Att A_Public Health Preparedness Capabilities

Public Health Preparedness Capabilities:
National Standards for State and Local Planning
March 2011

Centers for Disease Control and Prevention

Table of Contents

Public Health Preparedness Capabilities:
National Standards for State and Local Planning
Page
Executive Summary ..................................................................................................................................................................... 2
Using this Document for Strategic Planning ...................................................................................................................... 6
At-A-Glance: Capability Definitions, Functions, and Associated Performance Measures ............................... 10
Capabilities (in alphabetical order)
1. Community Preparedness ................................................................................................................................. 16
2. Community Recovery .......................................................................................................................................... 22
3. Emergency Operations Coordination ........................................................................................................... 27
4. Emergency Public Information and Warning ............................................................................................. 36
5. Fatality Management .......................................................................................................................................... 45
6. Information Sharing ............................................................................................................................................. 55
7. Mass Care ................................................................................................................................................................. 62
8. Medical Countermeasure Dispensing ........................................................................................................... 71
9. Medical Materiel Management and Distribution ...................................................................................... 81
10. Medical Surge ........................................................................................................................................................ 92
11. Non-Pharmaceutical Interventions .............................................................................................................. 102
12. Public Health Laboratory Testing ................................................................................................................. 109
13. Public Health Surveillance and Epidemiological Investigation ......................................................... 119
14. Responder Safety and Health ........................................................................................................................ 127
15. Volunteer Management ................................................................................................................................... 133
Endnotes .................................................................................................................................................................................... 140

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Centers for Disease Control and Prevention

Public Health Preparedness Capabilities:
National Standards for State and Local Planning

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EXECUTIVE SUMMARY

Public health threats are always present. Whether caused by natural, accidental, or intentional means, these threats
can lead to the onset of public health incidents. Being prepared to prevent, respond to, and rapidly recover from
public health threats is critical for protecting and securing our nation’s public health.

The 2009 H1N1 influenza pandemic underscored the importance of communities being prepared for potential threats.
Because of its unique abilities to respond to infectious, occupational, or environmental incidents, the Centers for Disease
Control and Prevention (CDC) plays a pivotal role in ensuring that state and local public health systems are prepared for
these and other public health incidents. CDC provides funding and technical assistance for state, local, and territorial public
health departments through the Public Health Emergency Preparedness (PHEP) cooperative agreement. PHEP cooperative
agreement funding provides approximately $700 million annually to 50 states, four localities, and eight U.S. territories and
freely associated states for building and strengthening their abilities to respond to public health incidents.

Evolving Threats and Strengthening the Public Health System

Public health departments have made progress since 2001, as demonstrated in CDC’s state preparedness reports
(http://www.cdc.gov/phpr/reportingonreadiness.htm). However, state and local public health departments continue to face
multiple challenges, including an ever-evolving list of public health threats. Regardless of the threat, an effective public health
response begins with an effective public health system with robust systems in place to conduct routine public health activities.
In other words, strong state and local public health systems are the cornerstone of an effective public health response.
Today, public health systems and their respective preparedness programs face many challenges. Federal funds for
preparedness have been declining, causing state and local planners to express concerns over their ability to sustain the real
and measurable advances made in public health preparedness since September 11, 2001, when Congress appropriated
funding to CDC to expand its support nationwide of state and local public health preparedness. State and local planners likely
will need to make difficult choices about how to prioritize and ensure that federal dollars are directed to priority areas within
their jurisdictions.

Defining National Standards for State and Local Planning

In response to these challenges and in preparation for a new five-year PHEP cooperative agreement that takes effect in August
2011, CDC implemented a systematic process for defining a set of public health preparedness capabilities to assist state and
local health departments with their strategic planning. The resulting body of work, Public Health Preparedness Capabilities:
National Standards for State and Local Planning, hereafter referred to as public health preparedness capabilities, creates national
standards for public health preparedness capability-based planning and will assist state and local planners in identifying
gaps in preparedness, determining the specific jurisdictional priorities, and developing plans for building and sustaining
capabilities. These standards are designed to accelerate state and local preparedness planning, provide guidance and
recommendations for preparedness planning, and, ultimately, assure safer, more resilient, and better prepared communities.
Public health preparedness capabilities. CDC identified the following 15 public health preparedness capabilities (shown in
their corresponding domains) as the basis for state and local public health preparedness:

Biosurveillance

Incident Management

- Public Health Laboratory Testing
- Emergency Operations Coordination

- Public Health Surveillance and
Information Management

Epidemiological Investigation
- Emergency Public Information and Warning
Community Resilience - Information Sharing

- Community Preparedness
Surge Management

- Community Recovery
- Fatality Management

Countermeasures and Mitigation
- Mass Care

- Medical Countermeasure Dispensing
- Medical Surge

- Medical Materiel Management and Distribution
- Volunteer Management

- Non-Pharmaceutical Interventions

- Responder Safety and Health

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Public Health Preparedness Capabilities:
National Standards for State and Local Planning

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EXECUTIVE SUMMARY
These domains highlight significant dependencies between certain capabilities. A jurisdiction should choose the order of the
capabilities it decides to pursue based upon their jurisdictional risk assessment (see Capability 1: Community Preparedness for
additional or supporting detail on the requirements for this risk assessment) but are strongly advised to ensure that they first are
able to demonstrate capabilities within the following domains:
•
•
•
•
•

Biosurveillance
Community resilience
Countermeasures and mitigation
Incident management
Information management

To identify the public health aspects for each capability, CDC used the names and definitions from the U.S. Department of
Homeland Security (DHS) Target Capabilities List, content from the Pandemic and All-Hazards Preparedness Act (PAHPA),
and capabilities from the National Health Security Strategy (NHSS) as a baseline. As part of this process, the biosurveillance
aspects of animal disease and emergency support, food and agriculture safety and defense, and environmental health were
incorporated into the public health surveillance and epidemiological investigation capability. In addition, the detection of
chemical, biological, radiological, nuclear, and explosive agents were incorporated into the laboratory testing capability.
Important cross-cutting preparedness topics such as legal preparedness, vulnerable or at-risk populations, and radiological/
nuclear preparedness are addressed in several of the 15 capabilities.
Aligning across national programs. The Pandemic and All-Hazards Preparedness Act (PAHPA) specifies the need to maintain
consistency with certain other national programs, specifically the NHSS preparedness goals. PAHPA also directs that the
NHSS be consistent with the DHS National Preparedness Guidelines, a major component of which is the Target Capabilities
List. The National Preparedness Guidelines represent a standard for
preparedness based on establishing national priorities through a
capabilities-based planning process.
In addition to aligning with the National Preparedness Guidelines, CDC
determined that the public health preparedness capabilities should be
aligned with the 10 Essential Public Health Services model developed
by the U.S. Department of Health and Human Services (HHS). CDC
conducted a mapping process which determined that several of
the public health preparedness capabilities aligned with multiple
essential public health services. Thus, the state and local preparedness
capabilities align with both the DHS target capabilities and the HHS
10 Essential Public Health Services, with a focus on public health
capabilities critical to preparedness (see figure at right). The public
health preparedness capabilities defined by CDC also directly align
with 21 of the NHSS capabilities.
Everyday use. The public health preparedness capabilities now represent a national public health standard for state and
local preparedness that better prepares state and local health departments for responding to public health emergencies and
incidents and supports the accomplishment of the10 Essential Public Health Services. Each of the public health preparedness
capabilities identifies priority resource elements that are relevant to both routine public health activities and essential public
health services. While demonstrations of capabilities can be achieved through different means (e.g., exercises, planned events,
and real incidents), jurisdictions are encouraged to use routine public health activities to demonstrate and evaluate their
public health preparedness capabilities.
A systematic approach. The content of each public health preparedness capability is based on evidence-informed
documents, applicable preparedness literature, and subject matter expertise gathered from across the federal government
and the state and local practice community.
In developing this document, CDC reviewed key legislative and executive directives to identify state and local public health
preparedness priorities. These include the following:
• Pandemic and All-Hazards Preparedness Act (PAHPA), which authorizes state and local preparedness funding
• U.S. Department of Homeland Security (DHS) Homeland Security Presidential Directives 5, 8, and 21
• National Health Security Strategy (NHSS)
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EXECUTIVE SUMMARY
CDC also reviewed relevant preparedness documents from national partners such as the Association of State and Territorial
Health Officials (ASTHO) and the National Association of County and City Health Officials (NACCHO), and third-party
organizations including Trust for America’s Health and RAND Corporation.
The methodology for selecting the capabilities was peer reviewed by the Board of Scientific Counselors for CDC’s Office of
Public Health Preparedness and Response. The Board deemed that the methodological approach and the capabilities as
presented were within the scope of state and local preparedness.
Engaging stakeholders. Numerous stakeholders were involved in developing the 15 public health preparedness capabilities.
Stakeholders included approximately 200 subject matter experts from CDC and other federal agencies and professional
organizations. Federal agencies actively involved in the process included the HHS Office of the Assistant Secretary for
Preparedness and Response, DHS Federal Emergency Management Agency and Office of Health Affairs, and the U.S.
Department of Transportation’s National Highway Traffic Safety Administration. CDC also worked with national associations
including the American Hospital Association, the Association of Public Health Laboratories, the Council of State and Territorial
Epidemiologists, the National Emergency Management Association, and the National Public Health Information Coalition.
In addition, CDC collaborated with national partners such as the ASTHO and NACCHO to engage the state and local practice
community.
This collaborative process began in January 2010 when CDC representatives and other subject matter experts began working
together to develop the public health preparedness capabilities. Over the next year, CDC held weekly subject matter expert
capability working groups to develop recommendations for the scope of the selected capabilities, capability functions, and
resource elements for each capability. Their work was extensively vetted with many key stakeholders throughout the process.

Moving Forward
State and local public health departments are first responders for public health incidents, and CDC remains committed to
strengthening their preparedness. CDC’s Public Health Preparedness Capabilities: National Standards for State and Local Planning
will assist public health departments in developing annual and long-term preparedness plans to guide their preparedness
strategies and investments. These standards will be refined over time as emerging evidence becomes available to advance our
preparedness knowledge.

About this Document: How the Public Health Preparedness Capabilities Are Organized
The public health preparedness capabilities are numbered and presented alphabetically in this document.
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.

Community Preparedness
Community Recovery
Emergency Operations Coordination
Emergency Public Information and Warning
Fatality Management
Information Sharing
Mass Care
Medical Countermeasure Dispensing
Medical Materiel Management and Distribution
Medical Surge
Non-Pharmaceutical Interventions
Public Health Laboratory Testing
Public Health Surveillance and Epidemiological Investigation
Responder Safety and Health
Volunteer Management

U.S. Department of Health and Human Services
Centers for Disease Control and Prevention

A Guide
for Strategic Planning
The 15 capability sections in
this document are intended to
serve as national standards that
state and local public health
departments can use to advance
their preparedness planning.

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EXECUTIVE SUMMARY
Each capability includes a definition of the capability and list of the associated functions, performance measures, tasks, and
resource considerations.
• The Capability Definition defines the capability as it applies to state, local, tribal, and territorial public health.
• The Function describes the critical elements that need to occur to achieve the capability.
• The Performance Measure(s) lists the CDC-defined performance measures (if any) associated with a function.
• The Tasks describes the steps that need to occur to complete the functions.
• The Resource Elements section lists the resources a jurisdiction needs to have or have access to (via an arrangement
with a partner organization, memoranda of understanding, etc.) to successfully perform a function and the associated
tasks. CDC categorizes the Resources into three categories: 1. Planning, 2. Skills and Training, and 3. Equipment and
Technology. CDC further defines some Resources Elements as “Priority.” Priority elements are considered to be the most
critical of the Resource Elements and as “minimum standards” for state and local preparedness. The remaining Resource
Elements are recommended or suggested activities for consideration by jurisdictions.
Resource Elements:
Planning: Elements that should be included in existing operational plans, standard operating procedures and/or
emergency operations plans. This may include language on suggested legal authorities and at-risk populations.
Skills and Training: The baseline competencies and skills necessary for personnel and teams to possess to competently
deliver a capability.
Equipment and Technology: The equipment that a jurisdiction should have in their possession (or have access to), and the
equipment should be in sufficient quantities to adequately achieve the capability within the jurisdiction.
Note: As a first step, jurisdictions are encouraged to self-assess their ability to address the prioritized planning resource
elements of each capability followed by an assessment of their ability to demonstrate the functions and tasks within each
capability. CDC has defined successful accomplishment of prioritized resource elements as the following: a public health
agency has either the ability to have (within their own existing plans or other written documents) or has access to (partner
agency has the jurisdictional responsibility for this element in their plans and evidence exists that there is a formal agreement
between the public health agency and this partner regarding roles and responsibilities for this item) the resource element.
Jurisdictions are not required to submit plans to CDC but should have plans available for review upon request.

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National Standards for State and Local Planning

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USING THIS DOCUMENT FOR STRATEGIC PLANNING

CDC’s National Standards for State and Local Planning provides a description of the capabilities needed for achieving

state and local public health preparedness. The content is intended to serve as a planning resource that state and local
public health preparedness staff can use to assess their jurisdictional preparedness.
CDC is making these national standards for public health preparedness available to the nation’s public health system to
support their planning efforts. Jurisdictions also are encouraged to use other tools and local-level input in their planning
processes, such as existing jurisdictional strategic plans, data from current hazard and vulnerability assessments, and results
from After Action Reports/Improvement Plans.

Public Health Preparedness Capabilities Planning Model
To assist jurisdictions in using the capabilities for planning, CDC has developed a Public Health Preparedness Capabilities
Planning Model. The model describes a high-level planning process that state and local public health departments may wish
to follow to help determine their preparedness priorities and plan their preparedness activities. This planning model fits into
the planning phase of the U.S. Department of Homeland Security Preparedness Cycle.
The Public Health Preparedness Capabilities Planning Model is not intended to be a prescriptive methodology, but rather it is
intended to describe a series of suggested activities for preparedness planning. The diagram below depicts the model’s three
main phases and associated steps.

The following are descriptions for the suggested steps to complete each of the three phases.

