Catastrophic Incident Supplement to the National Response Plan September 2004 FINAL DRAFT FOR OFFICIAL USE ONLY Catastrophic Incident Supplement January 2005 FOR OFFICIAL USE ONLY Homeland Security FINAL DRAFT to the National Response Plan January 2005 Catastrophic Incident Supplement | 1 National Response Plan National Response Plan ? Catastrophic Incident Supplement Implementation Instructions This Catastrophic Incident Supplement provides the operational framework for implementing the strategy contained in the National Response Plan Catastrophic Incident Annex, and is effective upon issuance. Departments and Agencies with designated responsibilities under this Catastrophic Incident Supplement (to include those specific response actions listed in the Catastrophic Incident Response Execution Schedule) are authorized 120 days to establish and institutionalize processes and procedures necessary to effectively execute those responsibilities, should the provisions of this Supplement be implemented. Departments and Agencies will notify the Secretary of Homeland Security, in writing, when the necessary processes and procedures are in place. Should conditions so warrant, the Secretary of Homeland Security may implement the provisions contained within the Supplement prior to the expiration of the 120-day process institutionalization period. Within 1 year of its effective date, the Secretary of Homeland Security will conduct an interagency review to assess the effectiveness of the National Response Plan Catastrophic Incident Supplement, identify improvements, and provide modification and reissuance recommendations, as required. The Department of Homeland Security will establish an operational review cycle to ensure regular revalidation of the actions and capabilities listed herein. 2 | Catastrophic Incident Supplement January 2005 National Response Plan THIS PAGE INTENTIONALLY LEFT BLANK January 2005 Catastrophic Incident Supplement | 3 National Response Plan National Response Plan ? Catastrophic Incident Supplement Table of Contents Implementation Instructions .........................................................1 Table of Contents ...................................................................3 List of Figures......................................................................4 List of Tables ......................................................................4 Basic Plan...........................................................................5 1. Purpose.......................................................................... 5 2.Premise........................................................................... 5 3. Concept of Operations............................................................ 7 5. Federal Execution Strategy....................................................... 9 6. Catastrophic Response Inhibitors ................................................ 15 Operational Annexes Annex 1 – Execution Schedule ........................................................1-1 Annex 2 – Transportation Schedule....................................................2-1 Reference and Overview Appendices Appendix 1 – Basic Planning Assumptions .............................................A1-1 Appendix 2 – Inventory of Federal Response Teams ....................................A2-1 Appendix 3 – Mass Care Response Overview.............................................A3-1 Appendix 4 – Search and Rescue Response Overview.....................................A4-1 Appendix 5 – Decontamination Response Overview ......................................A5-1 Appendix 6 – Public Health and Medical Support Response Overview.....................A6-1 Appendix 7 – Medical Equipment and Supplies Response Overview........................A7-1 Appendix 8 – Patient Movement Response Overview......................................A8-1 Appendix 9 – Mass Fatality Response Overview ........................................A9-1 Appendix 10 – Housing Response Overview ............................................ A10-1 Appendix 11 – Public Information and Incident Communications Response Overview.......A11-1 Appendix 12 – Private Sector Support Overview....................................... A12-1 Appendix 13 – Acronyms, Abbreviations, and Terms.................................... A13-1 4 | Catastrophic Incident Supplement January 2005 National Response Plan National Response Plan ? Catastrophic Incident Supplement List of Figures Figure 1 – NRP-CIS Resource Flow Concept of Operations.............................. 13 Figure 2 – NRP-CIS Resource Flow with Assessment Points............................. 14 Figure 4-1 – National Urban Search and Rescue Response System........................A4-4 Figure 5-1 – HAZMAT Team Response Times .............................................A5-10 Figure 5-2 – Ladder Pipe Decontamination System .....................................A5-12 Figure 5-3 – Personnel Decontamination Station (PDS) ................................A5-12 Figure 5-4 – Emergency Decontamination Corridor System (EDCS)........................A5-13 Figure 5-5 – Decontamination Decision Tree Example...................................A5-14 Figure 6-1 – Available Health/Medical Personnel Deployment Projections ..............A6-2 Figure 6-2 – NDMS Medical Specialty Force Strength...................................A6-4 Figure 6-3 – Operational (Type-I) Disaster Medical Assistance Teams and Management Support Team ........................................................................A6-5 Figure 6-4 – Medical Response Teams Under Development ...............................A6-6 Figure 6-5 – Medical Specialty Response Teams .......................................A6-6 Figure 6-6 – National Disaster Medical System Timeline of Care.......................A6-9 Figure 6-7 – U.S. Public Health Service Commissioned Corps Force Strength............A6-9 Figure 6-8 – Active U.S. Public Health Service Commissioned Corps Force Roster ......A6-10 Figure 6-9 – Medical Reserve Corps Communities.......................................A6-12 Figure 6-10 – Department of Veterans Affairs Staff ..................................A6-12 Figure 6-11 – Federal Coordinating Center Locations .................................A6-14 Figure 6-12 – Potential National Disaster Medical System Beds Available Through Federal Coordinating Centers ........................................................A6-14 List of Tables Table 1 – Push Assets ...............................................................2-2 January 2005 Catastrophic Incident Supplement | 5 National Response Plan National Response Plan ? Catastrophic Incident Supplement Basic Plan 1. Purpose The National Response Plan Initial Catastrophic Incident Supplement (henceforth, the NRP-CIS) outlines a coordinated strategy for accelerating the delivery and application of Federal and Federally accessible resources and capabilities in support of a jurisdictional response to a catastrophic mass victim/mass evacuation incident. Such an incident may result from a technological or natural disaster, or terrorist attack involving chemical, biological, radiological, nuclear, or high-yield explosive (CBRNE) weapons of mass destruction (WMD). As part of the articulated Federal response strategy contained herein, the NRPCIS outlines an aggressive concept of operations, establishes an execution schedule and implementation strategy, and, in the supporting appendices, provides functional capability overviews and outlines specific responsibilities of Departments and Agencies. The NRP-CIS provides the operational strategy summarized in the National Response Plan Catastrophic Incident Annex (NRP-CIA). 2. Premise A. An urban or metropolitan area, or more expansive geographical area encompassing a large aggregate population, suffers a sudden, catastrophic incident resulting (either immediately or over time) in tens of thousands of casualties (dead, dying, and injured) and producing tens of thousands of evacuees and/or affected-in-place. The response capabilities and resources of the local jurisdiction (to include mutual aid from surrounding jurisdictions and response support from the State) are profoundly insufficient and quickly, if not immediately, overwhelmed. In addition, characteristics of the precipitating event, such as contamination concerns or other public health implications, severely aggravate the response strategy and further tax the capabilities and resources available to the venue. Life saving support from outside the area will be required, and time is of the essence. It is expected that venue capabilities will be exceeded in one or more of the following areas: (1) Mass Care. The ability of State and local first responders to adequately manage and provide mass care (food and shelter) to a large, displaced, and potentially contaminated evacuee population numbering in the tens of thousands will be quickly exceeded. (2) Search and Rescue. If the incident involves collapsed structures, organic and mutual aid, search and rescue resources are likely to be extremely limited. If the search and rescue operations are required in areas of contamination, the availability of properly trained and equipped resources will be further reduced. (3) Decontamination. A WMD incident may involve contamination, and will require State and local first responders and reception centers receivers to organize, support, and conduct mass decontamination of casualties (including animals), evacuees, vehicles, and facilities. In addition, it will require the commencement of site characterization as well as monitoring of both air quality and for contamination among members of the public. Given the potentially immense numbers of casualties, evacuees, vehicles, and facilities resulting from such an incident, decontamination requirements will immediately outstrip State and local capabilities. (4) Public Health and Medical Support. There will be significant issues relating to environmental health and public health needs, including mental health services. Medical support will be 6 | Catastrophic Incident Supplement January 2005 National Response Plan required not only at medical facilities, but in large numbers at victim collection and evacuation points, evacuee and refugee points and shelters, and to support field operations. In addition, any contamination dimension will increase the requirement for technical assistance. The situation will quickly tax the organic public health and medical infrastructure. (5) Medical Equipment and Supplies. Depending on the nature of the incident, organically available supplies of preventive and therapeutic pharmaceuticals and treatments will be insufficient or unavailable to meet the demand, both real and perceived. Additionally, there will be insufficient numbers of qualified medical personnel to administer available prophylaxis to both the affected and adjacent (but worried) populations. Timely distribution of prophylaxis may be able to forestall additional people becoming ill and reduce the impact of disease among those already exposed. (6) Victim and Fatality Management and Transportation. The number of dead, injured, and exposed may number in the tens of thousands and immediately overwhelm State and local transportation capabilities and infrastructure. In addition, the immense numbers of casualties are likely to overwhelm the bed capacities of State and local medical facilities. (7) Public Information. A catastrophic mass victim/mass evacuation incident resulting from an act of terrorism may terrify the population, both in the incident area and nationally. If the State and local Government is overwhelmed by the scope and dimensions of the event and unable to provide quick, positive, continuous, consistent, and clear public information and guidance to the affected population, mass confusion and panic may ensue. On a national scale, the Federal Government must be prepared to immediately provide clear and coherent guidance and direction. B. Recognizing that Federal and/or Federally accessible resources will be required to support State and local response efforts in some or all of the preceding areas, the Federal Government has preidentified resources (e.g., medical teams, transportable shelters, preventive and therapeutic pharmaceutical prophylactic caches, Federal medical facilities, cargo and passenger aircraft, etc.) that are expected to be needed/required at or in support of an incident venue. Upon NRP-CIS implementation, the Federal Government will unilaterally and immediately “push” these predesignated resources to a federal mobilization center or staging facility near the incident area, as well as “push” certain actions (e.g., activate or make available Federal facilities, such as hospitals). Upon arrival, these resources will be redeployed to the incident area and integrated into the response operation only when requested/approved by and in collaboration with state/local incident command authorities, in accordance with the NRP and NIMS. (1) The NRP-CIS recognizes that State and local authorities may or may not ultimately require all of the resources that are initially “pushed” or made available to an incident venue in support of response operations and in anticipation of projected needs. Nevertheless, these resources will be deployed as rapidly as possible to ensure their timely availability, if and when needed. Additional resources will be deployed (if available) as precise requirements are subsequently identified through postincident needs assessments. (2) The development of venue-specific plans that fully integrate and leverage the resources and capabilities of all levels of Government and the private sector into a coordinated incident-specific advance response strategy will further accelerate the delivery of support and reduce the ratio of unneeded resources and capabilities within the pre-established “push-packages.” January 2005 Catastrophic Incident Supplement | 7 National Response Plan 3. Concept of Operations A. Local (Venue) Response (1) Responsibility for immediate response to an incident typically rests with local authorities and first responders, as augmented by inter-jurisdictional mutual aid and, when requested, the State. Accordingly, immediately following an incident, local authorities will: (a) Establish an Incident Command System (ICS) response and management authority and structure (e.g., identify an Incident Commander, establish an inter-jurisdictional Unified Command and, if necessary, Area Command) and initiate whatever response actions they are capable of taking with organic and inter-jurisdictional mutual aid resources. All resources and assistance provided to support the response (regardless of source) will be integrated within and employed through this incident command structure. (b) Commence assessment activities to determine critical support requirements that cannot be met by organic (Governmental and non-Governmental) and mutual aid resources, and that will require support and augmentation from the Federal Government. These requirements will be communicated to inter-jurisdictional, State, Tribal, and Federal authorities through and within the incident command structure, in accordance with the National Incident Management System (NIMS). NOTE: While the Catastrophic Incident Supplement is designed to augment and support the State and local response to a catastrophic incident, the Federal Government must be prepared to assume a more robust incident management role should State and local incident command capabilities be profoundly and adversely impacted by the catastrophic incident. (2) The Federal Government recognizes that each State and major urban area possesses varying levels of capability, organic resources, and mutual aid availability, as well as unique physical and social characteristics that will influence a tactical response strategy. Accordingly, to facilitate the rapid, coordinated, and seamless integration of Federal and Federally accessible resources into a localized immediate response effort, States and jurisdictions should, as part of a comprehensive pre-event planning strategy: (a) Retool existing State and jurisdiction response plans to reflect a coordinated advance strategy for receiving, deploying, and/or using the pre-identified resources contained in the Catastrophic Incident Response Execution Schedule (or venue-tailored variation thereof). (b) Identify Mobilization Centers, staging areas, receiving and distribution sites, victim collection points, temporary housing sites, and other key operational support facilities and necessary staffing. (c) Identify projected priority support requirements that will not be met by the Catastrophic Incident Response Execution Schedule or through existing local, mutual aid, and State resources and capabilities. B. State Response (1) The State will fully activate its incident management/response support architecture and coordinate, through the incident command structure overseeing the response, the provision of additional resources to the extent that State capabilities permit. 8 | Catastrophic Incident Supplement January 2005 National Response Plan (2) The ability of the State to quickly and effectively augment local response operations will be enhanced through participation in the retooling/development of venue-specific response plans to include a coordinated advance strategy for receiving, deploying, and/or using pre-identified State resources. C. Federal Response (1) The NRP-CIS assumes that a catastrophic mass victim/mass evacuation incident will trigger a Presidential disaster declaration, immediately or otherwise. Accordingly, the NRP-CIS will be implemented under and carried out within the framework, operating principles, and authorities of: (a) The National Response Plan (NRP). (b) The NIMS ICS organizational and relational structure. (c) Homeland Security Presidential Directive (HSPD)-5, Domestic Incident Management. (d) The Robert T. Stafford Disaster Relief and Assistance Act (henceforth, the Stafford Act). (e) National Preparedness for Bioterrorism and other Public Health Emergencies, 42 United States Code (U.S.C.) Sections 300hh and 300hh-11. (2) Federal support under the NRP is normally provided on an expressed-need basis. Incident venues, through their State emergency management authorities and in accordance with the ICS, identify life and property-saving requirements that cannot be met by organic and mutual aid resources, and request and, following a Presidential disaster or emergency declaration, receive assistance from the Federal Government. However, given the clear and compelling impacts and ramifications of a catastrophic incident, the NRP-CIS provides a more proactive and aggressive approach to the provision of Federal support. Immediately upon recognition that a venue has suffered a catastrophic mass victim/mass evacuation incident as determined by the Secretary of Homeland Security, this NRP-CIS will be implemented and the specific actions reflected in the Execution Schedule (Annex 1) initiated. Those actions (both standard NRP and unique to this NRP-CIS) include, but are not limited to: (a) Designating and deploying a Principal Federal Official (PFO) and support staff to directly represent the Secretary of Homeland Security. Until the designated PFO arrives in the area of response, the U.S. Department of Homeland Security (DHS)/Federal Emergency Management Agency (FEMA) Regional Director will assume the role of and function as Interim PFO. (b) Designating and deploying a Federal Coordinating Officer (FCO) and activating and deploying a Federal Incident Response Support Team (FIRST) and National Emergency Response Team (ERT-N) to the State Emergency Operations Center (EOC) and/or incident venue. The FIRST and ERT-N will coordinate Federal support, through the State and incident command structure, to local authorities. (c) Identifying and rapidly establishing necessary support facilities (Mobilization Centers, Joint Field Offices (JFOs), etc.) proximal to the incident venue. January 2005 Catastrophic Incident Supplement | 9 National Response Plan (d) Immediately activating and mobilizing incident-specific resources and capabilities (e.g., pharmaceutical caches, search and rescue teams, medical teams and equipment, shelters, etc.) for deployment to the incident venue. (e) Activating national and Regional-level operations centers and field support centers (e.g., teleregistration centers). (f) Activating and deploying reserve personnel to augment and support organic State/local response capabilities and requirements in critical skills areas. (g) Activating and preparing Federal facilities (e.g., hospitals) to receive and treat casualties from the incident area. Tribal hospitals and clinics in the area of the incident need to be considered. (h) Issuing timely public announcements to inform and assure the Nation about the incident and actions being undertaken to respond. If the venue and/or State infrastructure are incapable of providing timely incident information, warning, and guidance to the public in and around the affected area, the Federal Government will provide the necessary communications. (i) Activating supplementary support agreements with the private sector. NOTE: The advance retooling of State and local response plans to specifically address and include the pre-identification of projected victim and mass care support requirements, Regionally available private sector capabilities, critical skill and resource augmentation requirements, and corresponding deployment/employment strategies, will accelerate the availability, delivery, and integration of such resources. 4. Federal Execution Strategy A. The NRP-CIS will be implemented when the Secretary of Homeland Security determines that a precipitating incident will or may result in a mass victim/mass evacuation situation. Upon an implementation decision, relayed by the Homeland Security Operations Center (HSOC): (1) All Federal Departments and Agencies (including the American Red Cross (ARC)) identified to initiate incident type-specific actions in the Execution Schedule (refer to Annex 1) will implement/initiate those assigned actions within the directed timeframe(s), to include activating and mobilizing teams and resources for deployment. Transportation of mobilizing resources will be in accordance with the procedures beginning at paragraph C, below. (2) All Federal Departments and Agencies (including the ARC) assigned primary or supporting Emergency Support Function (ESF) responsibilities under the NRP will immediately implement those responsibilities, as appropriate or directed. Refer to the NRP for a description of individual ESF responsibilities. (3) The incident command structure/organization managing the response at the incident venue will prepare to receive and direct the integration of deploying/activated Federal resources into the response. B. Resource mobilization actions directed in the Execution Schedule will be initiated no later than their corresponding initiation times. However, deployment of mobilized resources will depend on the 10 | Catastrophic Incident Supplement January 2005 National Response Plan availability of air and surface transportation and the availability of adequate reception capabilities at the programmed destination. C. Upon activation of the NRP-CIS, DOT (as ESF#1 lead) will: (1) Fully mobilize the Crisis Management Center (CMC) at DOT HQ. This team will immediately begin an assessment of the transportation system and infrastructure providing reports to the DHS Homeland Security Operations Center (HSOC) and NRCC. (2) Provide dedicated staff to the DHS HSOC and IIMG. (3) Staff the ESF#1 desk at the NRCC. (4) Activate the ESF#1 Emergency Transportation Center (ETC) in Atlanta, GA. (5) Dispatch DOT Regional Emergency Transportation Representatives (RETREPs) to appropriate Regional Response Coordination Centers (RRCCs) and, when established, the JFO and Mobilization Center(s). If multiple incidents occur, DOT will support each venue in the same manner. DOT has Regional Emergency Transportation Coordinators (RETCOs) and RETREPS in nine Regions and Alaska. (One RETCO serves Regions 1 and 2.) (6) Coordinate, with the NRCC, issuance of a Mission Assignment that authorizes the deployment of DOT personnel and funds transportation of all appropriate Push Assets in Annex 2. D. The Transportation response will be provided in two broad categories. The first is the immediate movement of pre-identified teams, equipment, and personnel to a Mobilization Center or centers. The second category involves the movement of specifically requested assets into or from the affected area. Transportation services will continue until the affected infrastructure returns to selfsufficiency. (1) Immediate – Push Items (Dispatched during first 48 hours of incident): Assets that will be transported automatically without any request from State or local authorities. These include Emergency Response Teams (ERTs), equipment, and other supplies. Movement of these assets will be sequenced to arrive at the incident Mobilization Center(s) in an appropriate order and quantity. These assets are summarized in Annex 2. DOT maintains a separate listing of all assets in Annex 2 that provide detailed coordination, locality, cargo, and contact information to facilitate the movement of these assets. (2) Mid-Term – Pull Items (Dispatched within first 10 days). Assets that are likely to be needed at the incident site, but will not be transported until requested by appropriate authority at the DHS/Federal Emergency Management Agency (FEMA) Region, Joint Field Office (JFO) (local response cell), or DHS/FEMA Headquarters (HQ). A DOT transportation representative will be present at each of these locations. (3) Long-Term Operations. Transportation services will be sustained as long as necessary, until normal infrastructure is self-sustaining, and there is no longer a need for ESF#1 to support Federal, State, or local efforts. E. Requests for transportation services will be made through the NRCC. The RRCC and/or JFO, when established, can originate requests as well. DOT representatives are present at each of these locations. Transportation of the asset(s) at the origination site will normally occur within 6 hours of receipt of the request. ERTs with their own vehicles must notify the ESF#1 watch at the NRCC to January 2005 Catastrophic Incident Supplement | 11 National Response Plan facilitate coordination at the receiving location. Assets transported outside of DOT will not automatically benefit from the unique capabilities offered through the DOT-shipped program. Assets in transit will not be centrally tracked rerouting around damaged infrastructure, and special waivers and clearances must be obtained individually. There will be no in-transit tracking of these movements. F. Consistent with their functional responsibilities under the NRP, ESF#1 will coordinate the movement of assets it is tasked to transport into, and out of, the incident scene. The primary source of transportation services is the industry itself, administered through contracts. When necessary, the Department of Defense (DOD) and other alternative transportation methods will be used. (1) DOT will activate a 24/7 Emergency Transportation Center (ETC) that coordinates the movement of supplies and resources via air, sea, and land transport. Movement of these materials includes special handling of unique and unusually large size and quantities of equipment and commodities. Types of items shipped include generators, automobiles, boom tucks, refrigerated trailers, potable water tankers, construction equipment, medical supplies, hazardous materials (HAZMAT), utility poles, support teams (e.g., Disaster Medical Assistance Team (DMAT), Disaster Mortuary Operational Response Team (DMORT), Urban Search and Rescue (US&R)), passengers, and firearms for U.S. Marshals. This service maintains a fully functional Continuity of Operations (COOP) site and regularly participates in training and exercises. (2) Shipments will be competitively contracted with a wide range of commercial transportation operators based on the most cost efficient, effective, and productive mode and carrier. Other Departments and Agencies possess their own transportation capabilities to meet their own transportation needs or supplement the DOT-provided service as alternate resources. DOT will augment response agency/activity capabilities, when and where necessary: G. Assets will be picked up, in accordance with the Execution Schedule, at any location within the mainland United States within 6 hours. Times will vary for operations outside the continental United States (OCONUS) and for international movements. H. DOT will provide emergency transportation services in all Presidential declared emergencies/disasters or when it is determined to be in the Government’s best interest to use these services, including cases of an imminent threat or predeployment. Assets will be shipped to a Mobilization Center or, when needed, shipped through to local distribution centers. When necessary, DOT will expedite HAZMAT waivers and provide airspace clearances/waivers to facilitate transportation of assets during emergencies. I. Response efforts will require at least one Mobilization Center. Immediately upon implementation of the NRP-CIS, an appropriate location for a Mobilization Center will be chosen. FEMA Regions, in collaboration with their respective States, have identified tentative Mobilization Center sites. Military bases may be available for use and, in most cases, possess adequate material handling facilities. However, the types of incidents envisioned by the NRP-CIS may create conditions that preclude the use of a nearby military installation as the Mobilization Center. Pre-identification of acceptable Mobilization Center r sites in each State will result in speedier and more organized response and logistical support activities. (1) The NRCC, through its Movement Coordination Center (MCC), establishes and maintains control of all logistics deployment operations until such control can be successfully transferred to JFO. Until that point, logistics coordination will take place at the NRCC MCC. 12 | Catastrophic Incident Supplement January 2005 National Response Plan (2) Designated resources will begin flowing in accordance with the Execution Schedule upon implementation of the NRP-CIS. Resource flow will be from the resource starting point/home station to the Mobilization Center location identified by the NRCC, unless notified to proceed to Interim Staging Area(s). An Interim Staging Area can be a formal site set up and staffed by logistics personnel, or an informal location, such as a rest area along the route. The function of an Interim Staging Area is to provide, as required, an intermediate, alternate deployment location in support of an organized and efficient Mobilization Center reception operation. Resources arriving at the Mobilization Center will be processed, but not released for employment until requested/directed by competent and appropriate authority. Resources stopped at an Interim Staging Area will proceed to the Mobilization Center or incident area, as appropriate, when directed by the MCC. (3) Figure 1 reflects, in general terms, resource flow following NRP-CIS activation. Figure 2 outlines the same flow information, but also reflects Assessment Points where the MCC (at either the NRCC or JFO) will direct resources to the Mobilization Center, Interim Staging Area(s), or into the incident area. Under this strategy: (a) Resources will deploy in accordance with the Execution Schedule. (b) Deployment will be to the Mobilization Center unless, at the first Assessment Point, the resource is redirected by the MCC to an Interim Staging Area. (c) If the resource has been stopped at an Interim Staging Area, the MCC will notify that resource when and where to move to - either to the Mobilization Center or to another location in direct support of the incident response. (d) If the resource is at the Mobilization Center, the MCC will notify that resource when and where to stage in direct support of the incident response. (4) The Mobilization Center, including associated Interim Staging Areas, is an integral component of the NRP-CIS concept of accelerated operations. DHS/FEMA Logistics maintains and exercises overall responsibility for Mobilization Center operations, to include providing guidance and direction regarding establishment, operations, and demobilization. ESF#7 (Resource Support and Logistics Management) has the lead role for providing logistical team support and will mission-assign necessary resources from supporting agencies (e.g., Incident Management Teams (IMTs) from the U.S. Forest Service (USFS)). However, in accordance with the Execution Schedule, USFS will activate and deploy IMTs to the designated Mobilization Center in advance of a direct mission assignment. (5) The Mobilization Center Management Team (MCMT) provides the organizational management structure for a Mobilization Center. Responsibilities include mission planning and direction, coordination and liaison, external relations, safety planning and operations, and security planning and operations. Upon NRP-CIS implementation, a MCMT will immediately activate and deploy (in accordance with the Execution Schedule) to the designated Mobilization Center to bring it to operational readiness as soon as possible. (6) The Mobilization Center Group is a component of the MCMT; its organizational structure (including associated Interim Staging Areas) will support the complexities and accelerated response requirements of a catastrophic incident response, as outlined in the NRP-CIS. A “heavy” Mobilization Center (with areas of responsibility assigned to the General Services Administration (GSA), U.S. Army Corps of Engineers (USACE), and USFS) will be established at full staffing levels, with augmented additional staffing at Interim Staging Areas. If necessary, a designated Interim Staging Area site can be expanded into an additional Mobilization Center. January 2005 Catastrophic Incident Supplement | 13 National Response Plan Figure 1 ? NRP-CIS Resource Flow Concept of Operations 14 | Catastrophic Incident Supplement January 2005 Figure 2 ? NRP-CIS Resource Flow with Assessment Points January 2005 Catastrophic Incident Supplement | 15 National Response Plan (7) Standard resource flow is depicted in Figure 1. Figure 2 identifies assessment points where the MCC (at either the NRCC or JFO) has the opportunity to make operational course adjustments to deploying resources. The ability to execute flow adjustments at designated points during deployment will ensure a smooth, organized Mobilization Center reception operation and ensure proper support of arriving resources. Resource flow steps are listed below. (a) The NRCC, through the MCC, will notify Resource Storage Centers to begin deploying resources in accordance with the NRP-CIS Execution Schedule. The NRCC, in coordination with Regional, State, and local officials will quickly determine the Mobilization Center location. (b) The MCC will notify Federal Emergency Operations Centers (EOCs) of the location of the Mobilization Center. Federal EOCs will notify Federal Resource Storage sites under their control. Resources will subsequently be deployed to Mobilization Center(s) in accordance with the Execution Schedule. (c) The NRCC and MCC will continually monitor and assess resource flow conditions to facilitate the safe, effective, and efficient movement of resources. (d) Personnel, teams, equipment, and other resources will be deployed from starting locations with instructions to proceed to the Mobilization Center. During this movement, the MCC will decide whether conditions require a change in instructions. The MCC will contact the resource with instructions to continue to the Mobilization Center or to proceed to an Interim Staging Area. (e) Resources arriving at the Mobilization Center will be processed and prepared for continued movement into the incident area. Resources arriving at an Interim Staging Area will await further instructions from the MCC. (f) Interim Staging Areas will be set up at primary points of arrival (e.g., specified airports for resources traveling by air; primary ground transportation route sites to process resources traveling overland). Transportation from both types of Interim Staging Area will be provided to the Mobilization Center. (g) Interim Staging Areas will also be set up along primary ground transportation routes to handle incoming resources such as teams and equipment. There is currently no formal structure for an Interim Staging Area; the only requirement is that staged resources have communication with the MCC to receive further instruction. Once at an Interim Staging Area, the resource will not leave until authorized by the MCC. (h) MCC operational and logistical control will be transferred to the JFO as soon as that activity is prepared to assume the mission. (8) DOT, as lead for ESF#1 (Transportation), will assist in the assessment of transportation requirements and provide transportation resources and authorities necessary to ensure the effective movement of teams, equipment, and supplies. Refer to Appendix 11 for a detailed transportation strategy. 