Radiation Protection and Measurements, Bethesda, MD.
- The Nuclear Detonation Scarce Resources Working Group has published a series of manuscripts about medical and public health planning and response to a nuclear disaster with scarce resources. (DMPHP, March 2011)
- State and Local Planners Playbook for Medical Response to a Nuclear Detonation (HHS/ASPR, March 2011)
- Responding to an RDD / RED Emergency: the HHS Playbook, guidance for executive decision makers within the Department of Health and Human Services (HHS) in the event of an actual radiological terrorist attack in a U.S. city. (HHS/ASPR, April 2010)
- Nuclear/Radiological Incident Annex to the National Response Plan (Current as of 6/08)
- Planning Guidance for Response to a Nuclear Detonation, Second edition, 6/2010 (PDF - 2.62 MB) (National Security Staff, Interagency Policy Coordination Subcommittee for Preparedness & Response to Radiological and Nuclear Threats)
- Planning Guidance for Protection and Recovery Following Radiological Dispersal Device (RDD) and Improvised Nuclear Device (IND) Incidents (PDF - 519 KB) (DHS/FEMA, published in Federal Register, August 1, 2008, Z-RIN 1660-ZA02)
- EPA Manual of Protective Action Guides and Protective Actions for Nuclear Incidents (PDF - 15.57 MB) (EPA 400-R-92_001, May 1992. Currently under revision.)
- Radiological Emergency Preparedness, Program Manual (Draft), Released for Public Comment, May 18, 2009 (PDF - 1.53 MB) (FEMA). This document is about making a response plan for a nuclear reactor accident and is currently under review.
- See also: Develop a Radiation Response Plan
- See also: Equip an Emergency Department for Decontamination
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State, Territorial, Tribal, and Local Government Disaster Response Planning
- National Alliance for Radiation Readiness
- Radiological Response Annex Template for Local Health Departments: a fully customizable template of a radiation-specific annex to an all-hazards Emergency Operations Plan. This template outlines the potential roles for local public health in a radiation emergency and provides links to additional tools and resources. (NACCHO, 2011)
- Department of Homeland Security template for all hazard disaster planning:
- State and Local Planners Playbook for Medical Response to a Nuclear Detonation (HHS/ASPR/OPEO/OPP, March 2011)
- Emergency Preparedness Resource Inventory (EPRI) - Second Generation A Tool for Local, Regional, and State Planners (HHS/AHRQ, May, 2011)
- Public Health Emergency Response Guide for State, Local, and Tribal Public Health Directors - Version 2.0, (HHS/CDC, April 2011)
- Public Health Preparedness Capabilities: State and Local Planning (PDF - 2.93 MB) (HHS/CDC, March, 2011)
- Planning for medical care with scarce resources:
- In mass casualty situations when there are scarce resources, it may become necessary to implement "crisis standards of care" for medical activities.
- The Nuclear Detonation Scarce Resources Working Group has published a series of manuscripts about medical and public health planning and response to a nuclear disaster with scarce resources. (DMPHP, March 2011)
- Guidance on creating, and implementing these standards is the subject of a recent report from the Institute of Medicine. (2009, purchase required) Brief summary is available without a fee (PDF - 319 KB). Updated recommendations from IOM were published in 2012, and implementation suggestions were published by AHRQ in 2012.
- Response planning for radiation mass casualty events (selected documents)
- Planning Guidance for Response to a Nuclear Detonation, Second edition, 6/2010 (PDF - 2.62 MB) (National Security Staff, Interagency Policy Coordination Subcommittee for Preparedness & Response to Radiological and Nuclear Threats)
- Key Response Planning Factors for the Aftermath of Nuclear Terrorism (PDF - 4.52 MB) (Lawrence Livermore National Laboratory, August 2009)
- Hrdina CM, Coleman CN, Bogucki S, Bader JL, Hayhurst RE, Forsha JD, Marcozzi D, Yeskey K, Knebel AR. The "RTR" medical response system for nuclear and radiological mass-casualty incidents: a functional TRiage-TReatment-TRansport medical response model. Prehosp Disaster Med. 2009 May-Jun;24(3):167-78. [PubMed Citation]
- Planning Guidance for Protection and Recovery Following Radiological Dispersal Device (RDD) and Improvised Nuclear Device (IND) Incidents (PDF - 519 KB) (DHS/FEMA, published in Federal Register, August 1, 2008, Z-RIN 1660-ZA02)
- See also: Surge Capacity
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Incident Command System and Hospital Incident Command System
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Selected National and International Radiation Event-specific Response Planning Documents
- Joint Radiation Emergency Management Plan of the International Organizations (European Commission, Europol, FAO, IAEA, INTERPOL, IMO, OECD/NEA, PAHO, UNEP, UN/OCHA, UN/OOSA, WHO, WMO, ICAO, UNSCEAR, January 1, 2010) (PDF - 1.57 MB)
- International Agency for Atomic Energy (IAEA)
- Triage, Monitoring and Treatment - Handbook for management of the public in the event of malevolent use of radiation (Registration required for download) (TMT Handbook Partners)
- Assessing Medical Preparedness to Respond to a Terrorist Nuclear Event. Workshop Report. (Institute of Medicine of the National Academies. June 15, 2009. Purchase required.)
- Public Health Preparedness and Response to Chemical and Radiological Incidents — Functions, Practices, and Areas for Future Work (RAND Corporation, 2009, TR-719-DHHS)
- Key Response Planning Factors for the Aftermath of Nuclear Terrorism (PDF - 4.52 MB) (Lawrence Livermore National Laboratory, August 2009)
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