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USING THIS DOCUMENT FOR STRATEGIC PLANNING
Phase 1: Assess Current State
Step 1a: Assess Organizational Roles and Responsibilities
The first step in the assessment phase is to determine which organizational entities within the jurisdiction are responsible
for each capability and function. These entities may include state agencies, partner organizations, local and tribal health
departments, and others. For instance, in some jurisdictions the coroner/medical examiner traditionally takes a lead role in
fatality management activities; public health should, therefore, seek this partner when identifying what role public health
contributes to this capability.
Step 1b: Assess Resource Elements
Each function within the capabilities includes a list of priority and recommended resource elements, divided into three
categories: Planning, Skills and Training, and Equipment and Technology. These are the resources that CDC and subject matter
experts have determined are the most critical for being able to build and maintain the associated capabilities. To assess
public health’s current capability, it is necessary to review the resource elements (particularly the priority resource elements)
to determine the extent that these elements exist in the jurisdiction. Not all public health agencies are expected to own
each resource element; jurisdictions are encouraged to partner with both internal and external jurisdictional partners to
assure access to resources as needed. Jurisdictions are encouraged to first self-assess their ability to address the prioritized
resource elements of each capability followed by their ability to demonstrate the functions and tasks within each capability.
Successfully addressing prioritized resource elements is defined as a public health agency either has the ability to demonstrate
that they have (within their own existing plans or other written documents) or have access to (partner agency has the
jurisdictional responsibility for this element in their plans and evidence exists that there is a formal agreement between the
public health agency and this partner regarding roles and responsibilities for this item) the resource element.
For each resource element, if not fully present as described in the capability definitions, any challenges or barriers to the full
attainment of that resource element should be noted.
In addition, CDC has crosswalked the resource element content with the Project Public Health Ready (PPHR) 2011 criteria and
the Public Health Accreditation Board (PHAB) measures (July 2009 beta test version) – these appear in the Endnotes section
where applicable. Jurisdictions which have or are pursuing PPHR or PHAB certification may be able to use this information to
further facilitate their assessments.
The resource elements described for each function are not intended to be an exhaustive list of all possible types of resources
required; nor do they give any indication of quantity of resources required (e.g., number of staff ). Therefore, it is critical that
in addition to assessing the defined resource elements, each jurisdiction notes the presence or absence of any other critical
resources needed to meet its needs and any challenges or barriers.
Step 1c: Assess Performance
After completing the resource element assessment, the next suggested step is to assess the performance of each capability
and function, and whether or not it meets the jurisdiction’s needs. Performance demonstration and evaluation may be
collected via activities to address CDC-defined performance measures or documented exercises or real incident activities.

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USING THIS DOCUMENT FOR STRATEGIC PLANNING
Phase 2: Determine Goals
Step 2a: Review Jurisdictional Inputs
After assessing the jurisdiction’s current level resource elements and performance, the next step is to identify needs and gaps.
In addition to the resource element assessment from the previous phase, there are a number of additional inputs which can be
used, including (but not limited to) the following:
•
•
•
•
•
•
•
•

Existing data from jurisdictional hazards and vulnerability analyses
Emergency management plans
Funding considerations (e.g., guidance or funding requirements from related federal preparedness programs)
Previous strategic plans or planning efforts
Previous state and local accreditation efforts
CDC’s Strategic National Stockpile Technical Assistance Review results
After Action Reports/Improvement Plans
Previous performance measure results

See Capability 1: Community Preparedness priority resource element requirements for additional detail on this topic.
Step 2b: Prioritize Capabilities and Functions
The capability definitions are broad; no jurisdiction is expected to be able to address all issues, gaps, and needs across all
capabilities in the immediate short term. Therefore, jurisdictions should choose the order of the capabilities they decide to
pursue based upon their jurisdictional risk assessments (see Capability 1: Community Preparedness for additional or supporting
detail on the requirements for this risk assessment), but are strongly advised to ensure that they first are able to demonstrate
capabilities within the following domains:
•
•
•
•
•

Biosurveillance
Community resilience
Countermeasures and mitigation
Incident management
Information management

Other prioritization criteria may include the following:
•
•
•
•
•

Missing/incomplete priority resource elements
Performance/ability is substantially lower than needed
Risks and threats to the public health, medical, and mental/behavioral health system
Ability to close gaps and develop capability is greatest
Evidence-based practice

Step 2c: Develop Short-term and Long-term Goals
This planning model defines short-term goals: one year, and long-term goals: two years to five years. Jurisdictions should
review the various inputs described in step 2a, analyze their priorities based on the prioritization criteria described in step 2b,
and determine a set of short-term (one year) and long-term (two years to five years) goals.
For the purposes of this model, all goals should refer to the capabilities, functions, and resource elements. For example, a
short-term goal may be to fully build a particular function within a capability, including ensuring the presence of all priority
resource elements. Long-term goals would be to build (individually or via partnerships), demonstrate performance, and,
ultimately, sustain all capabilities and functions.

Phase 3: Develop Plans

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USING THIS DOCUMENT FOR STRATEGIC PLANNING
Step 3a: Plan Organizational Initiatives
After determining the short-term and long-term goals, the next step is to engage in concrete initiatives and activity planning,
particularly for the short-term goals. While in practice jurisdictions may group together related activities to address multiple
functions or capabilities within the scope of one project or initiative, for the purposes of this planning model all activities are
viewed as related to individual capabilities, functions, and resource elements.
Step 3b: Plan Capacity Building/Sustain Activities
For each capability and function, jurisdictions generally will be either building, sustaining, or, perhaps, scaling back the
capability and/or function, depending on the needs, gaps, priorities, and goals that have been identified. For build and
sustain scenarios, jurisdictions are encouraged to pursue partnerships and memoranda of understanding with other agencies,
partners, and jurisdictions. For scale-back scenarios, jurisdictions should identify the challenges and barriers causing them to
scale back their efforts.
States should consider what types of support are required by their local and tribal health departments and plan assistance or
contracts accordingly. Support provided to local health departments should ideally describe which capabilities and functions
are intended to be addressed.
Jurisdictions should also determine any technical assistance needs they might have, whether from CDC or other sources.
Technical assistance may be needed to address challenges, barriers, or other needs.
For the purposes of this planning model, activities and technical assistance needs will, in general, relate to specific functions
and resource elements (i.e., developing or modifying plans or processes, training staff, or building/buying equipment and
technology).
Step 3c: Plan Capability Evaluations/Demonstrations
The final step in the planning process is to develop plans for demonstrating and evaluating the capabilities and functions,
especially those that have been newly developed. Demonstrations of capabilities can be through many different means such
as exercises, planned events, and real incidents. Jurisdictions are strongly encouraged to use routine public health activities
to demonstrate and evaluate their capabilities. Documentation of the exercise, event, or incident, and the use of quality
improvement-focused After Action Reports/Improvement Plans is a vital part of this process. For those capabilities and
functions where CDC-defined performance measures have been developed, jurisdictions are encouraged to collect data for
those measures.

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AT-A-GLANCE: Capability Definitions, Functions, and Associated Performance Measures
Capability 1: Community Preparedness
Definition: Community preparedness is the ability of communities to prepare for, withstand, and recover — in both the short
and long terms — from public health incidents. By engaging and coordinating with emergency management, healthcare
organizations (private and community-based), mental/behavioral health providers, community and faith-based partners, state,
local, and territorial, public health’s role in community preparedness is to do the following:
•
•
•
•
•
•

Support the development of public health, medical, and mental/behavioral health systems that support recovery
Participate in awareness training with community and faith-based partners on how to prevent, respond to, and recover
from public health incidents
Promote awareness of and access to medical and mental/behavioral health resources that help protect the community’s
health and address the functional needs (i.e., communication, medical care, independence, supervision, transportation)
of at-risk individuals
Engage public and private organizations in preparedness activities that represent the functional needs of at-risk
individuals as well as the cultural and socio-economic, demographic components of the community
Identify those populations that may be at higher risk for adverse health outcomes
Receive and/or integrate the health needs of populations who have been displaced due to incidents that have occurred
in their own or distant communities (e.g., improvised nuclear device or hurricane)

Functions and Associated Performance Measures: This capability consists of the ability to perform the functions listed below.
At present there are no CDC-defined performance measures for these functions.
Function 1:
Function 2:
Function 3:
Function 4:

Determine risks to the health of the jurisdiction
Build community partnerships to support health preparedness
Engage with community organizations to foster public health, medical, and mental/behavioral health social networks
Coordinate training or guidance to ensure community engagement in preparedness efforts

Capability 2: Community Recovery
Definition: Community recovery is the ability to collaborate with community partners, (e.g., healthcare organizations, business,
education, and emergency management) to plan and advocate for the rebuilding of public health, medical, and mental/
behavioral health systems to at least a level of functioning comparable to pre-incident levels, and improved levels where possible.
This capability supports National Health Security Strategy Objective 8: Incorporate Post-Incident Health Recovery into Planning
and Response. Post-incident recovery of the public health, medical, and mental/behavioral health services and systems within a
jurisdiction is critical for health security and requires collaboration and advocacy by the public health agency for the restoration
of services, providers, facilities, and infrastructure within the public health, medical, and human services sectors. Monitoring the
public health, medical and mental/behavioral health infrastructure is an essential public health service.
Functions and Associated Performance Measures: This capability consists of the ability to perform the functions listed below.
At present there are no CDC-defined performance measures for these functions.
Function 1: Identify and monitor public health, medical, and mental/behavioral health system recovery needs
Function 2: Coordinate community public health, medical, and mental/behavioral health system recovery operations
Function 3: Implement corrective actions to mitigate damages from future incidents

Capability 3: Emergency Operations Coordination
Definition: Emergency operations coordination is the ability to direct and support an event or incident with public health or
medical implications by establishing a standardized, scalable system of oversight, organization, and supervision consistent with
jurisdictional standards and practices and with the National Incident Management System.

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AT-A-GLANCE: Capability Definitions, Functions, and Associated Performance Measures
Functions and Associated Performance Measures: This capability consists of the ability to perform the functions listed below.
Associated CDC-defined performance measures are also listed below.
Function 1: Conduct preliminary assessment to determine need for public activation
Function 2: Activate public health emergency operations
Measure 1: Time for pre-identified staff covering activated public health agency incident management lead roles
(or equivalent lead roles) to report for immediate duty. Performance Target: 60 minutes or less
Function 3: Develop incident response strategy
Measure 1: Production of the approved Incident Action Plan before the start of the second operational period
Function 4: Manage and sustain the public health response
Function 5: Demobilize and evaluate public health emergency operations
Measure 1: Time to complete a draft of an After Action Report and Improvement Plan

Capability 4: Emergency Public Information and Warning
Definition: Emergency public information and warning is the ability to develop, coordinate, and disseminate information, alerts,
warnings, and notifications to the public and incident management responders.
Functions and Associated Performance Measures: This capability consists of the ability to perform the functions listed below.
Associated CDC-defined performance measures are also listed below.
Function 1:
Function 2:
Function 3:
Function 4:
Function 5:

Activate the emergency public information system
Determine the need for a joint public information system
Establish and participate in information system operations
Establish avenues for public interaction and information exchange
Issue public information, alerts, warnings, and notifications
Measure 1: Time to issue a risk communication message for dissemination to the public

Capability 5: Fatality Management
Definition: Fatality management is the ability to coordinate with other organizations (e.g., law enforcement, healthcare,
emergency management, and medical examiner/coroner) to ensure the proper recovery, handling, identification, transportation,
tracking, storage, and disposal of human remains and personal effects; certify cause of death; and facilitate access to mental/
behavioral health services to the family members, responders, and survivors of an incident.
Functions and Associated Performance Measures: This capability consists of the ability to perform the functions listed below.
At present there are no CDC-defined performance measures for these functions.
Function 1:
Function 2:
Function 3:
Function 4:
Function 5:

Determine role for public health in fatality management
Activate public health fatality management operations
Assist in the collection and dissemination of antemortem data
Participate in survivor mental/behavioral health services
Participate in fatality processing and storage operations

Capability 6: Information Sharing
Definition: Information sharing is the ability to conduct multijurisdictional, multidisciplinary exchange of health-related
information and situational awareness data among federal, state, local, territorial, and tribal levels of government, and the private
sector. This capability includes the routine sharing of information as well as issuing of public health alerts to federal, state, local,
territorial, and tribal levels of government and the private sector in preparation for, and in response to, events or incidents of
public health significance.

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AT-A-GLANCE: Capability Definitions, Functions, and Associated Performance Measures
Functions and Associated Performance Measures: This capability consists of the ability to perform the functions listed below.
At present there are no CDC-defined performance measures for these functions.
Function 1: Identify stakeholders to be incorporated into information flow
Function 2: Identify and develop rules and data elements for sharing
Function 3: Exchange information to determine a common operating picture

Capability 7: Mass Care
Definition: Mass care is the ability to coordinate with partner agencies to address the public health, medical, and mental/
behavioral health needs of those impacted by an incident at a congregate location. This capability includes the coordination of
ongoing surveillance and assessment to ensure that health needs continue to be met as the incident evolves.
Functions and Associated Performance Measures: This capability consists of the ability to perform the functions listed below.
At present there are no CDC-defined performance measures for these functions.
Function 1:
Function 2:
Function 3:
Function 4:

Determine public health role in mass care operations
Determine mass care needs of the impacted population
Coordinate public health, medical, and mental/behavioral health services
Monitor mass care population health

Capability 8: Medical Countermeasure Dispensing
Definition: Medical countermeasure dispensing is the ability to provide medical countermeasures (including vaccines, antiviral
drugs, antibiotics, antitoxin, etc.) in support of treatment or prophylaxis (oral or vaccination) to the identified population in
accordance with public health guidelines and/or recommendations.
Functions and Associated Performance Measures: This capability consists of the ability to perform the functions listed below.
Associated CDC-defined performance measures are also listed below.
Function 1: Identify and initiate medical countermeasure dispensing strategies
Function 2: Receive medical countermeasures
Function 3: Activate dispensing modalities
Measure 1: Composite performance indicator from the Division of Strategic National Stockpile in CDC’s Office of
Public Health Preparedness and Response
Function 4: Dispense medical countermeasures to identified population
Measure 1: Composite performance indicator from the Division of Strategic National Stockpile in CDC’s Office of
Public Health Preparedness and Response
Function 5: Report adverse events

Capability 9: Medical Materiel Management and Distribution
Definition: Medical materiel management and distribution is the ability to acquire, maintain (e.g., cold chain storage or other
storage protocol), transport, distribute, and track medical materiel (e.g., pharmaceuticals, gloves, masks, and ventilators) during an
incident and to recover and account for unused medical materiel, as necessary, after an incident.