5. Catastrophic Response Inhibitors A. The occurrence or threat of multiple catastrophic mass victim/mass care incidents may significantly reduce the size, speed, and depth of the Federal response. If deemed necessary or prudent, the Federal Government may: 16 | Catastrophic Incident Supplement January 2005 National Response Plan (1) Reduce the availability or allocation of finite resources when multiple venues are competing for the same resources. (2) Withhold certain otherwise available resources in reserve as a hedge against additional incidents. B. Major disruptions to the transportation infrastructure, either at or near the incident venue or occurring nationally, may significantly impede the timely deployment of Federal and Federally accessible resources. C. Large-scale civil disruption, either at or near the incident venue or occurring nationally, may significantly impede the timely deployment of Federal and Federally accessible resources. January 2005 Catastrophic Incident Supplement | 2-1 National Response Plan National Response Plan ? Catastrophic Incident Supplement Annex 1 ? Execution Schedule Upon implementation of the National Response Plan Initial Catastrophic Incident Supplement (NRP-CIS) by the Secretary of Homeland Security, responsible organizations will, unless specifically directed otherwise, initiate the following actions appropriate to the Incident Type no later than the time indicated. A. Unless indicated otherwise under the “Action” verbiage, the action reflects the time the action will be initiated, not completed. B. Bold actions/rows reflect resources that will deploy to or activate within or near the incident area. C. The term “ALL” when used under the “Responsible Agency” column refers to all Federal Departments and Agencies to which the action applies, not necessarily all Federal Departments and Agencies. D. Where multiple but specific agencies are listed under the “Responsible Agency” column, the corresponding Action Identifier is “M.” E. Action Identification numbers are provided to facilitate quick reference. F. Incident Types are as follows: NH = Natural Hazards (Earthquake, Hurricane, Tsunami, Volcano, et al) C = Chemical Incident B = Biological Incident R = Radiological Incident N = Nuclear Incident E = High-Explosive Incident G. This annex contains two Execution Schedules. Schedule 1 is organized by time and provides a sequential, chronological schedule of all actions to be taken. Schedule 2 is organized by Responsible Agency. A1-2 | Catastrophic Incident Supplement January 2005 National Response Plan 1. Schedule 1 Complete Execution Schedule Organized by Initiation Time NH = Natural Hazards (Earthquake, Hurricane, Tsunami, Volcano, et al) C = Chemical Incident, B = Biological Incident, R = Radiological Incident, N = Nuclear Incident, E = High-Explosive Incident Incident Type NH C B R N E Initiation Time (no later than) Action Responsible Agency / Support Agency Action Identification R N I+10 minutes Priority 4 activation of Emergency Alert System (EAS). DHS DHS-1 NH C B R N E I+10 minutes Activation of the Incident Communications Emergency Plan (ICEP). DHS DHS-2 NH C B R N E I+10 minutes Activate National Incident Communications Conference Line (NICCL). DHS DHS-3 R N I+10 minutes DHS Public Affairs coordinates first release of information to public. DHS DHS-4 NH C B R N E I+10 minutes Establish and maintain lines of communication with State authorities for incident venues. DHS DHS-5 NH C B R R N E I+15 minutes Activate and initiate deployment actions for the on-alert Federal Initial Response Support Team (FIRST) and the on-alert National Emergency Response Team (ERT-N). Place all remaining FIRSTs and ERT-Ns on full alert. DHS DHS-6 NH C B R R N E I+15 minutes Activate and initiate deployment actions for the Mobilization Center Management Team (MCMT). DHS DHS-7 NH C B R R N E I+15 minutes Activate, at full staffing levels, the IIMG, NRCC, all Headquarters (HQ), and Regional Operations Center(s) (ROCs) with incident oversight. Activate all other ROCs at watch staff levels. ALL A-1 RN I+15 minutes Implement protective actions that correspond to a ?SEVERE? condition under the Homeland Security Advisory System (HSAS) as directed by the Secretary of Homeland Security. ALL A-2 NH C B R R N E I+15 minutes Activate the HHS Secretary?s Emergency Response Team (SERT). HHS HHS-1 NH N E I+30 minutes Activate Deployment of Urban Search and Rescue (US&R) Incident Support Team Cache. DHS DHS-8 January 2005 Catastrophic Incident Supplement | 2-3 National Response Plan Incident Type NH C B R N E Initiation Time (no later than) Action Responsible Agency / Support Agency Action Identification NH C B R N E I+30 minutes Activate Mobile Emergency Response Support (MERS) to deploy Life Support Vehicles and MERS Emergency Operations Vehicle to the affected area to establish a temporary operating location for the Principal Federal Official (PFO) and support staff. DHS DHS-9 NH N E I+30 minutes If the incident involves collapsed structures, activate and initiate deployment actions for all onalert, weapons of mass destruction (WMD)-equipped National US&R Task Forces and Incident Support Teams (ISTs). Activate and fully mobilize all other WMD-equipped National US&R assets in place. Place all remaining National US&R Task Forces and ISTs on full alert. Deployment into the incident area will be as directed by the National Response Coordination Center (NRCC). DHS DHS-10 NH C B R N E I+30 minutes Deploy appropriate Emergency Support Function (ESF)#8 Regional resources (such as the Regional Health Administrator) to the Regional and State Operations Centers. HHS HHS-2 R N I+30 minutes Close airspace in affected area (via Temporary Flight Restrictions (TFRs) and Notices to Airmen (NOTAMs)). Coordinate ground stops as necessary. DOT DOT-1 NH C B R N E I+30 minutes Activate on call roster of U.S Public Health Service (PHS) Commissioned Corps. HHS HHS-3 NH R N I+30 minutes Initiate actions to immediately deploy 1600 cots. DHS DHS-11 NH R N I+30 minutes Initiate actions to immediately deploy 3200 blankets. DHS DHS-12 NH R N I+30 minutes Initiate actions to immediately deploy 10,000 emergency heater meals. DHS DHS-13 NH R N I+30 minutes Initiate actions to immediately deploy 500 personal toilets with privacy tents. DHS DHS-14 NH R N I+30 minutes Initiate actions to immediately deploy 2200 daily restroom kits. DHS DHS-15 NH R N I+30 minutes Initiate actions to immediately deploy 500 personal wash kits. DHS DHS-16 NH R N I+30 minutes Initiate actions to immediately deploy 300 sleeping bags. DHS DHS-17 A1-4 | Catastrophic Incident Supplement January 2005 National Response Plan Incident Type NH C B R N E Initiation Time (no later than) Action Responsible Agency / Support Agency Action Identification NH R N I+30 minutes Initiate actions to immediately deploy 100 tents (6-8 person). DHS DHS-18 NH I+30 minutes Initiate actions to immediately deploy 580 rolls of plastic sheeting (20x100). DHS DHS-19 NH R N I+30 minutes Initiate actions to immediately deploy 10,000 gallons of bottled water. DHS DHS-20 NH R N I+30 minutes Initiate actions to immediately deploy 16 mid-range generators. DHS DHS-21 NH R N I+30 minutes Initiate actions to immediately deploy 1million MREs. DHS DHS-22 NH R N I+30 minutes Initiate actions to immediately deploy 180,000 gallons of water. DHS DHS-23 NH R N I+30 minutes Initiate actions to immediately deploy ten 250-person Pre- Positioned Disaster Supply containers. DHS DHS-24 NH R N E I+30 minutes Initiate actions to immediately deploy nine 500-person Pre- Positioned Disaster Supply containers. DHS DHS-25 NH C B R N E I+40 minutes Interagency conference call develops initial communications strategy and plan. DHS DHS-26 NH C B R N E I+45 minutes Activate the American Association of Blood Banks Interorganizational Task Force on Domestic Disasters and Acts of Terrorism (AABB Task Force) to assess current blood supply levels throughout the country. HHS HHS-4 NH C B R N E I+1 hour Designate a PFO, who will assemble a support staff and deploy to the affected area as soon as possible. DHS DHS-27 NH C B R N E I+1 hour Activate Rapid Response Victim Registry. HHS HHS-5 R N I+1 hour Department of Energy (DOE) Nuclear Incident Team (NIT) Stands up at DOE Emergency Operations Center (EOC). DOE DOE-1 NH C B R N E I+1 hour Activate the National Disaster Medical System (NDMS). DHS DHS-28 NH C R N E I+1 hour Activate the patient movement portion of the NDMS. DHS HHS VA DOD DOT DHS-29 January 2005 Catastrophic Incident Supplement | 2-5 National Response Plan Incident Type N H C B R N E Initiation Time (no later than) Action Responsible Agency / Support Agency Action Identification NH C B R N I+1 hour Coordinate stoppage of all noncritical cargo and passenger rail, maritime, and highway transportation into affected area/region. DOT DOT-2 NH C B R N E I+1 hour For each incident venue, designate the nearest securable airfield (military or civilian) unaffected by the incident as the Federal Mobilization Center. DHS DHS-30 NH C B R N E I+1 hour Verify activation of Environmental Protection Agency (EPA) resources. EPA EPA-1 NH C B R N I+1 hour Provide initial HHS-coordinated public service announcement. Coordinate and issue follow-on announcements at frequent and regular intervals. DHS DHS-31 NH C B R N E I+1 hour Secretary DHS makes first senior Federal announcement of incident and response effort. DHS DHS-32 NH C B R N E I+1 hour Activate Hospital Asset Reporting and Tracking System (HARTS). HHS HHS-6 NH C B R N E I+1 hour Activate a National Joint Information Center (JIC) to coordinate all response-related press and media affairs. DHS DHS-33 NH C B R N E I+1 hour DHS Public Affairs releases updated nuclear incident advice. DHS DHS-34 C B R N I+1 hour Activate Public Affairs surge plans. DHS DHS-35 NH C B R N E I+1½ hours Establish Joint Information Center (JIC) at incident site. DHS DHS-36 NH C B R N E I+1½ hours Release updated incident and information statement to general public. DHS DHS-37 NH C B R N E I+2 hours Commence transportation of pre-identified Push Assets (refer to Table 11-1). DOT DOT-3 RN I+2 hours Deploy Radiological Assistance Program (RAP) Teams. DOE DOE-2 NH C B R N E I+2 hours Activate and deploy Aviation Resources as required by DHS, USDA, or Department of the Interior (DOI). USDA USDA-1 NH C B R N E I+2 hours Activate and deploy (through coordination with the NRCC) Incident Management Team(s) (IMTs) to establish and operationalize each Federal Mobilization Center. USDA USDA-2 A1-6 | Catastrophic Incident Supplement January 2005 National Response Plan NH C B R N I+2 hours Inventory existing available shelter space within a radius of 250 miles. Inventory national food supply stockpiles and their locations. ARC ARC-1 NH C B R N E I+2 hours Dispatch the Red Cross (Internal) Critical Response Team (CRT) to safe area near affected area(s) to assist with initial national response efforts. ARC ARC-2 NH C B R N E I+2 hours Assess mass care actions initiated by local response entities and determine additional resources needed to provide necessary services. ARC ARC-3 NH C B R N E I+2 hours Activate all Red Cross disaster response functions. ARC ARC-4 NH C B R N E I+2 hours Activate WMD/T Response Guidelines for all national HQ units, to include Biomedical Services Operations Center for blood coordination. ARC ARC-5 NH C B R N E I+2 hours Place a significant number of Red Cross Emergency Response Vehicles (ERVs) on standby for deployment to provide mobile feeding. ARC ARC-7 NH C B R N I+2 hours Coordinate with Red Cross Disaster Field Supply Centers to begin movement of a significant number of cots and blankets to affected area(s). ARC ARC-7 NH C B R N E I+2 hours Coordinate with national voluntary organizations and non- Governmental organization (NGO) partners to provide personnel and equipment to support response activities. ARC ARC-8 NH C B R N E I+2 hours Deploy Red Cross kitchens and other mobile feeding units to Staging Areas, once identified in safe area. ARC ARC-9 NH C B R N E I+2 hours Activate and deploy Prepositioned Equipment Program Teams. DHS DHS-38 NH C B R N E I+2 hours Activate Deployment of ERT-N Disaster Field Office (DFO) equipment and support kits. DHS DHS-39 NH C B R N E I+2 hours Activate Deployment of one NDMS Management Support Team (MST) equipments cache. DHS DHS-40 NH C B R N E I+2 hours Begin Deployment of Emergency Temporary Housing units into affected area. DHS DHS-41 January 2005 Catastrophic Incident Supplement | 2-7 National Response Plan C B R N E I+2 hours Activate Deployment of Domestic Emergency Support Team (DEST) and equipment cache. DHS DHS-42 C R N I+2 hours Ascertain if decontamination technical assistance resources have been requested and are engaged. DHS DHS-43 C B R N E I+2 hours Obtain preliminary estimate of the number of victims exposed to toxic/ hazardous substance(s), preliminary material identification, and source containment. DHS DHS-44 NH C B R N E I+2 hours Coordinate with the AABB Task Force to identify supply levels at the supporting medical facilities for the incident. Activate supply distribution plans for affected region(s). HHS HHS-7 NH C B R N E I+2 hours Activate links to the private sector (e.g., secure CEO COMLINK) and request them, as appropriate, to inventory and identify available transportation assets, potential mass shelter facilities, and medical facilities, personnel, equipment, and supplies. DHS DHS-45 N I+2 hours Activate Continuity of Operations (COOP) Plans. ALL A-3 NH C B R N E I+2 hours Deploy one (1) NDMS Management Support Team (MST). DHS DHS-46 NH C B R N E I+2 hours Deploy Defense Coordinating Officer (DCO) and supporting Defense Coordinating Element (DCE) to JFO or Initial Operating Facility (IOF). DOD DOD-1 C B R N E I+3 hours Alert HQ Joint Task Force ? Civil Support (JTF-CS) and designated Initial Entry Forces (IEFs). Deploy Command Assessment Element (CAE) to provide rapid mission assessment in coordination with Federal authorities. Pre-position key IEF capabilities as required based on assessment and coordination with DHS. DOD DOD-2 C B R N I+3 hours Determine zones and boundaries of contamination and advise all response entities. DHS DHS-47 NH C B R N I+3 hours Convene the NDMS Interagency Planning Group and Medical Inter- Agency Coordination Group (MIACG). DHS HHS VA DOD M-1 A1-8 | Catastrophic Incident Supplement January 2005 National Response Plan NH C B R N E I+3 hours Send qualified representatives to staff the IIMG at DHS HQ and/or other interagency EOCs (e.g., Strategic Information and Operations Center, NRCC, etc.), as rostered or directed under the Plan. ALL A-4 NH B R N I+3 hours Review all non-critical cargo and passenger aviation activities. Inventory and make available cargo and passenger aviation assets. Report availability to the NRCC. ALL A-5 NH C B R N I+3 hours Provide assessment of transportation system and infrastructure to DHS HSOC and FEMA NRCC. DOT DOT-4 NH C B R N E I+3 hours Alert ESF#3 Emergency Response Teams and assets (water, power, debris, housing, ice, deployable tactical operations system). USACE USACE-1 NH C B R N E I+4 hours Activate deployment of IOF/DFO equipment and support kits. DHS DHS-48 NH C B R N E I+4 hours Activate deployment of Federal Mobilization Center Management Team equipment kit. DHS DHS-49 NH C B R N E I+4 hours Activate Deployment of Individual Response Resource (IRR) assets from all FEMA Logistics Centers (includes cot, tents, water, food and emergency generators). DHS DHS-50 NH C B R N E I+4 hours Activate Deployment of NDMS MST initial equipment cache. DHS DHS-51 R N I+4 hours Aerial Measurements System (AMS) deployed. DOE DOE-3 R N I+4 hours Nuclear Radiological Advisory Team (NRAT) deploys with the DEST. DOE DOE-4 R N I+4 hours Initiate FRMAC and deploy Consequence Management Response Team. DOE DOE-5 C B R N EI+4 hours Deploy National Medical Response Team (NMRT). DHS DHS-52 NH E I+4 hours Activate deployment of field survey support team and remote sensing aircraft to incident area. DOC DOC-1 NH C B R N E I+4 hours Obtain Assistant Secretary for Health (ASH) approval for the AABB Task Force coordinated public information announcement regarding the adequacy and safety of the Nation?s blood supply. HHS HHS-8 NH C B R N E I+4 hours Stand up Animal and Plant Health Inspection Service (APHIS) EOC. USDA USDA-3 January 2005 Catastrophic Incident Supplement | 2-9 National Response Plan NH C B R N E I+4 hours Initiate/expedite actions to establish a JFO. DHS DHS-53 NH C B R N E I+4 hours Assess requirements for facility/ environmental decontamination. EPA EPA-2 NH C B R N E I+4 hours Deploy the HHS SERT. HHS HHS-9 C B R N E I+6 hours Deploy three (3) NDMS Disaster Medical Assistance Teams (DMATs). DHS DHS-54 C B R N E I+6 hours Activate Deployment of three (3) NDMS DMAT equipment caches. DHS DHS-55 B I+6 hours Activate and deploy EIS officers and other staff to support epidemiological investigations. HHS HHS-10 NH C B R N I+6 hours Activate and deploy food safety inspectors. HHS HHS-11 C B R N E I+6 hours Update estimates/actual reporting of number of victims. HHS HHS-12 NH C B R N E I+6 hours Initiate action planning for facility/ environmental decontamination. EPA EPA-3 NH C B R N I+6 hours Update status of transportation system and provide emergency transportation management recommendations to DHS. Continue updates as necessary. DOT DOT-5 C B R N E I+6 hours Ascertain extent of success of initial/gross decontamination and containment activities. DHS DHS-56 NH C R N I+6 hours Inventory and identify (to the NRCC) all large-space facilities/ structures within 250 miles of the incident venue(s) that could be made available as temporary shelters, temporary morgues, or to support mass casualty medical operations. ALL A-6 C B R N I+6 hours Ascertain extent of contaminated victim access to medical treatment facilities and impact on operational status. DHS HHS M-2 C R N I+6 hours Assess local emergency public information activities regarding victim decontamination and engage consultation if adjustments appear necessary. DHS DHS-57 NH C B R N E I+6 hours Verify need for additional monitoring equipment at medical treatment facilities and shelters and ensure necessary logistics actions are initiated. DHS DHS-58 A1-10 | Catastrophic Incident Supplement January 2005 National Response Plan NH C B R N E I+6 hours Deploy ESF#3 Emergency Response Teams and assets (water, power, debris, housing, ice, deployable tactical operations system). USACE USACE-2 C B R N I+12 hours Deploy and deliver appropriate Strategic National Stockpile (SNS) initial push-packages to a Federal Mobilization Center or other designated reception location. DHS HHS M-3 NH C B R N E I+12 hours Deploy on-call roster of PHS Commissioned Corps. HHS HHS-13 C B I+12 hours Identify laboratories that could be used to support diagnostic activity for agent of concern. ALL A-7 NH C B R N E I+12 hours Inventory and report on (to the NRCC) the availability and functionality status of all Plansupporting teams and resources. Identify any deficiencies or limiting factors in planned capability. ALL A-8 NH C B R N E I+12 hours Activate all PHS Commissioned Corps rosters. Deploy environmental health officers from the PHS Commissioned Corps as liaisons to the HHS SERT. HHS HHS-14 NH C B R N E I+12 hours All NDMS medical facilities inventory and report bed availability to Federal Coordinating Facilities. DHS HHS DOD VA M-4 C B R N E I+12 hours Deploy two (2) NDMS NMRTs. DHS DHS-59 C B R N E I+12 hours Activate Deployment of two (2) NDMS NMRT equipment caches. DHS DHS-60 NH C B R N E I+12 hours Deploy two (2) NDMS Veterinary Medical Assistance Teams (VMATs). DHS DHS-61 NH C B R N E I+16 hours Locate owners of, and available apartments in Federally funded multifamily housing to provide shelter to emergency response personnel proximal to the incident venue. USDA USDA-4 NH C B R N E I+18 hours NDMS hospitals prepare to begin receiving evacuated patients from affected areas. DHS DOD VA HHS M-5 C B R N E I+24 hours Deploy eleven (11) NDMS DMATs. DHS DHS-62 C B R N E I+24 hours Deploy two (2) NDMS DMORTs. DHS HHS M-6 C B R N E I+24 hours Activate deployment of eleven (11) NDMS DMAT equipment caches. DHS DHS-63 January 2005 Catastrophic Incident Supplement | 2-11 National Response Plan C B R N E I+24 hours Activate Deployment of two (2) NDMS DMORT deployable morgue units. DHS DHS-64 NH C B R N E I+24 hours Activate Deployment of one (1) full NDMS MST equipment cache. DHS DHS-65 NH C B R N E I+24 hours Deploy a medical regulating team. DOD DOD-3 NH C B R N E I+24 hours Release public messages providing information on how to apply for individual assistance. DHS DHS-66 NH C B R N E I+24 hours Department of Veterans Affairs (VA) Primary Receiving Centers (PRCs) within 500 miles of an incident venue prepare to terminate non-critical medical services and redirect available resources for receipt of patients at VA medical facilities, as required and directed by applicable authority. VA VA-1 NH R N I+24 hours Deploy additional 1600 cots to arrive within 48 hours. DHS DHS-67 NH R N I+24 hours Deploy additional 3200 blankets to arrive within 48 hours. DHS DHS-68 NH R N I+24 hours Deploy additional 10,000 emergency heater meals to arrive within 48 hours. DHS DHS-69 NH R N I+24 hours Deploy additional 500 personal toilets with privacy tents to arrive within 48 hours. DHS DHS-70 NH R N I+24 hours Deploy additional 2200 daily restroom kits to arrive within 48 hours. DHS DHS-71 NH R N I+24 hours Deploy additional 500 personal wash kits to arrive within 48 hours. DHS DHS-72 NH R N I+24 hours Deploy additional 300 sleeping bags to arrive within 48 hours. DHS DHS-73 NH R N I+24 hours Deploy additional 100 tents (6-8 person) to arrive within 48 hours. DHS DHS-74 NH Deploy additional 580 rolls of plastic sheeting (20x100) to arrive within 48 hours. DHS DHS-75 NH R NI+24 hours Deploy additional 10,000 gallons of bottled water to arrive within 48 hours. DHS DHS-76 NH R N I+24 hours Deploy additional 16 mid-range generators to arrive within 48 hours. DHS DHS-77 NH R N I+24 hours Deploy additional 1million MREs to arrive within 48 hours. DHS DHS-78 A1-12 | Catastrophic Incident Supplement January 2005 National Response Plan NH R N I+24 hours Deploy additional 180,000 gallons of water to arrive within 48 hours. DHS DHS-79 NH R N I+24 hours Deploy additional ten 250-person Pre-Positioned Disaster Supply containers to arrive within 48 hours. DHS DHS-80 NH R N I+24 hours Deploy additional nine 500- person Pre-Positioned Disaster Supply containers to arrive within 48 hours. DHS DHS-81 C B R N I+36 hours Assess short-term medical treatment needs of incident area population and evacuees and deploy follow-on medical support packages from SNS. HHS DHS M-7 NH C B R N E I+36 hours Patient evacuation initiated. Patient Federal patient movement established through DOD TRACES2 system. DHS HHS DOD GSA DOT ARC M-8 NH C B R N E I+48 hours Send veterinary team to evaluate situation. USDA USDA-5 NH C B R N E I+48 hours Determine animal/livestock disposal options. USDA USDA-6 NH R N I+48 hours Deploy additional 1600 cots to arrive within 72 hours. DHS DHS-82 NH R N I+48 hours Deploy additional 3200 blankets to arrive within 72 hours. DHS DHS-83 NH R N I+48 hours Deploy additional 10,000 emergency heater meals to arrive within 72 hours. DHS DHS-84 NH R N I+48 hours Deploy additional 500 personal toilets with privacy tents to arrive within 72 hours. DHS DHS-85 NH R N I+48 hours Deploy additional 2200 daily restroom kits to arrive within 72 hours. DHS DHS-86 NH R N I+48 hours Deploy additional 500 personal wash kits to arrive within 72 hours. DHS DHS-87 NH R N I+48 hours Deploy additional 300 sleeping bags to arrive within 72 hours. DHS DHS-88 NH R N I+48 hours Deploy additional 100 tents (6-8 person) to arrive within 72 hours. DHS DHS-89 NH I+48 hours Deploy additional 580 rolls of plastic sheeting (20x100) to arrive within 72 hours. DHS DHS-90 NH R N I+48 hours Deploy additional 10,000 gallons of bottled water to arrive within 72 hours. DHS DHS-91 January 2005 Catastrophic Incident Supplement | 2-13 National Response Plan NH R N I+48 hours Deploy additional 16 mid-range generators to arrive within 72 hours. DHS DHS-92 NH R N I+48 hours Deploy additional 1million MREs to arrive within 72 hours. DHS DHS-93 NH R N I+48 hours Deploy additional 180,000 gallons of water to arrive within 72 hours. DHS DHS-94 NH R N I+48 hours Deploy additional ten 250-person Pre-Positioned Disaster Supply containers to arrive within 72 hours. DHS DHS-95 NH R N I+48 hours Deploy additional nine 500- person Pre-Positioned Disaster Supply containers to arrive within 72 hours. DHS DHS-96 NH C B R N E I+72 hours Deploy all PHS Commissioned Corps rosters. HHS HHS-15 C B R N E I+72 hours Begin backfill of Pre-Positioned Disaster Supplies (PPDS) containers. DHS DHS-97 NH C B R N E I+72 hours Activate all PHS Commissioned Corps deployable assets. HHS HHS-16 NH C B R N E I+72 hours Establish crisis-counseling plan. DHS DHS-98 NH C B R N I+96 hours The national response coordination group will devise a national animal, plant, and health surveillance plan. USDA USDA-7 NH C B R N I+96 hours Determine animal/livestock treatment and vaccine options. USDA USDA-8 NH C B R N E I+96 hours Assess housing needs. DHS DHS-99 NH C B R N E I+96 hours Establish housing plan. DHS DHS-100 NH C B R N E I+96 hours Establish donations strategy and voluntary agency plan. DHS DHS-101 A1-14 | Catastrophic Incident Supplement January 2005 National Response Plan 2. Schedule 2 Complete Execution Schedule Organized by Responsible Agency NH = Natural Hazards (Earthquake, Hurricane, Tsunami, Volcano, et al) C = Chemical Incident, B = Biological Incident, R = Radiological Incident, N = Nuclear Incident, E = High-Explosive Incident Incident Type NH C B R N E Initiation Time (no later than) Action Responsible Agency / Support Agency Action Identification NH C B R N E I+15 minutes Activate, at full staffing levels, the Interagency Incident Management Group (IIMG), National Response Coordination Center (NRCC), all Headquarters (HQ) and Regional Operation Center(s) (ROC) with incident oversight. Activate all other ROCs at watch staff levels. ALL A-1 R N I+15 minutes Implement protective actions that correspond to a ?SEVERE? condition under the Homeland Security Advisory System (HSAS) as directed by the Secretary of Homeland Security. ALL A-2 N I+2 hours Activate Continuity of Operations (COOP) Plans. ALL A-3 NH C B R N E I+3 hours Send qualified representatives to staff the IIMG at U.S. Department of Homeland Security (DHS) HQ and/or other interagency Emergency Operations Centers (EOCs) (e.g., Strategic Information and Operations Center (SIOC), NRCC, etc.), as rostered or directed under the Plan. ALL A-4 NH C R N I+3 hours Review all non-critical cargo and passenger aviation activities. Inventory and make available cargo and passenger aviation assets. Report availability to the NRCC. ALL A-5 NH C R N I+6 hours Inventory and identify (to the NRCC) all large-space facilities/ structures within 250 miles of the incident venue(s) that could be made available as temporary shelters, temporary morgues, or to support mass casualty medical operations. ALL A-6 C B I+12 hours Identify labs that could be used to support diagnostic activity for agent of concern. ALL A-7 NH C B R N E I+12 hours Inventory and report on (to the NRCC) the availability and functionality status of all Plansupporting teams and resources. Identify any deficiencies or limiting factors in planned capability. ALL A-8 January 2005 Catastrophic Incident Supplement | 2-15 National Response Plan Multiple Responsible Agencies NH C B R N I+3 hours Convene the NDMS Interagency Planning Group and Medical Inter- Agency Coordination Group (MIACG). DHS HHS VA DoD M-1 C B R N I+6 hours Ascertain extent of contaminated victim access to medical treatment facilities and impact on operational status. DHS HHS M-2 C B R N I+12 hours Deploy and deliver appropriate Strategic National Stockpile (SNS) initial push-packages to a Federal Mobilization Center or other designated reception location. DHS HHS M-3 NH C B R N EI+12 hours All NDMS medical facilities inventory and report bed availability to Federal Coordinating Facilities. DHS HHS DOD VA M-4 NH C B R N E I+18 hours NDMS hospitals prepare to begin receiving evacuated patients from affected areas. DHS DOD VA HHS M-5 C B R N E I+24 hours Deploy two (2) NDMS DMORTs. DHS HHS M-6 C B R N I+36 hours Assess short-term medical treatment needs of incident area population and evacuees and deploy follow-on medical support packages from SNS. HHS DHS M-7 NH C B R N E I+36 hours Patient evacuation initiated. Patient Federal patient movement established through DOD TRACES2 system. DHS HHS DOD GSA DOT ARC M-8 A1-16 | Catastrophic Incident Supplement January 2005 National Response Plan American Red Cross NH C B R N I+2 hour Inventory existing available shelter space within a radius of 250 miles. Inventory national food supply stockpiles and their locations. ARC ARC-1 NH C B R N E I+2 hours Dispatch the Red Cross (Internal) Critical Response Team (CRT) to safe area near affected area(s) to assist with initial national response efforts. ARC ARC-2 NH C B R N E I+2 hours Assess mass care actions initiated by local response entities and determine additional resources needed to provide necessary services. ARC ARC-3 NH C B R N EI+2 hours Activate all Red Cross disaster response functions. ARC ARC-4 NH C B R N E I+2 hours Activate WMD/T Response Guidelines for all national HQ units, to include Biomedical Services Operations Center for blood coordination. ARC ARC-5 NH C B R N EI+2 hours Place a significant number of Red Cross Emergency Response Vehicles on standby for deployment to provide mobile feeding. ARC ARC-6 NH C B R N I+2 hours Coordinate with Red Cross Disaster Field Supply Centers to begin movement of a significant number of cots and blankets to affected area(s). ARC ARC-7 NH C B R N E I+2 hours Coordinate with national voluntary organizations and NGO partners to provide personnel and equipment to support response activities. ARC ARC-8 NH C B R N E I+2 hours Deploy Red Cross kitchens and other mobile feeding units to Staging Areas, once identified in safe area. ARC ARC-9 January 2005 Catastrophic Incident Supplement | 2-17 National Response Plan U.S. Department of Agriculture NH C B R N E I+2 hours Activate and deploy Aviation Resources as required by DHS, USDA, or Department of the Interior (DOI). USDA USDA-1 NH C B R N EI+2 hours Activate and deploy (through coordination with the NRCC) Incident Management Team(s) to establish and operationalize each Federal Mobilization Center. USDA USDA-2 NH C B R N EI+4 hours Stand up APHIS EOC. USDA USDA-3 NH C B R N E I+16 hours Locate owners of, and available apartments in Federally funded multifamily housing to provide shelter to emergency response personnel proximal to the incident venue. USDA USDA-4 NH C B R N E I+48 hours Send veterinary team to evaluate situation. USDA USDA-5 NH C B R N E I+48 hours Determine animal/livestock disposal options. USDA USDA-6 NH C B R N I+96 hours The national response coordination group will devise a national animal, plant, and health surveillance plan. USDA USDA-7 NH C B R N I+96 hours Determine animal/livestock treatment and vaccine options. USDA USDA-8 Department of Commerce NH E I+4 hours Activate deployment of field survey support team and remote sensing aircraft to incident area. DOC DOC-1 Department of Defense NH C B R N E I+2 hours Deploy DCO and supporting DCE to JFO or IOF. DOD DOD-1 C B R N E I+3 hours Alert HQ JTF-CS and designated Initial Entry Forces (IEF). Deploy Command Assessment Element (CAE) to provide rapid mission assessment in coordination with Federal authorities. Pre-position key IEF capabilities as required based on assessment and coordination with DHS. DOD DOD-2 NH C B R N E I+24 hours Deploy a medical regulating team. DOD DOD-3 A1-18 | Catastrophic Incident Supplement January 2005 Department of Energy R N I+1 hour DOE Nuclear Incident Team (NIT) Stands up at DOE EOC. DOE DOE-1 R N I+2 hours Deploy Radiological Assistance Program Teams. DOE DOE-2 R N I+4 hours Aerial Measurements System (AMS) deployed. DOE DOE-3 R N I+4 hours Nuclear Radiological Advisory Team (NRAT) deploys with the DEST. DOE DOE-4 R N I+4 hours Initiate FRMAC and deploy Consequence Management Response Team. DOE DOE-5 Department of Health and Human Services NH C B R N E I+15 minutes Activate the HHS Secretary?s Emergency Response Team. HHS HHS-1 NH C B R N E I+30 minutes Deploy appropriate ESF#8 Regional resources (such as the Regional Health Administrator) to the Regional and State Operations Centers. HHS HHS-2 NH C B R N E I+30 minutes Activate on call roster of PHS Commissioned Corps. HHS HHS-3 NH C B R N E I+45 minutes Activate the American Association of Blood Banks Interorganizational Task Force on Domestic Disasters and Acts of Terrorism (AABB Task Force) to assess current blood supply levels throughout the country. HHS HHS-4 NH C B R N E I+1 hour Activate Rapid Response Victim Registry. HHS HHS-5 NH C B R N E I+1 hour Activate Hospital Asset Reporting and Tracking System (HARTS). HHS HHS-6 NH C B R N EI+2 hours Coordinate with the AABB Task Force to identify supply levels at the supporting medical facilities for the incident. Activate supply distribution plans for affected region(s). HHS HHS-7 NH C B R N E I+4 hours Obtain ASH approval for the AABB Task Force coordinated public information announcement regarding the adequacy and safety of the Nation?s blood supply. HHS HHS-8 January 2005 Catastrophic Incident Supplement | 2-19 National Response Plan NH C B R N E I+4 hours Deploy the HHS Secretary?s Emergency Response Team (SERT). HHS HHS-9 B I+6 hours Activate and deploy EIS officers and other staff to support epidemiological investigations. HHS HHS-10 NH C B R N I+6 hours Activate and deploy food safety inspectors. HHS HHS-11 C B R N E I+6 hours Update estimates/actual reporting of number of victims HHS HHS-12 NH C B R N E I+12 hours Deploy on call roster of U.S. Public Health Service (PHS) Commissioned Corps. HHS HHS-13 NH C B R N E I+12 hours Activate all PHS Commissioned Corps rosters. Deploy environmental health officers from the PHS Commissioned Corps as liaisons to the HHS SERT. HHS HHS-14 NH C B R N E I+72 hours Deploy all PHS Commissioned Corps rosters. HHS HHS-15 NH C B R N E I+72 hours Activate all PHS Commissioned Corps deployable assets. HHS HHS-16 Department of Homeland Security R N I+10 minutes Priority 4 activation of Emergency Alert System (EAS). DHS DHS-1 NH C B R N E I+10 minutes Activation of the Incident Communications Emergency Plan (ICEP). DHS DHS-2 NH C B R N E I+10 minutes Activate National Incident Communications Conference Line (NICCL). DHS DHS-3 R N I+10 minutes DHS Public Affairs coordinates first release of information to public. DHS DHS-4 NH C B R N E I+10 minutes Establish and maintain lines of communication with state authorities for incident venues. DHS DHS-5 NH C B R N E I+15 minutes Activate and initiate deployment actions for the on-alert Federal Initial Response Support Team (FIRST) and the on-alert National Emergency Response Team (ERT-N). Place all remaining FIRSTs and ERT-Ns on full alert. DHS DHS-6 NH C B R N E I+15 minutes Activate and initiate deployment actions for the Mobilization Center Management Team (MCMT). DHS DHS-7 A1-20 | Catastrophic Incident Supplement January 2005 National Response Plan NH N E I+30 minutes Activate Deployment of Urban Search and Rescue (US&R) Incident Support Team Cache. DHS DHS-8 NH C B R N E I+30 minutes Activate Mobile Emergency Response Support (MERS) to deploy Life Support Vehicles and MERS Emergency Operations Vehicle to the affected area in order to establish a temporary operating location for the PFO and support staff. DHS DHS-9 NH N E I+30 minutes If the incident involves collapsed structures, activate and initiate deployment actions for all on-alert, WMD-equipped National US&R Task Forces and Incident Support Teams. Activate and fully mobilize all other WMDequipped National US&R assets in place. Place all remaining National US&R Task Forces and ISTs on full alert. Deployment into the incident area will be as directed by the NRCC. DHS DHS-10 NH R N I+30 minutes Initiate actions to immediately deploy 1600 cots. DHS DHS-11 NH R N I+30 minutes Initiate actions to immediately deploy 3200 blankets. DHS DHS-12 NH R N I+30 minutes Initiate actions to immediately deploy 10,000 emergency heater meals. DHS DHS-13 NH R N I+30 minutes Initiate actions to immediately deploy 500 personal toilets with privacy tents. DHS DHS-14 NH R N I+30 minutes Initiate actions to immediately deploy 2200 daily restroom kits. DHS DHS-15 NH R N I+30 minutes Initiate actions to immediately deploy 500 personal wash kits. DHS DHS-16 NH R N I+30 minutes Initiate actions to immediately deploy 300 sleeping bags. DHS DHS-17 NH R N I+30 minutes Initiate actions to immediately deploy 100 tents (6-8 person). DHS DHS-18 NH I+30 minutes Initiate actions to immediately deploy 580 rolls of plastic sheeting (20x100). DHS DHS-19 NH R N I+30 minutes Initiate actions to immediately deploy 10,000 gallons of bottled water. DHS DHS-20 NH R N I+30 minutes Initiate actions to immediately deploy 16 mid-range generators. DHS DHS-21 NH R N I+30 minutes Initiate actions to immediately deploy 1million MREs. DHS DHS-22 January 2005 Catastrophic Incident Supplement | 2-21 National Response Plan NH R N I+30 minutes Initiate actions to immediately deploy 180,000 gallons of water. DHS DHS-23 NH R N I+30 minutes Initiate actions to immediately deploy ten 250-person Pre- Positioned Disaster Supply containers. DHS DHS-24 NH R N I+30 minutes Initiate actions to immediately deploy nine 500-person Pre- Positioned Disaster Supply containers. DHS DHS-25 NH C B R N E I+40 minutes Interagency conference call develops initial communications strategy and plan. DHS DHS-26 NH C B R N E I+1 hour Designate a Principal Federal Official (PFO), who will assemble a support staff and deploy to the affected area as soon as possible. DHS DHS-27 NH C B R N E I+1 hour Activate the National Disaster Medical System (NDMS). DHS DHS-28 NH C R N E I+1 hour Activate the patient movement portion of the NDMS. DHS HHS VA DOD DOT DHS-29 NH C B R N E I+1 hour For each incident venue, designate the nearest securable airfield (military or civilian) unaffected by the incident as the Federal Mobilization Center. DHS DHS-30 NH C B R N I+1 hour Provide initial HHS-coordinated public service announcement. Coordinate and issue follow-on announcements at frequent and regular intervals. DHS DHS-31 NH C B R N E I+1 hour Secretary DHS makes first senior Federal announcement of incident and response effort. DHS DHS-32 NH C B R N E I+1 hour Activate a National Joint Information Center (JIC) to coordinate all response-related press and media affairs. DHS DHS-33 NH C B R N E I+1 hour DHS Public Affairs releases updated nuclear incident advice. DHS DHS-34 C B R N I+1 hour Activate Public Affairs surge plans. DHS DHS-35 NH C B R N E I+1½ hours Establish JIC at incident site. DHS DHS-36 NH C B R N E I+1½ hours Release updated incident and information statement to general public. DHS DHS-37 NH C B R N E I+2 hours Activate and deploy Prepositioned Equipment Program Teams. DHS DHS-38 A1-22 | Catastrophic Incident Supplement January 2005 National Response Plan NH C B R N E I+2 hours Activate Deployment of National Emergency Response Team (ERT-N)/ Disaster Field Office equipment and support kits. DHS DHS-39 NH C B R N E I+2 hours Activate Deployment of one NDMS Management Support Team (MST) equipments cache DHS DHS-40 NH C B R N E I+2 hours Begin Deployment of Emergency Temporary Housing units into affected area DHS DHS-41 C B R N E I+2 hours Activate Deployment of Domestic Emergency Support Team (DEST) and equipment cache. DHS DHS-42 C R N I+2 hours Ascertain if decontamination technical assistance resources have been requested and are engaged. DHS DHS-43 C B R N E I+2 hours Obtain preliminary estimate of the number of victims exposed to toxic/ hazardous substance(s), preliminary material identification, and source containment. DHS DHS-44 NH C B R N E I+2 hours Activate links to the private sector (e.g., secure CEO COMLINK) and request them, as appropriate, to inventory and identify available transportation assets, potential mass shelter facilities, and medical facilities, personnel, equipment, and supplies. DHS DHS-45 NH C B R N E I+2 hours Deploy one (1) NDMS Management Support Team (MST). DHS DHS-46 C B R N I+3 hours Determine zones and boundaries of contamination and advise all response entities. DHS DHS-47 NH C B R N EI+4 hours Activate deployment of IOF/DFO equipment and support kits. DHS DHS-48 NH C B R N E I+4 hours Activate Deployment of Federal Mobilization Center Management Team equipment kit. DHS DHS-49 NH C B R N E I+4 hours Activate deployment of Individual Response Resource (IRR) Assets from all FEMA Logistics Centers (Includes cot, tents, water, food, and emergency generators). DHS DHS-50 NH C B R N E I+4 hours Activate deployment of NDMS MST initial equipment cache. DHS DHS-51 C B R N E I+4 hours Deploy NMRT. DHS DHS-52 NH C B R N E I+4 hours Initiate/expedite actions to establish a JFO. DHS DHS-53 January 2005 Catastrophic Incident Supplement | 2-23 National Response Plan C B R N E I+6 hours Deploy three (3) NDMS DMATs. DHS DHS-54 C B R N E I+6 hours Activate deployment of three (3) NDMS DMAT equipment caches. DHS DHS-55 C B R N E I+6 hours Ascertain extent of success of initial/gross decontamination and containment activities. DHS DHS-56 C R N I+6 hours Assess local emergency public information activities regarding victim decontamination and engage consultation if adjustments appear necessary. DHS DHS-57 NH C B R N E I+6 hours Verify need for additional monitoring equipment at medical treatment facilities and shelters and ensure necessary logistics actions are initiated. DHS DHS-58 C B R N E I+12 hours Deploy two (2) NDMS NMRTs. DHS DHS-59 C B R N E I+12 hours Activate deployment of two (2) NDMS NMRT equipment caches. DHS DHS-60 NH C B R N E I+12 hours Deploy two (2) NDMS Veterinary Medical Assistance Teams (VMATs). DHS DHS-61 C B R N E I+24 hours Deploy eleven (11) NDMS DMATs. DHS DHS-62 C B R N E I+24 hours Activate deployment of eleven (11) NDMS DMAT equipment caches. DHS DHS-63 C B R N E I+24 hours Activate deployment of two (2) NDMS DMORT deployable morgue units. DHS DHS-64 NH C B R N E I+24 hours Activate Deployment of one (1) full NDMS MST equipment cache. DHS DHS-65 NH C B R N E I+24 hours Release public messages providing information on how to apply for individual assistance. DHS DHS-66 NH R N I+24 hours Deploy additional 1600 cots to arrive within 48 hours. DHS DHS-67 NH R N I+24 hours Deploy additional 3200 blankets to arrive within 48 hours. DHS DHS-68 NH R N I+24 hours Deploy additional 10,000 emergency heater meals to arrive within 48 hours. DHS DHS-69 NH R N I+24 hours Deploy additional 500 personal toilets with privacy tents to arrive within 48 hours. DHS DHS-70 NH R N I+24 hours Deploy additional 2200 daily restroom kits to arrive within 48 hours. DHS DHS-71 A1-24 | Catastrophic Incident Supplement January 2005 National Response Plan NH R N I+24 hours Deploy additional 500 personal wash kits to arrive within 48 hours. DHS DHS-72 NH R N I+24 hours Deploy additional 300 sleeping bags to arrive within 48 hours. DHS DHS-73 NH R N I+24 hours Deploy additional 100 tents (6-8 person) to arrive within 48 hours. DHS DHS-74 NH I+24 hours Deploy additional 580 rolls of plastic sheeting (20x100) to arrive within 48 hours. DHS DHS-75 NH R N I+24 hours Deploy additional 10,000 gallons of bottled water to arrive within 48 hours. DHS DHS-76 NH R N I+24 hours Deploy additional 16 mid-range generators to arrive within 48 hours. DHS DHS-77 NH R N I+24 hours Deploy additional 1million MREs to arrive within 48 hours. DHS DHS-78 NH R N I+24 hours Deploy additional 180,000 gallons of water to arrive within 48 hours. DHS DHS-79 NH R N I+24 hours Deploy additional ten 250-person Pre-Positioned Disaster Supply containers to arrive within 48 hours. DHS DHS-80 NH R N I+24 hours Deploy additional nine 500- person Pre-Positioned Disaster Supply containers to arrive within 48 hours. DHS DHS-81 NH R N I+48 hours Deploy additional 1600 cots to arrive within 72 hours. DHS DHS-82 NH R N I+48 hours Deploy additional 3200 blankets to arrive within 72 hours. DHS DHS-83 NH R N I+48 hours Deploy additional 10,000 emergency heater meals to arrive within 72 hours. DHS DHS-84 NH R N I+48 hours Deploy additional 500 personal toilets with privacy tents to arrive within 72 hours. DHS DHS-85 NH R N I+48 hours Deploy additional 2200 daily restroom kits to arrive within 72 hours. DHS DHS-86 NH R N I+48 hours Deploy additional 500 personal wash kits to arrive within 72 hours. DHS DHS-87 NH R N I+48 hours Deploy additional 300 sleeping bags to arrive within 72 hours. DHS DHS-88 NH R N I+48 hours Deploy additional 100 tents (6-8 person) to arrive within 72 hours. DHS DHS-89 January 2005 Catastrophic Incident Supplement | 2-25 National Response Plan NH I+48 hours Deploy additional 580 rolls of plastic sheeting (20x100) to arrive within 72 hours. DHS DHS-90 NH R N I+48 hours Deploy additional 10,000 gallons of bottled water to arrive within 72 hours. DHS DHS-91 NH R N I+48 hours Deploy additional 16 mid-range generators to arrive within 72 hours. DHS DHS-92 NH R N I+48 hours Deploy additional 1million MREs to arrive within 72 hours. DHS DHS-93 NH R N I+48 hours Deploy additional 180,000 gallons of water to arrive within 72 hours. DHS DHS-94 NH R N I+48 hours Deploy additional ten 250-person Pre-Positioned Disaster Supply containers to arrive within 72 hours. DHS DHS-95 NH R N I+48 hours Deploy additional nine 500- person Pre-Positioned Disaster Supply containers to arrive within 72 hours. DHS DHS-96 C B R N E I+72 hours Begin Backfill of Pre-Positioned Disaster Supplies (PPDS) containers. DHS DHS-97 NH C B R N E I+ 72 hours Establish crisis-counseling plan. DHS DHS-98 NH C B R N E I+96 hours Assess housing needs. DHS DHS-99 NH C B R N E I+96 hours Establish housing plan. DHS DHS-100 NH C B R N E I+96 hours Establish donations strategy and voluntary agency plan. DHS DHS-101 Department of Transportation R N I+30 minutes Close airspace in affected area (via TFRs and NOTAMs). Coordinate ground stops as necessary. DOT DOT-1 NH C B R N I+1 hour Coordinate stoppage of all noncritical cargo and passenger rail, maritime and highway transportation into affected area/region. DOT DOT-2 NH C B R N E I+2 hours Commence transportation of pre-identified Push Assets (refer to Table 11-1). DOT DOT-3 NH C B R N E I+3 hours Provide assessment of transportation system and infrastructure to DHS HSOC and FEMA NRCC. DOT DOT-4 A1-26 | Catastrophic Incident Supplement January 2005 National Response Plan NH C B R N I+6 hours Update status of transportation system and provide emergency transportation management recommendations to DHS. Continue updates as necessary. DOT DOT-5 Department of Veterans Affairs NH C B R N E I+24 hours VA Primary Receiving Centers (PRCs) within 500 miles of an incident venue prepare to terminate non-critical medical services and redirect available resources for receipt of patients at VA medical facilities, as required and directed by applicable authority. VA VA-1 Environmental Protection Agency NH C B R N E I+1 hour Verify activation of EPA resources. EPA EPA-1 NH C B R N E I+4 hours Assess requirements for facility/environmental decontamination. EPA EPA-2 NH C B R N E I+6 hours Initiate action planning for facility/environmental decontamination. EPA EPA-3 U.S. Army Corps of Engineers (DOD) NH C B R N EI+3 hours Alert ESF#3 Emergency Response Teams and assets (water, power, debris, housing, ice, deployable tactical operations system). USACE USACE-1 ¦ NH C B R N EI+6 hours Deploy ESF#3 Emergency Response Teams and assets (water, power, debris, housing, ice, deployable tactical operations system). USACE USACE-2 January 2005 Catastrophic Incident Supplement | 2-1 National Response Plan National Response Plan ? Catastrophic Incident Supplement Annex 2 ? Transportation Schedule 1. The Transportation response will be provided in two broad categories. The first is the immediate movement of pre-identified teams, equipment, and personnel to a Mobilization Center or centers. The second category involves the movement of specifically requested assets into or from the affected area. Transportation services will continue until the affected infrastructure returns to self-sufficiency. 