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AT-A-GLANCE: Capability Definitions, Functions, and Associated Performance Measures
Functions and Associated Performance Measures: This capability consists of the ability to perform the functions listed below.
Associated CDC-defined performance measures are also listed below.
Function 1: Direct and activate medical materiel management and distribution
Measure 1: Composite performance indicator from the Division of Strategic National Stockpile in CDC’s Office of
Public Health Preparedness and Response
Function 2: Acquire medical materiel
Measure 1: Composite performance indicator from the Division of Strategic National Stockpile in CDC’s Office of
Public Health Preparedness and Response
Function 3: Maintain updated inventory management and reporting system
Measure 1: Composite performance indicator from the Division of Strategic National Stockpile in CDC’s Office of
Public Health Preparedness and Response
Function 4: Establish and maintain security
Measure 1: Composite performance indicator from the Division of Strategic National Stockpile in CDC’s Office of
Public Health Preparedness and Response
Function 5: Distribute medical materiel
Measure 1: Composite performance indicator from the Division of Strategic National Stockpile in CDC’s Office of
Public Health Preparedness and Response
Function 6: Recover medical materiel and demobilize distribution operations
Measure 1: Composite performance indicator from the Division of Strategic National Stockpile in CDC’s Office of
Public Health Preparedness and Response

Capability 10: Medical Surge
Definition: Medical surge is the ability to provide adequate medical evaluation and care during events that exceed the limits of
the normal medical infrastructure of an affected community. It encompasses the ability of the healthcare system to survive a
hazard impact and maintain or rapidly recover operations that were compromised.
Functions and Associated Performance Measures: This capability consists of the ability to perform the functions listed below.
At present there are no CDC-defined performance measures for these functions.
Function 1:
Function 2:
Function 3:
Function 4:

Assess the nature and scope of the incident
Support activation of medical surge
Support jurisdictional medical surge operations
Support demobilization of medical surge operations

Capability 11: Non-Pharmaceutical Interventions
Definition: Non-pharmaceutical interventions are the ability to recommend to the applicable lead agency (if not public health)
and implement, if applicable, strategies for disease, injury, and exposure control. Strategies include the following:

•
•
•
•
•
•

Isolation and quarantine
Restrictions on movement and travel advisory/warnings
Social distancing
External decontamination
Hygiene
Precautionary protective behaviors

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AT-A-GLANCE: Capability Definitions, Functions, and Associated Performance Measures
Functions and Associated Performance Measures: This capability consists of the ability to perform the functions listed below.
At present there are no CDC-defined performance measures for these functions.
Function 1:
Function 2:
Function 3:
Function 4:

Engage partners and identify factors that impact non-pharmaceutical interventions
Determine non-pharmaceutical interventions
Implement non-pharmaceutical interventions
Monitor non-pharmaceutical interventions

Capability 12: Public Health Laboratory Testing
Definition: Public health laboratory testing is the ability to conduct rapid and conventional detection, characterization,
confirmatory testing, data reporting, investigative support, and laboratory networking to address actual or potential exposure to
all-hazards. Hazards include chemical, radiological, and biological agents in multiple matrices that may include clinical samples,
food, and environmental samples (e.g., water, air, and soil). This capability supports routine surveillance, including pre-event or
pre-incident and post-exposure activities.
Functions and Associated Performance Measures: This capability consists of the ability to perform the functions listed below.
Associated CDC-defined performance measures are also listed below.
Function 1: Manage laboratory activities
Measure 1: Time for sentinel clinical laboratories to acknowledge receipt of an urgent message from the CDC
Public Health Emergency Preparedness (PHEP)-funded Laboratory Response Network biological (LRN-B)
laboratory
Measure 2: Time for initial laboratorian to report for duty at the CDC PHEP-funded laboratory
Function 2: Perform sample management
Measure 1: Percentage of Laboratory Response Network (LRN) clinical specimens without any adverse quality
assurance events received at the CDC PHEP-funded LRN-B laboratory for confirmation or rule-out
testing from sentinel clinical laboratories
Measure 2: Percentage of LRN non-clinical samples without any adverse quality assurance events received at the
CDC PHEP-funded LRN-B laboratory for confirmation or rule-out testing from first responders
Measure 3: Ability of the CDC PHEP-funded Laboratory Response Network chemical (LRN-C) laboratories to collect
relevant samples for clinical chemical analysis, package, and ship those samples
Function 3: Conduct testing and analysis for routine and surge capacity
Measure 1: Proportion of LRN-C proficiency tests (core methods) successfully passed by CDC PHEP-funded
laboratories
Measure 2: Proportion of LRN-C proficiency tests (additional methods) successfully passed by CDC PHEP-funded
laboratories
Measure 3: Proportion of LRN-B proficiency tests successfully passed by CDC PHEP-funded laboratories
Function 4: Support public health investigations
Measure 1: Time to complete notification between CDC, on-call laboratorian, and on-call epidemiologist
Measure 2: Time to complete notification between CDC, on-call epidemiologist, and on-call laboratorian
Function 5: Report results
Measure 1: Percentage of pulsed field gel electrophoresis (PFGE) subtyping data results for E. coli O157:H7
submitted to the PulseNet national database within four working days of receiving isolate at the PFGE
laboratory
Measure 2: Percentage of PFGE subtyping data results for Listeria monocytogenes submitted to the PulseNet
national database within four working days of receiving isolate at the PFGE laboratory
Measure 3: Time to submit PFGE subtyping data results for Salmonella to the PulseNet national database upon
receipt of isolate at the PFGE laboratory
Measure 4: Time for CDC PHEP-funded laboratory to notify public health partners of significant laboratory results

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AT-A-GLANCE: Capability Definitions, Functions, and Associated Performance Measures
Capability 13: Public Health Surveillance and Epidemiological Investigation
Definition: Public health surveillance and epidemiological investigation is the ability to create, maintain, support, and strengthen
routine surveillance and detection systems and epidemiological investigation processes, as well as to expand these systems and
processes in response to incidents of public health significance.
Functions and Associated Performance Measures: This capability consists of the ability to perform the functions listed below.
Associated CDC-defined performance measures are also listed below.
Function 1: Conduct public health surveillance and detection
Measure 1: Proportion of reports of selected reportable diseases received by a public health agency within the
jurisdiction-required time frame
Function 2: Conduct public health and epidemiological investigations
Measure 1: Percentage of infectious disease outbreak investigations that generate reports
Measure 2: Percentage of infectious disease outbreak investigation reports that contain all minimal elements
Measure 3: Percentage of acute environmental exposure investigations that generate reports
Measure 4: Percentage of acute environmental exposure reports that contain all minimal elements
Function 3: Recommend, monitor, and analyze mitigation actions
Measure 1: Proportion of reports of selected reportable diseases for which initial public health control measure(s)
were initiated within the appropriate time frame
Function 4: Improve public health surveillance and epidemiological investigation systems

Capability 14: Responder Safety and Health
Definition: The responder safety and health capability describes the ability to protect public health agency staff responding to an
incident and the ability to support the health and safety needs of hospital and medical facility personnel, if requested.
Functions and Associated Performance Measures: This capability consists of the ability to perform the functions listed below.
At present there are no CDC-defined performance measures for these functions.
Function 1:
Function 2:
Function 3:
Function 4:

Identify responder safety and health risks
Identify safety and personal protective needs
Coordinate with partners to facilitate risk-specific safety and health training
Monitor responder safety and health actions

Capability 15: Volunteer Management
Definition: Volunteer management is the ability to coordinate the identification, recruitment, registration, credential verification,
training, and engagement of volunteers to support the jurisdictional public health agency’s response to incidents of public health
significance.
Functions and Associated Performance Measures: This capability consists of the ability to perform the functions listed below.
At present there are no CDC-defined performance measures for these functions.
Function 1:
Function 2:
Function 3:
Function 4:

Coordinate volunteers
Notify volunteers
Organize, assemble, and dispatch volunteers
Demobilize volunteers

U.S. Department of Health and Human Services
Centers for Disease Control and Prevention

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CAPABILITY 1: Community Preparedness
Community preparedness is the ability of communities to prepare for, withstand, and
recover — in both the short and long terms — from public health incidents.1 By engaging
and coordinating with emergency management, healthcare organizations (private and
community-based), mental/behavioral health providers, community and faith-based
partners, state, local, and territorial, public health’s role in community preparedness is to
do the following:
• Support the development of public health, medical, and mental/behavioral health systems that support
•
•
•
•
•

recovery
Participate in awareness training with community and faith-based partners on how to prevent, respond to,
and recover from public health incidents
Promote awareness of and access to medical and mental/behavioral health 2 resources that help
protect the community’s health and address the functional needs (i.e., communication, medical care,
independence, supervision, transportation) of at-risk individuals
Engage public and private organizations in preparedness activities that represent the functional needs of
at-risk individuals as well as the cultural and socio-economic, demographic components of the community
Identify those populations that may be at higher risk for adverse health outcomes
Receive and/or integrate the health needs of populations who have been displaced due to incidents that
have occurred in their own or distant communities (e.g., improvised nuclear device or hurricane)

This capability consists of the ability to perform the following functions:
Function 1: Determine risks to the health of the jurisdiction
Function 2: Build community partnerships to support health preparedness
Function 3: Engage with community organizations to foster public health, medical, and
mental/behavioral health social networks
Function 4: Coordinate training or guidance to ensure community engagement
in preparedness efforts

Function 1: Determine risks to the health of the jurisdiction
Identify the potential hazards, vulnerabilities, and risks in the community that relate to the jurisdiction’s public health, medical,
and mental/behavioral health systems, the relationship of those risks to human impact,3 interruption of public health, medical,
and mental/behavioral health services, and the impact of those risks on the jurisdiction’s public health, medical, and mental/
behavioral health infrastructure.

Tasks

This function consists of the ability to perform the following tasks:
Task 1: Utilize jurisdictional risk assessment to identify, with emergency management and community and faith-based partners,
the public health, medical, and mental/behavioral health services for which the jurisdiction needs to have access to
mitigate identified disaster health risks.
Task 2: Utilize jurisdictional risk assessment to identify, with emergency management and community and faith-based partners,
the public health, medical, and mental/behavioral health services within the jurisdiction that currently support the
mitigation of identified disaster health risks.

Performance Measure(s)

At present there are no CDC-defined performance measures for this function.

U.S. Department of Health and Human Services
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CAPABILITY 1: Community Preparedness
Function 1: Determine risks to the health of the jurisdiction
Resource Elements

Note: Jurisdictions must have or have access to the resource elements designated as Priority.
P1: (Priority) Written plans should include policies and procedures to identify populations with the following:
–
–
–
–
–

Health vulnerabilities such as poor health status
Limited access to neighborhood health resources (e.g., disabled, elderly, pregnant women and infants,
individuals with other acute medical conditions, individuals with chronic diseases, underinsured persons,
persons without health insurance)
Reduced ability to hear, speak, understand, or remember
Reduced ability to move or walk independently or respond quickly to directions during an emergency
Populations with health vulnerabilities that may be caused or exacerbated by chemical, biological, or radiological
exposure

These procedures and plans should include the identification of these groups through the following elements:
–
–
–
–

Review/access to existing health department data sets
Existing chronic disease programs/maternal child health programs, community profiles
Utilizing the efforts of the jurisdiction strategic advisory council
Community coalitions to assist in determining the community’s risks4, 5

P2: (Priority) Written plans should include a jurisdictional risk assessment, utilizing an all-hazards approach with the input
and assistance of the following elements:

PLANNING (P)

–
–

Public health and non–public health subject matter experts (e.g., emergency management, state radiation
control programs/radiological subject matter experts (http://www.crcpd.org/Map/RCPmap.htm))
Existing inputs from emergency management risk assessment data, health department programs, community
engagements, and other applicable sources, that identify and prioritize jurisdictional hazards and health
vulnerabilities

This jurisdictional risk assessment should identify the following elements:
–
–
–

Potential hazards, vulnerabilities, and risks in the community related to the public health, medical, and mental/
behavioral health systems
The relationship of these risks to human impact, interruption of public health, medical, and mental/behavioral
health services
The impact of those risks on public health, medical, and mental/behavioral health infrastructure6

Jurisdictional risk assessment must include at a minimum the following elements:
–
–
–
–

A definition of risk
Use of Geospatial Informational System or other mechanism to map locations of at-risk populations
Evidence of community involvement in determining areas for risk assessment or hazard mitigation
Assessment of potential loss or disruption of essential services such as clean water, sanitation, or the interruption
of healthcare services, public health agency infrastructure

Suggested resource
–

Hazard Risk Assessment Instrument, University of California, Los Angeles, Center for Public Health and Disaster:
http://www.cphd.ucla.edu/hrai.html

P3: Written plans, as a stand-alone plan, annex, or via other documentation, developed with input from jurisdictional
partners7, 8 should indicate how the health department will assist with the following elements:

–– Assurance of community public health, medical, mental/behavioral health services in an incident, with particular
–

attention to assure access to health services to populations and areas of low economic resources and displaced
populations9,10
Addressing the concerns and needs of populations not directly impacted by a particular incident but concerned
about the possibility of adverse health effects

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Centers for Disease Control and Prevention

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CAPABILITY 1: Community Preparedness
Function 1: Determine risks to the health of the jurisdiction
Resource Elements (continued)
–
–
–
–
–

Family reunification assistance and patient tracking for family members impacted by the incident
Providing for the functional needs of at-risk individuals for adverse health outcomes with social services or
other lead agencies (e.g., disabled persons, low-income populations needing medication assistance, medical
transportation, or assistance in accessing sub-specialty medical technology and medical care)
Child care
Pet services and pet care
Psychological first aid and other relevant mental/behavioral health services11

PLANNING (P)

Suggested resources
––
–

CDC Radiation Emergencies website: http://emergency.cdc.gov/radiation/
Planning Guidance for Responding to a Nuclear Detonation, Second Edition, June 2010:
http://hps.org/hsc/documents/Planning_Guidance_for_Response_to_a_Nuclear_Detonation-2nd_Edition_
FINAL.pdf
– Listening Session on At-Risk Individuals in Pandemic Influenza and Other Scenarios: After Action Report, U.S.
Health and Human Services, Assistant Secretary for Preparedness and Response Office for At-Risk Individuals,
Behavioral Health, and Human Services Coordination:
http://www.phe.gov/Preparedness/planning/abc/Documents/abc_listening_session.pdf
– Preparedness Tools and Resources for Disabled Populations:
http://www.disability.gov/emergency_preparedness

SKILLS AND TRAINING (S)

P4: Written plans should include memoranda of understanding or other letters of agreement with community health centers,
non-profit community agencies, hospitals, and private providers within the jurisdiction or with neighboring jurisdictions,
if applicable, who are willing to or who can provide access to medical and mental/behavioral health services during and
after an incident.12,13
S1: Have or have access to services of persons with expertise in Geospatial Informational Systems to assist in locating/
mapping locations of at-risk populations. These Geospatial Informational System services may be found within other
governmental agencies (e.g., emergency management) or within academic settings (e.g., schools of public health).

Function 2: Build community partnerships to support health preparedness
Identify and engage with public and private community partners who can do the following:
• Assist with the mitigation of identified health risks
• Be integrated into the jurisdiction’s all-hazards emergency plans with defined community roles and responsibilities
related to the provision of public health, medical, and mental/behavioral health as directed under the Emergency
Support Function #8 definition at the state or local level

Tasks

This function consists of the ability to perform the following tasks:
Task 1: Identify community sector groups to be engaged for partnership based upon the jurisdictional risk assessment.

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CAPABILITY 1: Community Preparedness
Function 2: Build community partnerships to support health preparedness
Tasks (continued)
Task 2: Create and implement strategies for ongoing engagement with community partners who may be able to provide
services to mitigate identified public health threats or incidents (concept of “strategic advisory council” or joint
collaborative).
Task 3: Utilize community and faith-based partnerships as well as collaborations with any agencies primarily responsible for
providing direct health-related services to help assure the community’s ability to deliver public health, medical, and
mental/behavioral health services in both short and long term settings during and after an incident.
Task 4: Utilize a continuous quality improvement process to incorporate feedback from community and faith-based partners
into jurisdictional emergency operations plans.
Task 5: Identify community leaders that can act as trusted spokespersons to deliver public health messages.