2. Immediate – Push Items (Dispatched during first 48 hours of incident): Assets that will be transported automatically without any request from State or local authorities. These include Emergency Response Teams (ERTs), equipment, and other supplies. Movement of these assets will be sequenced to arrive at the incident Mobilization Center(s) in an appropriate order and quantity. These assets are summarized in the following table. DOT maintains a separate listing of all assets in Table 2-1 that provide detailed coordination, locality, cargo, and contact information to facilitate the movement of these assets. A1-2 | Catastrophic Incident Supplement January 2005 National Response Plan TABLE 2-1 Push Assets Appendix 1 ? Basic Planning Assumptions 1. A catastrophic event or attack may occur with little or no warning. 2. The nature and scope of a catastrophic incident attack will initiate an immediate Federal response. 3. The majority of deployment-dependent Federal response resources are not likely to provide significant lifesaving or life-sustaining capabilities until 18 to 36 hours after the event. However, Regional Federal capabilities (hospitals, specialists, etc.) can begin providing critical support almost immediately. 4. State and local response capabilities will be quickly overwhelmed; movement of casualties throughout the area of operations will pose a significant challenge. 5. There will be a significant shortage response and casualty/evacuee reception capabilities, equipment, and pharmaceuticals. 6. Adequate water supplies (both potable and non-potable to drive air conditioning systems) will be compromised. Similarly, loss of city power will be only partially met by auxiliary power sources. Lack of adequate water and power will impose significant issues for the population and operational limitations on hospitals and blood centers. 7. Depletion of medical supplies and pharmaceuticals will significantly stress the Nation’s industrial base and its ability to rapidly meet national resource requirements. 8. Blood supplies will be severely taxed and significant Regional shortages could occur within short order after an event has occurred. Blood manufacturing, infectious disease testing, and distribution of tested blood will be problematic. 9. Due to potentially unforeseen delays in the identification of a non-naturally occurring epidemiological event, detection of disease outbreaks may not occur until large numbers of victims are affected, particularly when the agent has a long incubation period. 10. Patient transportation to and from airheads and medical treatment facilities (MTFs) will be problematic due to excessive congestion on local roads and limited patient movement alternatives (e.g., rotary wing lift). 11. Emergency protective actions recommended to the public will likely be without the benefit of detailed assessment data. 12. There will be significant issues regarding environmental health (e.g., air quality and food safety) and public health (e.g., sanitation, housing, animal health) needs, including mental health services. 13. Public anxiety related to the catastrophic incident will require effective risk communication and may require mental health and substance abuse services. A1-2 | Catastrophic Incident Supplement January 2005 National Response Plan 14. A non-detected/recognized biological release spares the physical infrastructure but results in a uniformly exposed population that is likely to create an overwhelming demand on medical resources. However, the physical infrastructure may require decontamination. 15. A nuclear detonation will significantly degrade and potentially destroy initial local emergency response management, medical, and public health capabilities. 16. Non-Federal hospitals of the National Disaster Medical System (NDMS), as well as Department of Veterans Affairs (VA) Primary Receiving Centers (PRCs) and Department of Defense (DOD) MTFs are authorized to provide definitive care to casualties of a catastrophic mass casualty incident. 17. The assets identified in the response strategy may not be available at the time of a catastrophic event due to needs at their home institutions, family requirements, etc. 18. Neighboring States/jurisdictions will be reluctant or resistant to accepting patients that are contaminated or infectious. January 2005 Catastrophic Incident Supplement | A2-1 National Response Plan National Response Plan ? Catastrophic Incident Supplement Appendix 2 ? Inventory of Federal Response Teams Chart A2-14 | Catastrophic Incident Supplement January 2005 National Response Plan THIS PAGE INTENTIONALLY LEFT BLANK January 2005 Catastrophic Incident Supplement | A3-1 National Response Plan National Response Plan ? Catastrophic Incident Supplement Appendix 3 ? Mass Care Response Overview 1. Mission Mass Care coordinates Federal assistance in support of Regional, State, and local efforts to meet the mass care needs of victims of a disaster. This Federal assistance will support the delivery of mass care services of shelter, feeding, and emergency first aid to disaster victims; the establishment of systems to provide bulk distribution of emergency relief supplies to disaster victims; and the collection of information to operate a Disaster Welfare Information (DWI) system to report victim status and assist in family reunification. 2. Planning Assumptions A. The American Red Cross (ARC) is designated a primary agency for Emergency Support Function (ESF) #6 (Mass Care, Housing, and Human Services) with the lead for mass care. In this role, the ARC mission is to coordinate Federal mass care assistance and support when a disaster event exceeds the resources and capacity of State and local responders. B. ARC also independently provides mass care services to disaster victims as part of a broad program of disaster relief, and as outlined in charter provisions enacted by Congress – Act of January 1905 (36 United States Code (U.S.C.) Section 3001, et seq.). The responsibilities assigned to ARC as the co-primary agency for ESF#6 at no time will supersede those responsibilities assigned to the ARC by its congressional charter. C. The ARC is assigned support agency responsibilities for ESF#8 (Public Health and Medical Services) by the National Response Plan (NRP). These responsibilities center on augmenting certain health and medical service response activities as requested by the primary ESF#8 agency, the Department of Health and Human Services (HHS). HHS also provides support to ARC for the mass care portion of ESF#6. D. Significant disruption of the affected area’s infrastructure, particularly power, transportation, and communications systems, may occur. This will hinder the ability of responders to initiate and accomplish emergency, restoration, and recovery actions in a timely manner. E. The U.S. Department of Homeland Security (DHS) will likely raise the Homeland Security Advisory System (HSAS) to “red” status immediately following a terrorist attack for designated areas, if not the entire Nation. Depending on the location, scope, and magnitude of the event, this elevated status can prompt actions limiting the availability of air transportation within the United States. Such travel limitations can negatively impact the timely convergence, at the disaster-affected area, of needed personnel and material resources. F. As a result of the incident, many local emergency personnel—paid and volunteer—that normally respond to disasters may be dead, injured, involved with family concerns, or otherwise unable to reach their assigned posts. G. Depending on the nature of the event, a catastrophic disaster will cause a substantial need for mass sheltering and feeding within, near, and beyond the disaster-affected area. A3-2 | Catastrophic Incident Supplement January 2005 National Response Plan H. State and local resources will immediately be overwhelmed; therefore, Federal assistance will be needed immediately. I. Extensive self-directed population evacuations may also occur with families and individuals traveling throughout the United States to stay with friends and relatives outside the affected area. J. Populations likely to require mass care services include the following: (1) Primary victims (with damaged or destroyed homes) (2) Secondary and tertiary victims (denied access to homes) (3) Transients (visitors and travelers within the affected area) (4) Emergency workers (seeking feeding support, respite shelter(s), and lodging) NOTE: There will also be a need for interpreters to provide assistance in communicating with non- English speaking populations. K. In the initial phase (hours and days) of a catastrophic disaster, organized and spontaneous sheltering will occur simultaneously within and at the periphery of the affected area as people leave the area. Additional congregate sheltering may be required for those evacuating to adjacent population centers. L. The wide dispersal of disaster victims will complicate Federal Government assistance eligibility and delivery processes for extended temporary housing, tracking, and need for registering the diseased, ill, injured, and exposed. M. More people will initially flee and seek shelter from terrorist attacks involving chemical, biological, radiological, nuclear, or high-yield explosive (CBRNE) agents than for natural catastrophic disaster events. They will also exhibit a heightened concern for the health-related implications related to the disaster agent. N. Long-term sheltering, interim housing, and the mass relocation of affected populations may be required for incidents with significant residential damage and/or contamination. (Refer to Appendix 10 for information on catastrophic housing.) O. Substantial numbers of trained mass care specialists and managers will be required for an extended period of time to augment local responders and to sustain mass care sheltering and feeding activities. P. Timely logistical support to shelters and feeding sites will be essential and required for a sustained period of time. Food supplies from the U.S. Department of Agriculture (USDA) positioned at various locations across the country will need to be accessed and transported to the affected area in a timely manner. Q. Close liaison and coordination with numerous voluntary and non-Governmental organizations (NGOs) will be necessary on the national, Regional, State, and local levels. R. Service delivery to affected populations by voluntary agencies and NGOs will occur in locations deemed safe by appropriate Government officials. January 2005 Catastrophic Incident Supplement | A3-3 National Response Plan S. Public safety, health, and contamination monitoring expertise will be needed at shelters following CBRNE events. Measures to ensure food and water safety will be necessary following CBRNE events, and the general public will also need to be reassured concerning food and water safety. T. Immediately following major CBRNE events, decontamination facilities may not be readily available in all locations during the early stages of self-directed population evacuations. Unaware contaminated persons therefore may seek entry to shelters. These facilities may, as a result, become contaminated, adversely affecting resident health and general public trust. U. Public health and medical care in shelters will be a significant challenge as local Emergency Medical Services (EMS) resources and medical facilities will likely be overwhelmed quickly. The deployment of public health and medical personnel and equipment to support medical needs in shelters will need to be immediate and sustained by HHS. (Refer to Appendix 6 for information on medical support activities.) V. Shelters will likely experience large numbers of elderly with specific medication requirements and other evacuees on critical home medical care maintenance regimens. (Refer to Appendix 6 for information on medical support activities.) W. Significant numbers of special needs shelters will likely be required as nursing homes and other similar care facilities are rendered inoperable and are unable to execute their evacuation mutual aid plans and agreements with other local facilities. ARC will coordinate with HHS in these situations. X. DWI may be a priority concern for family members throughout the United States. Y. Family reunification within the affected area will be an immediate and significant concern as many family members may be separated at the time of the event. Z. Transient populations within the affected areas, such as tourists, students, and foreign visitors will require assistance. AA. There will be an immediate and sustained need for the bulk distribution of relief supplies. Requirements will depend on the nature of and human needs produced by the incident. BB. The DHS Private Sector desk will coordinate incident response and recovery support from the private sector. CC. Criteria for identifying and validating priority needs will need to be established immediately. DD. Populations with the resources to help themselves will be encouraged to take independent action. EE. Spontaneous volunteers and donations management will require significant attention immediately following the event. If not promptly and appropriately managed, attention to this activity will demand the diversion of resources away from service delivery. FF. Significant, additional logistical support and coordination and public information systems will be required whenever a “shelter in place” or a “quarantine” order is implemented. A3-4 | Catastrophic Incident Supplement January 2005 National Response Plan GG. Coordinated, accurate, timely public information will be required immediately to inform the public of appropriate protective and self-care actions. ARC will support activities at Joint Information Centers (JICs). HH. Accurate and timely information over time must be distributed to the affected populations to control rumors and assuage anxiety related to the event. This activity will be particularly important following CBRNE-related events. II. Mental health services will be sought by victims and responders in and near the affected area, as well as (on a lesser scale) throughout the Nation. ARC will coordinate activities with HHS. JJ. If decontamination is ongoing during the early stages of a catastrophic incident, persons undergoing decontamination will have logistical, medical, and mental health needs that will need to be addressed quickly. KK. Red Cross staff will have access to needed medications/vaccinations made available to other response personnel providing services. 3. Catastrophic Response Strategy A. Response Strategy: IMMEDIATE. (1) Assumptions (a) Immediate response activities will focus on meeting urgent mass care needs of victims in safe areas. There will be an increased emphasis on contamination, safety, and security issues for CBRNE events. (b) In coordination with State, Tribal, and local officials, determinations will be made on the scope of the event and need for additional resources to provide mass care services. (c) Local ARC chapters and other entities, which provide mass care services at the local level, will initiate shelter and feeding activities in or near the impacted area, depending on the nature of the event. (Sheltering will include organized sheltering efforts as well as “ad hoc” shelters formed by community organizations and groups and “spontaneous” shelters established by evacuating residents.) (d) Adjacent communities need to be prepared to deal with significant numbers of fleeing persons from the affected area. These “host” communities will also need significant mass care support. (e) ARC chapters will be immediately augmented (in the form of additional personnel, materials, and equipment deployed to the disaster area) by Red Cross Service Areas and national headquarters. (Refer to Annex 1 – Execution Schedule.) (f) ESF#6 (Mass Care, Housing, and Human Services) operational cells will be established at the Federal Emergency Management Agency (FEMA) Regional Response Coordination Center(s) (RRCC) and DHS/FEMA’s National Response Coordination Center (NRCC). Assessments for resource support to the disaster-affected area will be promptly conducted. The receipt of Federal Government support in the form of personnel, material, and equipment will be in accordance with the NRP. January 2005 Catastrophic Incident Supplement | A3-5 National Response Plan (g) Contact and coordination will immediately proceed with other voluntary organizations and NGOs. Available resources will be numerated and promptly applied to identified needs and requirements. (h) HHS will ensure the provision of blood/blood products and public messaging blood supply safety through coordination with the American Association of Blood Banks Task Force on Domestic Disasters and Acts of Terrorism (AABB Inter-Organizational Task Force). B. Response Strategy: FIRST 10 DAYS. (1) Assumptions (a) Mass care services are at peak activity and in coordination with other voluntary organizations, NGOs, ESF#6 support Federal agencies, and State and local governments. The location and related information for all actual and potential shelters within a 250-mile radius is determined (as well as can be established) and communicated to appropriate authorities and the public. Additionally, logistical support is in place to meet the mass care needs of persons in all shelters, those sheltered in-place, and residents of quarantined quarters. (b) Full coordination with DHS and other Federal Departments/Agencies related to mass care services. Information flows uninterrupted between agencies at the Federal level. Problem area and resolution action information is exchanged promptly and routinely. (c) Planning is under way with DHS/FEMA and other agencies regarding the prompt relocation of people beyond the affected area. This strategy will address the significant logistical requirements of supporting thousands of sheltered people in an otherwise difficult environment for prolonged periods of time. This will also allow the affected area’s infrastructure to be repaired and rebuilt without placing additional strain on severely stressed resources. Relocation outside the affected area may also be required because of limited available local housing stock and the long-term decontamination of the disaster affected area. (d) Ongoing work with HHS and other Federal Agencies will continue to ensure that public health and medical care personnel and equipment are on site where needed. (e) Liaison and coordination continues at the national level with FEMA, HHS, and the Department of Defense (DOD). (f) Coordination is under way with the DHS Private Sector desk to draw upon additional resources for mass care support from the private sector. (Refer to Appendix 13 for information on private sector activities.) (g) Public information is provided via the ARC National Call Center, ARC public Web site, and local chapters across the Nation. Health information is coordinated closely with the Centers for Disease Control and Prevention (CDC), HHS, and other agencies as appropriate. (h) The Coordinated Assistance Network (CAN) client information sharing system is initiated by non-Governmental relief organizations to support relief activities. This system will enable sharing of client information among identified participating relief agencies, but only under the strictest standards of confidentiality and only with appropriate client approval. A3-6 | Catastrophic Incident Supplement January 2005 National Response Plan (i) DWI and family reunification services continue; collaboration proceeds with HHS and the National Disaster Medical System (NDMS) regarding casualty and patient information for the DWI system. (j) Support efforts for ESF#8 activities are underway, as required. (2) Primary Areas of Concern (a) Shelter i. Additional sheltering capability at levels beyond which currently exists within the Red Cross system will need to be identified immediately if information is not readily available from partners and Government entities. ii. The safety and integrity of shelters is of paramount importance in order to ensure that victims will use shelters. If decontamination is required for an incident, Federal, State, and local assets must work with the Red Cross and other entities providing shelter to ensure that persons entering shelters are free from contamination. Additionally, persons must be free from communicable diseases and not exhibiting symptoms of an agent-related sickness. (b) Food i. Distribution of food within the affected area will require a substantial logistical effort and may be complicated by the disruption of transportation systems within the affected area and/or raising the HSAS to red. ii. Special dietary considerations will need to be integrated into meal planning at shelters as soon as possible. (c) Other Human Needs i. Human needs will need to be met on a significant scale in a catastrophic disaster. These include such items as showers, toiletry items, bedding, diapers, and clothing. ii. The ability to obtain large quantities of these items may be affected by “just-in-time” supply strategies of major manufacturers and the nature of the event. (d) Medical i. Persons in shelters requiring medical care must receive appropriate medical assistance from appropriate medical entities as soon as possible. ii. Special needs persons will be a significant challenge during a catastrophic disaster. (3) Strategies (a) Shelter. To ensure all victims are sheltered quickly and safely in the immediate aftermath of a catastrophic event, the Red Cross will use all sheltering capability in its jurisdiction to meet initial needs, as well as work with partner agencies to ensure all sheltering needs are met. January 2005 Catastrophic Incident Supplement | A3-7 National Response Plan i. Experience indicates that many persons fleeing an affected area will seek shelter with relatives or stay in a hotel/motel, depending on their financial situation. However, a significant number of persons will seek shelter in traditional shelter facilities. ii. Ad hoc or spontaneous shelters may be established in the immediate aftermath of the catastrophic incident and will need to be integrated into the official mass care response activities as soon as possible. iii. Depending on the nature of the event, the safety and integrity of shelters may come into play. If decontamination is required for an incident, Federal, State, and local assets must work to ensure that persons entering shelters are free from contamination prior to entry. Additionally, persons entering shelters must be free from communicable diseases and not exhibiting symptoms of an agent-related sickness. iv. The Red Cross will work with Federal partners to ensure that as many persons as possible are moved from shelters to interim housing situations within 30 to 45 days of an event. It is likely, however, that many shelters will not be able to close for up to 90 days (or longer) after the event. Since all shelters are not necessarily suitable to be used for long-term sheltering, this may prove a significant problem. (b) Food. The Red Cross will use significant internal assets, as well as work with partner agencies under existing Memorandums of Understanding (MOUs), to meet the significant feeding requirements a catastrophic incident will entail. This includes reliance on feeding equipment, such as large kitchens, being brought into or near the affected area by such organizations as the Southern Baptists and Salvation Army. Additionally, work with the USDA and private sector vendors, under existing Standard Operating Procedures (SOPs) and MOUs at the national, State, and local level, is anticipated on a significant scale. (c) Other Human Needs. Meeting the human needs of significant numbers of people will necessitate close, timely, and sustained collaboration with private sector vendors during the recovery phase. i. Bulk distribution of items will need to be accomplished quickly at central locations. Needed items will include shower accessories such as towels, washcloths, toiletry items, bedding, diapers, and clothing. The management of donated goods will be coordinated with the DHS Private Sector desk. ii. Special dietary considerations will need to be rapidly integrated into meal planning at shelters. iii. Management of people’s expectations will need to be quickly addressed, and include timely and frequent dissemination of accurate information about what is happening. Family reunification issues and Disaster Welfare Inquiries will also need to be quickly dealt with. (d) Medical. Ensure that persons requiring medical care receive appropriate medical assistance as soon as possible to include evaluating requirements and developing strategies for coping with special needs evacuees and providing medical support to emergency shelters. The Red Cross will work closely with local EMS and Federal partners through HHS to address these needs and ensure that proper medical care is given as soon as possible. A3-8 | Catastrophic Incident Supplement January 2005 National Response Plan C. Response Strategy: SUSTAINED and TRANSITION. (1) Sustained Strategy (a) Mass care services are provided as needed; ongoing collaboration and coordination continues with Federal, State, and local officials. (b) Efforts continue with DHS/FEMA to enable execution of interim, alternate longterm temporary and permanent housing strategies, and the provision of other Federal assistance. (Refer to Appendix 10 for housing strategy.) (c) Family resettlement actions and services will take on an increased momentum. (2) Transition Strategy. Within 2 weeks of the catastrophic incident, the Red Cross and DHS/FEMA will jointly develop a plan for transportation of persons in shelters out of the affected area and into interim housing situations. This will require close coordination with the Department of Transportation (DOT). Shelterees requiring medical attention, or special needs shelter(s) populations, will be given priority in leaving the area. This will involve close coordination with HHS. 4. Transportation and Logistical Requirements A. Transportation needs include the ability to move mobile feeding units into and near the affected area quickly. These units include Red Cross Emergency Response Vehicles (ERVs), large kitchens, and feeding units from other voluntary organizations and NGOs. Additionally, communications vehicles and logistical support trucks must be moved in a rapid manner. B. The transportation of needed mass care and support workers from around the country must be accomplished quickly and sustained over time. C. Material requirements will include but are not limited to the procurement and transportation of cots, blankets, and other feeding and shelter supplies beyond those available from Red Cross and other NGOs; the procurement and transport of food, including USDA commodities; and bulk distribution of relief supplies from various venders and points across the country. D. Procurement and distribution of potable water and ice to support the individual shelters and feeding sites. Potable water and ice distribution will also be required for individuals who are able to continue residing in their homes, but are without safe drinking water. E. Portable showers and sanitation units at the individual shelter and feeding sites. F. Possible transportation of residents requiring relocation beyond the affected area. G. In the event of electrical power disruption, power generation support will be required for the shelters and particularly the food preparation, storage, and feeding sites. H. Portable food containers will be required at the food preparation and feeding sites. I. Public safety and security personnel will be required at the larger shelters and to routinely patrol shelters, food preparation sites, and fixed feeding stations. The Red Cross may augment with private security, if needed. January 2005 Catastrophic Incident Supplement | A3-9 National Response Plan J. Transportation and allied logistics systems will need to be established within the incident area. Moreover, linkages would be required, outside the affected area, with adjacent staging and marshalling sites. K. Information on venders, products, and services will need to be available on a real-time basis. L. Transportation and other linkages need to be established with in-kind donation sites and warehouses and mass care facilities within and near the incident area. M. Each shelter will need to provide residents with access to telecommunication services. 5. Response Limitations and Unique Concerns A. Refer to planning assumptions in Section 2 of this appendix. B. The lack of a real-time national database reflecting all potential shelters for geographic areas around major metropolitan areas poses a significant problem for mass care response activities during a catastrophic incident. C. Many metropolitan areas view mass care activities, especially sheltering, as a short-term problem and have not developed plans for potential long-term shelter situations or coordinated plans across geographic areas. This will pose significant challenges for mass care response activities at the time of a catastrophic incident. D. Lack of significant numbers of trained mass care specialists and managers will hinder effective mass care response activities, as it is estimated that 30,000 mass care staff will be needed to provide services for 300,000 displaced persons over extended periods of time. 6. Response Capabilities A. Organic. In accordance with its assigned responsibilities as the primary agency for ESF#6 (Mass Care, Housing, and Human Services), the ARC has an organizational structure to support mass care activities, which includes: (1) Formal liaison and coordination with Federal, Regional, State, Tribal, and local authorities for disaster planning preparedness and response. (2) Ongoing planning, collaboration, and operational relationships with the following Federal Agencies and private sector organizations: DHS, Interagency Incident Management Group (IIMG) and NRCC; HHS, including the CDC; and the American Association of Blood Banks (AABB). The ARC also supports FEMA RRCCs. (3) Nearly 900 chapters responsible for implementing initial disaster response activities in collaboration and cooperation with their local Government disaster response counterparts. (4) Regional Red Cross Service Areas that provide technical guidance and resource support to disaster affected chapters in coordination with Red Cross national headquarters. (5) The 24/7 Disaster Operations Center (DOC) at the ARC national headquarters in Washington, DC, routinely initiates major relief operations in support of field units, and coordinates A3-10 | Catastrophic Incident Supplement January 2005 National Response Plan related ARC activities with Federal Departments and Agencies. The DOC directs the nationwide movement of personnel, materials, and equipment to major disaster affected areas. This includes: (a) Critical Response Team (CRT). Specialized all-hazards trained teams of ARC personnel who deploy immediately to major disaster affected areas. These teams support and enhance the efforts of affected ARC chapters and integrate the introduction and application of external personnel, material, and equipment resources. (b) Disaster Services Human Resources (DSHR). Over 26,000 trained disaster response personnel, resident nationwide, who can assist with major disaster relief operations and support initial local chapter response activities. (c) Logistics Support Network. Features a fleet of more than 300 ERVs prepositioned nationwide to provide mobile feeding; two large mobile kitchens; ten mobile satellite (voice and data) communications vehicles; five Local Area Network (LAN)-based field deployable automated systems, ten Disaster Field Supply Centers (warehouses) with more than 50,000 stored cots and blankets, feeding equipment, disaster victim hygiene kits, and home cleanup kits. (d) The ability to activate Statements of Understanding (SOUs) between ARC with 43 national organizations that have signed SOUs and MOUs with ARC to support disaster relief activities. (6) The Biomedical Services Operations Center (BSOC) in Washington, DC, coordinates Red Cross Blood Services operations, handling approximately half the Nation’s blood supply. The BSOC coordinates with the AABB Inter-Organizational Task Force and HHS concerning blood availability and public messaging regarding the safety and availability of the Nation’s blood supply. B. Non-Organic (Collaborative). Includes voluntary organizations, NGOs, and private sector entities with which ARC has written MOUs/SOUs to provide assistance at the time of a disaster. Certain organizations may provide services in more than one area. For example, the Teamsters assist with finding facilities and also provide volunteers to work in shelters. The list of current MOU/SOU partners includes but is not limited to the following: (1) Food and Shelter Assistance (a) North American Mission Board of Southern Baptists (b) The Salvation Army (c) America’s Second Harvest (d) Church of Jesus Christ of Latter Day Saints (e) Woodmen of the World Insurance Society (f) National Restaurant Association (g) American School Food Service Association (2) Additional Mass Care Volunteer Assistance (a) Corporation of National and Community Service (CNCS) (b) National Urban League (c) Faith-based partners, such as Catholic Charities and Church World Service (d) U.S. Jaycees January 2005 Catastrophic Incident Supplement | A3-11 National Response Plan (3) Transportation Assistance (a) Civil Air Patrol (b) Amtrak (c) Federal Express (FedEx) (4) Child Care Assistance. Church of the Brethren (5) Mental Health Assistance (a) American Psychological Association (b) National Mental Health Association (c) American Counseling Association (d) American Psychiatric Association (e) Various Associations for Chaplains of varying denominations (f) National Association of Social Workers (g) Association of Marriage and Family Therapists (6) Facilities Procurement (a) International Brotherhood of Teamsters (b) International Brotherhood of Painters and Allied Trades (c) Faith-based partners (7) Technical Assistance (a) American Radio Relay League (b) Humane Society of the United States (c) American Veterinary Medical Foundation (d) National Funeral Directors Association (e) National Foundation for Mortuary Care (f) American Society of Civil Engineers (g) National Voluntary Organizations Active in Disaster (NVOAD) 7. Responsibilities A. ARC Responsibilities as Coordinating Agency for ESF#6 (Mass Care, Housing, and Human Services) (1) Shelter. Provide temporary congregate shelters to displaced individuals or persons denied access to their homes by the disaster incident. This will involve the use of the pre-identified facilities and facilities secured during and immediately following the incident. Sheltering will occur both within and outside the disaster-affected area. (2) Feeding. Provide prepared meals and food items to the disaster-affected area residents in need. This may include a combination of fixed feeding sites, mobile feeding units, and the bulk distribution of food. While the feeding and other logistical support for emergency workers is the responsibility of their employing agency or organization, emergency workers will have access to feeding sites within the disaster-affected area. A3-12 | Catastrophic Incident Supplement January 2005 National Response Plan (3) Emergency First Aid. Provided to victims and workers at mass care facilities and at designated sites within or around the incident area. This service will be supplemental to the emergency health and medical care services established and managed by Government and medical authorities. This service consists of basic first aid review and referral to appropriate medical personnel and facilities. The ARC will not provide direct medical care to victims/workers. Direct medical care is addressed under Medical Support in Appendix 6. (4) Disaster Welfare Information. Information on well-being will be collected from individuals residing within the affected area and provided, with their approval, to immediate family members located outside the affected area. The DWI system, managed by the ARC, will also be used to aid in reunification of family members separated at the time of the incident. A “reverse DWI” system will also be deployed. It will allow affected area residents in shelters to directly contact immediate family members outside the affected area using a telephone. (5) Bulk Distribution of Emergency Relief Items. Sites will be established within or near the incident area for the general distribution of relief items to meet urgent disaster victim needs. B. Support Agency Responsibilities to ESF#6 (Mass Care, Housing, and Human Services) (1) U.S. Department of Homeland Security (DHS). FEMA will identify temporary housing, and provide NDMS assets to help assist with medical care in shelters. The Red Cross will also work with the DHS Private Sector desk, State and local desk, Public Affairs desk, and others as appropriate. (2) Department of Health and Human Services (HHS). Specifically, U.S. Public Health Service (PHS) Commissioned Corps deployable assets to provide medical care in shelters. (3) Department of Defense (DOD). Provide requested logistical support, as approved by the Secretary of Defense. (4) U.S. Department of Agriculture (USDA). Coordinate food stockpile locations and identify for movement to incident areas. (5) Department of Housing and Urban Development (HUD). Coordinate temporary shelter and long-term housing assistance. (6) Department of Veterans Affairs (VA). Provide food preparation and storage in its facilities nationwide; provide medical supplies, mental health practitioners, and other personnel to shelters; and offer facilities as possible shelter sites. Provide professional mental health staff to augment local and Red Cross resources. (7) U.S. Army Corps of Engineers (USACE). Provide, via contract, potable water and ice to incident area(s) in need; also, inspect shelters for structural suitability and provide assistance in constructing temporary shelters, if necessary. (8) General Services Administration (GSA). Provide procurement and contracting services and assistance based on defined mass care requirements. Also provide communications links between the Disaster Welfare Inquiry Center (DWIC) and incident area. (9) U.S. Postal Service (USPS). Provide change of address cards for victims who are relocating, as well as provide an electronic file of address change information. January 2005 Catastrophic Incident Supplement | A4-1 National Response Plan National Response Plan ? Catastrophic Incident Supplement Appendix 4 ? Search and Rescue Response Overview 1. Mission Search and Rescue provides technical support (personnel and equipment) to assist in the location and extraction of individuals from collapse and water rescue events. 2. Planning Assumptions A. Terrorist employment of nuclear or high explosive weapons of mass destruction (WMD) will create catastrophic devastation of buildings and physical structures in densely populated urban areas. As a result, there will be a need to conduct Urban Search and Rescue (US&R) operations to locate surviving victims. B. Given that US&R is extremely time sensitive, initial operations will be undertaken by State and local responders and those volunteer personnel willing to assist in locating victims. If the catastrophic incident involves collapsed buildings, national US&R task force response assets will immediately deploy in accordance with the Catastrophic Incident Response Execution Schedule (Annex 1). The goal will be to have full task forces on the scene and operational within 24 hours of occurrence. C. Federal US&R assets are under the control of the U.S. Department of Homeland Security (DHS)/Federal Emergency Management Agency (FEMA) and will be activated and deployed to support the US&R mission. This would include the activation of an overhead US&R Incident Support Team (IST) to assist with the integration and coordination of national US&R task forces with the local incident command system. Federal US&R assets possess organic supplies and equipment to conduct the US&R mission, which includes conducting limited defensive operations and victim decontamination in a chemical, biological, radiological, nuclear, or high-yield explosive (CBRNE) contaminated environment. D. DHS/FEMA will, in coordination with the Department of State (DOS), U.S. Agency for International Development (USAID), Office of Foreign Disaster Assistance, coordinate the use and employment of international search and rescue assets/resources if the level of response will overwhelm our national capability. E. The doctrine of “do no additional harm” will apply to all US&R operations. Search and rescue personnel will take into consideration the danger of contamination and unstable physical structures before entering into an area that may contain surviving victims and will take appropriate safety and protective measures before commencing operations. 3. Catastrophic Response Strategy A. Response Strategy: IMMEDIATE. The National US&R Response System uses a defined Activation Rotation Model (maintained by DHS/FEMA) for the selection and activation of US&R task forces. The first three task forces used—in accordance with the timing established in the Catastrophic Incident Response Execution Schedule in Annex 1—will be the three geographically closest task forces that are operationally ready. (1) If more than three task forces are or will be required, the Program Office will refer to the annual Task Force Rotation Model for resources using the following protocols: A4-2 | Catastrophic Incident Supplement January 2005 National Response Plan (a) Assuming that the three closest selected task forces have been activated, the strategy will be to move to the “1st Rotation” column and select the next closest task force in that column for activation. (b) All of the task forces in the “1st Rotation” column will be activated before moving to the “2nd Rotation” column. This process is repetitive. (c) Absent a compelling reason otherwise, the process will not involve horizontal movement on the rotation model to find an operational task force. (This protocol balances the immediate needs of the victims—by activating the closest task forces first—with the need to maintain a fair system of activations that will include all task forces.) (2) It is estimated that one IST and three Type-I task forces would be able to address initial and moderate scale incidents. For a catastrophic incident involving widespread collapses, a far larger IST and task force response will be required and initiated. (A Type-I US&R task force has an estimated useful operational period of 5 to 7 days, based on prior experiences.) (3) US&R task forces will address activities and operations within contaminated areas. This will include establishing perimeters and hot, warm, and cold zones, as well as ingress/egress and decontamination points. These actions/determinations will be coordinated with the local first responders/ Incident Commander and other Federal resources on site. B. Response Strategy: FIRST 10 DAYS. Additional task forces will be activated and deployed (based on anticipated/emerging requirements and/or as requested by Incident Command Authorities or ISTs) to provide continuous operations, usually on a 5 to 7 day basis. C. Response Strategy: SUSTAINED. For extended operations, additional task forces will be activated and rotated in to provide continuous operations, usually on a 5 to 7 day basis. 4. Transportation and Logistical Requirements A. US&R task force sponsoring/parent organizations handle all immediate transportation needs of their task force if the task force is required to move to the incident site by ground transportation. Parent organizations arrange transportation for their personnel and supporting equipment cache to the identified point of departure (airport/airbase) if transportation is by air. If necessary, ESF#9 will request air transportation support from ESF#1. B. IST personnel are activated directly by the US&R Program Office at FEMA Headquarters (HQ) and are responsible for coordinating their own transportation reservations. C. Task forces require minor to moderate logistical support on incident. Each task force arrives with 72-hour self-sufficiency. Task forces that have an immediate need for large forklift capability to assist in cache movement and management will request such support from the IST through local sources and/or the Incident Command Logistics Branch. D. ISTs have supporting administrative and on-site support equipment caches and will coordinate through FEMA to have one or more of these transported to the incident site. January 2005 Catastrophic Incident Supplement | A4-3 National Response Plan 5. Response Limitations and Unique Concerns A. The program is limited to the 28 task forces in the national system. This resource size has been able to address significant WMD/terrorist events to date (e.g., Oklahoma City, The Pentagon, World Trade Center) when integrated with local/Regional resources. However, the system could be overwhelmed by an extremely large catastrophic incident involving many collapsed structures or the occurrence of multiple concurrent incidents involving collapsed structures. B. The WMD task forces in the national system are capable of only limited/defensive hazardous material (HAZMAT) operations. 6. Response Capabilities A. Organic Federal (1) Twenty-eight Type-I task forces, each comprised of a 70-person, WMD-capable task force and full equipment cache (see Figure 4-1 for a system overview). Each task force is fully selfsufficient for the first 72 hours of operation. A Type-I task force has an internal HAZMAT component staffed by two HAZMAT managers and eight HAZMAT specialists. A Type-I task force is capable of addressing limited, defensive HAZMAT operations in a contaminated environment to enable the rescue of trapped victims or rescuers. In addition, WMD cache enhancements have been added to the traditional equipment cache and include atmospheric monitors, personnel protective equipment (PPE), and decontamination equipment for approximately 60 ambulatory or 20 non-ambulatory patients per hour. (2) Three 21-person ISTs, each of which is activated with US&R task forces for mission operation. The IST provides command, control, and coordination (C3) with the local Incident Commander and first responders. (3) Three National Disaster Medical System (NDMS) National Medical Response Teams (NMRTs) for mass decontamination. (4) U.S. Coast Guard (USCG) personnel and assets for assistance and movement of US&R task force personnel, either by fixed or rotor wing, and/or boat operations in areas of still or open water or areas of inundation. B. Non-Organic Federal. Approximately 12 to 15 International Search and Rescue Teams of varying sizes/configurations are potentially available through the USAID/U.S. Office of Foreign Disaster Assistance and the International Search and Rescue Advisory Group (INSARAG). A4-4 | Catastrophic Incident Supplement January 2005 National Response Plan Figure 4-1 ? National Urban Search and Rescue Response System Graph with map 7. Responsibilities of Coordinating and Support Agencies/Organizations A. Coordinating Agency – DHS/FEMA will: (1) Serve as national-level ESF#9 coordinator. (2) Establish, maintain, and manage the National US&R Response System. This responsibility includes predisaster activities such as training, equipment purchase, and evaluation of operational readiness. (3) Dispatch ISTs and task forces to the affected area(s) upon implementation of and when directed by the Catastrophic Incident Response Execution Schedule. (4) Manage US&R task force deployment to, employment in, and redeployment from the affected area. (5) Coordinate logistical support for US&R assets during field operations. (6) Develop policies and procedures for the effective use and coordination of US&R assets. (7) Provide status reports on US&R operations throughout the affected area. (8) Under the NDMS: (a) Provide administrative support to US&R task force medical teams to: January 2005 Catastrophic Incident Supplement | A4-5 National Response Plan i. Ensure medical team personnel who are not Federal employees have appropriate and valid licenses to practice in their States and they are provided Federal tort claims liability coverage for the practice of medicine. ii. Develop an appropriate pay scale for US&R task force medical team personnel. iii. Register medical teams of each National US&R Response System task force as specialized teams under the NDMS. (b) Provide operational support to US&R task force medical teams and IST from ESF#8 (Public Health and Medical Services), as requested by DHS, to provide liaisons; medical supplies, equipment, and pharmaceuticals; supporting personnel; and veterinary support. (c) Provide NDMS patient evacuation and continuing care after trapped victims are removed from collapsed structures by US&R task force personnel. B. Support Agencies (1) U.S. Department of Agriculture (USDA), U.S. Forest Service (USFS) (a) Develop standby agreements with US&R task forces to provide equipment and supplies from the National Interagency Cache System at the time of deployment. (b) Develop contingency plans for use of National Interagency Fire Center contract aircraft by ESF#9 during disasters. (2) Department of Health and Human Services (HHS). Provide operational support to US&R task force medical teams and IST from ESF#8, as requested by DHS. (3) Department of Defense (DOD) (a) Serve as primary source for the following assistance: i. Fixed-wing transportation of US&R task forces and ISTs from base locations to Mobilization Centers or Base Support Installations (BSIs). Target timeframe for airlift missions is 6 hours from the time of task force activation. ii. Rotary-wing transportation of US&R task forces and ISTs to and from isolated, surface inaccessible, or other limited access locations. iii. Through the U.S. Army Corps of Engineers (USACE), provide trained structures specialists and System to Locate Survivors (STOLS) teams to supplement resources of US&R task forces and ISTs. iv. Through the USACE, provide pre-disaster training for US&R task force and IST structures specialists. (b) Serve as secondary source for the following assistance: A4-6 | Catastrophic Incident Supplement January 2005 National Response Plan i. Ground transportation for US&R task forces and ISTs within the affected area. ii. Mobile feeding units for US&R task forces and IST personnel. iii. Portable shelter (i.e., tents) for use by US&R task force and IST personnel for eating, sleeping, and working. January 2005 Catastrophic Incident Supplement | A5-1 National Response Plan National Response Plan ? Catastrophic Incident Supplement Appendix 5 ? Decontamination Response Overview 1. Mission In the immediate aftermath of a catastrophic incident involving nuclear, radiological, or chemical contamination, provide technical advice and assistance to State and local governments regarding the decontamination of persons, first responders and medical treatment equipment and facilities, and animals in service. Thereafter, augment technical advice with expert personnel and equipment, supplies, and systems to assist in the decontamination of buildings and equipment (especially those providing essential/ critical services), and the environment. In the recovery phase, assist in providing augmented/replacement first responder decontamination resources and capability. 2. Planning Assumptions A. Overview. For catastrophic incidents depicted in the planning scenarios related to this plan, decontamination involves several related and sequential activities. Chief among these are (1) immediate (or gross) decontamination of persons exposed to toxic/hazardous substances; (2) continual decontamination of first responders so that they can perform their essential functions; (3) decontamination of animals in service to first responders; (4) continual decontamination of response equipment and vehicles; (5) secondary, or definitive, decontamination of victims at medical treatment facilities to enable medical treatment and protect the facility environment; (6) decontamination of facilities (public infrastructure, business and residential structures); and (7) environmental (outdoor) decontamination supporting recovery and remediation. B. Decontamination of victims exposed to toxic/hazardous substances is primarily a State and local responsibility. Noting that Federal responders rarely arrive in time to provide such a service, the Federal Government will provide the maximum support possible. The primary Federal roles in the immediate aftermath of a catastrophic incident would be: (1) Providing technical advice and assistance for local personnel managing decontamination activities. (2) Obtaining status/assessment information regarding the extent and effectiveness of local decontamination activities in order to analyze their implications for ongoing medical treatment and population protection. (3) Ensuring that requirements for additional equipment and/or personnel to support local decontamination activities to be provided by the Federal Government are obtained and acted upon expeditiously. C. Catastrophic incidents using credible threat scenarios could potentially affect people based on an estimated population density of 2,000 people per square mile. These numbers will be much higher in major downtown urban areas. In addition, special event situations such as sporting events, conventions, and holiday events create situations where a very large number of people gather and could become potential victims. D. Given a nuclear/radiological or chemical incident, and in certain situations for biological agents, decontamination may be required for: A5-2 | Catastrophic Incident Supplement January 2005 National Response Plan (1) People (victims, including affected responders/workers who are decontaminating buildings and the environment will need their protective equipment decontaminated during response, recovery, and remediation; viable patients with injuries, exposure effects, and potential contamination; victims with no medically significant injuries or requiring only psychological support; and fatalities). (2) Animals (working rescue and response service animals, companion animals, and livestock). (3) Equipment (equipment or apparatus required for or of potential use in response, equipment or apparatus required for or of potential use in recovery, and non-critical equipment or apparatus not meeting the first two criteria). (4) Facilities (facilities and infrastructure required for or of potential use in response, facilities and infrastructure required for or of potential use in recovery, and non-critical facilities and infrastructure not meeting the first two criteria). (5) Geographic outdoor areas requiring remediation. E. Decontamination priorities will be set using the following priorities, in order of importance: life safety, incident stabilization, and property conservation. F. The following crosscutting issues must also be considered: (1) Decontamination procedures to date have treated the public as a homogeneous entity and have not differentiated needs of specific subgroups. For example, decontamination techniques for adults may not be applicable to children and infants or the elderly who require a heated environment. (2) Decontamination has been a humiliating and degrading experience for women and men who are forced to strip off their clothing in front of other people. Accordingly, gender separation and privacy draping by tarpaulins, etc., is a recommended practice, as is provision of expedient clothing (e.g., blankets, sweat suits, large plastic bags). (3) It is very likely that a significant number of persons exposed to the plume cloud will flee the scene before first responders arrive and therefore will not be present for gross decontamination. This reinforces the requirements for (a) effective risk communications/emergency public information and (b) monitoring and detection capability at medical treatment facilities, first responder facilities, and reception centers/mass care shelters. (4) Secondary contamination has been noted as a major concern. Hospital emergency rooms have been closed when contaminated victims have been admitted without decontamination. This was a major problem in the Tokyo subway sarin incident. Other secondary contamination issues of note include control of runoff of fluids used in decontamination and the handling of contaminated remains such as clothing and personal effects. Secondary contamination of first responders must be planned accordingly, even if wearing personal protective equipment (PPE). Such contamination can occur during the removal of a patient from a hazardous area, performing basic life support functions, or because initial responders are unaware that a hazardous material (HAZMAT) is involved. (5) Another significant national issue is the lack of hospital preparedness for handling contaminated patients or performing decontamination operations. Although many have plans in place, few actually have the necessary facilities. Those with facilities can only process a limited number of January 2005 Catastrophic Incident Supplement | A5-3 National Response Plan patients at a time. One of the critical issues in hospital preparedness is the availability and use of appropriate PPE. Many hospitals are in the process of receiving PPE and the training associated with how to put on, work in, and safely remove PPE. However, there still remains much education to do on PPE and decontamination activities to be performed at the hospital level. (6) The psychological dimension of exposure to a toxic chemical, biological, or radiological substance and the subsequent decontamination is an important, but not fully understood, topic. Epidemic hysteria has been associated with perceived exposure to toxic substances among adolescent groups. Concerns exist that psychological stress triggered by an accident will result in symptoms resembling actual exposure and people with such stress symptoms may report to medical facilities seeking treatment. Little documentation exists, however, to support this concern. Of greater concern are the short and longterm psychological consequences of people actually exposed to a chemical or biological substance that experience negative health effects. The decontamination process may compound negative psychological effects from such experiences. Short-term stress symptoms may, in some cases, lead to long-term debilitating psychological effects, which are referred to as post-traumatic stress disorder (PTSD). (7) The worried well is a significant population to deal with. Hundreds or thousands can easily overwhelm healthcare facilities. Being able to provide assurances via monitoring and detection equipment will yield highly positive results. (8) A major question remains concerning the effectiveness of decontamination techniques and determining if a building or person are “clean.” This is less problematic for buildings where time allows for multiple actions and extensive testing. Some buildings and equipment may be decontaminated in phases depending on intended use and nature of contamination. It should also be noted that it might not be possible to decontaminate areas to “clean.” For example, following a nuclear incident, the source area may be so contaminated that it is more realistic to constrain access than to attempt to decontaminate. Determining if people are clean following decontamination is more problematic, due to the inability to test for and verify levels of residual contamination following decontamination procedures. (9) Internal contamination may be a significant threat in radiological or nuclear incidents. Victims who have internalized significant amounts of radiological contaminants may themselves present a radiological threat to those in their vicinity. Because of the foregoing information and considerations, there exists an urgent preparedness imperative, particularly at the local Government/local mutual aid partners level. As venue-specific catastrophic incident planning continues, it is vital that local first responder, medical provider, public health, emergency management, business, and volunteer organization leaders address in pre-incident preparedness activities, decontamination issues to include: (a) Development and implementation of a modular approach to medical treatment facilities, first responder facilities, and reception centers/mass care shelters, which includes designation of those facilities and tasking of elements/units and required equipment and supplies to provide portal and point monitoring/detection, human and animal decontamination, and physical security to each of these locations, whose operating viability must be maintained in order to engage a minimally successful incident response. (b) Development and implementation of risk communications/emergency public information capabilities to deliver, via robust and redundant means, timely and accurate information, on an ongoing basis throughout the response phase, regarding the nature and extent of the incident and the actions to be taken to reduce the risk of weapons of mass destruction (WMD) agent contamination, obtain personal and facility decontamination support and/or conduct self-help decontamination, implement shelter-in-place or evacuation procedures, establishment of exclusion/isolation/quarantine zones, and related matters regarding human and animal health with respect to WMD agent dispersal. A5-4 | Catastrophic Incident Supplement January 2005 National Response Plan (c) Provision of personal, family, workplace, and institutional setting information, awareness, and guidance on personal, animal, and facility decontamination. 3. Catastrophic Response Strategy A. Response Strategy: IMMEDIATE. (1) Local governments have the primary responsibility for initial response to catastrophic incidents. Accordingly, local responders will be implementing mass decontamination of people during the most crucial period where minutes matter regarding reducing or eliminating negative human health effects of external exposure to toxic/hazardous chemicals/materials. Removal of clothing and thorough washing with a copious flow of water is the most expeditious and effective mass (or gross) procedure. Initially individuals, if properly prepared, could begin mass decontamination actions of people, followed by mass decontamination procedures that are part of local level response. If a Metropolitan Medical Response System (MMRS) team is available, it will immediately respond to the incident. (a) Metropolitan Medical Response System (MMRS). The MMRS program assists highly populated jurisdictions to develop plans, conduct training and exercises, and acquire pharmaceuticals and PPE, to achieve the enhanced capability necessary to respond to a mass casualty event caused by a WMD terrorist act, with their own resources, during the first hours crucial to lifesaving and population protection, until significant external assistance can arrive. Gaining this capability also increases the preparedness of the jurisdictions for a mass casualty event caused by an incident involving HAZMAT, an epidemic disease outbreak, or a natural disaster. (b) The MMRS approach requires linkages among first responders, medical treatment resources, public health, emergency management, volunteer organizations, and other local elements, to work together to develop the capability to reduce the mortality and morbidity that would result from major terrorist acts. It also requires planning integration with neighboring jurisdictions, State and Federal agencies, and emphasizes enhanced mutual aid. MMRS capacity requirements include pharmaceuticals sufficient to provide care for at least 1,000 victims of a chemical incident and for 10,000 victims for the first 48 hours of response to a biological event. (2) Reduce the potential for persons becoming contaminated (e.g., sheltering) by screening these potentially contaminated individuals. Portal monitors and handheld detection instrumentation can add effectiveness and efficiency in sorting priorities in the population prior to decontamination activities. Using such capabilities as the Interagency Modeling and Atmospheric Assessment Center (IMAAC) may minimize public exposures. (3) Biological agents typically have delayed symptoms and lack easily recognizable signatures such as color or odor. There will rarely be an on-site incident to respond to when a biological agent is released unless there is a dissemination warning, a claimed or suspected dissemination device is found, or a perpetrator is caught in the act of disseminating the agent. Healthcare facilities are the most likely locations for managing a biological agent incident. If a biological agent is suspected, care must be taken to protect current patients, staff, and faculty from infection. If there is an on-site response to a biological incident, decontamination is necessary to reduce the risk of additional contamination. When biological decontamination is performed, thoroughness is more important than speed. (4) The full decontamination procedure should occur in the following order: January 2005 Catastrophic Incident Supplement | A5-5 National Response Plan (a) People known to be in the plume path/debris field and others seeking decontamination and first responders engaged in incident response. (b) First responder equipment and vehicles, medical treatment facilities, reception centers, and mass care shelters (should contamination prevention fail). (c) Working rescue and response animals are critical for continued response operations. (d) Transportation vehicles needed to move casualties and evacuees (should contamination prevention fail). (e) Critical infrastructure (e.g., water and sewer systems, electric power, communications, banking, etc.). (f) Pets and livestock. Depending on the type of incident, livestock (including poultry) may need to be euthanized instead of decontaminated. Sheep, goats, and smaller animals will be dead within minutes if exposed to a nerve agent. Animals with dense fur are almost impossible to decontaminate, especially if they are exposed to a mustard agent. (5) Local authorities will issue timely and accurate risk communications/emergency public information, via multiple means, regarding decontamination and protective actions regarding shelter-inplace or evacuation. (6) In the initial hours after a catastrophic incident, the priority Federal roles will be to provide reach-back technical advice/assistance to local responders and assess the effectiveness of decontamination as an element of situation awareness and assessment. B. Response Strategy: FIRST 10 DAYS. (1) Decontamination of critical infrastructure will likely continue well into the first 10 days, and into the sustained response after decontamination of people, animals in service, critical infrastructure, State and Federal facilities, and businesses that are critical to defense/security and the national/Regional economy. (2) Medical monitoring of contaminated and potentially contaminated victims should be under way. (3) Federal resources “on the ground” will focus on supporting State and local authorities with facility and environmental decontamination, contaminated debris removal, and monitoring/ assessment in support of recovery and restoration. C. Response Strategy: SUSTAINED. (1) Continued decontamination of people as needed. (2) Monitoring and decontamination of buildings/facilities and equipment in support of restoration and recovery. Federal assistance will be available as long as necessary. (3) Local authorities must have predesignated locations for storage of contaminated debris. A5-6 | Catastrophic Incident Supplement January 2005 National Response Plan (4) Local authorities (with technical support from Federal and State governments) will determine when buildings/facilities and areas are safe for reentry, other utilization, or are to be condemned. (5) Federal assistance will be available for contaminated debris removal, storage, and monitoring. D. Additional Considerations (1) No Federal resources, other than off-site technical experts will be available for approximately the first 4 hours of the incident. Significant quantities of Federal resources may not be available for up to 24 hours. (2) Lack of resources available to decontaminate all people, animals, facilities, and equipment, or to contain contaminants and runoff will result in failure to contain the spread of some hazardous materials. The Environmental Protection Agency (EPA) recognizes that actually saving lives takes priority over protecting the environment from contaminated runoff and has addressed this runoff issue in a policy letter. (3) Decontamination requirements will immediately exceed State and local capabilities. Additional response assets will be available from intra-State Regional sources, State resources, and neighboring States under the Emergency Management Assistance Compact (EMAC) within several hours. (4) Contaminated people and animals will not remain at any one contaminated location. Public officials will direct victims to collection points, potentially directing those who can selfdecontaminate to do so. (5) A majority of victims will make their own way to their home or medical treatment facility and disregard first responder instructions to undergo gross decontamination unless a significant crowd control regimen is instituted by law enforcement. In a radiological or nuclear incident, it may be better to allow victims to leave the area of contamination rather than waiting for decontamination, to provide them an opportunity to remove themselves from exposure to ionizing radiation. (6) Medical treatment facilities and mass care shelters need to be kept clean yet are at great risk of contamination. Law enforcement is critical to maintain integrity at medical treatment facilities and shelters. (7) There is a significant lack of monitoring equipment necessary to ensure the thoroughness of decontamination and to protect entries to medical treatment facilities and mass care shelters. (8) The reception center concept employed in the Radiological Emergency Preparedness (REP) Program around commercial nuclear power plants—where monitoring, decontamination, and registration occur—has great merit for consideration as an intermediate victim processing step between gross decontamination and entry to a medical treatment facility, shelter, or return home. This concept needs to be integrated into existing State and local planning and preparedness for catastrophic incident response. (9) A positive identification technique needs to be employed for persons who have received gross decontamination so that medical treatment facilities and shelter managers can readily identify them January 2005 Catastrophic Incident Supplement | A5-7 National Response Plan and take action for those without a decontamination marker. Some local governments already accomplish this with plastic wristbands and a data field on triage tags. (10) According to common practice, local responders will position resources at road network choke points and hospitals according to common practice in order to control and handle the maximum possible number of affected people. (11) Public information and guidance on self-decontamination and shelter-in-place strategies will be distributed as soon as practical. Local responders generally provide this information. In the rare instance that State and local governments are not able to release such information, the Federal Government may do so. (12) Patient movement assets of the National Disaster Medical System (NDMS) will not accept patients for evacuation out of the incident area unless decontaminated. (13) Persons who have self-decontaminated will still need to be accounted for to verify and tag them as decontaminated without processing them. Their action may allow authorities to handle them last since they will not be exposed further unless they pass through a contaminated area. (14) The principal Federal interagency reference for mass personnel decontamination is “Best Practices and Guidelines for Mass Personnel Decontamination,” published by the Technical Support Working Group in collaboration with the Chemical and Biological Defense Information Analysis Center and the Department of Health and Human Services (HHS). (15) Appropriate coordinating authorities focus Federal, State, and local efforts on the containment of contaminants as soon as resources and the situation allow. 4. Transportation and Logistical Requirements A. There are no transportation or logistical requirements for Federal decontamination assets in the push package for the immediate response phase. B. Follow-on Federal assets, including personnel and equipment assigned to support facility and environmental decontamination and removal of contaminated debris, should be able to use the situationspecific transportation and logistical arrangements. 5. Resource Limitations and Unique Concerns A. In general, at the venue level, there will be insufficient firefighter apparatus and personnel to conduct immediate gross decontamination due to incident impact on these resources, size of the contaminated population, competing tasks, and possible disruption to municipal water supply. B. In general, at the venue level, there will be insufficient quantities of detection and monitoring equipment for first responders, reception centers, mass care shelters, and medical treatment facilities. C. There may be inadequate, untimely, or competing plume modeling to support rapid decisionmaking regarding population protection measures—principally shelter-in-place or evacuation. D. Due to the site-specific nature of many cleanup issues, there is currently no universal definitive guidance on “how clean is safe” in regard to returning to residences and resumption of businesses. A5-8 | Catastrophic Incident Supplement January 2005 National Response Plan Cleanup levels will be determined on a site-by-site basis by local governments working in tandem with Federal and State technical experts. 6. Response Capabilities A. Organic Federal (1) The National Response Center (NRC) is designated by Federal statute as the single mandatory point of reporting by the discovering party for HAZMAT spills. By interagency agreement, the NRC is also the single point of contact (POC) for members of the public and industry to report potential terrorist incidents. The NRC will notify other Federal agencies as appropriate and will assist the reporting party with referrals for technical assistance. (2) EPA and the U.S. Coast Guard (USCG) will respond to HAZMAT incidents, through the authorities, organization, and procedures contained in the “National Oil and Hazardous Substances Pollution Contingency Plan.” (3) EPA is creating a National Decontamination Team (specific to structures, infrastructure, and critical items; not people). This 15-person team will be located in Cincinnati, OH. This team will augment existing EPA response capabilities and will be dedicated to decontamination and the research and development of decontamination techniques and decontamination execution, technologies, and engineering for WMD. (4) EPA maintains Emergency, Environmental, and Radiological Emergency Response teams comprised of Federal On-Scene Coordinators (OSCs) (250 individuals in 10 EPA regions in 26 locations), the Environmental Response Team (50 experts in three locations: New Jersey, Ohio, and Nevada), and the Radiological Response Team (two locations: Alabama and Nevada). EPA has further reach-back capabilities with programs dealing with enforcement, air, water, research and development, and pesticides. EPA’s Radiological Emergency Response Team (RERT) members serve as part of the Federal Radiological Monitoring and Assessment Center (FRMAC) for radiological or nuclear incidents. For the intermediate and long-term phases of a radiological or nuclear incident, EPA takes over leadership of the FRMAC. (5) The Department of Energy (DOE) will activate Radiological Assistance Program (RAP) Teams, the National Atmospheric Release Advisory Capability (NARAC), a FRMAC, and the Radiation Emergency Assistance Center/Training Site (REAC/TS), in accordance with the Federal Radiological Emergency Response Plan (FRERP). RAP Teams respond to incidents involving radioactive materials and provide resources, including trained personnel and equipment, to evaluate, assess, advise, and assist in the mitigation of radiation hazards. NARAC provides real-time assessment advisories on nuclear, biological, or chemical (NBC) releases into the atmosphere. The FRMAC coordinates, through the primary agency, all Federal radiological monitoring and assessment activities during major radiological emergencies. REAC/TS provides medical consultation on the treatment of radiation exposure and contamination. DOE’s Aerial Measuring System (AMS) capability is an important asset that will allow the FRMAC to gather information about the site more quickly and safely than would be possible with only individuals performing monitoring. (a) RAP Teams: 27 teams in 8 DOE Regions, based at DOE facilities. RAP Teams are on a 2-hour call up (packed and in transit to the incident location within 2 hours) during working hours and on a 4-hour call up during non-working hours. January 2005 Catastrophic Incident Supplement | A5-9 National Response Plan (b) NARAC: Can provide initial dispersion plots, based on weather information, in as little as 15 minutes. NARAC continues to refine calculations and provide updated data until the release has been fully mapped and impacts assessed. (c) FRMAC: The Phase I Consequence Management Response Team (CMRT) keeps a readiness posture of “wheels-up” from Las Vegas in 4 hours, arriving on-scene in 6 to 10 hours for most of the continental United States (CONUS). Phase II CMRT, enabling round-the-clock operations, can be on-scene and running in 24 to 36 hours. The full FRMAC capability can be staffed with up to 500 people (including RAP elements) in a catastrophic incident, and use fixed and rotary-wing airborne assets for wide-area radiation monitoring. The full FRMAC capability is supported by DOE personnel and assets but is an interagency team of Federal and State technical experts. (d) REAC/TS: Radiation experts with REAC/TS are on-call 24 hours a day to provide direct medical and radiological advice. (6) The following Federal teams/organizations provide (or are a source for) decontamination special assistance: (a) Agency for Toxic Substances and Disease Registry (ATSDR) Emergency Response Teams. (b) U.S. Marine Corps (USMC) Chemical Biological Incident Response Force (CBIRF). (c) DOE Nuclear Emergency Support Team (NEST). (d) EPA Environmental Response Team (ERT). (e) EPA RERT. (f) Federal Bureau of Investigation (FBI), Laboratory Division, Hazardous Materials Response Unit (HMRU). (g) USCG National Strike Force (NSF). (h) Occupational Safety and Health Administration (OSHA) Health Response Team. (i) U.S. Army Corps of Engineers (USACE) Rapid Response Program. (j) U.S. Department of Agriculture (USDA). (k) National Response Center (NRC). (l) Medical Emergency Radiological Response Team (MERRT). B. HAZMAT Teams Deployment Time. Figure 5-1 reflects the number of hours before team is capable of departure from home unit or base. “HAZMAT Response Team” is defined as an organized group of individuals trained and equipped to perform work to control actual or potential leaks, spills, discharges, or releases of hazardous materials, requiring possible close approach to the material. The team/equipment may include external or contracted resources. A5-10 | Catastrophic Incident Supplement January 2005 National Response Plan Type I Type II Type III ATSDR CBIRF 1 Hour 1 Hour 1 Hour DOE NEST EPA ERT 4 Hours 4 Hours 4 Hours EPA Office of Enforcement Compliance, and Assurance (OECA)/National Counterterrorism Evidence Response Team (NCERT) 6 Hours 6 Hours 6 Hours EPA RERT FBI HMRU <1 Hour <2 Hours National Oceanic and Atmospheric Administration (NOAA) National Pollution Funds Center (NPFC) NSF 2 Hours 2 Hours OSHA HRT Supervisor of Salvage (SUPSALV) USACE Rapid Response NOTE: EPA OSCs are capable of departure from home unit or base within 1 hour. Figure 5-1 ? HAZMAT Team Response Times C. Inventory of Other (Federally Accessible) Capabilities. National Medical Response Teams (NMRTs). NMRTs are private practitioners who are organized into teams and Federalized for activation and deployment. Teams deploy to and operate within a HAZMAT environment providing physiciansupervised advanced level medical services, human decontamination services, agent detection, and/or assistance to response agencies. (1) All NMRT personnel are minimally trained to the OSHA HAZMAT operational level and some are at the technical level. All have specialized WMD medical training. The team is maintained in a state of readiness and is prepared to deploy within 4 hours of notification, 24 hours a day/7 days a week. (2) The NMRT consists of 50 personnel as the standard deployed force, although specialized missions can require as few as 12 personnel. It is designed to deploy by ground or air and is self-contained (except for water for decontamination). Ground transportation may be needed at the receiving site for personnel and equipment. (3) The NMRT may be requested for planned events, after a WMD event has occurred, when a credible threat exists or to assist with technological disasters. 