Performance Measure(s)

At present there are no CDC-defined performance measures for this function.

Resource Elements

Note: Jurisdictions must have or have access to the resource elements designated as Priority.

PLANNING (P)

P1: (Priority) Written plans should include a policy and process to participate in existing (e.g., led by emergency
management) or new partnerships representing at least the following 11 community sectors:14 business; community
leadership; cultural and faith-based groups and organizations; emergency management; healthcare; social services;
housing and sheltering; media; mental/behavioral health; state office of aging or its equivalent; education and childcare
settings.15 ,16
P2: (Priority) Written plans should include a protocol to encourage or promote medical personnel (e.g., physicians, nurses,
allied health professionals) from community and faith-based organizations and professional organizations to register and
participate with community Medical Reserve Corps or state Emergency Systems for Advance Registration of Volunteer
Health Professionals programs to support health services during and after an incident.17,18,19 (For additional or supporting
detail, see Capability 15: Volunteer Management)
P3: Written plans should include documentation of community and faith-based partners’ roles and responsibilities for each
phase of the health threat.
P4: Written plans should include a process to provide mechanisms (e.g., town hall meetings, websites) to discuss public
health hazard policies and plans of action with community partners.20
P5: Written plans should include strategies to support the provision of community health services during multiple types of
hazard scenarios (also known as robustness) in order to support the identified risks in the jurisdiction.21

SKILLS AND TRAINING (S)

P6: Written plans should include a process to provide guidance to community and faith-based partners to support
development of these groups’ emergency operations plans/response operations.

S1: Mid-level public health staff participating in community preparedness activities should be able to demonstrate the
“Plan For and Improve Practice” domain within the core competencies in Public Health Preparedness and Response Core
Competency Model.
Suggested resource

– Association of Schools of Public Health Preparedness Competencies:

http://www.asph.org/userfiles/PreparednessCompetencyModelWorkforce-Version1.0.pdf
For further information on competency content and locations offering this training, see:
http://emergency.cdc.gov/cdcpreparedness/training/

U.S. Department of Health and Human Services
Centers for Disease Control and Prevention

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CAPABILITY 1: Community Preparedness
Function 3: Engage with community organizations to foster public health, medical, and
mental/behavioral health social networks
Engage with community organizations to foster social connections22 that assure public health, medical and mental/behavioral
health services in a community before, during, and after an incident.

Tasks

This function consists of the ability to perform the following tasks:
Task 1: Ensure that community constituency groups understand how to connect to public health to participate in public health
and community partner preparedness efforts.
Task 2: Ensure that public health, medical, and mental/behavioral health service agencies that provide essential health services
to the community are connected to jurisdictional public health preparedness plans and efforts.23
Task 3: Create jurisdictional networks (e.g., local businesses, community and faith-based organizations, ethnic radio/media, and,
if used by the jurisdiction, social networking sites) for public health, medical, and mental/behavioral health information
dissemination before, during, and after the incident. (For additional or supporting detail, see Capability 4: Emergency Public
Information and Warning)
Note: Tasks 1 through 3 apply to all jurisdictions; states are expected to ensure attainment by their local communities.

Performance Measure(s)

At present there are no CDC-defined performance measures for this function.

PLANNING (P)

Resource Elements
P1: Written plans should include a process for community engagement in problem solving strategy sessions to identify how
the short-term or permanent relocation of health-related supplies and other services can support the direct restoration
of a sense of community and social connectedness in terms of public health, medical, and mental/behavioral health
services.24
P2: Written plans should include a protocol to identify health services needed to support identified disaster risks and ensure
these services are culturally and socially competent.25

Function 4: Coordinate training or guidance to ensure community engagement
in preparedness efforts
Coordinate with emergency management, community organizations, businesses, and other partners to provide public health
preparedness and response training or guidance to community partners for the specific risks identified in the jurisdictional risk
assessment.

Tasks

This function consists of the ability to perform the following tasks:
Task 1: Integrate information on resilience, specifically the need for community-derived approaches to support the provision
of public health, medical, and mental/behavioral health services during and after an incident, into existing training and
educational programs related to crisis and disaster preparedness and response.
Task 2: Promote training to community partners that may have a supporting role to public health, medical, and mental/
behavioral health sectors (e.g., education, child care, juvenile justice, child welfare, and congregate childcare settings).

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CAPABILITY 1: Community Preparedness
Function 4: Coordinate training or guidance to ensure community engagement
in preparedness efforts
Tasks (continued)
Task 3: Provide guidance to community partners, particularly groups representing the functional needs of at-risk populations,
to assist them in educating their own constituency groups regarding plans for addressing preparedness for and recovery
from the jurisdiction’s identified risks and for access to health services that may apply to the incident.
Note: Tasks 1 through 3 apply to all jurisdictions; states are expected to ensure attainment by their local communities.

Performance Measure(s)

At present there are no CDC-defined performance measures for this function.

Resource Elements

Note: Jurisdictions must have or have access to the resource elements designated as Priority.
P1: (Priority) Written plans should include documentation that public health has participated in jurisdictional approaches to
address how children’s medical and mental/behavioral healthcare will be addressed in all-hazard situations, including but
not limited to the following elements:

PLANNING (P)

–
–
–
–
–

Approaches to support family reunification
Care for children whose caregivers may be killed, ill, injured, missing, quarantined, or otherwise incapacitated
for lengthy periods of time
Increasing parents’ and caregivers’ coping skills
Supporting positive mental/behavioral health outcomes in children affected by the incident
Providing the opportunity to understand the incident26

Suggested resources
–
–
–

Kids Dealing with Disasters:
http://www.oumedicine.com/body.cfm?id=3745
National Commission on Children and Disasters: 2010 Report to the President and Congress:
http://www.ahrq.gov/prep/nccdreport/nccdreport.pdf
Post-Katrina Emergency Management Reform Act of 2006:
http://frwebgate.access.gpo.gov/cgi-bin/getdoc.cgi?dbname=109_cong_bills&docid=f:s3721is.txt.pdf

SKILLS AND TRAINING (S)

P2: (Priority) Written plans should include a process and procedures to build and sustain volunteer opportunities for
residents to participate with local emergency responders and community safety efforts year round (e.g., Medical Reserve
Corps). (For additional or supporting detail, see Capability 15: Volunteer Management)
S1: Identify, recommend, or develop standardized and competency-based disaster education and training programs (such as
the National Disaster Life Support Program, the American Academy of Pediatrics disaster medicine curriculum, National
and State Voluntary Organizations Active in Disaster planning documents) for emergency responders, citizen volunteers,
and other community residents.
S2: Have or have access to at least one Medical Reserve Corps and coordinate with existing Community Emergency Response
Teams/Citizen Corps. (For additional or supporting detail, see Capability 15: Volunteer Management)

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CAPABILITY 2: Community Recovery
Community recovery is the ability to collaborate with community partners, (e.g., healthcare
organizations, business, education, and emergency management) to plan and advocate for
the rebuilding of public health, medical, and mental/behavioral health systems to at least a
level of functioning comparable to pre-incident levels, and improved levels where possible.
This capability supports National Health Security Strategy Objective 8: Incorporate Post-Incident Health Recovery
into Planning and Response. Post-incident recovery of the public health, medical, and mental/behavioral health
services and systems within a jurisdiction is critical for health security and requires collaboration and advocacy by
the public health agency for the restoration of services, providers, facilities, and infrastructure within the public
health, medical, and human services sectors. Monitoring the public health, medical and mental/behavioral health
infrastructure is an essential public health service.27,28,29,30

This capability consists of the ability to perform the following functions:
Function 1: Identify and monitor public health, medical, and mental/behavioral
health system recovery needs
Function 2: Coordinate community public health, medical, and mental/behavioral
health system recovery operations
Function 3: Implement corrective actions to mitigate damages from future incidents

Function 1: Identify and monitor public health, medical, and mental/behavioral
health system recovery needs
Assess the impact of an incident on the public health system31 in collaboration with the jurisdictional government and community
and faith-based partners, in order to determine and prioritize the public health, medical, or mental/behavioral health system
recovery needs.
This function addresses the intent of National Health Security Strategy Outcome 8 that there should be a collaborative effort
within a jurisdiction that results in the identification of public health, medical, and mental/behavioral assets, facilities, and other
resources which either need to be rebuilt after an incident or which can be used to guide post-incident reconstitution activities.

Tasks

This function consists of the ability to perform the following tasks:
Task 1: In collaboration with jurisdictional partners, document short-term and long-term health service delivery priorities and
goals.
Task 2: Identify the services that can be provided by the public health agency and by community and faith-based partners that
were identified prior to the incident as well as by new community partners that may arise during the incident response.
(For additional or supporting detail, see Capability 1: Community Preparedness, Capability 7: Mass Care, and Capability 10:
Medical Surge)
Task 3: Activate plans previously created with neighboring jurisdictions to provide identified services that the jurisdiction does
not have the ability to provide during and after an incident.
Task 4: In conjunction with healthcare organizations (e.g., healthcare facilities and public and private community providers) and
based upon recovery operations, determine the community’s health service priorities and goals that are the responsibility
of public health. (For additional or supporting detail, see Capability 10: Medical Surge)

Performance Measure(s)

At present there are no CDC-defined performance measures for this function.

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CAPABILITY 2: Community Recovery
Function 1: Identify and monitor public health, medical, and mental/behavioral
health system recovery needs
Resource Elements

Note: Jurisdictions must have or have access to the resource elements designated as Priority.
P1: (Priority) Written plans should include processes for collaborating with community organizations, emergency
management, and healthcare organizations to identify the public health, medical, and mental/behavioral health system
recovery needs for the jurisdiction’s identified hazards.
Suggested resource
–

National Disaster Recovery Framework (draft February 2010):
http://disasterrecoveryworkinggroup.gov/ndrf.pdf

P2: (Priority) Written plans should include how the health agency and other partners will conduct a community assessment
and follow-up monitoring of public health, medical, and mental/behavioral health system needs after an incident.
Suggested resource for environmental incidents
–

Community Assessment for Public Health Emergency Response Toolkit
http://www.emergency.cdc.gov/disasters/surveillance/pdf/CASPER_toolkit_508%20COMPLIANT.pdf

Suggested resource for radiation incidents

PLANNING (P)

– State Radiation Control Programs: http://www.crcpd.org/Map/RCPmap.htm
(For additional or supporting detail, see Capability 1: Community Preparedness)
P3: (Priority) Written plans should include the following elements (either as a stand-alone Public Health Continuity of
Operations Plan or as a component of another plan):
–
–
–
–
–
–
–
–
–
–

Definitions and identification of essential services needed to sustain agency mission and operations
Plans to sustain essential services regardless of the nature of the incident (e.g., all-hazards planning)
Scalable work force reduction
Limited access to facilities (social distancing, staffing or security concerns)
Broad-based implementation of social distancing policies if indicated
Positions, skills and personnel needed to continue essential services and functions (Human Capital Management)
Identification of agency vital records (legal documents, payroll, staff assignments) that support essential
functions and/or that must be preserved in an incident
Alternate worksites
Devolution of uninterruptible services for scaled down operations
Reconstitution of uninterruptible services32,33,34

P4: Written plans should include pre-defined statements, or message templates, that address likely questions and concerns
in an emergency. Message maps should be used by public health spokespersons to use with community media and
community organizations. (For additional or supporting detail, see Capability 1: Community Preparedness and Capability 4:
Emergency Public Information and Warning)
P5: Written plans should include recovery strategies for the timely repair or rebuilding of public health services (e.g.,
wastewater treatment and potable water supply).
P6: Written plans should include procedures that guide the provision of public health, medical, and mental/behavioral
healthcare beyond initial life-sustaining care. This includes processes to assure that short- and long-term programs
and services are available (pre- and post-incident) to meet the needs of responders and the general public in terms of
assuaging stress, grief, fear, panic, and anxiety, as well as to address other medical and mental/behavioral health issues.
(For additional or supporting detail, see Capability 1: Community Preparedness and Capability 14: Responder Safety and
Health)

U.S. Department of Health and Human Services
Centers for Disease Control and Prevention

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National Standards for State and Local Planning

23

CAPABILITY 2: Community Recovery
Function 1: Identify and monitor public health, medical, and mental/behavioral
health system recovery needs
Resource Elements (continued)
P7: Written plans should include protocols to identify jurisdictional legal authorities to permit non-jurisdictional clinicians to
be credentialed to work in emergency situations.
–

Suggested template: “Menu of Suggested Provisions for Public Health Mutual Aid Agreements” and especially the
section “Licenses and Permits” accessible at http://www2a.cdc.gov/phlp/mutualaid/mutualpermits.asp

P8: Written plans should include documentation that addresses the identification of the sectors (e.g., business, nongovernmental organizations, community and faith-based organizations, education, social services) that can provide
support to the recovery effort.
PLANNING (P)

–

For examples of potential sectors, see: Building Community Resilience for Children and Families, Terrorism and
Disaster Center at the University of Oklahoma Health Sciences Center35

Plan or annex should also include the process to facilitate or assist these organizations with developing their own
continuity of operations plans that detail how they will perform these functions in all-hazards recovery situations.
Recommended components include the following elements:
–
–

What community stakeholder operations are necessary to sustain public health operations/functions
What health support operations do/can they provide (e.g., shelter, day care, spiritual guidance, food, medication
support, and transportation)

Planning process should document the inclusion of regularly scheduled meetings prior to an incident at which
representatives from the different community sectors can meet to do the following:
– Establish and maintain interpersonal relationships
– Share promising practices/approaches to recovery from similar incidents
– Learn about relevant response and recovery processes and policies within the jurisdiction
– Ask questions and exchange information
(For additional or supporting detail, see Capability 1: Community Preparedness)

Function 2: Coordinate community public health, medical, and mental/behavioral
health system recovery operations
Facilitate interaction among community and faith-based organizations (e.g., businesses and non-governmental organizations) to
build a network of support services which will minimize any negative public health effects of the incident.
This function addresses the National Health Security Strategy Objective 8 outcome recommendation that jurisdictions should
have an integrated plan as to how post-incident public health, medical, and mental/behavioral services can be coordinated with
organizations responsible for community restoration.