7. Responsibilities of Coordinating and Support Agencies/Organizations A. When requested by the Coordinating Agency, DOE will: (1) Establish the FRMAC and coordinate monitoring and assessment of radioactive contamination, as outlined in the NRP Nuclear/Radiological Incident Annex. January 2005 Catastrophic Incident Supplement | A5-11 National Response Plan (2) Provide advisory assistance on radiological decontamination and monitoring techniques. (3) Assist in providing characterization of radiation deposition in affected areas. (4) Provide medical consultation on the treatment of persons injured by radioactive contamination or exposure and provide lists of all local medical personnel trained in the treatment of such injuries by the REAC/TS. B. EPA will: (1) Assume primary Federal responsibility for coordinating structural and environmental decontamination. (2) Assume primary Federal responsibility for measuring and informing the public and responders on air and environmental quality. C. HHS/ATSDR will: (1) Perform specific functions concerning the effect on public health of hazardous substances in the environment. ATSDR primarily supports and advises EPA, and is also available to States or local entities on request. (2) Immediately initiate or support State/local initiation of a health registry for both victims and responders. 8. Graphic Illustrations of Decontamination Operations A. Figure 5-2 depicts the “Ladder Pipe” method of emergency decontamination. It requires minimal resources, is quick to establish, and can process a large number of patients. B. Figure 5-3 depicts an example personnel decontamination station configuration. C. Figure 5-4 depicts the “Emergency Decontamination Corridor” method of emergency decontamination. It takes additional time to establish and does not have the same throughput as the Ladder Pipe method but provides some patient privacy and protection from the weather. D. Figure 5-5 depicts a sample decontamination decision tree (the example is for a chemical incident). A5-12 | Catastrophic Incident Supplement January 2005 National Response Plan Flow Chart showing victims' movement from contamination area to medical triage and staging Figure 5-2 ? Ladder Pipe Decontamination System Figure 5-3 ? Personnel Decontamination Station (PDS) Map of Personnel Decontamination Station January 2005 Catastrophic Incident Supplement | A5-13 National Response Plan Figure 5-4 ? Emergency Decontamination Corridor System (EDCS) Map of EDCS Layouts and EDCS Decontamination Area Setup A5-14 | Catastrophic Incident Supplement January 2005 National Response Plan Figure 5-5 ? Decontamination Decision Tree Example January 2005 Catastrophic Incident Supplement | A6-1 National Response Plan National Response Plan ? Catastrophic Incident Supplement Appendix 6 ? Public Health and Medical Support Response Overview 1. Mission Quickly augment the public health and medical support resources and capabilities of State, Tribal, and local governments responding to a catastrophic mass casualty/mass evacuation incident. 2. Planning Assumptions A. The Federal public health and medical response to a catastrophic incident will be coordinated by the Department of Health and Human Services (HHS) as outlined in Emergency Support Function (ESF)#8. B. During a catastrophic incident, medical support will be required not only at medical facilities, but in large numbers at casualty evacuation points, evacuee and refugee points, and shelters as well as to support field operations. C. Mass field triage will be required. D. Public anxiety regarding the catastrophic incident will require effective public information and risk communication and may also require appropriate mental health and substance abuse services. E. The Federal medical assets that can be brought to bear in a catastrophic incident are organized into four categories: Personnel (and their specific capabilities), Hospital Beds, Medical Countermeasures, and Equipment/Supplies. This appendix discusses personnel and hospital beds. Appendix 6 discusses equipment and medical supplies. F. Federal public health assets that can be brought to bear in are organized into five categories: Health Surveillance, Worker Health and Safety, Radiological/Chemical/Biological Hazards Consultation, Public Health Information, and Vector Control. G. Federal public health and medical assets are accessible through a wide number of components within the Federal Government, as well as from volunteer programs administered by the Federal Government. These assets may not always be available during the response to a catastrophic incident, depending on needs at their home institutions, family requirements, etc. H. U.S. Department of Homeland Security (DHS) National Disaster Medical System (NDMS) and HHS U.S. Public Health Service (PHS) Commissioned Corps assets will be the first Federal health and medical assets to arrive on the scene of a catastrophic event. I. Epidemiologic Intelligence Service (EIS) officers and the Center for Disease Control and Prevention (CDC) emergency response assets (including the Agency for Toxic Substances and Disease Registry (ATSDR)) will be the first Federal public health assets to arrive on the scene of a catastrophic event. J. While civilian Federal employees cannot be ordered to respond to a catastrophic incident, it is anticipated that a sizable portion will volunteer to assist with the response. A6-2 | Catastrophic Incident Supplement January 2005 National Response Plan K. Because of disparate systems for counting personnel, numbers in this appendix are likely to overestimate the number of available personnel as a result of “double counting.” L. Additional teams are currently being developed, such as the National Nurse Response Team (NNRT) and the National Pharmacy Response Team (NPRT). M. A State-based Emergency System for Advanced Registration of Voluntary Healthcare Personnel (ESAR-VHP) is being developed. N. The assets identified in the response strategy may not be available at the time of a catastrophic event due to needs at their home institutions, family requirements, etc. 3. Catastrophic Response Strategy A. Response Strategy: IMMEDIATE. (1) The personnel that can be brought to bear in response to a catastrophic incident come from various Federal Departments and Agencies and are coordinated through ESF#8 under the leadership of HHS. Figure 6-1 approximates the personnel available to deploy the first week of a catastrophic event. Each column represents the number of additional people who could be deployed. 24 Hours 48 Hours 72 Hours Total Physician 48 39 240 327 Nurse Practitioner /Physician Assistant 37 26 188 251 Nurse 120 146 515 781 Paramedic 39 118 64 221 Pharmacist/Technician 74 25 432 531 Administrative Support 99 117 445 661 Mental Health 23 13 125 161 Respiratory Therapist 0 0 0 0 Medical Staff Support 219 0 1,331 1,550 Total 659 484 3,340 4,483 3 DMATs, 1 NMRT and 70 percent of 1 PHS Roster 11 DMATs and 2 NMRTs 8 DMATs and 70 percent of 6 PHS Rosters Figure 6-1 ? Available Health/Medical Personnel Deployment Projections (2) In addition to the resources depicted in Figure 6-1: (a) The American Red Cross (ARC) will deploy local assets immediately following the incident. National ARC assets can be deployed within 72 hours. ARC assets include mental health and nursing personnel. These assets are under the ARC command structure, but will work in coordination with Federal, State, Tribal, and local efforts. Refer to Appendix 3 for more details. January 2005 Catastrophic Incident Supplement | A6-3 National Response Plan (b) Community Health Centers (CHCs) and Community Mental Health Centers (CMHCs) are available in all States and many jurisdictions. These centers are responsible for providing health and mental health services to their communities. While these centers typically receive the majority of their funding from State and local governments, they also receive substantial Federal funding. During a catastrophic incident, these centers could provide services to the injured and those needing mental health services. The use of CHCs and CMHCs should be coordinated with Federal, State, Tribal, and local authorities. The number of assets available will vary depending on local incident demands and preincident staffing levels. In Fiscal Year (FY) 2004, there were more than 3,650 CHC sites and 915 to 920 grantees across the country. In FY00 (the most recent year with available data) there were 2,075 CMHCs. (c) Memoranda of Understanding (MOU) between individual Department of Defense (DOD) military treatment facility commanders and surrounding local authorities may allow provision of medical treatment facility (MTF) and/or personnel support for emergency care under immediate response authorities, or when requested by ESF#8 and approved for employment by the Secretary of Defense (SECDEF). (d) As provided for in local community emergency response plans, and as authorized under applicable authorities, Department of Veterans Affairs (VA) Directors may provide emergency medical care to victims in a mass casualty event. B. Response Strategy: FIRST 10 DAYS. (1) After the first week, there will be an additional 390 NDMS personnel (members of augmentation and developmental teams) that can serve as relief for NDMS personnel deployed during the initial response. (2) In addition to the PHS Commissioned Corps officers listed in Figure 6-1, there are more than 700 other PHS officers who could be deployed to support a mass casualty event. C. Response Strategy: SUSTAINED. In accordance with the guidance and direction outlined in the ESF#8 annex of the National Response Plan (NRP). 4. Transportation and Logistical Requirements Movement of personnel, equipment, and (potentially) patients will require transportation and logistics support. 5. Response Limitations and Unique Concerns A. There is no unified database to inventory the health and medical personnel employed in administrative and research jobs within the Federal Government. These personnel could be a valuable resource in a catastrophic incident. B. Systems required to move personnel, patients, and equipment require extensive review and should be simultaneously exercised during national, State, and local exercises. C. Federal planning efforts need to be tied more closely to the efforts of Regional, State, and local planners. D. Plans need to be developed for rotating staff and incorporating volunteers. A6-4 | Catastrophic Incident Supplement January 2005 National Response Plan 6. Response Capabilities A. Organic Federal Resources (1) HHS Secretary’s Command Center (SCC). The SCC serves as an information and operations center providing a single focal point for the Federal health and medical response to a catastrophic incident, including information sharing, command and control (C2), communications, specialized technologies and information collection, assessment, analysis, and sharing. HHS Operating Divisions (OPDIVs) will provide liaisons to the SCC, at the request of the Assistant Secretary for Public Health Emergency Preparedness (ASPHEP), to facilitate coordination of the health and medical response to a catastrophic incident. (2) Secretary’s Emergency Response Team (SERT). The ASPHEP, on behalf of the HHS Secretary, directs and coordinates HHS efforts to prevent, prepare for, respond to, and recover from the public health and medical consequences of a catastrophic incident. The SERT and/or SERT Advance element acts as the HHS Secretary’s agent at incident sites. The SERT directs and coordinates the activities of all HHS personnel deployed to the incident site to assist State, Tribal, local and other Federal and Government agencies, as applicable. (3) DHS National Disaster Medical System (NDMS). NDMS medical response teams will be activated in response to a catastrophic incident and includes various teams that can deploy to the scene of the incident. Current NDMS medical specialty force strength is reflected in Figure 6-2. NDMS teams include: (a) Management Support Team (MST). There is currently one MST. The MST serves as the operational interface between NDMS response teams and the local Incident Commander, as well as with State and local governments. Role Number Physician 574 Nurse Practitioner/Physician?s Assistant 234 Registered Nurse 1,159 Emergency Medical Technician (EMT)/Paramedic 738 Pharmacist 158 Mortician 235 Veterinarians 100 Mental Health Professionals 48 Figure 6-2 ? NDMS Medical Specialty Force Strength (b) Disaster Medical Assistance Teams (DMATs). A DMAT is a group of professional and para-professional medical personnel (supported by a cadre of logistical and administrative staff) designed to provide medical care in response to a disaster or other incident. The DMAT mission is to rapidly deploy to a disaster site to provide primary and acute care; triage of mass casualties; initial resuscitation, stabilization, advanced life support; and preparation of sick or injured patients for evacuation. The DMAT structure includes specialized teams, such as the four National Medical Response Teams (NMRTs), five Burn Teams, two Pediatric Teams, one Crush Medicine Team, January 2005 Catastrophic Incident Supplement | A6-5 National Response Plan two Mental Health Teams, and one International Medical/Surgical Response Team (IMSuRT), with two additional IMSuRTs under development. The specific capabilities of the NMRT, IMSuRT, NNRT, and NPRT are described in succeeding paragraphs. Figure 6-3 shows the location of the MST and operational DMATs. Figure 6-4 shows the medical response teams under development. Figure 6-3 ? Operational (Type-I) Disaster Medical Assistance Teams and Management Support Team Figure 6-4 ? Medical Response Teams Under Development Figure 3 DMAT MEDICAL OPERATIONAL TEAMS A6-6 | Catastrophic Incident Supplement January 2005 National Response Plan Figure 6-5 ? Medical Specialty Response Teams (3) DMAT Types and Strength (a) Type-I (Fully Operational Teams) – 9 total teams. Type-I teams consist of required equipment caches and rostered personnel that have demonstrated the ability to pack their cache and report to the team’s duty station within 6 hours of activation (among other criteria). (b) Type-II (Operational Teams) – 13 total teams. Type-II teams consist of required equipment caches and rostered personnel that have demonstrated the ability to pack their cache and report to the team’s duty station within 12 hours of activation (among other criteria). (c) Type-III (Augmentation/Local Teams) – 16 total teams. Type-III teams may be used to supplement other deployed teams, or may be deployed by NDMS within their home State to assist a Type I deployed team. Personnel can be deployed 24 hours after activation by NDMS. (d) Type-IV (Developmental Teams) – 17 total teams. Type-IV teams may be used to supplement other teams during deployments to allow the members an opportunity to gain the experience, training, and skills necessary to upgrade the team status. Team personnel can be deployed in 24+hours following activation by NDMS. (4) DMAT Capabilities (a) Deploy to an incident site within 6 hours, for a 14-day period. (b) Provide emergent care within 30 minutes of arrival at an incident site. MEDICAL SPECIALTY RESPONSE TEAMS Map of the US divided into West, Central and East Border Teams January 2005 Catastrophic Incident Supplement | A6-7 National Response Plan (c) Be fully operational within 6 hours of arrival at an incident site. (d) Sustain 24-hour operations for 72 hours without external support. (e) Provide initial resuscitative care to victims. (f) For a 24-hour mission, provide out-of-hospital, acute care to 250 patients (including geriatric and pediatric patients). (g) Provide sustained 24/7 care to 125 patients per day, including: i. Limited laboratory and pharmaceutical services. ii. Immediate referral, transfer, or evacuation for 25 patients. iii. Stabilizing/holding a maximum of six patients for up to 10 hours. iv. Supporting two critical patients for up to 24 hours. (h) Provide sustained hospital ward care for 30 medical/surgical (non-critical) inpatients. (i) Provide primary response to a mass casualty incident resulting from a nonchemical, biological, radiological, nuclear, or high-yield explosive (CBRNE) event. (j) Triage and prepare 200 patients at a casualty collection point for evacuation or transport in a mass casualty incident. (k) Provide patient staging for up to 100 patients at a Federal Coordinating Center (FCC) reception site. (l) Augment or assist at a mass drug distribution, immunization, or packaging center. (m) Staff or augment alternate care facilities. (5) National Medical Response Teams (NMRTs). The four 50-person NMRTs are equipped and trained to perform the functions of a DMAT, but possess additional capabilities to respond to a CBRNE event, to include operating in Level “A” protective equipment. Each NMRT is equipped with its own chemical and biological monitors and detectors, used primarily for personnel and victim safety. Additionally, each team carries medical supplies and medications, including sufficient antidotes to manage 5,000 victims of a chemical incident. The team can deploy in 4 hours and can be fully operational within 30 minutes of arrival on the scene of a catastrophic incident. A NMRT can perform the following specific functions: (a) Provide mass or standard decontamination. (b) Collect samples for laboratory analysis. (c) Provide medical care to contaminated victims. (d) Provide technical assistance to local Emergency Medical Services (EMS). A6-8 | Catastrophic Incident Supplement January 2005 National Response Plan (e) Assist in triage and medical care of CBRNE events before and after decontamination. (f) Provide technical assistance, decontamination, and medical care at a medical facility. (g) Provide medical care to Federal responders on-site. (6) International Medical Surgical Response Team (IMSuRT). There is currently one operational IMSuRT, which is located in Boston, MA. The mission of the IMSuRT is to assist in international disasters at the request of the Department of State (DOS) and to augment other U.S. disaster assets outside the continental United States (OCONUS). Each team is comprised of 25 medical and 5 logistic personnel. The medical personnel include trauma and general surgeons, physician’s assistants, registered nurses (some with trauma expertise), anesthesiologists, and Emergency Medical Technicians (EMTs)-paramedics. The IMSuRT provides triage and initial stabilization, definitive surgical care, critical care, and evacuation capacity. The team can deploy in 4 hours and is self sustaining for 72 hours. (7) Disaster Mortuary Operational Response Team (DMORT). There are currently 11 DMORTs. Each team is comprised of Funeral Directors, Medical Examiners, Coroners, Pathologists, Forensic Anthropologists, Medical Records Technicians and Transcribers, Fingerprint Specialists, Forensic Odontologists, Dental Assistants, X-Ray Technicians, Computer Professionals, Administrative Support staff, and Security and Investigative personnel. During an emergency response, DMORTs work under the guidance of local authorities by providing technical assistance and personnel to recover, identify, and process deceased victims. Capabilities include temporary morgue facilities; victim identification; forensic dental pathology; forensic anthropology; and processing, preparation, and disposition of remains. The DMORT program maintains two Disaster Portable Morgue Units (DPMUs) at FEMA Logistics Centers (one in Rockville, MD; the other in Sacramento, CA). The DPMU is a cache of equipment and supplies for deployment to an incident site. It contains a complete morgue, including workstations for each processing element and prepackaged equipment and supplies. (8) NDMS Planning Assumptions and Timeline of Care (a) Transportation routes—ground and air—are available to move NDMS assets. (b) Twenty-four hour post activation (day plus one (D+1)) teams will be in place, setup, and providing care within their region (East, Central, and West). (c) If an incident occurs in one region (East or West), only one third of assets will be on site and providing care at D+1. All other activated teams will arrive and initiate care at D+2 to D+3. (d) In the event of catastrophic incident, the “standard of care” will be minimal life support and patient holding for 2 to 3 days. (e) The NDMS timeline of care (Figure 6-6) is based on the following teams: i. 12 DMATs ii. 3 NMRTs iii. 1 IMSuRT iv. 3 Base Support Teams (BSTs) Figure 6-7 US Public Health Service Commissioned Corps Force Strength January 2005 Catastrophic Incident Supplement | A6-9 National Response Plan Role Number Physicians 1,210 Dentists 502 Nurses 1,224 Engineers 415 Science 269 Environmental Health 375 Veterinarian 97 Pharmacists 877 Dieticians 82 Therapists 117 Health Services 831 TOTAL 5,999 Figure 6-6 ? National Disaster Medical System Timeline of Care (D+3) Care Provided Single Team (D+0) 14 Teams (D+1) Entire NDMS System 35 Personnel 660 Personnel (D+3) 1,080 Personnel Treat and Release 250 patients per day 2,500 patients per day 5,000 patients per day (Outpatient Facility) Treat and Limited Holding (Alternate Care Facility) 160 outpatients per day 2,250 outpatients/day 4,500 outpatients per day 8 inpatients 112 inpatients 224 inpatients Figure 6-6 ? National Disaster Medical System Timeline of Care (9) PHS Commissioned Corps. The mission of the PHS Commissioned Corps is to provide highly trained and mobile health professionals to carry out programs to promote the health of the Nation. As one of the seven uniformed services of the United States, the PHS Commissioned Corps is designed to attract, develop, and retain health professionals who may be assigned to Federal, State, Tribal, or local agencies or international organizations to accomplish its mission. Figure 6-7 and Figure 6-8 illustrate the force strength and breadth of skill sets available among Commissioned Corps officers. Commissioned Corps officers can provide a wide variety of public health and medical services (both domestically and internationally), to include: (a) Direct medical and dental care to disaster victims and/or responders: (b) Mental health and social work services to victims and/or responders: (c) Provision of occupational health support to responders. Corps officers can provide occupational health support to include personal protective equipment, environmental hazards, hygiene, food, water, and sanitation: (d) Providing general health educators to provide information to victims and their families: (e) Environmental health and industrial hygiene officers to evaluate potable water, wastewater, and sanitation issues. (f) Environmental health, food safety, and dietician officers to evaluate food safety and security issues. (g) Epidemiologists to work with local public health departments to identify and evaluate morbidity and mortality issues. (h) Forensic dentists to support the local medical examiner in mass fatalities. A6-10 | Catastrophic Incident Supplement January 2005 National Response Plan (i) Information technology (IT) and medical records experts to improve the collection and communication of public health information: (j) Veterinarians and epidemiologists to support animal health disasters and disease control, which may or may not transfer to humans. Roles include supporting the U.S. Department of Agriculture (USDA) and augmenting the VMATs. (k) Engineers, Environmental Health, Industrial Hygienists, and Safety Officers to evaluate buildings, roads, bridges, or water and sewer systems, as well as investigate and ameliorate environmental hazards and airborne materials in support of State and local jurisdictions and the SNS. Deployment Time Deployment Role 24 Hours 72 Hours Totals Clinical Dietitian 5 32 37 Clinical Veterinarian 5 31 36 Communications Officer 6 40 46 Dentist 36 226 262 Emergency Coordinator Augmentee 12 70 82 Emergency Medical Technician 1 4 5 Epidemiologist 48 288 336 Food Safety 9 51 60 General Environmental Health Officer 46 279 325 General Health Educator 38 232 270 General Nurse 72 435 507 Hazardous Waste/ Materials 5 32 37 Liaison Officer 29 159 188 Medical Records Administrator 3 21 24 Medical Technologist (Laboratory Technician) 6 36 42 Mental Health Provider 19 117 136 Occupational Health/ Industrial Hygiene 9 56 65 Optometrist 8 46 54 Pharmacist (General) 65 391 456 Pharmacist (Strategic National Stockpile) 5 33 38 Physical Therapist 8 50 58 Physician Assistant 11 63 74 Primary Care Nurse Practitioner 18 109 127 Primary Care Physician 36 216 252 Safety Officer 6 38 44 Strategic National Stockpile Officer 2 13 15 TOTALS 508 3,068 3,576 70 percent 356 2,148 2,503 Figure 6-8 ? Active U.S. Public Health Service Commissioned Corps Force Roster NOTE: In response to a catastrophic incident, all officers are potentially deployable. However, at any given time, 50 percent of officers are fulfilling mission-critical roles and will not be deployable. January 2005 Catastrophic Incident Supplement | A6-11 National Response Plan (l) The PHS Commissioned Corps includes approximately 6,000 officers, divided among seven rosters, on-call on a rotating monthly basis. Officers are categorized according to the 26 deployment roles outlined in Figure 6-8. Once the mission requirements and the category/discipline/ specialty of members are determined, the Office of the Surgeon General (OSG) will match the requirement against the qualifications of officers on that month’s rotational roster. Realistically, 70 percent of the on-call officers can be deployed within 24 hours (Figure 6-8). Within 72 hours, 70 percent of the people on the other six rotational rosters could be deployed. (m) Fifty-five of the medical providers (e.g., physicians, nurses, dentists, nurse practitioners, and physician’s assistants) listed in Figure 6-8 participate in the Health Resources and Services Administration’s (HRSA’s) Ready Responder program. These Officers annually receive 2 weeks of specialized training to respond to weapons of mass destruction (WMD) events. (n) CDC has more than 200 public health professionals that are trained in incident response and have been medically cleared and fit tested for respirators. In addition, it is estimated that additional CDC staff will volunteer to assist with the response to a catastrophic public health emergency. Specific capabilities include: i. Health Surveillance. Assistance in establishing surveillance systems to monitor the general population and special high-risk population segments, carry out field studies and investigations, monitor injury and disease patterns and potential disease outbreaks, and provide technical assistance and consultations on disease and injury prevention and precautions. ii. Worker Health/Safety. Assistance in monitoring the health and wellbeing of emergency workers, perform field investigations and studies addressing worker health and safety issues, and provide technical assistance and consultation on worker health and safety measures and precautions. iii. Radiological/Chemical/Biological Hazards Consultation. Assistance in assessing health and medical effects of radiological, chemical, and biological exposures on the general population and on high-risk population groups; conduct field investigations, including collection and analysis of relevant samples; advise on protective actions related to direct human and animal exposure, and on indirect exposure through radiologically, chemically, or biologically contaminated food, drugs, water supply, and other media; and provide technical assistance and consultation on medical treatment and decontamination of radiologically, chemically, or biologically injured/contaminated victims. iv. Public Health Information. Assistance by providing public health, disease, and injury prevention information that can be transmitted to members of the general public who are located in or near areas affected by a major disaster or emergency. v. Vector Control. Assistance in assessing the threat of vector-borne diseases following a major disaster or emergency; conduct field investigations, including the collection and laboratory analysis of relevant samples; provide vector control equipment and supplies; provide technical assistance and consultation on protective actions regarding vector-borne diseases; and provide technical assistance and consultation on medical treatment of victims of vector-borne diseases. (10) Medical Reserve Corps. The response to a catastrophic incident will begin locally. The local response will vary depending on the level of preparedness in the area of the incident. The Medical Reserve Corps (MRC) program is establishing teams of local medical and public health volunteers to enhance and support existing local capabilities on a regular basis and during emergencies. A6-12 | Catastrophic Incident Supplement January 2005 National Response Plan The MRC program is headquartered in the OSG. This program is part of a national initiative involving the U.S. Freedom Corps (sponsored by the White House) and Citizen Corps (sponsored by DHS). Joining the MRC ranks are over 5,000 volunteers from 186 communities. The number of volunteers is expected to double within the next 12 months. Figure 6-9 shows the locations of the 186 MRC units. Based on the interest in this program and the preliminary data from MRC units, the MRC program could be expanded to provide local staff for a catastrophic incident. Figure 6-9 ? Medical Reserve Corps Communities Map of US showing Medical Reserve Corps Units (11) Department of Veterans Affairs (VA). The VA can ask available medical, surgical, mental health, and other health service support people to volunteer to assist the primary Federal agency in the prosecution of a catastrophic event. Refer to Figure 6-10 for a list of potentially available VA staff. In addition, local VA Medical Directors are authorized, under applicable authorities, to provide emergency medical care to victims of mass casualty events. Public Law requires that patients be billed for services provided. Role Total Number Physicians 14,529 Physician Extenders 4,262 Nurses 35,834 Pharmacists 5,159 Respiratory Therapists 98 Medical Support Staff 39,717 Mental Health Providers 8,625 Administrative Support 14,878 TOTAL 123,102 Figure 6-10 Department of Veteran Affairs Staff January 2005 Catastrophic Incident Supplement | A6-13 National Response Plan (12) Department of Defense (DOD). Under imminently serious conditions, when there is inadequate time to seek the approval of higher Headquarters (HQ), the commanders of DOD installations near the incident may provide necessary assistance to save lives, prevent human suffering, or mitigate great property damage without prior approval of the SECDEF. Continuation of such assistance beyond the short term will require DOD approval. Availability of further assistance will be determined by DOD, based on priority military requirements of ongoing DOD missions. (13) Hospital Beds. In the United States there are approximately 5,800 non-Federal hospitals with a staffed bed capacity of approximately 1 million. Of these non-Federal hospitals, over 1,600 have signed MOUs with NDMS agreeing to serve as receiving hospitals in an emergency. The NDMS system has designated FCCs that would determine the number of available beds among the NDMS hospitals in their region and coordinate patient movement to these facilities. The locations of the FCCs are shown in Figure 6-11. The FCCs and the potential hospital beds that would be available to receive patients in a mass casualty event are provided in Figure 6-12. These hospital beds may/may not be available due to existing circumstance in each facility. Thus real-time bed availability will be captured through a contingency bed report. Available hospital beds are defined as beds vacant for 24 hours prior to the day of the report and can immediately receive patients. They must be in a functioning medical or psychiatric treatment facility ready for all aspects of patient care. They must include supporting space, equipment, medical material, ancillary and support services, and staff to operate under normal circumstances. Excluded are transient patient beds, bassinets, incubators, and labor and recovery beds. FCCs will input the number of available hospital beds in their catchment area into the DOD U.S. Transportation Command C2 Evacuation System (TRACES2) database. (a) If the number of casualties exceeds the available beds in non-Federal NDMS hospitals, non-Federal hospitals outside of the NDMS system will be contacted to determine their ability to accept patients. Furthermore, the VA has designated 65 hospitals as Primary Receiving Centers (PRCs) to receive, transport, and treat patients from DOD in time of war. DOD has Military Treatment Facilities (MTFs) that may—through local MOUs and within the vicinity of the incident site—provide necessary assistance to save lives, prevent human suffering, or mitigate great property damage under imminently serious conditions without prior approval by the SECDEF. (b) Tribal facilities may be called upon to assist in a catastrophic incident. Tribal facilities can be Federally owned and operated, Federally owned but Tribally operated, and Tribally owned and operated. These facilities can include hospitals and health centers. These facilities may or may not be available during a catastrophic incident, but they should be considered as part of planning efforts. (c) The HHS SCC has a hospital resource tracking system known as Hospital Asset Reporting and Tracking System (HARTS). This system can be used during a catastrophic event to canvas American Hospital Association (AHA) hospitals in the area of the disaster regarding available assets. This data is entered through a secure Web site by the hospital. Using Geographic Information System (GIS) capabilities, the HARTS can provide direction for movement of patients and resources to best support the medical needs during the response to a catastrophic incident. A6-14 | Catastrophic Incident Supplement January 2005 National Response Plan Figure 6-11 ? Federal Coordinating Center Locations Map of US displaying Federal Coordinating Center Locations Figure 6-12 ? Potential National Disaster Medical System Beds Available Through Federal Coordinating Centers Federal Coordinating Center (FCC) Name/Identification State # of NDMS Hospitals Minimum Beds Maximum Beds Birmingham/Montgomery AL 17 516 819 Mobile (Keesler Air Force Base Alabama) AL 6 396 707 Phoenix (Luke Air Force Base) AZ 25 664 1,444 Tucson AZ 10 145 379 Little Rock AR 14 183 417 Long Beach/Greater Los Angeles Area CA 21 421 1,538 Oakland/San Francisco CA 15 825 1,573 Orange County (Camp Pendleton Naval Base) CA 28 290 1,048 Sacramento/Travis (Travis Air Force Base) CA 15 130 961 San Diego (San Diego Naval Base) CA 17 319 945 Denver/Boulder (Fort Carson Army Base) CO 20 720 1,316 New Haven/Hartford (Groton Naval Base) CT 31 502 2,304 Washington, DC/Maryland (Bethesda) DC 6 163 260 Wilmington/Dover (Dover Air Force Base) DE 7 126 475 Jacksonville (Jacksonville Naval Base) FL 11 106 269 Miami/Fort Lauderdale/ Tampa/Orlando FL Miami 35 681 1,403 Tampa 35 372 1,229 Bay Pines 6 166 375 Pensacola/Gulfport (Keesler Air Force Base Florida) FL 7 182 322 Atlanta GA 32 567 1,100 Augusta (Fort Gordon Army Base) GA 8 144 751 Honolulu (Tripler Army Base) HI N/A Chicago/Gary/Hammond (Great Lakes Naval Base) IL 24 863 1,793 Indianapolis IN 17 372 807 Des Moines IA 8 145 500 Wichita KS 5 240 595 Louisville/Lexington KY Lexington 11 98 383 Louisville 16 127 355 New Orleans/Baton Rouge/ Shreveport LA New Orleans 23 595 1,433 Shreveport 8 154 428 Baltimore (Walter Reed Army Base) MD 32 676 1,729 Boston/Eastern MA/ Northampton/ Central & Western MA MA Bedford 60 1,157 3,803 Northampton 22 254 779 Detroit/Flint/Ann Arbor/Grand Rapids MI 36 1,151 2,747 Minneapolis/St. Paul MN 26 569 1,338 Biloxi/Gulfport/Mobile, AL (Keesler Air Force Base Mississippi) MS 9 185 435 Jackson/Vicksburg MS 12 221 452 Kansas City, MO/ Kansas City, KS MO 9 380 700 St. Louis (Scott Air Force Base) MO 20 377 1,229 Omaha/Lincoln (Offutt Air Force Base) NE 17 219 578 Newark/Northern/Central (Lyons) NJ 71 2,090 3,758 Albuquerque/Santa Fe NM 10 216 403 Nassau/Suffolk/Brooklyn/ Queens/Manhattan/Staten Island NY Long Island 25 659 1,132 Brooklyn 18 189 463 New York 19 584 1,120 Rochester/Buffalo/ Western NY/Syracuse NY Albany 19 500 850 Buffalo 28 648 1,307 Syracuse 25 613 1,102 Southern Tier/Mid-Hudson/ New York Northern Metropolitan/Bronx NY 42 705 1,447 North Carolina NC 80 2,085 4,584 Cincinnati/Columbus/ Dayton/Toledo (Wright Patterson Air Force Base) OH Cincinnati 22 265 485 A6-16 | Catastrophic Incident Supplement January 2005 Toledo 6 75 155 Dayton 13 130 265 Columbus 8 120 225 Cleveland/Akron OH 38 927 2,070 Oklahoma City/Tulsa OK 12 340 801 Portland/Vancouver, WA OR 16 511 1,142 Philadelphia/Southern New Jersey PA 75 1,236 2,837 Pittsburgh/Northern West Virginia PA 51 953 3,260 Puerto Rico and Virgin Islands PR 19 193 378 Providence (Newport Naval Base) RI 18 123 544 Charleston (Charleston Naval Base) SC 5 55 125 Columbia/Greenville/ Spartanburg (Fort Jackson Army Base) SC 22 341 632 Nashville/Knoxville TN Nashville 31 811 1,823 Memphis as Patient Reporting Activity (PRA) Pending Dallas/Fort Worth TX 50 1,082 2,459 El Paso/Las Cruces, NM (William Beaumont Army Base) TX 9 216 503 Houston TX 59 1,215 2,530 San Antonio TX 33 472 1,293 Salt Lake City UT 23 294 839 Norfolk/Virginia Beach (Portsmouth Naval Base) VA 16 395 726 Northern Virginia Suburbs (Andrews Air Force Base)VA 7 184 353 Richmond/Central/Western Virginia VA 21 758 1,301 Seattle/Everett/Tacoma (Madigan Army Base) WA 27 767 2,173 Milwaukee WI 17 358 756 TOTAL 1,656 35,511 83,560 January 2005 Catastrophic Incident Supplement | A7-1 National Response Plan National Response Plan ? Catastrophic Incident Supplement Appendix 7 ? Medical Equipment and Supplies Response Overview 1. Mission This appendix will consider medical assets for a Federal response to a catastrophic incident, irrespective of cause or hazard. These assets will include a description of various programs and their overall capabilities and are not limited to post-exposure prophylaxis. 