Tasks

This function consists of the ability to perform the following tasks:
Task 1: Participate with the recovery lead jurisdictional agencies (e.g., emergency management and social service) to ensure
that the jurisdiction can provide health services needed to recover from a physical or mental/behavioral injury, illness,
or exposure sustained as a result of the incident, with particular attention to the functional needs of at-risk persons (e.g.,
those displaced from their usual residence). (For additional or supporting detail, see Capability 3: Emergency Operations
Coordination)

U.S. Department of Health and Human Services
Centers for Disease Control and Prevention

Public Health Preparedness Capabilities:
National Standards for State and Local Planning

24

CAPABILITY 2: Community Recovery
Function 2: Coordinate community public health, medical, and mental/behavioral
health system recovery operations
Tasks (continued)
Task 2: In conjunction with jurisdictional government and community partners, inform the community of the availability of
mental/behavioral, psychological first aid, and medical services within the community, with particular attention to how
these services affect the functional needs of at-risk persons36 (including but not limited to children, elderly, their care
givers, the disabled, or individuals with limited economic resources) (For additional or supporting detail, see Capability 4:
Emergency Public Information and Warning)
Task 3: Notify the community via community partners of the health agency’s plans for restoration of impacted public health,
medical, and mental/behavioral health services. (For additional or supporting detail, see Capability 4: Emergency Public
Information and Warning)
Task 4: Solicit community input via community partners regarding health service recovery needs during and after the acute
phase of the incident. (For additional or supporting detail, see Capability 4: Emergency Public Information and Warning and
Capability 8: Medical Countermeasure Dispensing)
Task 5: Partner with public health, medical, and mental/behavioral health professionals and other social networks (e.g.,
faith-based, volunteer organizations, support groups, and professional organizations) from within and outside the
jurisdiction, as applicable to the incident, to educate their constituents regarding applicable health interventions being
recommended by public health. (For additional or supporting detail, see Capability 4: Emergency Public Information and
Warning, Capability 6: Information Sharing, and Capability 11: Non-Pharmaceutical Interventions)
Task 6: In conjunction with jurisdictional government and community partners, inform the community of the availability of
any disaster or community case management services being offered that provide assistance for community members
impacted by the incident. (For additional or supporting detail, see Capability 4: Emergency Public Information and Warning)

Performance Measure(s)

At present there are no CDC-defined performance measures for this function.

SKILLS AND TRAINING (S)

Resource Elements
S1: Incorporate mental/behavioral health training into Medical Reserve Corps, volunteer (e.g., Emergency Systems for
Advance Registration of Volunteer Health Professionals) training programs (e.g., grief counseling services). (For additional
or supporting detail, see Capability 15: Volunteer Management)

Function 3: Implement corrective actions to mitigate damages from future incidents
Incorporate observations from the current incident to describe actions needed to return to a level of public health, medical,
and mental/behavioral health system function at least comparable to pre-incident levels or improved levels where appropriate.
Document these items in a written after action report and improvement plan, and implement those corrective actions that are
within the purview of public health.
This function addresses the intent of the National Health Security Strategy Outcome 8 recommendation that jurisdictions should
have a monitoring and evaluation plan for recovery efforts.
U.S. Department of Health and Human Services
Centers for Disease Control and Prevention

Public Health Preparedness Capabilities:
National Standards for State and Local Planning

25

CAPABILITY 2: Community Recovery
Function 3: Implement corrective actions to mitigate damages from future incidents
Tasks

This function consists of the ability to perform the following tasks:
Task 1: In conjunction with jurisdictional government and community partners, conduct post-incident assessment and planning
as part of the after action report process that affects short and long-term recovery for those corrective actions that are
within the control and purview of jurisdictional public health, including the mitigation of damages from future incidents.
Task 2: Collaborate with sector leaders37 to facilitate collection of community feedback to determine corrective actions.
Task 3: Implement corrective actions for items that are within the scope or control of public health to affect short and long-term
recovery, including the mitigation of damages from future incidents.
Task 4: Facilitate and advocate for collaborations among government agencies and community partners so that these agencies
can fulfill their respective roles in completing the corrective actions to protect the health of the public.

Performance Measure(s)

At present there are no CDC-defined performance measures for this function.

PLANNING (P)

Resource Elements
P1: Written plans should include a process to engage with jurisdictional business, educational, and social service sectors to
support the restoration of access to public health, medical and mental/behavioral health services.
P2: Written plans should include a process for how the public health agency will solicit feedback and recommendations from
the following sectors, at a minimum, for improved community access to health services:
–

Education, medical, public health, mental/behavioral health, and environmental health

U.S. Department of Health and Human Services
Centers for Disease Control and Prevention

Public Health Preparedness Capabilities:
National Standards for State and Local Planning

26

CAPABILITY 3: Emergency Operations Coordination
Emergency operations coordination is the ability to direct and support an event38 or
incident39 with public health or medical implications by establishing a standardized,
scalable system of oversight, organization, and supervision consistent with jurisdictional
standards and practices and with the National Incident Management System.40
This capability consists of the ability to perform the following functions:
Function 1:
Function 2:
Function 3:
Function 4:
Function 5:

Conduct preliminary assessment to determine need for public activation
Activate public health emergency operations
Develop incident response strategy
Manage and sustain the public health response
Demobilize41 and evaluate public health emergency operations

Function 1: Conduct preliminary assessment to determine need for public activation
Define the public health impact of an event or incident and gather subject matter experts to make recommendations on the need
for, and scale of, incident command operations.

Tasks

This function consists of the ability to perform the following tasks:
Task 1: At the time of an incident and as applicable during an incident, work with jurisdictional officials (e.g., other agency
representatives; elected or appointed leadership officials; epidemiology, laboratory, surveillance, medical, and chemical,
biological, and radiological subject matter experts; and emergency operations leadership) to analyze data, assess
emergency conditions and determine the activation levels based on the complexity of the event or incident. Activation
levels should be consistent with jurisdictional standards and practices (e.g., jurisdictional Emergency Operations
Plans and applicable annexes). (For additional or supporting detail, see Capability 13: Public Health Surveillance and
Epidemiological Investigation)
Task 2: At the time of an incident and as applicable during an incident, determine whether public health has the lead role, a
supporting role, or no role. These roles are defined as follows:
––
––
––

Lead role: public health has primary responsibility to establish event or incident objectives and response
strategies and to task other supporting agencies (e.g., outbreaks of meningitis, measles, seasonal influenza)
Supporting role: public health may be tasked by lead agency (e.g., oil spills, earthquakes, wild fires, hurricanes)
No role: there is no public health implication

Task 3: Define incident command and emergency management structure for the public health event or incident according to
one of the Federal Emergency Management Agency (FEMA) types.42 FEMA incident type may have an impact on training
and accreditation requirements and may help determine what level of resources are needed and how to request more
resources using standardized language for emergency response.43,44

Performance Measure(s)

At present there are no CDC-defined performance measures for this function.

U.S. Department of Health and Human Services
Centers for Disease Control and Prevention

Public Health Preparedness Capabilities:
National Standards for State and Local Planning

27

CAPABILITY 3: Emergency Operations Coordination
Function 1: Conduct preliminary assessment to determine need for public activation
Resource Elements

PLANNING (P)

Note: Jurisdictions must have or have access to the resource elements designated as Priority.
P1: Written plans should include a matrix indicating public health involvement in potential incidents based on items
identified in the jurisdictional risk assessment. Development of these plans should also include subject matter experts
(e.g., epidemiology, laboratory, surveillance, medical, and chemical, biological, and radiological subject matter experts
and emergency operations leadership) to help determine public health involvement in an incident that differs from
those identified in the jurisdictional risk assessment. 45,46 (For additional or supporting detail, see Capability 1: Community
Preparedness)

SKILLS AND TRAINING (S)

S1: At least one representative (either the Incident Commander or someone who can help to coordinate the public health
response to the incident) trained at a minimum to the CDC definition of Responder Training level Tier 4 which includes
completion of the following National Incident Management System courses:

EQUIPMENT AND TECHNOLOGY (E)

P2: Written plans should include processes and protocols for acting upon information that indicates there may be an incident
with public health implications that requires an agency-level response.

E1: Have or have access to communications equipment that includes a primary and a backup system which may consist of
(but not limited to) any of the following: telephones, fax, dedicated telephone line, cellular telephones with chargers,
radios (walkie talkies), television, high frequency radios, internet, and satellite communication.

–
–
–
–
–
–

Introduction to Incident Command System (IS-100.b)
Incident Command System for Single Resources and Initial Action Incidents (IS-200.b)
Intermediate Incident Command System (ICS-300)
Advanced Incident Command System (ICS-400)
National Incident Management System, An Introduction (IS-700a)
National Response Framework, An Introduction (IS-800.b)

Function 2: Activate public health emergency operations
In preparation for an event, or in response to an incident of public health significance, engage resources (e.g., human, technical,
physical space, and physical assets) to address the incident or event in accordance with the National Incident Management
System and consistent with jurisdictional standards and practices.

Tasks

This function consists of the ability to perform the following tasks:
Task 1: Prior to an event or incident, identify incident command and emergency management functions for which public health
is responsible.
Task 2: Prior to an event or incident, identify a pool of staff who have the skills necessary to fulfill required incident command
and emergency management roles deemed necessary for a response. The pool should include public health subject
matter experts, Incident Commander, Section Chiefs, Command Staff, and support positions (e.g., Informational
Technology Specialist).
U.S. Department of Health and Human Services
Centers for Disease Control and Prevention

Public Health Preparedness Capabilities:
National Standards for State and Local Planning

28

CAPABILITY 3: Emergency Operations Coordination
Function 2: Activate public health emergency operations
Tasks (continued)
Task 3: Prior to an event or incident, identify staff to serve in the required incident command and emergency management
roles for multiple operational periods to ensure continuous staffing during activation.
Task 4: Prior to an event or incident, identify primary and alternate physical locations or a virtual structure47 (owned by public
health or have access to through a memorandum of understanding or other written agreements) that will serve as the
public health emergency operations center.
Task 5: At the time of an event or incident, notify designated incident command staff of public health response.
Task 6: In preparation for or at the time of an event or incident, assemble designated staff at the appropriate emergency
operations center(s) (i.e., public health emergency operations center or jurisdictional emergency operations center).

Performance Measure(s)

This function is associated with the following CDC-defined performance measure:
Measure 1: Time for pre-identified staff covering activated public health agency incident management lead roles (or equivalent
lead roles) to report for immediate duty. Performance Target: 60 minutes or less
–
–

Start time: Date and time that a designated official began notifying staff to report for immediate duty to cover
activated incident management lead roles
Stop time: Date and time that the last staff person notified to cover an activated incident management lead role
reported for immediate duty

Resource Elements

Note: Jurisdictions must have or have access to the resource elements designated as Priority.
P1: (Priority) Written plans should include standard operating procedures that provide guidance for the management,
operation, and staffing of the public health emergency operations center or public health functions within another
emergency operations center. The following should be considered for inclusion in the standard operating procedures:

PLANNING (P)

–
–

Activation procedures and levels, including who is authorized to activate the plan and under what circumstances
Notification procedures; procedures recalling and/or assembling required incident command/management
personnel and for ensuring facilities are available and operationally ready for assembled staff

Suggested resource
–

Federal Emergency Management Agency Incident Command System Forms:
http://training.fema.gov/EMIWeb/IS/ICSResource/ICSResCntr_Forms.htm

P2: Written plans should include job action sheets or equivalent documentation for incident command positions and others
with roles in a public health emergency.
–

For guidance on developing job action sheets, refer to the tool provided by the National Association of County
and City Health Officials: http://www.naccho.org/toolbox/tool.cfm?id=5

P3: Written plans should include a list of staff that has been selected in advance of an incident that could fill the incident
management roles adequate to a given response, including public health responses and cross-agency responses. Health
departments must be prepared to staff multiple emergency operations centers at the agency, local, and state levels as
necessary.
P4: Written plans should include a list that ensures personnel and equipment arriving at the incident can check in and check
out at various incident locations.
–

The use of Incident Command System Form 211 – “Check-In List” or equivalent documentation is
recommended.

U.S. Department of Health and Human Services
Centers for Disease Control and Prevention

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National Standards for State and Local Planning

29

CAPABILITY 3: Emergency Operations Coordination
Function 2: Activate public health emergency operations

PLANNING (P)

Resource Elements (continued)
P5: Written plans should include mutual aid or other written agreements between public health agencies and response
partners at the state, tribe, territorial and local levels to support Emergency Support Function #8 related activities
across jurisdictions. These agreements facilitate the sharing of resources, facilities, services, and other potential support
required during an incident:
–
–
–
–
–
–
–
–
–

Procedures for coordinating investigation and response operations across agencies
Procedures for requesting and providing assistance
Procedures, authorities, and rules for payment, reimbursement, and allocation of cost
Notification procedures for activation of memoranda of understanding and/or memoranda of agreements
Mutual aid agreements with surrounding jurisdictions
Workers compensation
Treatment of liability and immunity
Recognition of qualifications and certifications
Sharing agreements as required

S1: (Priority) Staff involved in incident response should have competency in the incident command and emergency
management responsibilities they may be called upon to fulfill in an emergency. A precursor to having competency is for
staff to attain the applicable National Incident Management System (NIMS) Certification based on discipline, level and/or
jurisdictional requirements. Additional information on NIMS is located at http://www.fema.gov/emergency/nims/.
A suggested approach to establish your NIMS training needs based on CDC guidelines is outlined below.
Tier One: Personnel who, in the event of a public health emergency, will not be working within the emergency operations
center/multiagency coordination system or will not be sent out to the field as responders. Applicable training courses are

SKILLS AND TRAINING (S)

–
–

National Incident Management System, An Introduction (IS-700a)
National Response Framework, An Introduction (IS-800.b)

Tier Two: Personnel who, in a public health emergency, will be assigned to fill one of the functional seats in the
emergency operations center during the response operation. Applicable training courses are listed below:
–
–
–
–

Introduction to Incident Command System (IS-100.b)
Incident Command System for Single Resources and Initial Action Incidents (IS-200.b)
National Incident Management System: An Introduction (IS-700a)
National Response Framework: An Introduction (IS-800.b)

Tier Three: Personnel who, in a public health emergency, have the potential to be deployed to the field to participate
in the response, including personnel who are already assigned to a field location. Applicable training courses are listed
below:
–
–
–
–
–

Introduction to Incident Command System (IS-100.b)
Incident Command System for Single Resources and Initial Action Incidents (IS-200.b)
Intermediate Incident Command System (ICS-300)
National Incident Management System, An Introduction (IS-700a)
National Response Framework, An Introduction (IS-800.b)

Tier Four: Personnel who, in a public health emergency, are activated to Incident Management System leadership and
liaison roles and are deployed to the field in leadership positions. Applicable training courses are listed below
–
–
–
–
–
–

Introduction to Incident Command System (IS-100.b)
Incident Command System for Single Resources and Initial Action Incidents (IS-200.b)
Intermediate Incident Command System (ICS-300)
Advanced Incident Command System (ICS-400)
National Incident Management System, An Introduction (IS-700a)
National Response Framework, An Introduction (IS-800.b)

U.S. Department of Health and Human Services
Centers for Disease Control and Prevention

Public Health Preparedness Capabilities:
National Standards for State and Local Planning

30

CAPABILITY 3: Emergency Operations Coordination
Function 2: Activate public health emergency operations
EQUIPMENT AND TECHNOLOGY (E)

Resource Elements (continued)
E1: Have or have access to back up equipment (e.g., generators) in the event of system failure or power loss in the public
health emergency operations center.
E2: Have or have access to communications equipment that allows information to be transmitted inside and outside the
emergency operations center (e.g., telephones, fax, dedicated telephone line, cellular telephones with chargers, radios
(walkie talkies), television, high frequency radios, internet, and satellite communication). (For additional or supporting
detail, see Capability 6: Information Sharing)
E3: Have or have access to information technology equipment in quantities sufficient to meet event/incident objectives (e.g.,
projectors, computers, audio/video teleconferencing, WebEOC, or other resource tracking systems).

Function 3: Develop incident response strategy
Produce or provide input to an Incident Commander or Unified Command approved, written Incident Action Plan, as dictated by
the incident, containing objectives reflecting the response strategy for managing Type 1, Type 2, and Type 3 events or incidents, as
described in the National Incident Management System,48 during one or more operational periods.

Tasks

This function consists of the ability to perform the following tasks:
Task 1: Produce or contribute to49 an Incident Commander or Unified Command approved Incident Action Plan prior to the start
of the second operational period.
Task 2: Disseminate the Incident Action Plan to public health response staff. (For additional or supporting detail, see Capability 6:
Information Sharing)
Task 3: Revise and brief staff on the Incident Action Plan at least at the start of each new operational period. Incident Action
Plans must include the following:
• What was accomplished in the previous operational period
• What is to happen in the next operational period

Performance Measure(s)

This function is associated with the following CDC-defined performance measure:
Measure 1: Production of the approved Incident Action Plan before the start of the second operational period

Resource Elements

PLANNING (P)

Note: Jurisdictions must have or have access to the resource elements designated as Priority.
P1: (Priority) Written plans should include a template for producing Incident Action Plans. The following should be
considered for inclusion in Incident Action Plans as indicated by the scale of the incident:
–
–
–
–
–
–

Incident goals
Operational period objectives (major areas that must be addressed in the specified operational period to achieve
the goals or control objectives)
Response strategies (priorities and the general approach to accomplish the objectives)
Response tactics (methods developed by Operations to achieve the objectives)
Organization list with Incident Command System chart showing primary roles and relationships
Assignment list with specific tasks

U.S. Department of Health and Human Services
Centers for Disease Control and Prevention

Public Health Preparedness Capabilities:
National Standards for State and Local Planning

31

CAPABILITY 3: Emergency Operations Coordination
Function 3: Develop incident response strategy
Resource Elements (continued)

PLANNING (P)

–
–
–
–
–
–
–

Critical situation updates and assessments
Composite resource status updates
Health and safety plan (to prevent responder injury or illness)
Logistics plan (e.g., procedures to support Operations with equipment and supplies)
Responder medical plan (providing direction for care to responders)
Map of the incident or of ill/injured persons (e.g., map of incident scene)
Additional component plans, as indicated by the incident

SKILLS AND TRAINING (S)

The use of the following Incident Command System forms or equivalent documentation is recommended: Form 202 –
“Incident Objectives,” Form 203 – “Organization Assignment List,” and Form 204 – “Division/Group Assignment List.”
S1: Staff participating in the incident action plan should participate in National Incident Management System training:
–
–
–
–
–

Introduction to Incident Command System (IS-100.b)
Incident Command System for Single Resources and Initial Action Incidents (IS-200.b)
Intermediate Incident Command System (ICS-300)
National Incident Management System, An Introduction (IS-700a)
National Response Framework, An Introduction (IS-800.b)

Function 4: Manage and sustain the public health response
Direct ongoing public health emergency operations to sustain the public health and medical response for the duration of the
response, including multiple operational periods and multiple concurrent responses.

Tasks

This function consists of the ability to perform the following tasks:
Task 1: Coordinate public health and medical emergency management operations for the public health response (e.g., phone
calls, meetings, and conference calls).
Task 2: Track and account for all public health resources during the public health response.
Task 3: Maintain situational awareness using information gathered from medical, public health, and other health stakeholders
(e.g., fusion centers). (For additional or supporting detail, see Capability 6: Information Sharing)
Task 4: Conduct shift change briefings between outgoing and incoming public health staff to communicate priorities, status of
tasks, and safety guidance.

Performance Measure(s)

At present there are no CDC-defined performance measures for this function.

Resource Elements
PLANNING (P)

Note: Jurisdictions must have or have access to the resource elements designated as Priority.
P1: (Priority) Written plans should include processes and protocols to ensure the continued performance of pre-identified
essential functions during a public health incident and during an incident that renders the primary location where the
functions are performed inoperable. This can be a stand-alone plan or annex but at a minimum the plan must include
these elements:
–

Definitions and identification of essential services needed to sustain agency mission and operations

U.S. Department of Health and Human Services
Centers for Disease Control and Prevention

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National Standards for State and Local Planning

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CAPABILITY 3: Emergency Operations Coordination
Function 4: Manage and sustain the public health response
Resource Elements (continued)
–
–
–
–
–
–

PLANNING (P)

–
–
–

Plans to sustain essential services regardless of the nature of the incident (e.g., all-hazards planning)
Scalable workforce reduction
Limited access to facilities (e.g., social distancing and staffing or security concerns)
Broad-based implementation of social distancing policies if indicated
Positions, skills, and personnel needed to continue essential services and functions (Human Capital
Management)
Identification of agency vital records (e.g., legal documents, payroll, and staff assignments) that support essential
functions and/or that must be preserved in an incident
Alternate worksites
Devolution of uninterruptible services for scaled-down operations
Reconstitution of uninterruptible services

For guidance on developing a Continuity of Operations Plan, refer to the resources provided by the Federal Emergency
Management Agency: http://www.fema.gov/government/coop/index.shtm
P2: Written plans should include standard operating procedures for managing a response. The following should be
considered for inclusion:
–
–
–
–

Processes for accounting for staff time, equipment, and other items used during the public health response
Procedures/templates for situation reports
Procedures/templates for shift change briefings
Staff rhythms to support the collection of information to support critical information requirements

P3: Written plans should include a protocol describing how to respond to an incident regardless of the nature of the incident
(e.g., all-hazards planning). The following should be considered for inclusion in the plan:
–
–
–

Public health roles in a response
When these roles must be fulfilled (e.g., before, during, and immediately after a public health incident)
Resources (e.g., equipment, necessary to fulfill public health roles)

SKILLS AND TRAINING (S)

S1: Public health staff participating in public health emergency operations should be trained on any jurisdictionally identified
emergency operations center incident supporting software (e.g., WebEOC) prior to an incident.
S2: Staff likely to participate in a response should be trained on health department plans and procedures (e.g., Standard
Operating Procedures, Continuity of Operation Plan, and Emergency Operations Plan) and understand their role(s), if
any, during a public health response. Staff should be trained on any jurisdictionally defined training on continuity of
operations and emergency operations. Recommended additional courses include the following:
–
–

Continuity of Operations Awareness (IS-546)
Introduction to Continuity of Operations (IS-547.a)

S3: Public health staff participating in public health emergency operations should be trained on National Incident
Management System training including the following:
–
–
–
–

Introduction to Incident Command System (IS-100.b)
Incident Command System for Single Resources and Initial Action Incidents (IS-200.b)
National Incident Management System, An Introduction (IS-700a)
National Response Framework, An Introduction (IS-800.b)

Function 5: Demobilize and evaluate public health emergency operations
Release and return resources that are no longer required by the event or incident to their pre-ready state and conduct an
assessment of the efforts, resources, actions, leadership, coordination, and communication utilized during the incident for the
purpose of identifying and implementing continuous improvement activities.
U.S. Department of Health and Human Services
Centers for Disease Control and Prevention

Public Health Preparedness Capabilities:
National Standards for State and Local Planning

33

CAPABILITY 3: Emergency Operations Coordination
Function 5: Demobilize and evaluate public health emergency operations
Tasks

This function consists of the ability to perform the following tasks:
Task 1: Return resources to a condition of “normal state of operation” as appropriate. This may include archiving records
and restoring systems, supplies, and staffing to a pre-incident ready state.
Task 2: Conduct final incident closeout of public health operations including the turnover of documentation, an incident
debriefing, and a “final closeout” with the responsible agency or jurisdiction executive/officials.
Task 3: Produce After Action Report for public health operations to identify improvement areas and promising practices.
Task 4: Implement Improvement Plan items (e.g., project work plans and evidence of improvement actions) that have
been assigned to public health.
Task 5: Track the implementation progress of Improvement Plan items assigned to public health through a corrective
action system.

Performance Measure(s)

This function is associated with the following CDC-defined performance measure:
Measure 1: Time to complete a draft of an After Action Report and Improvement Plan
–
–

Start time: Date exercise or public health emergency operation completed
Stop time: Date the draft After Action Report and Improvement Plan were submitted for clearance within the
public health agency

Resource Elements

Note: Jurisdictions must have or have access to the resource elements designated as Priority.
P1: (Priority) Written plans should include demobilization procedures for public health operations. The following should be
considered for inclusion:
–
–
–
–

PLANNING (P)

–

General information about the demobilization process
Responsibilities/agreements for reconditioning of equipment/resources
Responsibilities for implementation of the Demobilization Plan
General release priorities (i.e., resource type such as staff or equipment to be released) and detailed steps and
processes for releasing those resources
Directories (e.g., maps and telephone listings)

The use of Incident Command System Form 221 - “Demobilization Checkout” or equivalent documentation is
recommended.
P2: Written plans should include an After Action Report/Improvement Plan template, which must include, at a minimum, the
following elements:
–
–
–
–
–
–

Executive Summary
Event Overview
Event Summary
Analysis of Capabilities
Conclusion
Improvement Plan, which includes (at a minimum)
□□ Capability Name
□□ Observation
□□ Title
□□ Recommendation
□□ Corrective Action Description

U.S. Department of Health and Human Services
Centers for Disease Control and Prevention

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National Standards for State and Local Planning

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CAPABILITY 3: Emergency Operations Coordination
Function 5: Demobilize and evaluate public health emergency operations

PLANNING (P)

Resource Elements (continued)
□□
□□
□□
□□
□□

For guidance on developing an After Action Report, refer to the Homeland Security Exercise and Evaluation Program
(https://hseep.dhs.gov/pages/1001_HSEEP7.aspx).
P3: Written plans should include an incident close out briefing template to include the following elements:
–
–
–
–
–
–

SKILLS AND TRAINING (S)

Capability Element
Primary Responsible Agency
Agency Point of Contact
Start Date
Completion Date

Incident summary
Major events that have lasting implications
Documentation, including components that are not finalized
Opportunity for discussion to bring up any concerns from agency officials
Final evaluation of incident management by agency officials
Team performance evaluation

S1: Public health staff that will participate in or lead exercises (at least one staff member) should have an understanding
of Homeland Security Exercise and Evaluation Program policies, procedures, and terminology as well as experience in
design, development, conduct, evaluation, and improvement planning for exercises. Recommended courses include the
following:
–
–
–

An Introduction to Exercises (IS.120.a)
Exercise Evaluation and Improvement Planning (IS-130)
Exercise Design (IS-139)

National Incident Management System training includes the following:
–
–
–
–
–

Introduction to Incident Command System (IS-100.b)
Incident Command System for Single Resources and Initial Action Incidents (IS-200.b)
Intermediate Incident Command System (ICS-300)
National Incident Management System, An Introduction (IS-700a)
National Response Framework, An Introduction (IS-800.b)

U.S. Department of Health and Human Services
Centers for Disease Control and Prevention

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National Standards for State and Local Planning

35

CAPABILITY 4: Emergency Public Information and Warning
Emergency public information and warning is the ability to develop, coordinate,
and disseminate information, alerts, warnings, and notifications to the public and
incident management responders.
This capability consists of the ability to perform the following functions:
Function 1:
Function 2:
Function 3:
Function 4:
Function 5:

Activate the emergency public information system
Determine the need for a joint public information system
Establish and participate in information system operations
Establish avenues for public interaction and information exchange
Issue public information, alerts, warnings, and notifications

Function 1: Activate the emergency public information system
Notify and assemble key public information personnel and potential spokespersons, which were identified prior to an incident,50
to provide information to the public during an incident.

Tasks

This function consists of the ability to perform the following tasks:
Task 1: Prior to an incident, identify Public Information Officer, support staff (depending on jurisdictional vulnerabilities and
subject matter expertise), and potential spokesperson(s) to convey information to the public.
Task 2: Prior to an incident, identify a primary and alternate physical and/or virtual structure that will be used to support
alerting and public information operations. (For additional or supporting detail, see Capability 3: Emergency Operations
Coordination)
Task 3: Prior to the incident, ensure identified personnel are trained in the functions they may be asked to fulfill.
Task 4: At the time of an incident, notify Public Information Officer, support staff, spokesperson(s), and subject matter experts,
if applicable to the incident, of the need to either be on-call or to report for duty as necessary within a time frame
appropriate to the incident.
Task 5: At the time of an incident, assemble public information staff at the physical or virtual location, debrief on incident, and
assign response duties. (For additional or supporting detail, see Capability 3: Emergency Operations Coordination)
Task 6: Assist local public health systems in implementing emergency communication abilities.

Performance Measure(s)

At present there are no CDC-defined performance measures for this function.