2. Response Capabilities A. Organic Federal (1) Strategic National Stockpile (SNS) Program (a) 12-Hour Push Package. This is a 50-ton assortment of medical assets and pharmaceuticals from the SNS. The 12-hour Push Package provides a broad spectrum of countermeasures applicable to a broad array of threats. The dozen 12-hour Push Packages are identical, pre-packaged in specialized cargo containers, and stored for prompt access by SNS program transportation partners. The 12-hour Push Package is assured for delivery to any site in the United States or its Territories within 12 hours of a Federal order to deploy. Transportation methodology (via ground or air) is situationally determined by the SNS program. (b) Vendor-Managed Inventory (VMI). VMI comprises the majority of medical assets and pharmaceuticals in the SNS program (e.g., VMI can provide 12 million citizens with much of the 60 days of anthrax prophylaxis). Nearly the entire VMI is maintained by manufacturers who rotate various product lines to ensure current product dating. VMI is designed for a tailored response to provide specific pharmaceuticals or medical assets to a suspected or confirmed agent. (c) Department of Veterans Affairs (VA) National Acquisition Center (NAC). The SNS program selected the VA NAC as its procurement partner. VA NAC annually procures more than $3.5 billion in medicines and medical material for the VA medical system and allows the SNS program to take advantage of economies of scale. The established relationship with the VA NAC also allows the SNS program to rapidly procure products not contained within the SNS formulary that are needed to respond to a specific event. The VA NAC also assists the SNS program in determining overall market availability and production capacity of pharmaceuticals and medical assets. (d) Treatment and Prophylaxis Capabilities of the SNS Program. The SNS formulary is designed for both pediatric and adult populations. The baseline capacity for children is based on the 2000 U.S. Census data and is applied to the SNS program requirements for prophylaxis or treatment for threat agents. The SNS capability against various threat agents will change over time as the formulary content is augmented, enhanced, or modified to respond to present or emerging threats. Therefore, the capabilities report will need to be continually updated. (e) SNS Formulary Content. A list detailing the specific formulary contents of the SNS is provided to State and local emergency planners through the SNS program consultant to that State. The list does not include quantities of the specific products available, as the SNS program considers this information to be sensitive in nature. The SNS formulary content changes over time as the formulary is A7-2 | Catastrophic Incident Supplement January 2005 National Response Plan modified, enhanced, or augmented to respond to present or emerging threats. The SNS formulary content may be divided in to various categories to include: i. Airway management supplies (endotracheal tubes, manual resuscitators (ambu bags)) and intravenous (IV) supplies, including catheters and solutions (normal saline, lactated ringers). ii. Pharmaceuticals (antibiotics, analgesics, sedatives, chemical nerve agent antidotes, anti-epileptic drugs, anti-emetics and paralytics). iii. Wound management supplies (bandages, ointments, laceration repair supplies). iv. Vaccines (smallpox, anthrax). v. Antitoxin (botulism). vi. Ventilators. (f) Emergency Use Authorization (EUA). The National Defense Authorization Act was signed into law in November 2003. Section 1603 adds Section 564 to the Food, Drug, and Cosmetic Act (Authorization for Medical Products for Use in Emergencies), and states that the Department of Health and Human Services (HHS) Secretary may declare an emergency justifying the authorization, under this subsection, for a product (either an unapproved product or an unapproved use of an approved product) to be introduced into interstate commerce. The Secretary may make such an emergency declaration on the basis of the determination by the Secretary of Defense (SECDEF) that there is a military emergency, or a significant potential for an emergency, involving a heightened risk to U.S. military forces from an attack with a specified biological, chemical, radiological, or nuclear agent(s). The Secretary of HHS may issue an authorization under this section with respect to emergency use of a product only if, after consultation with the Director of the National Institutes of Health (NIH) and the Director of the Centers for Disease Control and Prevention (CDC), the Secretary concludes that: (1) an agent specified above can cause a serious or life-threatening disease or condition; (2) it is reasonable to believe that the product may be effective in diagnosing, treating, or preventing such disease or condition; (3) the benefits or using a product outweigh the risks; and (4) there are no adequate, approved, and available alternatives. Under EUA, healthcare providers and patients are informed about the risk and benefits and alternative interventions. The SNS program is currently working with the Food and Drug Administration (FDA) to evaluate the impact of the EUA on pharmaceuticals currently requiring an Investigational New Drug (IND) for distribution and use as well as the overall impact on the SNS formulary. (g) SNS Transportation of Assets. The SNS program has transportation partnerships with the commercial sector. The SNS program will make the decision of whether to execute a Federal order to deploy a 12-hour Push Package or VMI by air or by ground based on such factors as the safety and physical condition of the closest airfield where it is possible to land a wide-body aircraft, weather and road conditions, the likelihood of continuing terrorist activity, or other perils that may threaten SNS material. In making this decision, the SNS program will invite input from State and local officials from the affected area; Federal health, homeland security, intelligence, meteorology, and law enforcement agencies; and the SNS program transportation partners who must carry out delivery. (h) State Roles in Distribution. It is the State’s responsibility to formulate and implement a distribution and dispensing plan for SNS medical assets, including antibiotics for postJanuary 2005 Catastrophic Incident Supplement | A7-3 National Response Plan exposure prophylaxis. The resources required to implement each plan will vary by State and the organization of their SNS preparedness plan. (i) Cooperative Agreement Guidance. Sixty-two project areas receive funding to develop the necessary plans and infrastructure to receive and distribute the SNS assets. The project areas include 50 States, eight Territories, Commonwealth and Compact States, and four cities. Project areas obtain guidance from three sources: i. The CDC. The CDC program announcement sets forth the broad expectations for using these funds and stresses the need for State-level infrastructure to help carry out SNS preparedness; a need to fund Regional and local SNS preparedness infrastructure development; and the need to develop these infrastructures based on CDC guidance. ii. SNS Program Preparedness Branch. The SNS Program Preparedness Branch offers technical assistance. iii. CDC Guidance Documentation. The CDC guidance document, “Receiving, Distributing, and Dispensing the Strategic National Stockpile: A Guide for Planners, Version 9” details the functions that State and local planners need to have in place in order for an affected area to effectively manage and use SNS assets in a deployment. This includes information and instructions on: (i) Requesting SNS assets. (ii) What State and local communities must do prior to arrival of the SNS. (iii) State and local responsibilities under C2 function. (iv) Receipt, storage, and staging of SNS assets. (v) Controlling SNS inventory. (vi) Distributing SNS assets from staging warehouse to dispensing sites, treatment centers, or other distribution locations. (vii) Dispensing medications at emergency prophylaxis sites. (j) State Requirements to Request SNS Assets. The Governor of the State or his/her official designee is expected to initiate any request for Federal assets in an emergency. This request can be made to the President, to the Federal Emergency Management Agency (FEMA), or, in the case of requesting the SNS, to the Director of the CDC. There are no other requirements for a State to receive these assets. SNS assets can be deployed in the absence of Presidential or Public Health Emergency Declarations, and will be deployed when appropriate under the Catastrophic Incident Response Execution Schedule. (k) Resources States May Use to Achieve the Distribution and Dispensing of SNS Assets. States may use a variety of resources within their State to assist with the distribution and dispensing of medical assets and pharmaceuticals. These resources are not limited to State and local health professionals, law enforcement, Government workers outside of primary response agencies, and the National Guard, but can include volunteers from the community and professional organizations. The following U.S. Public Health Service (PHS) Commissioned Corps categories (and their proposed A7-4 | Catastrophic Incident Supplement January 2005 National Response Plan activities) are appropriate for assisting State and local personnel in the distribution of prophylaxis medications to an affected population: i. General Health Educator: Assist with preparation and distribution of educational materials at distribution points. ii. Pharmacist: Assist with packaging/labeling of medications and distribution to affected population at community dispensing sites. iii. Dentist: Medical screening or counseling and assistance with dispensing of medications to affected populations. iv. Emergency Medical Technician (EMT): Medical screening or counseling and assistance with dispensing of medications to affected populations. v. General Nurse: Medical screening or counseling and assistance with distribution of medications to affected populations, including distributing SNS assets from staging warehouse to dispensing sites, treatment centers, or other distribution locations, as well as dispensing medications at emergency prophylaxis sites. vi. Physician Assistant: Medical screening or counseling and assistance with distribution of medications to affected populations. vii. Primary Care Nurse Practitioner. Supervision of Federal personnel assisting with overall medical screening and/or counseling activities and assist with distribution of medications to affected populations. viii. Primary Care Physician: Supervision of Federal personnel assisting with overall medical screening and/or counseling activities and assist with distribution of medications to affected populations. NOTE: Other PHS Commissioned Corps personnel categories may be required to assist with registration, information distribution, and other distribution site organization and support activities. (2) Department of Veterans Affairs (VA) (a) The VA maintains pharmaceutical caches at their medical centers to protect VA patients, staff, and visitors in the event of a terrorist attack. In a catastrophic incident, these caches could be employed as required to provide humanitarian medical assistance to non-veteran beneficiary populations although these caches are primarily intended to treat veterans, staff, and other victims that may present to a local VA medical center. These caches are designed to ensure short-term preservation of the VA healthcare infrastructure until other resources can be made available in the immediate area and to support the facility’s involvement in the local community disaster plan. They contain limited stocks of pharmaceuticals, fluids, and other items needed for a terrorist attack. The VA pharmaceutical caches come in two different sizes. The small cache will support 1,000 casualties for 1 to 2 days while the large cache will support 2,000 casualties for 1 to 2 days. Each cache is color-coded to indicate its contents based on type of attack, with the exception of the color yellow, which indicates that the contents are supplies. Caches (and associated color) are available for the following incident types: i. Biological (B)......................Blue ii. Chemical (C) .......................Green January 2005 Catastrophic Incident Supplement | A7-5 National Response Plan iii. Explosion and Burn (E)....... Red iv. Radiological (R).................. Orange v. Supplies (S) .........................Yellow (b) Of the 143 current caches, 89 are large (1,500 square foot) and 54 are small (1,000 square foot) caches. All caches are on rollable carts secured by unbreakable, tamper-proof locks. The two exceptions are IV fluids, which are located on pallets in same area where the cache is stored, and all Class II and Class III items (controlled substances), which must be stored in a vault or safe in compliance with Drug Enforcement Agency (DEA) regulations. Should mobilization of the cache be necessary, operating procedures ensure that all Class II and Class III pharmaceuticals will be included with the cache. (c) The SNS program delivery goal is 12 hours from notification and approval of request. Although the delivery time of SNS assets to hospitals or dispensing sites will vary from State to State and is situation dependent, it is expected that assets will be delivered to the end user within 24 hours of the approval for activation. In a mass casualty event, hospitals should plan to function with on-hand stocks and limited resupply for at least 24 hours. (3) Blood and Blood Products. In a catastrophic incident there will be a need for blood and blood products. Currently, blood reserves for national emergencies consist of 500 units of pretested, pre-positioned packed red cells held at two locations—250 on the East Coast and 250 on the West Coast. Another 750 units are held in geographically dispersed private blood collection facilities. Blood can be ready for ground shipment within 4 to 6 hours. The responsibility for air shipment is dependent upon the situation. (a) The provision of blood/blood products will depend on the nature of the event; however, local blood collections, processing activities, and testing capabilities may be suspended. (b) Depending on the type of incident, blood collection centers and associated activity locations (i.e., processing, testing, and distribution) may require decontamination. These facilities should be given priority, as identified in Appendix 4. (4) Additional Equipment and Supplies. National Disaster Medical System (NDMS) Teams have their own caches of equipment and supplies. 3. Response Limitations and Unique Concerns A. Regional and local healthcare facilities lack sufficient quantities of antibiotics, antidotes, and other pertinent pharmaceuticals and medical countermeasures to effectively handle mass casualty incident requirements. B. Since most healthcare systems use a “just in time” inventory system for supplies, “on hand” supplies could be depleted quickly during a large-scale event. A7-6 | Catastrophic Incident Supplement January 2005 National Response Plan THIS PAGE INTENTIONALLY LEFT BLANK January 2005 Catastrophic Incident Supplement | A8-1 National Response Plan National Response Plan ? Catastrophic Incident Supplement Appendix 8 ? Patient Movement Response Overview 1. Mission Coordinate the communication, transportation, and medical regulating system to evacuate seriously ill or injured patients from the disaster site to reception facilities where they may receive definitive medical care. 2. Planning Assumptions A. Casualties requiring medical care following a catastrophic incident are expected to present themselves or be taken to hospitals near the incident site for treatment. This includes hospitals not participating in the National Disaster Medical System (NDMS). B. Medical evacuation operations (through air, ground, or sea assets) that may occur in affected areas within the first 96 hours following a catastrophic incident are limited. C. State and/or local transportation assets, if available, will be used to transport casualties requiring medical care to the designated patient collection point before further movement to a shelter or to a hospital or other medical facility for care. D. There is no preferred method of patient movement. Air, ground, and rail resources will be used to support patient transportation. E. Periodic reports of estimated beds available in the NDMS, Department of Veterans Affairs (VA) Patient Reception Centers (PRCs), and Military Treatment Facilities (MTFs) represent the approximate definitive medical capability available to accomplish continental United States (CONUS) medical regulating and patient movement. F. The Department of Health and Human Services (HHS) can help identify available hospital resources that could potentially accept casualties. G. Various asset-tracking systems need to be coordinated. H. The Department of Defense (DOD) Global Patient Medical Regulating Center will serve as the single patient movement manager when moving patients on U.S. Transportation Command Assets or other Federal Departments’ (e.g., Department of Transportation (DOT)) and Agencies’ (e.g., General Services Administration (GSA)) transportation resources. Federal patient movement operations will be integrated into DOD’s information technology (IT) system, TRAC2ES (U.S. Transportation Command Command and Control (C2) Evacuation System—the system of choice for casualty movement in response to a catastrophic incident) to ensure visibility of patient movement to hospital-definitive care by the Federal sector. Patients can be regulated to NDMS hospitals that have agreed to participate in NDMS. I. The movement of casualties on non-DOD Federal assets will require: (1) Medical crews and specialists to support ambulatory and non-ambulatory patient movement. A8-2 | Catastrophic Incident Supplement January 2005 National Response Plan (2) Patient regulating teams to enter data into TRACE2ES and associated hardware/ software. (3) Patient liaison teams to support patients placed in non-Federal, non-NDMS hospitals. J. NDMS hospitals are authorized to provide emergency care to casualties of a catastrophic mass casualty incident. If the number of casualties exceeds the available beds in NDMS hospitals, hospitals outside the NDMS system will be contacted to determine their ability to accept patients. VA PRCs and DOD MTFs are authorized to provide emergency care to casualties of a catastrophic mass casualty incident. DOD MTFs may, through local Memoranda of Understanding (MOU) and if within the vicinity of the incident site, provide necessary assistance to save lives, prevent human suffering, or mitigate great property damage under imminently serious conditions without prior approval by the Secretary of Defense (SECDEF). Subject to ongoing DOD missions and approval by the SECDEF, other MTFs may be available to assist during a domestic incident. 3. Catastrophic Response Strategy A. DHS/ FEMA will rapidly establish at least one Federal Mobilization Center (FMC), generally at military bases/airfields, near each affected venue. B. State and local authorities will collect and transport patients to designated transportation hubs in coordination with FMCs for outbound and inbound patient movement operations. C. A Medical Inter-Agency Coordination Group (MIACG), consisting of representatives from DHS, HHS, DOD, and the VA will convene and assess national capabilities, including those of the NDMS, to accept casualties into definitive, hospital-based care. D. Patient care services at non-incident locations will generally be used only by specific affected metropolitan areas. Destination facilities identified as being used by one affected metropolitan area will not generally be considered for use by any other affected metropolitan area. E. Patients will generally not be transported to facilities located near threatened metropolitan areas. F. DOD’s U.S. Transportation Command (TRANSCOM) will coordinate the movement of casualties/patients from patient collection points, such as Mobilization Centers, to airfields or other transporting sites, to hospitals for definitive care. This will be accomplished through DOT, GSA, and available DOD transportation assets (aircraft, rail, bus, ship), to NDMS hospitals. All Federal missions will be entered into DOD’s TRAC2ES IT system. Once the casualties exceeds the available capacity in non-Federal NDMS hospitals, other non-Federal hospitals may be contacted to determine their ability to accept patients. VA hospitals and DOD MTFs within the vicinity of the incident site may be able to provide support, pursuant to ongoing missions and availability of resources. Subject to the approval by the SECDEF, other MTFs may be available to assist during a domestic incident. 4. Transportation and Logistical Requirements A. Available beds are beds considered vacant as of 24 hours prior to the day of the report, and patients can be immediately transported to fill them. The beds must be in a functioning medical treatment facility set up and ready for all aspects of the care of a patient. It must include supporting space, equipment, medical material, ancillary and support services, and staff to operate under normal circumstances. Excluded are transient patient beds, bassinets, incubators, and labor and recovery beds. January 2005 Catastrophic Incident Supplement | A8-3 National Response Plan B. Throughput is defined as the maximum number of patients (stable or stabilized) by category that can be received at the airport, staged, transported, and received at the proper hospital(s) within any 24-hour period (including DOD/VA/NDMS hospitals). This is an estimate, subjectively derived from considerations that include limitations on the reception site, local transportation, and personnel. 5. Response Limitations and Unique Concerns The Federal sector’s capability to transport non-ambulatory patients requiring medical care during transit is limited. Additionally, resources to move contaminated and/or contagious patients are extremely limited and, for planning purposes, it should be assumed that this capability does not exist within the Federal sector. 6. Responsibilities of Coordinating and Support Agencies/Organizations A. Coordinating Agency: HHS. When a catastrophic incident with significant numbers of victims occurs, HHS will: (1) In collaboration with DHS/FEMA/NDMS, through the VA Readiness Operations Center, and the DOD Office of the Assistant Secretary of Defense for Health Affairs, alert local NDMS Federal Coordinating Centers (FCCs) to obtain bed availability reports from the participating non-Federal NDMS hospitals and report bed status to Global Patient Medical Regulating Center (GPMRC). (2) Through VA, DOD representatives and appropriate VA and Military Services C2 systems, alert local NDMS FCCs to obtain bed availability reports from the participating hospitals and report bed status to GPMRC. (3) The concept of operation is for local authorities to operate Casualty Collection Points (CCPs) that will feed into State-operated Regional Evacuation Points (REPs). Emergency Support Function (ESF)#8 will coordinate the hand-off of patients from the REPs into the NDMS evacuation system. B. Supporting Agencies (1) Department of Defense. DOD will provide health and medical services support as outlined in the National Response Plan (NRP) Public Health and Medical Services Annex (ESF#8). (2) Department of Veterans Affairs. The VA is responsible for supporting in-hospital patient care services. A8-4 | Catastrophic Incident Supplement January 2005 National Response Plan THIS PAGE INTENTIONALLY LEFT BLANK January 2005 Catastrophic Incident Supplement | A9-1 National Response Plan National Response Plan ? Catastrophic Incident Supplement Appendix 9 ? Mass Fatality Response Overview 1. Planning Assumptions A. A catastrophic incident that produces mass fatalities will place extraordinary demands (including tremendous religious, cultural, and emotional burdens) on local jurisdictions and the families of victims. Accordingly, after a disaster, the timely, safe, and respectful disposition of the deceased is an essential component of an effective response. Accurate, sensitive, and timely public relations are crucial to this effort. A catastrophic incident involving mass fatalities will require Federal assistance to transport, recover, identify, process, and store deceased victims. The actual work of identifying and processing the victims can be lengthy and painstaking work, often complicated by the needs of investigative agencies. Most local jurisdictions are not equipped to handle a mass fatality event and will experience profound difficulties coping with the disaster. B. During a mass fatality incident, local jurisdictions will lack sufficient personnel, equipment, and storage capacity to handle significant numbers of deceased victims. Assistance from Federal, public, and private agencies will be required to assist in the transportation, tagging, removal, processing, identification, and final disposition of victims and remains. Advanced methods of DNA typing and information management will be essential to effectively support mass fatality disasters. C. In the event of a mass casualty event, mutual aid resources and Federal assets will be needed to support local medical examiner/coroner activities, as well as to coordinate public and private assistance to grieving families. D. The mission of mass fatality management is to recover, transport, appropriately process, and protect all human remains; establish victim identities and causes of death; preserve all property found on or adjacent to the bodies; and maintain legal evidence for criminal or civil court action. E. Catastrophic mass fatalities will present unique logistical challenges, including the need for thousands of refrigerated trucks, disaster body pouches, and related supplies. F. If the deceased have been contaminated with chemical, biological, radiological, and/or nuclear agents, mortuary personnel will need to use special precautions to prevent cross contamination. G. Refrigerated truck capacity is limited to 40 remains per vehicle, since “stacking” can cause unnatural bruising or discoloration of the remains. Accordingly, the ability of the Federal Government to quickly secure 3,000 or more refrigerated trucks to support transportation and long-term storage will enable medical examiners/coroners time to identify, process, and “hold” remains until they can be delivered to local funeral parlors. H. Basic to a mass fatality response will be the identification and selection of a number of Casualty Collection Points (CCPs), using a combination of refrigerated trucks, portable preparation and storage sites (generally tents), the use of existing facilities such as National Guard/Reserve facilities, Department of Veterans Affairs (VA) facilities, and/or abandoned or under-used and convenient community structures. Collection sites will present significant challenges regarding access, traffic control, security, access to power, loading docks, and air quality (related to diesel engines). A9-2 | Catastrophic Incident Supplement January 2005 National Response Plan I. Local medical examiners/coroners, State funeral associations, State and local emergency management agencies, local and interState mutual aid, non-Governmental organizations (NGOs), local hospitals and hospitals councils, the American Red Cross (ARC), Federal Emergency Management Agency (FEMA), and Disaster Mortuary Operational Response Teams (DMORTs) will immediately and actively respond to a mass fatality event. Additional Federal support will be coordinated in accordance with National Response Plan (NRP) and National Incident Management System (NIMS) protocols, and may include support from the Department of Defense (DOD), Department of Transportation (DOT), and the VA. 2. Inventory of Federal Capabilities A. Disaster Mortuary Operational Response Teams. There are currently 10 DMORTs; each comprised of funeral directors, medical examiners, coroners, forensic pathologists, forensic anthropologists, medical records technicians and transcribers, fingerprint specialists, forensic odontologists, dental assistants, x-ray technicians, computer professionals, administrative support staff, and security and investigative personnel. During an emergency response, DMORTs—working within the incident command and management structure established by local authorities—provide technical assistance and personnel to recover, identify, and process deceased victims. (1) DMORT capabilities include: (a) Temporary morgue facilities (b) Victim identification (c) Forensic dental pathology (d) Forensic anthropology (e) Processing, preparation, and disposition of remains (2) In support of the DMORT program, FEMA maintains two Disaster Portable Morgue Units (DPMUs) at FEMA Logistics Centers; one in Rockville, MD, and the other in San Jose, CA. The DPMU is a cache of equipment and supplies for deployment to a disaster site and includes a complete morgue equipped with designated workstations for each processing element. B. DOD Mortuary Services (1) Following a mass fatality incident, which is likely to occur without warning and result in considerable confusion, there is generally a lack of sufficient personnel to handle the sensitive tasks of caring for the deceased. The Federal, State, and local governments may request DOD assistance in a mass fatality incident. In the event of mass disasters when the requirements for mortuary services exceeds that available from the civilian community, available DOD mortuary services support that has been approved by the Secretary of Defense (SECDEF) can be provided to support the Coordinating Agency in responding to a mass fatality request. DOD military services have Mortuary Affairs (MA) units that establish, operate, and maintain MA collection points and coordinate evacuation operations for deceased military personnel throughout the military area of operations worldwide. Capabilities include: (a) Search and recovery of remains (b) Presumptive identification January 2005 Catastrophic Incident Supplement | A9-3 National Response Plan (c) Processing and evacuation of remains (d) Storage of remains (2) Military MA units or personnel can provide these services listed above at an incident site in support of the Coordinating Agency or augment the local authorities within existing civilian processing/storage facilities (morgue) by providing technical assistance, processing, administration, and storage of remains. Each Service—U.S. Air Force (USAF), U.S. Army, U.S. Navy (USN), and U.S. Marine Corps (USMC)—have MA teams comprised of Active Duty and Reserve personnel. They range from nine to 350 member teams that are used for DOD missions, and if available and approved by the SECDEF, may be used to provide MA support as part of the Federal response to a catastrophic event. Some of these teams complement the Dover Air Force Base (AFB) mass disaster investigation processing facility that is led by the Armed Forces Institute of Pathology. Others may augment remains search, recovery, and presumptive identification services at or near the disaster site. Active Duty members of DOD MA Teams can be deployed quickly; however, a full complement will require mobilization of Reservists that could take up to 10 days. (3) Mass casualty investigation technical assistance and processing for conventional weapons or natural disaster incidents can be provided at the mass disaster investigation and remains processing facility at Dover AFB. However, investigation for contagious or contaminated remains cannot be processed by DOD’s mass disaster investigation and processing facility; their capabilities only include victim identification through dental examination, Federal Bureau of Investigation (FBI) fingerprinting, and x-ray and digital processing. (4) Armed Forces Medical Examiner Teams can provide technical assistance and pathology and identification services to local authorities at the disaster site. Additionally, the Armed Forces Institute of Pathology can provide death investigation services and support activities for toxicology, DNA testing, and forensic anthropology. (5) The Joint Prisoner of War/Missing in Action (POW/MIA) Accounting Command (JPAC), Oahu, HI, accounts for missing Americans from previous conflicts and could support a homeland security incident to account for unaccounted victims. JPAC performs analysis, investigation, recovery of missing persons, and identification of remains of deceased victims. JPAC’s Central Identification Laboratory provides anthropological studies, DNA identification, and odontosearch (before and after death dental comparison) to establish personal identification. 3. Response Strategy A. Response Strategy: IMMEDIATE. (1) National Disaster Medical System (NDMS) DMORT and Disaster Medical Assistance Team (DMAT) assets will commence deployment actions in accordance with the Catastrophic Incident Response Execution Schedule (Annex 1). Based on subsequent situational assessment information and the judgment of local medical examiners/coroners, Emergency Support Function (ESF)#8 will: (a) Deploy additional DMORTs, DMATs, portable morgues, and such rental units that may be available. (b) Initiate, in coordination with local authorities, selected mass disposal of human remains. A9-4 | Catastrophic Incident Supplement January 2005 National Response Plan (c) Locate and establish 50 reception sites for human remains. (d) Secure human remains retrieval staffing from Urban Search and Rescue (US&R) Teams, National Guard, Reserve elements, American Red Cross (ARC), and available volunteers from participating NGOs supporting various Federal, State, and local mutual aid resources. (e) Secure as many as 3,000 refrigerated trucks to both transport and store human remains. (f) Provide information technology (IT)/DNA-typing support unit(s). (g) Establish a transportation coordination and development unit to address logistical issues and transportation requirements of human remains to and from local hospitals, reception sites, medical examiner/coroner offices, and local funeral parlors. (h) Provide, with support from NGOs, mental health and counseling services for families of victims. (i) Assign human remains retrieval teams to the larger reception sites. B. Response Strategy: FIRST 10 DAYS. (1) During this period, decisions will be made regarding mass disposition strategies, storage, and processing at the reception sites and follow-on deployment of national DMORT assets. State and local emergency management agencies will quickly experience staffing/resource limitations as local funeral directors, the National Guard, and contractors begin exhausting existing inventories. Accordingly, the Federal Government will approach a variety of Federal, State, and local governmental—as well as private—entities to assist in the provision of additional personnel and equipment to search for, retrieve, transport, identify, categorize, and otherwise process potentially tens of thousands of humans remains. Staffing and equipment augmentation will be sought from the following organizations: (a) Federal DMORTs (b) National US&R Teams (c) State Funeral Director’s Associations (d) Local and Federally recognized mutual aid providers (e) National Guard (f) DOD (g) VA (h) DOT January 2005 Catastrophic Incident Supplement | A9-5 National Response Plan C. Response Strategy: SUSTAINED. (1) From Day 10 until the last victim has either been the subject of mass disposition or released by the local medical examiner/coroner to a local funeral parlor, the emphasis will shift from the location and retrieval of the remains to full functioning (staffing, securing, and equipping) of the reception sites. Federal Coordination Centers (FCCs) will continue to work with the local medical examiner/coroner offices and State and local emergency management agencies, though restocking and rotation of personnel will continue to be heavily weighted as Federal assignments. 4. Transportation Requirements A. For the first 10 days following a catastrophic incident, the location, retrieval, transportation, identification, and processing of human remains will be the initial focus of mass fatality response efforts. Depending on the characteristics of the situation, mass disposition may be implemented. DMORTs are expected to play a major role in support of these initial response activities, to include acquiring several thousand refrigerator trucks, staffing massive human remains transportation initiatives, and securing tens of thousands of disaster pouches. B. During Days 10 to 20 the focus of mass fatality response efforts will broaden to include the staffing and equipping of 50 reception sites and the establishment of a transportation rotation between the various sites involved with processing and storing remains. C. From Day 20 forward, the response will focus on completing the staffing and equipping of reception sites and ensuring the proper disposition of all remains. D. Mass fatality-related transportation and logistics requirements may include: (1) Deployment of up to 10 DMORTs and two DPMUs and related assets, including portable morgues and associated equipment. (2) Deployment of up to 10,000 pathologists, funeral directors, and additional mortuary support personnel. (3) Up to 3,000 refrigerated trucks (2,500 for storage and 500 for transportation) for storage and transportation of human remains. (4) Up to 10,000 personnel to load, drive, repair, and secure the trucks at reception sites. (5) Between 50,000 and 120,000 disaster pouches for human remains. (6) Up to 50 reception sites with appropriate security, privacy, loading docks, power outlets, and dormitory facilities (for up to 5,000 personnel, based on a 12-hour shift schedule). (7) Up to 100 Technical Information Specialists. (8) Up to 100 qualified personnel to augment DMORT DNA-typing resources. (9) U.S. Public Health Service (PHS) Commissioned Corps Forensic Dentists. A9-6 | Catastrophic Incident Supplement January 2005 National Response Plan 5. Limitations A. All potential or requested assets and resources may not be available to respond to a catastrophic event due to competing requirements at their home institutions (e.g., DOD assets may not be available due to primary mission priorities) or because of family concerns. B. Logistics systems may be overwhelmed and unable to move, in a timely manner, the projected volume of personnel, victims, and equipment. C. Protocols on movement and MA and identification processing of biologically and/or chemically contaminated remains are non-existent. D. Lack of standards for decontaminated remains. E. Storage area where remains can be processed for family members to help identify the remains. Could be a large permanent structure; but would require refrigeration. Contracted refrigeration vans would suffice. F. Storage area needed for personal effects; local procedures for inventorying personal effects may be incorporated into Federal inventory procedures. G. Supplies and equipment (e.g., pouches and litters) will be needed for large number of deceased. 6. Responsibilities of Coordinating and Support Agencies/Organizations A. Coordinating Agency: HHS. As coordinating agency for ESF#8, HHS provides leadership in directing, coordinating, and integrating overall Federal efforts to provide mortuary assistance, equipment, and supplies in support of the incident response. B. Support Agencies (1) U.S. Department of Homeland Security. DHS assists, principally through the NDMS, in providing victim identification and mortuary services (including DMORTs); temporary morgues; forensic dental and/or forensic pathology/anthropology; and support for processing, preparation, and disposition of remains. (2) Department of Defense. DOD provides assistance in managing human remains, including victim identification and disposition. (3) American Red Cross. ARC provides support counseling for family members of victims and provides personnel, if available, to assist morgue operations. January 2005 Catastrophic Incident Supplement | A10-1 National Response Plan National Response Plan ? Catastrophic Incident Supplement Appendix 10 ? Housing Response Overview 1. Mission This appendix outlines interim and long-term catastrophic incident housing requirements and strategy using current capabilities. 2. Planning Assumptions A. A large number of people are homeless. Primary dwellings are destroyed, heavily damaged, unlivable, and/or inaccessible. B. There will be significant disruption of infrastructure that impacts residential area and endangers public health and safety. C. The ability to reenter and reoccupy primary dwellings will be dependent upon the incident hazard, event, and geography. D. Existing emergency shelter and temporary housing resources will not be sufficient to address the numbers of individuals in need. E. The Emergency Management Assistance Compact (EMAC) will be activated and neighboring States will be accepting disaster victims. F. There will be significant public health, law enforcement, and transportation issues. G. This housing strategy will be implemented in cooperation with the affected State, Tribal, and/or local governments(s). H. There will be other disaster events such as floods, tornadoes, or hurricanes elsewhere in the country during this response and recovery operation. I. Federal and voluntary agencies will be available under the National Response Plan (NRP) for primary and support functions. J. It will be necessary to register recipients of Federal assistance but there will be significant impediments to the registration process. Registration is necessary to provide continued assistance as victims become dispersed, to reunite families, and ensure program accountability. Using the standard teleregistration and inspection process will not be feasible in all areas. The field registration intake process will be concentrated in or near emergency shelters. Registrations will be taken in the field by caseworkers. K. Current means of disbursing and delivering disaster assistance will be inadequate to overcome disaster-related disruptions in banking and/or mail delivery services. L. Individuals will not have access to their homes, jobs, schools, stores, pharmacies, etc. There will be a lack of health and medical care, sanitation and hygiene, and food and water. A10-2 | Catastrophic Incident Supplement January 2005 National Response Plan M. Most individuals and families will be able to find shelter or temporary housing that is preferable to congregate shelters if they are given the financial means. This will require providing the victims money and, in some cases, transportation. Individuals and families will occupy individual dwellings such as apartments, hotels, motels, manufactured housing, or tents whenever possible. N. Normal methods of information dissemination will be significantly impaired due to the disruption of utility services. O. Management of the influx of incoming workers (e.g., Federal, State, and local response staff; insurance adjusters; and unsolicited volunteers and construction companies) is essential to prevent a second housing disaster from occurring. Planning for housing of these individuals is not included in this appendix. P. Elevation of the Homeland Security Advisory System (HSAS) will impact transportation alternatives for victims seeking shelter or being transferred from shelters to temporary housing. 