Resource Elements

PLANNING (P)

Note: Jurisdictions must have or have access to the resource elements designated as Priority.
P1: (Priority) Written plans should include description of the roles and responsibilities for the Public Information Officer,
support staff (depending on incident and subject matter expertise), and potential spokesperson(s) to convey information
to the public.51
P2: (Priority) Written plans should include message templates that address jurisdictional vulnerabilities, should be
maintained on a jurisdictionally defined regular basis, and include the following elements:
–
–
–
–

Stakeholder identification
Potential stakeholder questions and concerns
Common sets of underlying concerns
Key messages in response to the generated list of underlying stakeholder questions and concerns

U.S. Department of Health and Human Services
Centers for Disease Control and Prevention

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National Standards for State and Local Planning

36

CAPABILITY 4: Emergency Public Information and Warning
Function 1: Activate the emergency public information system
Resource Elements (continued)
Suggested resources
–
–
–

Message Template for the First Minute for all Emergencies:
http://www.emergency.cdc.gov/firsthours/resources/messagetemplate.asp
Communicating in the First Hours / First Hours Resources:
http://www.emergency.cdc.gov/firsthours/resources/index.asp
Communicating in the First Hours / Terrorism Emergencies:
http://www.bt.cdc.gov/firsthours/terrorist.asp

P3: Written plans should include a protocol for identification of a primary and alternate physical and/or virtual structure
that will be used to support alerting and public information operations. Staff assembly can occur at a physical location
(e.g., an emergency operations center, virtual location (e.g., web-based interface such as WebEOC or conference call), or
combination of both. (For additional or supporting detail, see Capability 3: Emergency Operations Coordination)

PLANNING (P)

P4: Written plans should include a roster/call down list with pre-identified staff to participate in communications. Plans
should also include a minimum of one back-up per role to serve if necessary.
P5: Written plans should include job action sheets for staff and volunteers detailing specific tasks of each identified role.52 (For
additional or supporting detail, see Capability 15: Volunteer Management)
P6: Written plans should include a protocol for staff notification and reporting for duty which may include the following
elements:53
–
–
–
–

Method in which staff will be notified
Where staff must report
How quickly staff will be notified of an incident
How long staff will have to report to designated location

P7: Written plans should include a process to activate Research, Media Operations, and Logistics roles as applicable to
the incident. These roles may be conducted by one or more individuals and include, at a minimum, the following: (For
additional or supporting detail, see Capability 3: Emergency Operations Coordination)
–
–
–
–

Fact gathering
Rumor control
Media monitoring
Speaker support

P8: Written plans should include a process to provide support and assistance to local public health systems in implementing
emergency communication abilities. (State jurisdictions) (For additional or supporting detail, see Capability 6: Information
Sharing)

SKILLS AND TRAINING (S)

S1: (Priority) Public Information staff should complete the following National Incident Management System training:
–
–
–
–
–
–

Introduction to Incident Command System (IS-100.b)
Incident Command System for Single Resources and Initial Action Incidents (IS-200.b)
Emergency Support Function 15 External Affairs: A New Approach to Emergency Communication and
Information Distribution (IS-250)
National Incident Management System, An Introduction (IS-700.a)
National Incident Management System Public Information Systems (IS-702.a)
National Response Framework, An Introduction (IS-800.b)

S2: (Priority) Deliver key messages using principles of crisis and emergency risk communication. To ensure this, the following
training must be taken within six months of hire date and at least once every five years thereafter by public information
staff within the jurisdiction:
–
–

CDC Crisis and Emergency Risk Communication Basic
CDC Crisis and Emergency Risk Communication for Pandemic Influenza

U.S. Department of Health and Human Services
Centers for Disease Control and Prevention

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National Standards for State and Local Planning

37

CAPABILITY 4: Emergency Public Information and Warning
Function 1: Activate the emergency public information system
Resource Elements (continued)

SKILLS AND TRAINING (S)

These courses may be taken in any of the following ways:
––
––
––
––

If for any reason staff is not able to attend these courses, completing training given by staff that has been CDC trained is
acceptable (train the trainer model).
S3: Public Information Officer responsibilities/competencies include the following:
–
–
–

EQUIPMENT AND TECHNOLOGY (E)

Self-paced online training, which is available at all times
Any CDC webinar course, which is offered four times per year
In-person training at CDC, which is offered four times per year
Access to Crisis and Emergency Risk Communication courses at the Preparedness and Emergency Response
Learning Centers

Representing and advising the Incident Commander on all public information matters relating to the
management of the incident, and monitoring and handling media and public inquiries
Managing day-to-day operations of the Joint Information Center
Coordinating with Public Information Officers from all participating government departments and organizations
to manage resources and avoid duplication of efforts

E1: Have essential services designation from telecom industry and utilities, including emergency service designation for the
designated inquiry line
E2: Have or have access to a dedicated phone line for inquiries from the media, stakeholders, and general public
E3: Have or have access to 24/7 alerting capacity (phone or alternate method). This includes maintenance, including but not
limited to licensing
E4: Have or have access to a redundant power supply to support 24/7 alerting and public messaging capacity
E5: Have or have access to walkie talkies (due to electromagnetic pulse risk from nuclear incidents), ham radios, or other
wireless devices

Function 2: Determine the need for a joint public information system
Determine the need for, and scale of, a joint public information system, including if appropriate, activation of a Joint Information
Center within the public health agency. Participate with other jurisdictional Joint Information Centers in order to combine
information sharing abilities and coordinate messages.

Tasks

This function consists of the ability to perform the following tasks:
Task 1: As applicable to the incident, establish a Virtual Joint Information Center, if establishment of a full-fledged Joint
Information Center is not optimal. (For additional or supporting detail, see Capability 3: Emergency Operations Coordination)
Task 2: Identify a health department representative to participate in the jurisdiction’s emergency operations center to ensure
public health messaging capacity is represented if a Joint Information Center (JIC) or Virtual Joint Information Center is
not applicable to the incident. (For additional or supporting detail, see Capability 3: Emergency Operations Coordination)
Task 3: Assign tasks to support staff (with staff redundancy to support extended operational periods) to support message
coordination and public information through three principal functions: Research, Media Operations, and Administration,54
as applicable to the incident.
U.S. Department of Health and Human Services
Centers for Disease Control and Prevention

Public Health Preparedness Capabilities:
National Standards for State and Local Planning

38

CAPABILITY 4: Emergency Public Information and Warning
Function 2: Determine the need for a joint public information system
Performance Measure(s)

At present there are no CDC-defined performance measures for this function.

Resource Elements

Note: Jurisdictions must have or have access to the resource elements designated as Priority.

PLANNING (P)

P1: Written plans should include a decision matrix for scalable joint information system operations; considerations include
the following:
–
–

Determine if the information needs of the incident will exceed the resources of the health department
If multiple organizations are responding to the incident, identify procedures as to how the health department
will participate in the jurisdiction’s Joint Information Center

P2: Written plans should include a process to establish a Virtual Joint Information Center, which consists of the connection of
public information agencies or personnel through telephone, internet, or other technical means of coordination without
working from a physical emergency operations center. (For additional or supporting detail, see Capability 3: Emergency
Operations Coordination)

EQUIPMENT AND TECHNOLOGY (E)

SKILLS AND TRAINING (S)

P3: Written plans should include a standard operating procedure for requesting additional alerting resources (e.g., personnel
and equipment) through the jurisdictional incident management system.
S1: Public health agency staff or volunteers from partner agencies, who will support the media, research, or administrative
support functions during an incident should have awareness-level training specific to media operations during an
incident (e.g., IS-702.a).

E1: (Priority) Minimum components of a Virtual Joint Information Center:

– Equipment to exchange information electronically within the jurisdiction and CDC, in real-time, if possible
– Shared site or mechanism or system to store electronic files of joint information center products, e-mail group
lists, incident information, and scheduling

Minimum components of a Virtual Joint Information Center for territory jurisdictions entail the following:
– Electronic access to both the CDC public website and the World Health Organization shared information site
E2: Recommended support materials for jurisdictions to send and receive information include internet access, contact
information for state and local officials and media, computers and printers, fax machines, phones and multiple phone
lines, clocks, cell phones, radio, television, video, and recording devices for both radio and television.
Recommended support materials for territory jurisdictions in order to send and receive information include internet
access, phones, and radio.

U.S. Department of Health and Human Services
Centers for Disease Control and Prevention

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National Standards for State and Local Planning

39

CAPABILITY 4: Emergency Public Information and Warning
Function 3: Establish and participate in information system operations
Monitor jurisdictional media, conduct press briefings, and provide rumor control for media outlets, utilizing a National Incident
Management System compliant framework for coordinating incident-related communications.

Tasks

This function consists of the ability to perform the following tasks:
Task 1: Develop, recommend, and execute approved55 public information plans and strategies on behalf of the Incident
Command or Unified Command structure. (For additional or supporting detail, see Capability 3: Emergency Operations
Coordination)
Task 2: Based on jurisdictional structure, provide a single release point of information for health and healthcare issues through a
pre-identified spokesperson in coordination with the JIC. (For additional or supporting detail , see Capability 6: Information
Sharing)
Task 3: Facilitate rumor control for media outlets for the jurisdiction such as television, internet, radio, and newspapers.

Performance Measure(s)

At present there are no CDC-defined performance measures for this function.

Resource Elements

EQUIPMENT AND TECHNOLOGY (E)

SKILLS AND TRAINING (S)

PLANNING (P)

Note: Jurisdictions must have or have access to the resource elements designated as Priority.
P1: Written plans should include a media contact list, accompanied by a procedure to keep the list up to date and accurate.56
P2: Written plans should include procedures to accomplish the following:
–
–
–
–

Track media contacts and public inquiries, listing contact, date, time, query, and outcome
Monitor media coverage to ensure information is accurately relayed
Correct misinformation before next news cycle
Coordinate interests and concerns from health-related media interests in the jurisdiction

S1: Public information staff should be trained in the following:
–
–

National Incident Management System (IS-701.a)
Emergency Management Institute G291- Joint Information System/Joint Information Center Planning
for Tribal, State and Local Public Information Officers

E1: Public Information Officers/spokespersons should have access to equipment to receive messaging from the jurisdictions’
public health alert system.

U.S. Department of Health and Human Services
Centers for Disease Control and Prevention

Public Health Preparedness Capabilities:
National Standards for State and Local Planning

40

CAPABILITY 4: Emergency Public Information and Warning
Function 4: Establish avenues for public interaction and information exchange
Provide methods for the public to contact the health department with questions and concerns through call centers, help desks,
hotlines, social media, web chat or other communication platforms.

Tasks

This function consists of the ability to perform the following tasks:
Task 1: Establish mechanisms (e.g., call center, poison control center, and non-emergency line such as 211 or 311) for public and
media inquiries that can be scalable to meet the needs of the incident.
Task 2: If health department websites exist, post incident-related information on health department website as a means of
informing and connecting with the public.
Task 3: Utilize social media (e.g., Twitter and Facebook) when and if possible for public health messaging.

Performance Measure(s)

At present there are no CDC-defined performance measures for this function.

Resource Elements

Note: Jurisdictions must have or have access to the resource elements designated as Priority.
P1: Written plans should include a procedure to activate designated inquiry line(s) if applicable to the jurisdiction.57 Possible
considerations include the following items:
–
–
–

Diversion of unnecessary calls away from the community 911 system
Diversion of non-critically ill patients away from the healthcare system
Updated public information regarding health department actions

PLANNING (P)

P2: Written plans should include procedures to identify community partners (e.g., public health, emergency management,
911 authority, Emergency Medical Services, healthcare agencies, community and faith-based partners, and poison
control centers) to create a Call Center “Concept of Operations.” Minimum components to be included in the “Concept of
Operations” are the following:
–
–
–
–
–
–
–

What set of circumstances causes the call center system to be activated
Who activates the call center system
Designation of call center leader
Process for call center system activation
Process for call center increased hours/staffing/de-escalation
Process for how the call center will interface with the jurisdiction’s incident management system/Joint
Information Center (JIC)
Call center scripts/staffing needs

P3: Written plans should include procedure to utilize CDC–INFO as a potential resource to increase response capacity for
public and healthcare provider inquiries in emergency and natural disaster incidents, if applicable to the jurisdiction.
(For additional or supporting detail, see Capability 6: Information Sharing)
P4: Written plans should include a protocol addressing the following items, if using social networking tools:
–
–
–
–
–
–

Linked websites
Promotion of participation in Twitter/Facebook
Evaluation of Twitter/Facebook participation
Collection of metrics or usage data
Responsibility for creating and clearing posts
Time frame or schedule for adding new tweets or posts

U.S. Department of Health and Human Services
Centers for Disease Control and Prevention

Public Health Preparedness Capabilities:
National Standards for State and Local Planning

41

CAPABILITY 4: Emergency Public Information and Warning
Function 4: Establish avenues for public interaction and information exchange
Resource Elements (continued)
Suggested resource
PLANNING (P)

– CDC’s guidance on using social media:

http://www.cdc.gov/SocialMedia/Tools/guidelines/pdf/microblogging.pdf

P5: Written plans should include guidelines for message development when utilizing social media:
–
–
–

Consideration of target audience
Ability of messages to stand alone
Action-oriented messages

EQUIPMENT AND TECHNOLOGY (E)

SKILLS AND TRAINING (S)

P6: Written plans should include scripts or message maps for call center staff.
S1: Public information staff should trained in use of social media and health communications.
S2: Public information staff should complete the following training: National Incident Management System Communications
and Information Management (IS-704)

E1: Have or have access to information technology or telephonic equipment to support the scalability of the inquiry line as
indicated by the incident. (A transferred call ties up a phone channel until the call is completed.)

Function 5: Issue public information, alerts, warnings, and notifications
Utilizing crisis and emergency risk communication principles, disseminate critical health and safety information to alert the media,
public, and other stakeholders to potential health risks and reduce the risk of exposure to ongoing and potential hazards.

Tasks

This function consists of the ability to perform the following tasks:
Task 1: Prior to the incident, comply with established jurisdictional legal guidelines to avoid communication of information that
is protected for national security or law enforcement reasons or that may infringe on individual and entity rights.
Task 2: Disseminate information to the public using pre-established message maps in languages and formats that take into
account jurisdiction demographics, at-risk populations, economic disadvantages, limited language proficiency, and
cultural or geographical isolation.
U.S. Department of Health and Human Services
Centers for Disease Control and Prevention

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National Standards for State and Local Planning

42

CAPABILITY 4: Emergency Public Information and Warning
Function 5: Issue public information, alerts, warnings, and notifications
Tasks (continued)
Task 3: Transmit health-related messaging information to responder organizations through secure58 messaging platforms. (For
additional or supporting detail, see Capability 6: Information Sharing)

Performance Measure(s)

This function is associated with the following CDC-defined performance measure:
Measure 1: Time to issue a risk communication message for dissemination to the public
––
––

Start time: Date and time that a designated official requested that the first risk communication message be
developed
Stop time: Date and time that a designated official approved the first risk communication message for
dissemination

Resource Elements

Note: Jurisdictions must have or have access to the resource elements designated as Priority.
P1: Written plans should include a clearance/approval process designating points of contact to address Information
verification and approval of documents.59
P2: Written plans should include a process and protocol to translate materials/resources for populations with limited
language proficiency.60
Suggested resources
–

PLANNING (P)

–
–

–
–
–

National Resource Center on Advancing Emergency Preparedness for Culturally Diverse Communities /
Translated Material:
http://www.diversitypreparedness.org/Resources/23/resourceTypeId__7782/
National Resource Center on Advancing Emergency Preparedness for Culturally Diverse Communities / National
Standard:
http://www.diversitypreparedness.org/Resources/Subtype/47/resourceTypeId__14784/subtypeId__16079/
National Resource Center on Advancing Emergency Preparedness for Culturally Diverse Communities / National
Consensus Statement and Guiding Principles on Emergency Preparedness and Cultural Diversity:
http://www.diversitypreparedness.org/Topic/Subtopic/Record-Detail/18/resourceTypeId__14784/
subtypeId__16946/resourceId__16947/
Cultural Competency Curriculum for Disaster Preparedness and Crisis Response:
http://www.thinkculturalhealth.hhs.gov
CDC/Association of State and Territorial Health Officials At-Risk Populations and Pandemic Influenza: Planning
Guidance for State, Territorial, Tribal, and Local Health Departments:
http://www.astho.org/Display/AssetDisplay.aspx?id=401
Preparedness Tools and Resources:
http://www.disability.gov/emergency_preparedness/preparedness_tools_%26_resources

P3: Written plans should include a process and protocol to create low literacy/easy to read printed materials.61
Suggested resources

– Centers for Disease Control and Prevention/Simply Put: A Guide for Creating Easy-To-Understand Materials:
–

http://www.cdc.gov/healthmarketing/pdf/Simply_Put_082010.pdf
National Cancer Institute/Clear and Simple: Developing Effective Print Materials for Low-Literate Readers:
http://www.cancer.gov/cancerinformation/clearandsimple

P4: Written plans should include a process and protocol to create materials for the visually or hearing impaired.