3. Catastrophic Response Strategy The core strategy for housing will be to provide people the financial and other assistance to move out of emergency shelters and into temporary and/or long-term housing as rapidly as possible. This will include encouraging people to temporarily leave the disaster area until local temporary housing becomes available. A. Response Strategy: IMMEDIATE. (1) In coordination with voluntary agencies, identify traditional and non-traditional shelter resources within the immediate vicinity of the impact area. (2) Identify traditional and non-traditional shelter resources within 250 miles of the impact area to shelter victims and recovery personnel. (3) Identify available housing resources within a 100-mile radius of the impact area, including potential sites for manufactured housing. (4) Deploy housing component of the Emergency Response Team to the area to establish an initial operating capability. (5) Activate contract employees to begin processing applications for disaster assistance and conducting residential damage inspections. (6) Disseminate public messages informing victims of what to do and the kind of disaster assistance to expect and the timeframes for delivery of services. Encourage people to temporarily relocate to outside the disaster area. B. Response Strategy: FIRST 10 DAYS. (1) Receive individuals and families into emergency shelters. Rapidly convert existing, structurally sound, accessible buildings for use as emergency shelters for meeting basic human needs. Structures in this category include commercially owned warehouses, manufacturing plants, vacant Federal facilities, stadiums, convention centers, and shopping malls. January 2005 Catastrophic Incident Supplement | A10-3 National Response Plan (2) Identify registration intake and damage inspection strategy. (3) Identify strategy for disbursing and delivering disaster assistance payments to displaced populations. (4) Consider private site use of tents and the use of larger tent cities (and prefabricated units) to house portions of the affected population. (5) Register individuals and families and conduct pre-placement interviews (PPIs). (6) Determine need and capabilities for expediting, postponing, or waiving residential damage inspections. (7) Identify housing resources within the disaster area and neighboring States. (8) Identify existing vacant manufactured housing sites (trailer parks) within 100 miles of the impact area. (9) Establish contracts with existing trailer parks and receive and position manufactured housing units there. (10) Identify undeveloped sites for manufactured housing units within 100 miles of the impact area. (11) Establish housing plan. (12) Establish and staff Disaster Recovery Centers (DRCs) in or near emergency shelters. (13) Disburse appropriate financial and other assistance to victims who want to temporarily leave the disaster area. (14) Refer individuals to available temporary housing such as apartments, hotels, motels, and manufactured housing, and provide them with appropriate financial and other assistance. (15) Deploy inspection and repair teams to identify and repair homes with minimal damage. (16) Identify neighborhoods with light damage that can be reoccupied if provided with water and sanitation services (e.g., portable toilets). (17) Deploy water and sanitation services to neighborhoods. (Mission would be tasked to the U.S. Army Corps of Engineers (USACE) by the Federal Emergency Management Agency (FEMA).) (18) Assemble Emergency Support Function (ESF)#14 to implement long-term recovery planning process. (19) Identify resources for the transport and relocation of individuals and families from shelters to temporary housing in areas of their choosing within 30 to 45 days. (20) Implement staff rotation plans for existing shelters. A10-4 | Catastrophic Incident Supplement January 2005 National Response Plan C. Response Strategy: SUSTAINED. (1) Integrate hardcopy registrations into the National Emergency Management Information System (NEMIS). (2) Continue to identify available housing. (3) Implement FEMA temporary housing strategy. (4) Continue to disburse financial and other assistance to victims and refer victims to temporary housing. (5) Continue repair of minimally damaged housing. (6) Coordinate procurement and delivery of temporary housing units. (7) Continue set up of manufactured housing and temporary shelter sites. (8) Place individuals and families in Federal or privately owned temporary housing. (9) ESF#14 coordinates long-term recovery strategy. (10) Convert and remodel available, structurally sound buildings to make the structures suitable for longer term interim housing. (11) Remove debris and remediate sites as appropriate to allow for reoccupation and/or the building of temporary and permanent structures. 4. Transportation and Logistical Requirements A. Victims from assembly points to emergency shelters. B. Recovery workers in and to the disaster area. C. Delivery of supplies to the DRCs. D. Delivery of housing units to the housing sites. E. Victims from shelters to temporary housing. 5. Response Limitations and Unique Concerns A. Individual assistance caseworkers and other trained staff. B. Existing shelter sites. C. Trained housing inspectors. D. Public/private partnerships. January 2005 Catastrophic Incident Supplement | A10-5 National Response Plan 6. Response Capabilities A. Organic Federal (1) Staff from: (a) FEMA National Processing Service Centers (trained). (b) Internal Revenue Service (IRS) (trained and not trained). (c) FEMA Headquarters (HQ) and Regions (trained and not trained). (d) Other Federal Agencies (not trained). (2) Materials: (a) DRC Go Kits from Logistics warehouses. (b) Temporary Housing Units stock and tent stock. (c) Federally owned housing (U.S. Department of Agriculture (USDA), Department of Housing and Urban Development (HUD), Department of the Interior (DOI), Department of Defense (DOD)). B. Non-Organic Federal (1) Staff from: (a) FEMA inspections services contract. (b) USACE inspection, engineering, and construction contracts. (c) Federal local hires. (2) Materials: (a) Temporary Housing Units procurement contracts. (b) Temporary Housing Units hauling and installing contracts. (c) Standby disaster procurement contracts. 7. Coordinating and Support Agencies/Organizations A. Coordinating Agency: U.S. Department of Homeland Security (DHS)/FEMA. B. Support: American Red Cross (ARC), DOD, Department of Labor (DOL), Department of Transportation (DOT), Department of Health and Human Services (HHS), HUD, Small Business Administration (SBA), USACE, USDA, U.S. Postal Service (USPS), Department of Veterans Affairs (VA), and the Private Sector. A10-6 | Catastrophic Incident Supplement January 2005 National Response Plan THIS PAGE INTENTIONALLY LEFT BLANK January 2005 Catastrophic Incident Supplement | A11-1 National Response Plan National Response Plan ? Catastrophic Incident Supplement Appendix 11 ? Public Information and Incident Communications Response Overview 1. Mission This appendix outlines how information will be communicated to the public in support of a catastrophic incident response effort. Interagency Coordination The National Response Plan (NRP) Incident Communications Emergency Policy and Procedures (ICEPP) is the primary incident communications plan for use by the Federal interagency. It is used in conjunction with State and local authorities to manage incident communications and Public Affairs activities during domestic incidents. The NRP-ICEPP incorporates specific incident communications guidance on operations in support of weapons of mass destruction (WMD) or catastrophic incident scenarios. This appendix will be used in conjunction with the NRP-ICEPP during such incidents. It provides detailed information on Departmental and Agency incident communications resources to support response contingency plans. Each Department or Agency has respective emergency plans that are implemented as appropriate subject to respective missions, the nature of the incident, and tasks. These authorities support the NRP-ICEPP through implementation of their respective plans. These actions are incorporated in the overall interagency planning effort that is developed in the first hours of the incident. This effort uses the incident communications processes of control, coordination, and communications to unify and synchronize the interagency effort. 2. Planning Assumptions A. National Incident Communications Planning Assumptions (1) Primary Communications Objectives. All weapons of mass destruction (WMD) incidents. Direct communication from the Federal Government to the public will focus on lifesaving and life-sustaining information. (2) National Reassurance Objective. All WMD incidents. Reassuring and informing the public in areas not affected by the incident is critically important to the stability of communities and security of our population. Updated or available preparedness information must be reemphasized and aggressively pointed out to the non-affected public. Progress reports on the incident and the Government recovery plan must be provided to the public. Reassuring and informing the non-affected population is critical to the overall success of the recovery effort. (3) Pre-Incident Education. All WMD incidents. Public responsiveness following a WMD incident will be significantly enhanced through increased pre-incident awareness of basic preparedness and response measures. Resources such as Ready.gov, media threat education, and predeveloped fact sheets all increase the ability of our citizens to better cope with or understand the nature of a threat and incident. A11-2 | Catastrophic Incident Supplement January 2005 National Response Plan (4) Scientific Support. All WMD incidents. Immediate and follow-on scientific support for Public Affairs and the public messaging effort is critical to saving lives, mass movement of people, and emotional stability of our citizens in affected and non-affected areas. Public information must be correct and consistent with scientific recommendations. (5) Panic and Rumors. All WMD incidents. It is possible that panic and rumors about an incident will occur and spread to non-affected areas of the Nation. The national incident communications effort must anticipate this possibility and ensure that measures are incorporated to mitigate or inhibit the spread of false information. Consistency among Federal, State, and local authorities in providing incident information beginning in the initial moments following the report of an incident is critical, as well as demonstrating that authorities do have plans and are working hard to implement them. (6) Communications Infrastructure. All WMD incidents. The capability to immediately and effectively communicate to the population in affected or damaged regions may be destroyed or severely degraded. Rapid employment of the Emergency Alert System (EAS), National Oceanic and Atmospheric Administration (NOAA) Weather Radio, maximum use of battery-powered radios, nontraditional measures (two-way radios, HAM radios, etc.), and other alternatives will be essential to communicating our messages until power and normal utilities are restored. The ability of the Joint Information System (JIS)/Joint Information Center (JIC) to coordinate and communicate may be significantly limited or precluded. In situations with severe loss of utilities, a battery-powered radio kept by citizens provides a very effective means to receive timely public instructions and incident information. (7) Control, Coordination, and Communication. All WMD incidents. A catastrophic mass casualty/mass evacuation incident resulting from an act of terrorism may cause significant public concern, both in the incident area and nationally. State and local authorities will retain the lead responsibility for communicating positive, continuous, consistent, and timely public information and guidance to the affected population and those citizens potentially at risk. Federal, State, and local authorities must synchronize their efforts from the outset of an incident to reduce the development and spread of panic and rumors. The Federal Government will immediately coordinate with and support State and local public information efforts in the affected areas to ensure that communications at all levels are synchronized and consistent. The Federal Government will coordinate with other non-affected States and authorities to reassure citizens, disseminate preparedness guidance, and protective measures. B. Federal Interagency Planning Assumptions (1) Department of Veterans Affairs (VA) (a) VA resources are distributed Nationwide and located in, or close to, major population centers. It may be assumed that should such an incident occur near a VA medical center without damaging or seriously diminishing its operational capacity, the facility will be a key asset in providing medical support and expertise to State and local emergency response agencies. This is in addition to maintaining all basic services to its constituent veteran population. (b) Because VA facilities are organized into Regional networks, personnel and material to support incident response activities would be directed through the network offices. (c) Public Affairs Officers (PAOs), many of whom serve in an additional duty status, are located throughout the VA’s national networks in each of its three administrations. In some cases these individuals provide support in overlapping geographic areas. January 2005 Catastrophic Incident Supplement | A11-3 National Response Plan (2) Department of Health and Human Services (HHS) (a) Ensuring that accurate medical and public health information and guidance is provided is of immediate paramount importance to protect and save lives of those who may be affected by the incident. This should be a top priority of Federal-wide incident communications. (b) HHS Public Affairs staff could be dispersed at the time of an event or could be directly affected by the event. HHS communication plans include the use of Public Affairs staff at its agencies in locations that would be unaffected directly. (c) HHS would rely on its family of agencies, in particular the Centers for Disease Control and Prevention (CDC), to assist in public information activities and to provide subject matter expertise in all communications activities. (3) U.S. Department of Agriculture (USDA) (a) The safety of food and livestock may be jeopardized during an event. (b) Public information about the safety of the food supply should be a top priority. (4) Environmental Protection Agency (EPA) (a) Will provide support in accordance with the National Response Plan (NRP). (b) EPA Public Affairs will use its Crisis Communications Plan. (5) Department of Transportation (DOT) (a) Large numbers of people may be casualties. These could include Departmental Public Affairs staff and news media representatives. (b) When the incident occurs, offices will be evacuated and staff dispersed. If it occurs after working hours or on a weekend or holiday, staff will be dispersed. (c) Public Affairs staff and leadership will be unable to access normal logistical support, such as the Department’s information technology (IT) and local area network (LAN). Computer networks and even personal computers (PCs) themselves will shut down. (d) Transportation in the area will stop. Roads will be jammed by people leaving the metropolitan area. In certain cases, cars, trucks, buses, subways, trains, aircraft, etc., will not operate because of electronic interference from the attack. (e) Demand for information about transportation facilities, roads, bridges, airports, etc., from news sources outside Washington, DC, will be great. New York, Chicago, Los Angeles, or other metropolitan areas will become news central. (6) American Red Cross (ARC) (a) The Public Affairs staff of the ARC will initiate communication strategies that support the response activities of the Red Cross. A11-4 | Catastrophic Incident Supplement January 2005 National Response Plan (b) The ARC will also mobilize its resources and capacities in coordination with Federal, State, and local governments, partner agencies, and other non-Governmental organizations (NGOs) to disseminate preparedness, safety, security, and calming messages to the affected communities and the general public. 3. Federal Public Affairs and Incident Communications Capabilities A. U.S. Department of Homeland Security (DHS) (1) Joint Information Centers (JICs). Following an incident of national significance or domestic incident, JICs are established to coordinate the Federal, State, Tribal, and local incident communications effort. A JIC is a central point for coordination of disaster information, Public Affairs activities, and media access to information about the latest developments. (a) National JIC. Initially, and at the national level, a virtual JIC led by DHS Public Affairs coordinates information among Federal Departments and Agencies. If necessary, a national JIC may be established at DHS/Federal Emergency Management Agency (FEMA) Headquarters (HQ) in Washington, DC, or another designated location. If established, Federal Departments and Agencies may be requested to provide representatives to the national JIC. A national JIC may be used when an incident of national significance is anticipated to have an extended duration (i.e., weeks or months). (b) Incident JIC. The JIC is a physical location where incident communications professionals from organizations involved in the response work together to provide critical emergency information and Public Affairs response functions. The JIC serves as a focal point for the coordination and dissemination of information to the public and media concerning incident prevention, preparedness, response, recovery, and mitigation. The JIC may be established at an on-scene location in coordination with State, Tribal, and local agencies depending on the requirements of the incident. In most cases, the JIC is established at, or is virtually connected to, the Joint Field Office (JFO), under the coordination of DHS Public Affairs. (2) Staff Organization. DHS Public Affairs personnel are managed by the DHS Assistant Secretary for Public Affairs (ASPA). This centralized management of highly trained personnel is particularly effective during incident management situations where additional assets can be surged from one component to support another or the overall national effort. Moreover, these personnel assets are distributed around the United States and provide depth or deployable support to other locations. (3) Staff Incident Management. During a domestic WMD or incident, DHS Public Affairs will support and manage the following elements: (a) Press Office. Performs primary media response and management of Departmental issues or queries, including changes to the Homeland Security Threat Status. (b) Speechwriting. Performs drafting tasks in support of the Secretary DHS and other senior leadership. They prepare statements for use during major announcements. (c) Interagency Incident Management Group (IIMG). DHS Public Affairs assigns a team of experienced incident management personnel to the IIMG. They coordinate and support the IIMG on Public Affairs issues and provide liaison with incident communications decisionmakers. They also assist in coordinating the interagency through the National Incident Communications Conference Line (NICCL). January 2005 Catastrophic Incident Supplement | A11-5 National Response Plan (d) Principal Federal Official (PFO) PAO. The deploying DHS PFO(s) will be assigned a DHS Staff PAO to provide coordination between the JIC, incident site Public Affairs leadership, and PFO personal staff. The PFO PAO will stay in close consultation with the DHS Public Affairs staff while deployed for an incident. (e) Homeland Security Operations Center (HSOC). The DHS Public Affairs Duty Officer (PADO) will remain on watch in the HSOC and liaise with the Press Office, IIMG, and other components. (f) Media Support. A media support staff assists the Press Office and interagency coordination efforts. (g) Web Support. The DHS Public Affairs Web team maintains close contact with the Press Office and other key staff to ensure the Web site contains the most relevant incident information. B. DHS Component Agencies. DHS Public Affairs manages Public Affairs personnel in 22 component agencies throughout the United States. Additional specialized resources are noted below: (1) Federal Emergency Management Agency (a) Emergency Response Team (ERT). ERTs have a Public Affairs component (full-time and reserve disaster cadre). (b) Mobile Emergency Response Support (MERS). The primary function of MERS is to provide mobile, self-sustaining telecommunications, logistics, operations, and administrative support required by Federal, State, and local responders in their efforts to save lives, protect property, and coordinate disaster operations. Assets include some 270 mobile units, from five detachments positioned throughout the United States that provide emergency telecommunications, logistics and operations support. (c) National Emergency Response Team (ERT-N). The ERT-Ns are activated for large disasters only. When disaster hits multiple States, each State gets its own ERT (or ERT-N if needed) based on the severity and magnitude of the incident (for example, during Hurricane Isabel, only Virginia got an ERT-N; the other affected States received regular ERTs, made up mostly of Regional resources). (d) Community Relations (CR). The CR function provides the vital information link between DHS/FEMA, the State, local communities, and those affected by disasters. The information link is designed to ensure the citizens of disaster-affected communities are aware of available Federal disaster assistance programs and how to access them. The CR cadre includes 241 personnel who work during times of a Presidential declared disaster or emergency to provide information and assistance to disaster victims and their communities to increase understanding of disaster assistance and to increase DHS/FEMA’s disaster response and recovery efforts. CR works in close coordination with Response and Recovery Divisions and the Regional Cadre Managers to ensure the CR Disaster Assistance Employees (DAEs) are trained to provide accurate and timely information to the Federal Coordinating Officer (FCO) and State Coordinating Officer (SCO), disaster victims as well as the State, local, and community leadership. CR DAEs also are trained to understand the communities and their disaster related issues. From this understanding, field reports are produced to reflect those concerns and a recommendation is produced to resolve the issue. The Federal and State Coordinating Officers and the Headquarters Cadre A11-6 | Catastrophic Incident Supplement January 2005 National Response Plan Manager also use these reports to ensure a clear understanding of how DHS/FEMA’s disaster assistance programs assist the community analysis and victims of a disaster. (e) Emergency Alert System (EAS). The EAS is activated for the President by FEMA and is managed in coordination with the FCC. It is also available within minutes to provide commercial broadcast resources to national, State, and local authorities in an emergency to transmit critical information to the public. The EAS is activated by the FEMA Operations Center (FOC) or the FEMA Alternative Operations Center (FAOC) to provide audio broadcasts at the direction of the President and DHS Secretary. (f) Broadcast Radio Teams. The Broadcast Radio Team and the Broadcast Television Team are the remote broadcast assets that FEMA deploys and is staffed by DAEs. These teams allow Federal response authorities and DHS/FEMA to set up an information broadcast in a community where normal media has been rendered incapable of broadcasting or operating. (2) Border and Transportation Security (BTS). DHS BTS Public Affairs retains a strong surge force of Public Affairs personnel through the many staffs and/organizations they support. This includes airports, seaports, border crossings, and other customs and immigration facilities. (3) U.S. Coast Guard (USCG). The USCG has a similar range of Public Affairs personnel and offices arrayed around the Nation. While they are mainly located in coastal areas, they can be surged and deployed for contingency purposes to other incidents. Special response capability is provided by a Public Information Assist Team (PIAT). This is a deployable specialized Public Affairs team skilled in hazardous material (HAZMAT) and environmental response, capable of supporting conventional, biological, and chemical incidents. C. Department of Veterans Affairs (VA). VA maintains a large force of field Public Affairs personnel to support the wide network of facilities around the Nation. Field PAOs are located at each VA medical center (162), Regional office (57), and cemetery (120). VA’s Regional offices of Public Affairs are located in New York, Washington, DC, Atlanta, Chicago, Dallas, Denver, and Los Angeles (21), plus the VA’s central office compliment of PAOs (20) brings the total to 380 people. (1) Field Capabilities. Each field location has, as a minimum, computer, telephone, and fax capabilities while approximately 20 VA medical centers possess some level of medical media support for documentary coverage capability. (2) Regional Offices. Five of the seven Regional offices of Public Affairs have digital cameras, two have 35mm cameras, and one owns a video camera. (3) VA Central Office. Operates a fully operational three-camera television studio with digital post-production editing capability and access to three satellite broadcast channels. A media services office provides a full range of audiovisual recording and still photography. D. U.S. Department of Agriculture (USDA). The USDA possesses the following Public Affairs resources: (1) Television and radio studio with satellite capabilities at the Washington, DC, HQ Building. (2) Agency Public Information Officers (PIOs) in regions, States, and many counties. January 2005 Catastrophic Incident Supplement | A11-7 National Response Plan (3) Virtual War Room plan would be implemented to support public information efforts. (4) Remote computer database capability to access lists. (5) Food and agricultural experts in U.S. embassies. (6) Food and agricultural constituent outreach lists. (7) Webcast capabilities. E. Department of Health and Human Services (HHS). HHS ASPA maintains the following team structure to be ready to respond to a catastrophic incident: (1) HHS ASPA. Coordinates the overall HHS Public Affairs response, maintains close liaison with the Secretary, White House, DHS, CDC Director, NIH Director, Food and Drug Administration (FDA) Commissioner, Assistant Secretary for Public Health Emergency Preparedness (ASPHEP), and other principals. HHS ASPA also directs all HHS/CDC Public Affairs Team operations and meets regularly with team leaders. (2) Media and Message Team. This team handles media inquiries to include coordinating and fulfilling requests. The team also coordinates development of unified talking points for principals and Public Affairs staff to use when speaking to the media or in other public venues. (3) Materials Development and Writing Team. The team develops, writes, and produces documents necessary to communicate emergency response information. Materials include news releases, background papers, factsheets, question and answer papers, and secretarial speeches. The team maintains and ensures all information is accurate and up-to-date. (4) Outreach Team. The team oversees outreach of communication materials and information to HHS partner organizations as well as all other interested organizations. This includes outreach to other governments, the private sector, not-for-profit organizations, minority groups, and other organizations affected by the crisis. The team will coordinate public information campaigns, public service announcements, and look for opportunities to partner with organizations to educate the public. (5) Go Team. The team is comprised of staff that deploy as Public Affairs representatives at various locations to assist HHS ASPA in liaison and communications activities. Upon activation, predesignated HHS ASPA personnel will report to the CDC in Atlanta, GA, the Secretary’s Emergency Operations Center (EOC) and the ASPHEP. A Public Affairs representative will also travel with the Secretary’s Emergency Response Team (SERT). Go Team members primary responsibilities are to prevent communications failures, misunderstandings, ensure coordination in the release of information and consult with HHS ASPA on all major media requests. (6) Web Team. The team oversees prompt posting of all Public Affairs materials to the HHS Web site. The team also assesses how the Internet can be best used to communicate with the public with information on the crisis. (7) Studio/Broadcast Team. The team ensures the HHS studio and auditorium are ready for use in an emergency situation. Their duties include setting up for news conferences, taping messages from the Secretary and other senior officials, establishing communications with CDC, handling teleconferences and documenting, via video and still photo, activities of the Secretary and key HHS response components during a crisis. A11-8 | Catastrophic Incident Supplement January 2005 National Response Plan (8) Support Team. The team handles all essential Public Affairs administrative and technical support. Their duties include procuring supplies, posting and distribution of news releases, handling incoming telephone calls, and maintaining and circulating news clips. (9) Preparedness and Health Information. HHS and its agencies maintain a wealth of medical and public health information on biological, chemical, nuclear, and radiological agents and hazards on their respective Web sites. (10) Emergency Web Support. HHS also maintains an emergency shell Web page that can be populated and posted quickly with information relevant to the event. F. Environmental Protection Agency (EPA) (1) EPA Headquarters. The EPA HQ Public Affairs staff consists of media relations; communications including Web posting on the EPA homepage; video and still photography, and public liaison. (2) EPA Regional Support. Public Affairs Offices in EPA’s 10 Regional HQ and laboratories. G. Nuclear Regulatory Commission (NRC). In the event of a nuclear or radiological emergency involving an NRC-licensed nuclear facility or materials, NRC would activate and fully staff its EOC at its HQ in Rockville, MD, including Public Affairs, to issue press announcements and operate a news center for press briefings, as needed. Briefings would be Webcast live and archived for future viewing by the public. (1) Regional Teams. Regional teams with Public Affairs staff would be deployed from one of four regions to the site of the emergency where they would support a pre-established joint information/news center provided by the facility operator. This facility accommodates Public Affairs staff of the facility operator, NRC, FEMA, possibly the Federal Bureau of Investigation (FBI), and the affected State and counties. Members of the media would be briefed periodically at this facility on the status of the facility and the response. (2) Headquarters Staff. NRC Public Affairs staff at HQ will handle incoming media calls and monitor news coverage. (3) Interagency Coordination. Coordination and communication with DHS and other Federal agency Public Affairs personnel would be achieved through the IIMG and the NICCL. Other communications would be coordinated with the JIC, affected States central news centers, and the plant operator’s public information organization. (4) NRC Incident Response Plan. Procedures and participants for responding to a radiological emergency are identified in the NRC Incident Response Plan, which will be followed if an event becomes an emergency in accordance with predetermined emergency classification levels. The NRC would post all its press releases and other Public Affairs material relevant to the event to its home page on the Internet as well as providing it directly to DHS, the JIC and media. H. Department of Transportation (DOT) (1) Office of the Secretary. Twelve Public Affairs supervisors and specialists. January 2005 Catastrophic Incident Supplement | A11-9 National Response Plan (2) Federal Aviation Administration (FAA). Thirteen Public Affairs supervisors and specialists in Washington, DC; 12 Regional supervisors and specialists in locations outside DC. (3) Federal Highway Administration. Three specialists in/four outside Washington, DC. (4) Federal Railroad Administration. Two specialists in Washington, DC. (5) National Highway Traffic Safety Administration (NHTSA). Ten specialists in Washington, DC, and 10 Regional specialists competent in advertising and promotion. (6) Federal Transit Administration. Five supervisors and specialists. (7) St. Lawrence Seaway Development Corporation. Three supervisors and specialists. (8) Maritime Administration. Two supervisory equivalents. (9) Research and Special Programs Administration. One supervisor and two specialists. (10) Bureau of Transportation Statistics. One supervisor and one specialist. (11) Federal Motor Carrier Safety Administration. One supervisor and one specialist. I. American Red Cross. The ARC maintains the following: (1) Rapid Response Team. Fifty-member team of trained, national media spokespersons. (2) Disaster Responders. Six hundred responders around the Nation to work with State and local media. (3) Web Support. Internet group for Web coding of both internal and public Web sites. (4) Photographic Support. Staff photographers and video production experts. (5) Nationwide Chapters. More than 900 local Red Cross chapters throughout the country provide a tangible local presence in communities. (6) Information Hotline. The Red Cross maintains a 24/7 public information hotline. (7) National Disaster Education Coalition Partnership. The Red Cross has extensive preparedness and safety messaging and collateral materials available in both printed and electronic formats. Much of the material is readily available on the public Web site. 4. Inventory of Other (Federally Accessible) Capabilities A. DHS and FEMA (1) DHS Ready.gov Preparedness Program. Ready.gov is a specially developed package of preparedness measures for the public. The measures and presentation are crafted to be easily understood by the public, and are available on-line in English and Spanish. A11-10 | Catastrophic Incident Supplement January 2005 National Response Plan (2) DHS Subject Matter Experts (SMEs). DHS Public Affairs maintains a comprehensive listing of available SMEs covering medical, radiological, nuclear, chemical, and biological threats. These experts can be made available to the media for technical explanations and in support of incident response leadership. (3) DHS Public Affairs and Ad Council. DHS Public Affairs and the Ad Council have established a contingency program wherein the Ad Council will develop and air preparedness and emergency medical or health segments. This program can be activated and provide features on air within 24 hours. (4) Strategic Partnerships. As part of the planning process, DHS and FEMA are developing strategic partnerships with large media conglomerates (especially radio) that have access to major markets in the United States. This would be beneficial during emergencies and facilitate mass communications efforts. (5) FEMA Radio Survey Effort. As part of the catastrophic planning process, FEMA is identifying State and local radio frequencies that may be available for broadcast of disaster information. B. Department of Health and Human Services. HHS is the lead Federal Department for protecting and preserving the Nation’s public health. Through its many Agencies, (CDC, NIH, FDA, HRSA, Substance Abuse and Mental Health Services Administration (SAMHSA), etc.), HHS has immediate access to a wide range of SMEs on virtually every medical and public health facet of any type of WMD incident. The Department’s most senior and visible spokespersons—from the HHS Secretary and NIH leadership to CDC Director and the Surgeon General—will be needed to quickly address the Nation’s health concerns. The HHS Public Affairs Office has significant experience in quickly providing the appropriate and needed SMEs to the media in any type of public health emergency, and would plan to do so in the event of any WMD incident. C. Department of Commerce (DOC), National Oceanic and Atmospheric Administration (NOAA) Weather Radio. NOAA Weather Radio broadcasts National Weather Service (NWS) warnings, watches, forecasts, and other non-weather related hazard information 24 hours a day. During an emergency, NWS forecasters interrupt routine weather programming and send out a special tone that activates weather radios in the listening area. Weather radios equipped with a special alarm tone feature can sound an alert and give immediate information about a life-threatening situation. D. Environmental Protection Agency. EPA maintains a contract with U.S. Newswire for electronic distribution of press releases. E. Department of Transportation. DOT maintains a contract for an Associated Press (AP) feed with eight stations. F. Department of Veterans Affairs. The VA maintains contracts for news monitoring, clipping services, and videotape and photo duplication services at the central office. Three Regional Public Affairs Offices have news clipping service contracts. G. U.S. Department of Agriculture. The USDA maintains mass casualty incident telephone support for 24/7 incident communications, as well as a satellite standby truck on call at Continuity of Operations (COOP) sites. January 2005 Catastrophic Incident Supplement | A11-11 National Response Plan H. American Red Cross. ARC can call upon cooperative relationships with the National Association of Broadcasters (NAB), the Public Relations Society of America (PRSA), and various corporate partners. 5. Response Strategy The Federal interagency Public Affairs effort is detailed in the NRP-ICEPP. It is integrated with the NRP, NIMS, and IIMG Standard Operating Procedure (SOP). Incident communications is the primary Public Affairs concept of operations used by DHS to manage domestic incidents. This concept incorporates the following key processes and is used to immediately coordinate and execute an integrated interagency, State, and local incident communications plan. ! Control. What are the lead Departments and Agencies, authority, and authorities for release? Key non-Federal players? ! Coordination. How will the communications strategy be developed, coordinated, executed, and through what plans and protocols? ! Communication. What is known? What are the health risk concerns, preparedness advice, warning issues, incident information, information flow, message, and audience? Who will deliver, them? When? How? Where? A. Execution. DHS Public Affairs will respond to and support the HSOC and IIMG as they coordinate the Nation’s management of a domestic incident. To this end, DHS Public Affairs executes the following steps and measures: (1) Response Strategy: FIRST 10 TO 60 MINUTES. (a) HSOC notified of an incident. (b) HSOC initiates procedures for a nuclear/radiological/biological incident. (c) HSOC notifications to key DHS leadership. (d) DHS Public Affairs activates the supporting Incident Communications Emergency Plan (ICEP) of the NRP-ICEPP. This mobilizes the DHS Public Affairs response structure and provides staff support to the IIMG. (e) DHS Public Affairs initiates communications with the following: i. White House Office of Communications. ii. Senior DHS IIMG/HSOC leadership. iii. Incident site (including State/local) Public Affairs leadership. iv. Federal interagency Public Affairs team (via NICCL). v. Media contact through pre-established emergency contact line. A11-12 | Catastrophic Incident Supplement January 2005 National Response Plan (f) DHS Public Affairs requires immediate scientific support as facts and statements are collected and prepared for release. Nuclear and biological scientific and trend information is extremely critical to the development and deployment of an accurate and timely message to the public. (g) NRP-ICEPP execution follows with DHS Secretary public announcement within 1 hour, subject to known facts, security, and confirmation of threat. (h) Immediate health and safety advisories from DHS (with interagency concurrence) or State and local authorities may precede the announcement. This health and safety advisory may be the first announcement by Federal, State, or local authorities. Consideration should be given towards a basic statement of the best precaution or protective measure until more refined information can be obtained, evaluated, and provided to the public. Specific examples could include: i. Immediate sheltering in place. ii. Immediate evacuation or avoidance of a specific area (e.g., fallout). iii. Basic facts (e.g., an anthrax attack has occurred, a nuclear blast, etc.). (i) Splash Web page (a Web page that can be immediately created with emergency updates), posted on Ready.gov with basic precautionary guidance. DHS Web site also updated with the same information, which must be coordinated through the Interagency Incident Communications Team to ensure that other Cabinet and Agency Web pages post or contain the same emergency information and guidance. (j) NICCL brings key Federal interagency incident communications team together to develop coordinated communications plan and unified message. Key issues addressed include: i. Incident situation. ii. Control, leads, and authority for release. iii. Coordination, plans in use, and key team for incident management. iv. Communications, facts, information already released or known, plans for next official statements, and health or safety advisories. v. Who will make the first releases and coordinate with State and local including synchronization of releases and role of spokespersons. vi. Key Point: DHS takes national leadership role; State and local take lead for on-scene medical and messaging, if feasible. (k) First release by the DHS Secretary. Additional cabinet members or technical experts may accompany or support this formal announcement. (2) Response Strategy: FIRST 10 DAYS. Sustaining messages coordinated by Federal, State, and local team: (see Note) (a) Protection of population from fallout and contaminated areas. January 2005 Catastrophic Incident Supplement | A11-13 National Response Plan (b) Evacuation guidance and support to State and local authorities. (c) Sheltering guidance as necessary. (d) Evacuation guidance as necessary. (e) Medical guidance (treatment, antidotes, prophylaxis, etc.). (f) Safety of food and water. (g) Dangers and hazards. (h) National situational and instructional communications to non-affected areas. (i) Distribution of key instructions for print, Web, television, and radio programming. NOTE: DHS will lead and coordinate the national messaging effort while the affected State and local incident communications authorities will lead and coordinate incident local public information. (3) Response Strategy: SUSTAINING ACTIONS. (a) Sustaining actions by the Intergovernmental Incident Communications Team: i. JIC established to manage and coordinate incident site Public Affairs activities. ii. DHS engages with non-affected States and initiates aggressive public preparedness and information communications effort. Emphasis on basic instructions, family plans, rationale for medical treatment, and distribution of appropriate medicines. iii. DHS deploys PFO and supporting Public Affairs team. iv. HHS and CDC may deploy Public Affairs teams to affected incident site to support State and local effort. Subject to incident and requests. v. FEMA establishes radio station to deliver incident and response activity. vi. FEMA distributes battery-powered radios. viii. FEMA initiates other incident site communications recovery efforts in support of normal ESF tasks. ix. Ad Council national public service television advertisements are covering threat, public instructions, and preparedness measures. x. SMEs are briefed and available to support sustaining communications. B. Department of Health and Human Services. The HHS ASPA has developed an emergency operations plan for situations involving major public health emergencies. When HHS ASPA activates the plan, designated personnel will staff the teams as outlined in preceding paragraphs. The plan relies on the A11-14 | Catastrophic Incident Supplement January 2005 National Response Plan use of all HHS Public Affairs Office staff. If events continue for an extended period of time, the HHS Public Affairs Office would supplement/rotate staff from its Agency (CDC, NIH, FDA) Public Affairs Offices to prevent staff burnout. C. U.S. Department of Agriculture. The USDA has a “virtual war room” plan to access Public Affairs assets and resources throughout the Department and includes media response, information development, outreach, and coordination. This process will allow USDA to sustain an information center for a long period of time and was most recently used during the “mad cow disease” outbreak in 2004 in the United States. The plan includes daily briefings, regular written updates for distribution, and Web posting and recorded messages on mass casualty incident line. The USDA also has an incident command team capability through the U.S. Forest Service (USFS), which includes ground Public Affairs support functions. D. Department of Veterans Affairs. The VA immediate response strategy is to carry out essential communications functions in support of VA’s primary mission and communicate emergency response and resource information to internal and external audiences in the affected incident area and across the VA system. Appropriate Public Affairs assets will be deployed as needed from closest available locations to assist with situational assessments and communications activities as directed by VA facility director or on-site authority. For the 10-day and sustained periods, additional resources would be deployed to the incident venue sufficient to provide necessary Public Affairs coverage and support with a 24/7 work schedule. E. Environmental Protection Agency (1) Immediate. Implement the EPA Public Affairs Crisis Communications Plan; implement Public Affairs COOP Plan if needed; provide PIO to EPA EOC; support DHS ICEP including EPA staffing at a JIC. (2) First 10 Days. Support and follow DHS Public Affairs lead and continue to support; provide environmental and public health information to the media and public. (3) Sustained. Provide continued support to DHS Public Affairs. F. Department of Transportation (1) Immediate. Three managers will disperse in the following manner: One with the Secretary of Transportation; another will go to another site in accordance with the COOP Plan; and the third will go to the DOT Crisis Management Center (CMC), also likely off-site. These managers will supervise and control the DOT Public Affairs response to the catastrophe. (2) First 10 Days. This configuration will continue for the first 10 days. Available local and, if needed, Regional Public Affairs staff will be called upon to execute the Department’s response and messaging. (3) Sustained. Public Affairs managers, supervisors, and staff will be called to an appropriate central location where they will set up an office and function as a team. G. American Red Cross. ARC response actions to support first hour to sustaining actions are detailed below: January 2005 Catastrophic Incident Supplement | A11-15 National Response Plan (1) Staffing. Immediately deploy Public Affairs staff and officer to the incident site. Rapid Response Team members will also be sent to the area to provide an ARC response to national news media. Red Cross representatives will be dispatched to staff JICs and other messaging coordination centers. (2) Messaging. National HQ Public Affairs staff will begin collecting information and messages for dissemination. Talking points and frequently asked questions (FAQs) will be written for use by ARC spokespersons. SMEs within the organization will be identified and recruited to speak when possible. (3) Call Center/Hotline. Preparedness, safety, security, and calming messages and information will be provided to Call Center staff for use in responding to public inquires. When available, specific response information is also sent to the Call Center to respond to inquiries from the affected area. (4) Internet Information. The Web team will receive information from the Public Affairs staff for posting to the public Web site. Web team members will also activate template pages of links to information pertinent to the specific emergency. Talking points and FAQs are also posted on the internal Web site for use by Red Cross State and local communicators, ensuring a coordinated message. (5) Senior Leadership. Additional staff from the Communication and Marketing department will coordinate information, messaging, and media presence for the President/CEO of the American Red Cross, when necessary and appropriate. 6. Transportation and Logistical Requirements A. U.S. Department of Homeland Security. Transportation and logistical requirements will be assessed by the interagency during conference discussions and incident communications strategy planning. Additional issues are noted below: (1) Transportation. Transportation will be required to deploy the various surge personnel and response teams to the incident site or Regional area. The scope of the incident will determine this requirement. FEMA and USCG response teams have pre-established transportation plans and should be able to respond if the infrastructure has not been severely degraded. (2) Logistics. Logistics requirements will also be determined by the nature and scope of the incident and available surviving infrastructure. Logistical support and facilities for temporary Public Affairs operations may be available at Regional DHS component agency sites. This may also include afloat vessels or large aircraft that could deploy to affected areas and provide power and utilities to run incident communications recovery operations. B. Department of Veterans Affairs. Depending on distances to be covered, transportation for deploying or incident support Public Affairs personnel would be by personal vehicle or commercial carrier using existing Government credit cards or purchase agreements. Temporary lodging would be provided through commercial hotel facilities in or near the affected area or deployment location. C. Environmental Protection Agency. Transportation of EPA personnel to JIC site would be required if the catastrophic incident disrupts normal transportation. If the incident forces closing of hotels and other lodging facilities, lodging of EPA JIC staff would also be required. A11-16 | Catastrophic Incident Supplement January 2005 National Response Plan D. Department of Health and Human Services. Upon activation of the HHS ASPA Public Affairs emergency operations plan, pre-designated HHS ASPA personnel will report to the CDC in Atlanta and also travel with the SERT to the incident jurisdiction. E. U.S. Department of Agriculture. This is addressed through the USDA COOP Plan. If USDA is needed to support another agency, transportation will be required. F. American Red Cross. Public Affairs staff responding to an emergency would work through existing channels and procedures within the Red Cross response plan to travel to the affected areas, and for housing need on site. In the event that common carriers are not available, the Red Cross would work with partner Government Departments and Agencies and private groups to facilitate alternate means of travel. 7. Limitations A. U.S. Department of Homeland Security. DHS Public Affairs has assessed the potential limitations during a WMD or catastrophic incident. Specific limitations are contained in the initial planning assumptions in paragraph one of this appendix. Briefly, these limitations focus on the following components: (1) Developing the Message. The process to develop the interagency message has been refined and exercised. However, the nature of a catastrophic incident will likely inhibit or restrict the timeliness of this effort. This will be exacerbated if relocation or COOP by DHS or other Federal leadership has been initiated. (2) Delivering the Message. Delivering the message may be problematic for some audiences. Loss of power by the audience, the nature and threat of the incident, loss of media broadcast capabilities in and around the affected region, and other limitations will inhibit and restrict the delivery of the message. This will be more apparent in a nuclear incident where infrastructure and destruction or damage is widespread. Delivery of a message during a biological incident may be less problematic, but normal access and movement will limit communications opportunities and delivery. (3) Receiving the Message. The audience and the public, especially those who require evacuation or other guidance, must have the capability to receive the message. This may also be problematic if they do not have electrical power or battery-powered communications capability. These limitations and message options are addressed in the NRP-ICEPP and supporting annexes. (4) DHS/FEMA. The FEMA on-site Public Affairs response will be limited by how quickly teams could get to the affected area based on health and safety considerations. Other issues include: (a) Staffing. Considering the national and Regional teams that FEMA PAOs requires, Public Affairs leadership has few remaining incident communications resources. This will present a concern if multiple venues or incidents occur simultaneously. (b) New Resources. A mobile broadcast unit would be useful for emergency broadcast capability in or near the incident locations. B. Department of Veterans Affairs. Given the distribution of resources across the country, it is reasonable to assume certain VA assets may be diminished or lost due to any significant manmade or January 2005 Catastrophic Incident Supplement | A11-17 National Response Plan natural disaster, or terrorist attack involving chemical, biological, radiological, nuclear, or high-yield explosive (CBRNE) WMD. C. U.S. Department of Agriculture. Standby satellite facilities and time as well as communications equipment that would take precedence on airtime is always needed. D. Department of Transportation. Transportation Public Affairs will be severely limited by the anticipated inability to communicate with both staff and news media. The demand for information about the safety and operation of transportation facilities will be great and urgent. 8. Responsibilities of Coordinating and Support Agencies/Organizations A. U.S. Department of Homeland Security. As Stated in the Basic Plan to the ICEP, when operating in support of catastrophic incidents, the Secretary of Homeland Security will coordinate the Federal incident communications response effort. This will involve execution of the ICEP, higher authority guidance, interagency plan execution, incident updates, and delivery of a consistent and unified message to the public. Other Departments, Agencies, and authorities may, however, retain incident communications roles for respective tasks and speak for these areas. Coordinating agency issues will be assessed and identified during initial conference call discussions and as necessary throughout the incident. Notional lead assignments for incident communications may include the following: (1) Incident Management. (2) Law Enforcement. (3) Medical or Health. (4) Environmental. (5) Protective Measures. (6) Search and Rescue. (7) Preparedness. (8) Mass Care, Housing, and Food Safety. (9) Recovery Assistance. B. Department of Health and Human Services. In a public health emergency, the HHS Public Affairs Office assumes the lead in media response for public health, coordinated with and through the JIC. Depending on the nature of the event or incident, HHS Public Affairs may designate one of the HHS Agencies (e.g., CDC, NIH, FDA) to take the lead on Public Affairs activities with the responsibility of consulting with HHS Public Affairs as they move forward to manage the incident communications. In addition, HHS Public Affairs would rely on its Agency Public Affairs Offices to supplement the office with additional staff if events continue for an extended period of time. C. U.S. Department of Agriculture. USDA would likely take the lead in animal and plant health related emergencies as well as food-related emergencies involving meat and poultry. Food-related activities would be coordinated with HHS. USDA and HHS have met to work through scenarios on foodA11- 18 | Catastrophic Incident Supplement January 2005 National Response Plan related issues and the appropriate response. USDA has also drilled internally with Agencies to address food and animal-related activities and have several written plans in place for scenarios. D. State and Local Authorities. Since most domestic terrorist incidents will occur within the jurisdiction of State or local authorities, integration and teamwork between Federal and non-Federal players is absolutely critical. State and local authorities retain their leadership role in assuring the health and safety of their citizens. To this end, they may make statements or provide preparedness instructions to their citizens at the onset of an incident. DHS Public Affairs and the Federal IIMG will use the ICEP to engage with these authorities as soon as possible to synchronize the overall incident communications effort and to provide support and assistance where State and local capabilities have been destroyed or degraded. State and local incident communications authorities are requested to contact DHS Public Affairs as soon as possible following a domestic incident. E. Environmental Protection Agency. EPA Public Affairs would provide staff and other support to the overall Federal effort and environmental and public health information via the media and the Internet. F. Department of Transportation. Following an incident, the Department of Public Affairs will look to DHS as the lead agency in coordinating a message. The Transportation Public Affairs message will, in turn, be managed solely by the Transportation Director of Public Affairs in coordination with other appropriate Federal agencies. G. American Red Cross. Will work in cooperation with DHS in the coordination of public messaging following a major disaster incident. The Public Affairs team at the Red Cross would take the lead in crafting and disseminating messaging that relates to the specific relief activities conducted by ARC, including mass care sheltering, feeding, bulk distribution of supplies, recovery assistance, and disaster welfare inquires. The Red Cross will also coordinate messaging related to preparedness, recovery assistance, protective measures, and health and safety with other lead agencies. H. Deparatment of Veterans Affairs. Public Affairs will follow the DHS lead in communicating the incident response message as well as supporting HHS regarding health and medical services as outlined in the Federal Response Plan (FRP) ESF#8. At the incident site(s), VA PAOs will assist in communicating appropriate medical and emergency response messages in coordination with local representatives of DHS, HHS, and State and local emergency response authorities whenever possible. January 2005 Catastrophic Incident Supplement | A12-1 National Response Plan National Response Plan ? Catastrophic Incident Supplement Appendix 12 ?? Private Sector Support Overview 1. Mission This appendix addresses how the private sector will be engaged to assist and support a catastrophic response effort. 2. Planning Assumptions A. Comprehensive response and recovery capabilities will be expanded and enhanced if private sector support is quickly involved and engaged. B. Many firms and/organizations within the private sector will work directly within existing volunteer organization structures to provide goods, services, building space, and trained personnel to assist in the response and recovery effort. C. State and local governments will create systems for donations receipt/prioritization and needs collection that will be staffed by State and local officials to ensure that needs and wants are coordinated and met. D. Some portion of what the private sector will provide will be made available without charge and the balance will be available under varying compensation arrangements. Any discussions of compensation to private organizations, instead of disaster victims, will be reviewed first with the agency providing the funding. 3. Catastrophic Response Strategy A. Private Sector Response Support Strategy: GENERAL. (1) Initial and immediate emphasis will be placed on supporting existing donation management frameworks, such as Federal Emergency Management Agency (FEMA) National Response Coordination Center (NRCC) and National Volunteer Organizations Active in Disasters (NVOAD), and linking potential donors (regardless of whether they are donating housing space, search and rescue assistance, or other assistance) with identified resource needs. (2) The U.S. Department of Homeland Security (DHS) Private Sector Office (PSO) will identify local donations coordination centers as soon as possible and establish a system for determining their needs and providing that information to the private sector contacts through an information sharing system, described below, with recommendations that the private sector firms work directly with the donations coordination centers to satisfy their needs. (3) The DHS/PSO will rapidly identify points of contact (POCs) from each Emergency Support Function (ESF) for inventorying the need for additional goods and services and for receiving donations of goods and services. (4) The DHS/PSO will obtain compensation information from lead agencies and provide it to the private sector and/or advise prospective donors to enter into written agreements with the recipient Federal, State, or local agency to cover issues of compensation. A12-2 | Catastrophic Incident Supplement January 2005 National Response Plan (5) The DHS/PSO will maintain an information sharing system to facilitate the submission of offers by private sector organizations and the transmittal of such information to those sector specific agencies or the donations centers. This will include a link/page on the Homeland Security Information System (HSIN) allowing ESF POCs to list specific needs (goods or services). The link/page will also advise companies or organizations to list information, including contact information, about the goods or services that the organizations are willing to donate and/or sell. The DHS/PSO will regularly validate the list and confirm, as necessary, the offers. At least daily, the DHS/PSO will share information about offers with the various ESF POCs and relevant donations centers organized by State and local governments. B. Private Sector Response Support Strategy: MASS CARE. (1) If a mass casualty incident occurs, the mass care response will look to non-Government entities—such as NVOAD, the American Red Cross (ARC), and other such groups—to augment Federal, State, and local efforts. (2) The mass care response will require existing and temporary facilities of varying kinds, equipment, food, other consumables, and trained or quickly trainable personnel. (3) DHS/PSO will coordinate with FEMA, ARC, NVOAD, the Citizens Corps, and other organizations to determine their short and long-term resource and augmentation needs and rapidly communicate those needs to private sector organizations. DHS/PSO will provide information about response needs and donation protocols to private sector organizations and facilitate donations or provision of needed goods and services. (4) Shelters, cots, blankets, and related items are likely to be insufficient to meet the tremendous demands of a catastrophic mass casualty/mass evacuation incident. Potential sources for such needs, within industry associations and other private sector organizations, include (but are not limited to) the following: (a) The Business Roundtable (b) The National Association of Manufacturers (c) The U.S. Chamber of Commerce (d) Veterans of Foreign Wars (e) Fraternal Organizations (e.g., Shriners) (f) Associations of Social Organizations (e.g., country clubs) C. Private Sector Response Support Strategy: HOUSING. (1) If a mass casualty/mass destruction event occurs, temporary housing will be required. Several types of private sector assistance could be tapped in addition to that identified in the Housing appendix. DHS/PSO will coordinate with FEMA, ARC, NVOAD, the Citizens Corps, and other organizations to determine their short and long-term resource and augmentation needs and rapidly communicate those needs to private sector organizations. DHS/PSO will provide information about response needs and donation protocols to private sector organizations and facilitate donations or provision of needed goods and services. January 2005 Catastrophic Incident Supplement | A12-3 National Response Plan (2) Potential industry association sources for addressing housing needs include: (a) Existing Rooms/Space Available i. Association of Hotels and Motels ii. International Association of Convention and Visitor Bureaus iii. Association of Mobile Home Builders iv. Association of Rental Buildings v. Association of Universities vi. Association of Cruise Ships vii. Association of Apartment/Housing Rental Agents (b) Space Convertible to Temporary Housing (includes sanitary/feeding facilities) i. National Association of Manufacturers ii. U.S. Chamber of Commerce iii. Association of Universities iv. Association of Public Schools v. Associations of Churches vi. Association of Summer Camps (c) Rapid Repair of Damaged Housing i. National Association of Home Builders ii. Association of General Contractors iii. Association of Lumber Yards and Home Supplies iv. Carpenter’s Union v. Habitat for Humanity D. Private Sector Response Support Strategy: SEARCH AND RESCUE. (1) If a catastrophic incident occurs that includes a mass destruction component, search and rescue operations will be required. Several types of private sector organizations (e.g., mining and construction companies) may have employees likely to have useful skills for such operations and may be willing to volunteer their assistance. Other organizations may have heavy construction equipment or steel working equipment that could be needed and transported to the incident site. (2) DHS/PSO will coordinate with ESF#9 (Urban Search and Rescue), FEMA, and other appropriate organizations to determine their short and long-term search and rescue resource and augmentation needs and rapidly communicate those needs to private sector organizations. DHS/PSO will provide information about response needs and donation protocols to private sector organizations and facilitate donations or provision of needed goods and services. (3) Potential industry association sources for addressing search and rescue needs include: (a) National Mining Association (b) Association of Builders and Contractors (c) Association of General Contractors of America A12-4 | Catastrophic Incident Supplement January 2005 National Response Plan (d) National Council of Erectors, Fabricators, and Riggers (e) Association for Bridge Construction and Design (f) Mechanical Contractors Association of America E. Private Sector Response Support Strategy: DECONTAMINATION. (1) If a catastrophic mass casualty/mass evacuation incident occurs that includes a contamination component, decontamination of well, injured, and deceased individuals and facilities, equipment, and property will be required. Several types of private sector organizations (e.g., nuclear power companies, service companies to the nuclear power industry and chemical industry) possess skills and experience in various decontamination situations and may be willing to volunteer to assist in the decontamination effort. (2) DHS/PSO will coordinate with appropriate organizations to determine their short and long-term decontamination resource and augmentation needs, and rapidly communicate those needs to private sector organizations. DHS/PSO will provide information about response needs and donation protocols to private sector organizations, and facilitate donations or provision of needed goods and services. (3) Potential industry association sources for supplementing decontamination needs: include: (a) Laboratory Services i. American Chemistry Council ii. Pharmaceutical Research and Manufacturers Association iii. Nuclear Energy Institute iv. American Chemical Society (Universities Section) v. Center for Chemical Research vi. Cosmetic and Specialties Manufacturers Association vii. The Food Processing Association (b) Decontamination Services i. Nuclear Energy Institute. ii. Chemical Transportation Emergency Center (CHEMTREC). iii. Private sector hazardous materials (HAZMAT) cleanup contractors. (c) Contaminated Transport i. Alliance of Auto Manufacturers ii. Used Car/Truck Sellers Association F. Private Sector Response Support Strategy: MEDICAL SUPPORT. (1) If a catastrophic mass casualty/mass evacuation incident occurs, various private sector organizations will be identified and/or contacted regarding response readiness, patient care, treatment, isolation and recovery to complement resources already identified by the National Defense Medical January 2005 Catastrophic Incident Supplement | A12-5 National Response Plan System (NDMS) and other Governmental health organizations. Many hospitals are not included in those already identified as part of the NDMS. Many large companies have medical facilities at their locations with staff with varying degrees of medical training. It is anticipated such hospitals/facilities will want to assist in the medical response to a mass casualty event. (2) Several types of private sector organizations have facilities, skills, and experience that would allow them to provide temporary care facilities in relative proximity the impacted area. Many factories, universities, schools, churches, fraternal or social organizations, and other organizations have large facilities with both feeding capabilities and space that could be converted for patient use. It is anticipated such companies/facilities will want to assist in the medical response to a mass casualty event. (3) DHS/PSO will coordinate with ESF#8 (Public Health and Medical Services) and other appropriate organizations to determine their short and long-term medical support resource and augmentation needs and rapidly communicate those needs to private sector organizations. DHS/PSO will provide information about response needs and donation protocols to private sector organizations, and facilitate donations or provision of needed goods and services. (4) Potential industry sources for providing supplementary medical support include: (a) National Business Group on Health (b) The Business Roundtable (c) The National Association of Manufacturers (d) American Hospital Association (e) Business Executives on National Security (f) Associations of Medical Equipment/Medical Care Consumables Suppliers (g) Veterans of Foreign Wars (h) Fraternal Organizations (e.g., Shriners) (i) Associations of Country Clubs (and other social organizations) G. Private Sector Response Support Strategy: MASS FATALITY. (1) If a catastrophic mass casualty/mass destruction incident occurs, assistance in recovering, identifying, and processing deceased victims will be required. Several sources of private sector assistance could be tapped to augment those capabilities identified in the Mass Fatality appendix. (2) DHS/PSO will coordinate with ESF#8 (Public Health and Medical Services) and other appropriate organizations to determine their short and long-term mass fatality management support resource and augmentation needs and rapidly communicate those needs to private sector organizations. DHS/PSO will provide information about response needs and donation protocols to private sector organizations, and facilitate donations or provision of needed goods and services. (3) Potential industry association sources for providing supplementary medical support include: A12-6 | Catastrophic Incident Supplement January 2005 National Response Plan (a) National Funeral Director Association (b) National Cemetery Association (c) American College of Forensic Examiners H. Private Sector Response Support Strategy: TRANSPORTATION. (1) The Department of Transportation (DOT) and its 10 major operating administrations maintain strong and historic relationships with the transportation industry. During periods of defense mobilization, DOT plays a vital coordinating role with private sector transportation providers and suppliers in order to meet emergency requirements. During a catastrophic mass casualty/mass evacuation incident requiring additional, extraordinary transportation resources, DOT, as the lead for ESF#1 (Transportation), will facilitate the rapid acquisition of additional specialized transportation related resources in coordination with State and local counterparts. Requirements would likely extend beyond those resources described in the Transportation appendix. (2) In response to a catastrophic incident, DOT would work closely with DHS/PSO to facilitate the identification of donated services. The transportation industry has a history of volunteer contributions to our nation during times of unprecedented need. It is imperative that any voluntary donation of transportation services be coordinated through ESF#1. This will ensure that donated services can be effectively organized to match nationally identified priorities; duplicative donations reduced or minimized; and ensure that donated services and equipment are documented, tracked, and free from controversy. ESF#1 can quickly validate the need for specific transportation services and equipment. (3) In the event of multiple major incidents, and under the most extreme circumstances, DOT will use allocation or prioritization authority under the Defense Production Act (DPA) of 1950, as amended. This authority is available if domestic emergency conditions required civil transportation materials, services, or facilities that are not available through the marketplace. For example, airlift, sealift, trains, or trucks may be needed to support the mass and sustained movement of personnel, casualties, equipment, or other resources into and away from the incident area. After identifying appropriate resources that could be used and confirming that they will not be provided voluntarily, DOT would seek a determination and concurrence from DHS. The DPA would only be used as a last resort. (4) Each of the Operating Administrations within DOT maintains extensive industry contact lists, which would be immediately accessible to DHS/PSO through ESF#1. These contact lists would be used by DHS/PSO to reduce conflicting or duplicative requests going to private sector organizations. January 2005 Catastrophic Incident Supplement | A13-1 National Response Plan National Response Plan ? Catastrophic Incident Supplement Appendix 13 ? Acronyms, Abbreviations, and Terms 1. Departments and Agencies APHIS Animal and Plant Health Inspection Service (USDA) ARC American Red Cross ASPA Assistant Secretary for Public Affairs (DHS & HHS) ASPHEP Assistant Secretary for Public Health Emergency Preparedness (HHS) ATF Bureau of Alcohol Tobacco and Firearms ATSDR Agency for Toxic Substances and Disease Registry BOR Bureau of Reclamation BTS Border and Transportation Security (DHS) CBP Customs and Border Control (DHS & BTS) CDC Centers for Disease Control CMC Crisis Management Center DHS Department of Homeland Security DOC Department of Commerce DOD Department of Defense DOE Department of Energy DOI Department of the Interior DOJ Department of Justice DOS Department of State DOT Department of Transportation DS/OFM Diplomatic Security Office of Foreign Missions (DOS) EPA Environmental Protection Agency FBI Federal Bureau of Investigation FCC Federal Communications Commission FDA Food and Drug Administration FEMA Federal Emergency Management Agency (DHS) FERC Federal Energy Regulatory Commission GSA General Services Administration HHS Department of Health and Human Services HUD Department of Housing and Urban Development ICE Immigration and Customs Enforcement (DHS) IRS Internal Revenue Service JS Joint Staff (Office of the Chairman of the Joint Chiefs of Staff, DOD) NASA National Aeronautics and Space Administration NIH National Institute of Health A13-2 | Catastrophic Incident Supplement January 2005 National Response Plan NIST National Institute of Standards and Technology NNSA National Nuclear Security Administration NOAA National Oceanic and Atmospheric Administration NORTHCOM U.S. Northern Command NRC Nuclear Regulatory Commission NWS National Weather Service OASD(HA) Office of the Assistant Secretary of Defense for Health Affairs OASD(HD) Office of the Assistant Secretary of Defense for Homeland Defense OSHA Occupational Safety and Health Administration S&T Science and Technology TRANSCOM U.S. Transportation Command TREAS Department of Treasury USACE U.S. Army Corps of Engineers USAID United States Agency for International Development USCG U.S. Coast Guard USDA U.S. Department of Agriculture USFS U.S. Forest Service USGS U.S. Geological Survey USPS U.S. Postal Service VA Department of Veterans Affairs 2. Key Acronyms and Terms AABB American Association of Blood Banks AHA American Hospital Association ARF Action Request Form ASH Assistant Secretary of Health BSOC Biomedical Services Operations Center CAE Command Assessment Element (DOD) CBIRF Chemical Biological Incident Response Force (USMC) CBRNE Chemical, Biological, Radiological, Nuclear, or High-Yield Explosive CCP Casualty Collection Point CCRF Commissioned Corps Readiness Force CHC Combined Health Center CIS Community Information System CMC Crisis Management Center CMHC Community Mental Health Centers CONOP Concept of Operations CONUS Continental United States COOP Continuity of Operations CRT Critical Response Team DCE Defense Coordinating Element DCO Defense Coordinating Officer January 2005 Catastrophic Incident Supplement | A13-3 National Response Plan DEMPS Disaster Emergency Medical Personnel System DEST Domestic Emergency Support Team DFO Disaster Field Office DMAT Disaster Medical Assistance Team DMORT Disaster Mortuary Operational Response Team DOC Disaster Operations Center DPMU Disaster Portable Morgue Units DRC Disaster Recovery Center DSHR Disaster Services Human Resources DWI Disaster Welfare Information EAS Emergency Alert System EIS Epidemiologic Intelligence Service EMAC Emergency Management Assistance Compact EOC Emergency Operations Center ERT Emergency Response Team (DHS/FEMA) ERT Environmental Response Team (EPA) ERT-N National Emergency Response Team ESF Emergency Support Function EST Emergency Support Team FCC Federal Coordinating Center FCO Federal Coordinating Officer FIRST Federal Incident Response Support Team (DHS/FEMA) FRERP Federal Radiological Emergency Response Plan FRMAC Federal Radiation Monitoring and Assessment Center FRP Federal Response Plan GIS Geographic Information System GPMRC Global Patient Movements Requirement Center HARTS Hospital Asset Resource Tracking System HMRU Hazardous Materials Response Unit HRSA Health Resources and Services Administration HRT Health Response Team HSAS Homeland Security Advisory System HSOC Homeland Security Operations Center HSPD Homeland Security Presidential Directive ICEP Incident Communications Emergency Plan IEF Initial Entry Forces (DOD) IIMG Interagency Incident Management Group INRP Initial National Response Plan INSARAG International Search and Rescue Advisory Group IOF Interim Operating Facility IRR Individual Response Resource IST Incident Support Team JFO Joint Field Office JIC Joint Intelligence/Information Center JTF-CS Joint Task Force – Civil Support A13-4 | Catastrophic Incident Supplement January 2005 National Response Plan LIDAR Light Detection and Ranging (System) LNG Liquefied Natural Gas MATTS Mobile Air Transportable Telecommunications System MCMT Mobilization Center Management Team MERS Mobile Emergency Response Support MIACG Medical Interagency Coordination Group MMRS Metropolitan Medical Response System MOU Memorandum of Understanding MRC Medical Reserve Corps MST Management Support Team MTF Military Treatment Facility NARAC National Atmospheric Release Advisory Capability NCP National Disaster Medical System NEIC National Earthquake Information Center NEMIS National Emergency Management Information System NEST Nuclear Emergency Support Team NGO Non-Governmental Organization NGS National Geodetic Survey NH Natural Hazard NICCL National Incident Communications Conference Line NIMS National Incident Management System NIT Nuclear Incident Team (DOE) NLT No Later Than NMRT National Medical Response Team NOTAM Notice to Airmen NRAT Nuclear Radiological Assessment Team NRC National Response Center NRCC National Response Coordination Center NRP National Response Plan NRP-CIA National Response Plan – Catastrophic Incident Annex NRP-CIS National Response Plan – Catastrophic Incident Supplement NSF National Strike Force (USCG) OPDIV Operating Divisions PADO Public Affairs Duty Officer PAO Public Affairs Office (or Officer) PFO Principal Federal Official PHS Public Health Service PIAT Public Information Assistance Team POE Point of Embarkation PPDS Pre-Positioned Disaster Supplies PPI Pre-Placement Interviews PRC Primary Receiving Center PSO Private Sector Office RAP Radiological Assistance Program REAC/TS Radiation Emergency Assistance Center/Training Site January 2005 Catastrophic Incident Supplement | A13-5 National Response Plan REP Regional Evacuation Point RERT Radiological Emergency Response Team RHS Rural Housing Service RNA Rapid Needs Assessment RRCC Regional Response Coordination Center SAR Search and Rescue SCC Secretary’s Command Center (HHS) SCO State Coordinating Officer SERT Secretary’s Emergency Response Team (HHS) SNS Strategic National Stockpile SOP Standard Operating Procedure SOU Statement of Understanding STOLS System To Locate Survivors TLC Territorial Logistics Center TRAC2ES TRANSCOM Command and Control (C2) Evacuation System TRF Temporary Flight Restriction US&R Urban Search and Rescue VA NAC Veterans Affairs National Acquisition Center VMAT Veterinary Medical Assistance Team VMI Vendor-Managed Inventory WMD Weapon(s) of Mass Destruction A13-6 | Catastrophic Incident Supplement January 2005 National Response Plan THIS PAGE INTENTIONALLY LEFT BLANK