U.S. Department of Health and Human Services
Centers for Disease Control and Prevention

Public Health Preparedness Capabilities:
National Standards for State and Local Planning

43

CAPABILITY 4: Emergency Public Information and Warning
Function 5: Issue public information, alerts, warnings, and notifications
Resource Elements (continued)
Suggested resource
–

Public Health Workbook to Define, Locate and Reach Special, Vulnerable, and At-Risk Populations in an
Emergency: http://emergency.cdc.gov/workbook

P5: Written plans should include a process and protocol to reach rural/ isolated populations.
Suggested resource
PLANNING (P)

––

Public Health Workbook to Define, Locate and Reach Special, Vulnerable, and At-Risk Populations in an
Emergency: http://emergency.cdc.gov/workbook

P6: Written plans should include a process to provide information to help at-risk individuals understand personal
preparedness, be knowledgeable about available services, and understand where they can obtain services.62
(Considerations should include the use of multiple media, multilingual and alternative formats, and age-appropriateness
of information.)

SKILLS AND TRAINING (S)

P7: Written plans should include the identification of jurisdictional legal authorities to avoid communication of information
that is protected for national security or law enforcement reasons or that may infringe on individual and entity rights.
S1: Information technology skill set to support health alert system. (For additional or supporting detail, see Capability 6:
Information Sharing)
S2: Training health communication staff in health communication and cultural sensitivity
Suggested resource
––

Public Health Workbook to Define, Locate and Reach Special, Vulnerable, and At-Risk Populations in an
Emergency: http://emergency.cdc.gov/workbook

U.S. Department of Health and Human Services
Centers for Disease Control and Prevention

Public Health Preparedness Capabilities:
National Standards for State and Local Planning

44

CAPABILITY 5: Fatality Management
Fatality management is the ability to coordinate with other organizations (e.g., law
enforcement, healthcare, emergency management, and medical examiner/coroner)
to ensure the proper recovery, handling, identification, transportation, tracking,
storage, and disposal of human remains and personal effects; certify cause of death;
and facilitate access to mental/behavioral health services to the family members,
responders, and survivors of an incident.
This capability consists of the ability to perform the following functions:
Function 1:
Function 2:
Function 3:
Function 4:
Function 5:

Determine role for public health in fatality management
Activate public health fatality management operations
Assist in the collection and dissemination of antemortem data
Participate in survivor mental/behavioral health services
Participate in fatality processing and storage operations

Function 1: Determine role for public health in fatality management
Coordinate with the lead jurisdictional authority (e.g., coroner, medical examiner, sheriff, or other agent) to identify the roles and
responsibilities of jurisdictional public health entities in fatality management activities.

Tasks

This function consists of the ability to perform the following tasks:
Task 1: Prior to an incident, characterize potential fatalities based on jurisdictional risk assessment and the impact of these
potential fatalities on jurisdictional resource needs.
Task 2: Prior to an incident, coordinate with subject matter experts (e.g., those with expertise in epidemiology, laboratory,
surveillance; community cultural/religious beliefs or burial practices; chemical, biological, radiological and emergency
operations leads; and partners from hospital, mortuary, emergency medical services) to determine public health’s role in
an incident that may result in fatalities. (For additional or supporting detail , see Capability 10: Medical Surge)
Task 3: Prior to an incident, coordinate with jurisdictional, private and federal Emergency Support Function #6 and Emergency
Support Function #8 resources as necessary to determine their roles and requirements for the response. (For additional or
supporting detail, see Capability 10: Medical Surge)

Performance Measure(s)

At present there are no CDC-defined performance measures for this function.

Resource Elements

PLANNING (P)

Note: Jurisdictions must have or have access to the resource elements designated as Priority.
P1: (Priority) Written plans should include memoranda of agreement, memoranda of understanding, mutual aid agreements,
contracts, and/or letters of agreement with other agencies to support coordinated activities and with other jurisdictions
to share resources, facilities, services, and other potential support required during the management of fatalities. Requests
should be determined by the local authority and follow the jurisdictional escalation process (i.e., local to state to federal).
––
––
––

State and federal resources (to include Disaster Mortuary Operational Response Teams) are requested when
anticipated resource needs exceed the local capacity. County/jurisdictional plans should address mass fatality
planning and thresholds for requesting additional resources.
Federal resources should be engaged/notified through the U.S. Department of Health and Human Services (HHS)
Regional Emergency Coordinators
Resources available through mutual aid (e.g., Emergency Management Assistance Compact (EMAC), memoranda
of understanding, and/or memoranda of agreement) should be engaged/notified through appropriate channels
(EMAC Coordinator, emergency management)

U.S. Department of Health and Human Services
Centers for Disease Control and Prevention

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National Standards for State and Local Planning

45

CAPABILITY 5: Fatality Management
Function 1: Determine role for public health in fatality management
Resource Elements (continued)
Suggested resources
–– National Response Framework: http://www.fema.gov/emergency/nrf/
–– National Oil and Hazardous Substances Pollution Contingency Plan:
http://www.epa.gov/oem/content/lawsregs/ncpover.htm
P2: Written plans should include documentation that identifies how the jurisdictional public health agency has participated
in planning activities with the jurisdictional fatality management lead authority to identify agencies’ roles and
responsibilities relating to the following topics during an incident with fatalities:63
–
–
–
–
–
–
–

PLANNING (P)

–
–
–
–
–
–
–
–
–
–

Magnitude: the estimated number of decedents and body portions
Type of incident: natural, criminal, terrorist, or accidental
Manifest: closed population with an existing manifest available, closed population with no manifest available, or
open population
Condition of human remains: visually identifiable, whole bodies, fragmented bodies, comingled, decomposed,
charred, or mutilated
Rate of recovery: rapid, moderate, slow
Recovery complexity: highly complex requiring anthropological consult, shifting, extensive gridding, known or
unknown recovery area boundaries
Presence of contamination or transmissible infection: decedents contaminated with chemical, biological, or
radiological agents or materials
Disaster site location characteristics: fixed or distributive location; presence of building materials, water/tides,
fire/smoldering; need to conduct excavation or debris removal
Environmental conditions: weather conditions (e.g., heat, cold, humidity, or rain)
Institution of public health/law enforcement community constraints: limitations placed on public gatherings or
establishment of curfews
Inherent limitation of assets or technology: present or not
Requirement to establish formal Health and Safety Plans: required for all fixed and/or ad hoc facilities, and/or
tasks involving hazardous work (e.g., recovery operations)
Level of asset integration: requirement for a simple functional or highly matrixed response command structure
Event occurrence: single event at one location, single event at multiple locations, reoccurring event at multiple
locations
Medical Examiner/Coroner and local jurisdiction infrastructure: operational, partially operational, or nonoperational
Decedent identification complexity: antemortem data collection complications, postmortem data collection
complications, requirement to issue death certificates via judicial decree, difficulty communicating with next
of kin
Family management considerations: single or multiple family assistance centers required; establishment of
virtual FACs; need for establishing a long-term family management response64

Additional consideration should also be given to the following:
–

Whether people should call 911 to report a death or whether the jurisdiction wishes to establish a separate call
center to coordinate this activity
– Providing for mental/behavioral health services
– Coordination with hospitals and healthcare facilities
(For additional or supporting detail; see Capability 12: Public Health Laboratory Testing and Capability 13: Public Health
Surveillance and Epidemiological Investigation)
P3: Written plans should include processes and protocols specifying how the public health agency will coordinate with
medical/legal authority and subject matter experts (e.g., those with expertise in epidemiology, laboratory, surveillance;
community cultural/religious beliefs or burial practices; chemical, biological, radiological and emergency operations
leads; and partners from hospital, mortuary, emergency medical services65) to make a determination on the roles and
responsibilities of public health entities in the response.66

U.S. Department of Health and Human Services
Centers for Disease Control and Prevention

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CAPABILITY 5: Fatality Management
Function 1: Determine role for public health in fatality management
Resource Elements (continued)
P4: Written plans should include processes and protocols for jurisdictional all-hazards fatality management including
addressing public health roles in fatality management.67,68,69 The plan should address the following items:
–
–
–
–
–
–
–

Coordination of facilities (e.g., morgue locations, portable and temporary morgues, decontamination, decedent
storage, hospitals, and healthcare facilities)
Coordination of family relations (e.g., notification, grief services, antemortem information, and call centers)
Procedures to acquire death certificates or permits (including sending human remains to international
destinations)
Regulations for crematoriums and other support groups
Antemortem data management (e.g., establish record repository, identify repository physical location, enter
interview data into library, and balance victim needs with those who have lost family members)
Personnel needs (e.g., medical and mental/behavioral, including psychological first aid)
Frequency that critical documentation is reviewed and updated (e.g., comprehensive fatality management
mission critical list, and contingency plans with local, state, and private entities regarding final disposition of
human remains)

PLANNING (P)

Suggested resources
–
–
–
–
–
–
–
–
–

–

SKILLS AND TRAINING (S)

–

Jurisdiction’s current fatality management plan
NACCHO: Managing Mass Fatalities: A Toolkit for Planning:
http://www.naccho.org/toolbox/tool.cfm?id=1595%20
National Mass Fatalities Institute: Mass Fatalities Institute Planners Course
Mass fatalities courses offered by the state and local agencies
Radiation Emergency Medical Management: Management of the Deceased:
http://www.remm.nlm.gov/deceased.htm
Pan American Health Organization: Management of Dead Bodies in Disaster Situations:
http://www.paho.org/English/DD/PED/ManejoCadaveres.htm
Pan American Health Organization: Management of Dead Bodies After Disasters – A Field Manual for First
Responders: http://www.paho.org/English/DD/PED/DeadBodiesFieldManual.htm
Department of Justice: Mass Fatality Incidents: A Guide for Human Forensic Identification:
http://www.ojp.usdoj.gov/nij/pubs-sum/199758.htm
Morgan OW, Sribanditmongkol P, Perera C,, Sulasmi Y, Van Alphen D, et al. (2006) Mass Fatality Management
Following the South Asian Tsunami Disaster: Case studies in Thailand, Indonesia, and Sri Lanka. PLoS Med 3(6):
e195. DOI: 10.1371/journal.pmed.0030195:
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1472696/pdf/pmed.0030195.pdf
U.S. Army Soldier and Biological Chemical Command (SBCCOM): Guidelines for Mass Fatality Management
During Terrorist Incidents Involving Chemical Agents:
http://www.ecbc.army.mil/downloads/cwirp/ECBC_guidelines_mass_fatality_mgmt.pdf
Disaster Mortuary Operational Response Team:
http://www.dmort.org/FilesforDownload/MassFatalityResources2007.pdf

S1: Public Health staff participating in fatality management activities should be trained on the jurisdiction’s fatality
management plans and procedures and understand their role(s), if any, during a public health response that includes
fatalities.
Recommended trainings include the following:
–
––
–
–

Federal Emergency Management Agency (FEMA) Mass Fatalities Incident Response (G-386) – Emergency
Management Institute – current version available but under review
FEMA Emergency Support Function #8 – Public Health and Medical Services (IS-808)
Mass fatalities courses offered by the jurisdiction
National Mass Fatalities Institute:
□□ Family Assistance and Behavioral Health Course, Responding to Active Shooter Incidents-Fatality
Management (MFI 100,200,300 and 400)

U.S. Department of Health and Human Services
Centers for Disease Control and Prevention

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National Standards for State and Local Planning

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CAPABILITY 5: Fatality Management
Function 1: Determine role for public health in fatality management
Resource Elements (continued)

EQUIPMENT AND TECHNOLOGY (E)

SKILLS AND TRAINING (S)

–

Suggested training primarily for medical examiners, coroners and morticians:
□□ Radiological Terrorism: A Tool Kit for Public Health Officials:
http://emergency.cdc.gov/radiation/publichealthtoolkit.asp
o Guidelines for Handling Decedents Contaminated with Radioactive Materials (document and
video): http://emergency.cdc.gov/radiation/pdf/radiation-decedent-guidelines.pdf
o Satellite Broadcast: Preparing for Radiological Population Monitoring & Decontamination:
http://www.phppo.cdc.gov/PHTN/Radiological2006/default.asp
□□ The Medical Examiner and Coroner’s Guide for Contaminated Deceased Body Management:
http://thename.org/index.php?option=com_docman&task=doc_download&gid=13&Itemid=26

E1: Have or have access to personal protective equipment to support designated public health roles (e.g., blood-borne
pathogen protection, laboratory safety equipment). Suggested personal protective equipment can include the following
items:
– Protective clothing (e.g., suit, coveralls, hoods, gloves, and boots)
– Respiratory equipment
– Air purifying respirators (e.g., N95)
– Cooling system (e.g., ice vest, air circulation, and water circulation)
– Head protection
– Eye protection
– Ear protection
– Inner garment
– Outer protection (e.g., over gloves, over boots, and flash cover)
(For additional or supporting detail, see Capability 14: Responder Safety and Health)

Function 2: Activate public health fatality management operations
Facilitate access to resources (e.g., human, record keeping, and physical space) to address the fatalities from an incident in
accordance with public health jurisdictional standards and practices and as requested by lead jurisdictional authority.

Tasks

This function consists of the ability to perform the following tasks:
Task 1: Assess data from the incident to inform and guide the public health resources needed for the response.
Task 2: Identify and coordinate with jurisdictional, regional, private, and federal Emergency Support Function #8 resources
with expertise in the potential cause(s) of fatalities to make recommendations regarding all phases of human remains
disposition: recovery, processing (e.g., decontamination, infection control, and other mitigation measures), storing, and
disposing.
Task 3: Coordinate with partners to initiate pre-determined (e.g., local, regional, state, federal, and private sector) processes for all
phases of human remains disposition.
Task 4: Coordinate incident details among members of the public health and medical health systems by sharing information
between programs and linking information databases, based on the scope of the incident. (For additional or supporting
detail, see Capability 6: Information Sharing)

Performance Measure(s)

At present there are no CDC-defined performance measures for this function.
U.S. Department of Health and Human Services
Centers for Disease Control and Prevention

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CAPABILITY 5: Fatality Management
Function 2: Activate public health fatality management operations
Resource Elements

Note: Jurisdictions must have or have access to the resource elements designated as Priority.

SKILLS AND TRAINING (S)

PLANNING (P)

P1: Written plans should include a list of potential fatality management advisory roles that public health may need to fill to
support a response per the jurisdiction’s plan.70 Consideration should be given to the inclusion of these elements:
– Search and recovery of human remains
– Removal, transfer/transportation, storage, and temporary burial of human remains
– Identification and re-burial of human remains where grave sites have been disrupted by the incident
– Assessment of morgue/examination center capacities
– Morgue/examination site staff
– Disposal of human remains
– Mental/behavioral health services
– Public affairs/communications
(For additional or supporting detail, see Capability 4: Emergency Public Information and Warning and Capability 15: Volunteer
Management)
S1: Public health staff participating in fatality management operations should be trained on plans and procedures (i.e.,
standard operating procedures) and the jurisdictional fatality management plan and understand their role(s), if any,
during a public health response with fatalities.

EQUIPMENT AND TECHNOLOGY (E)

E1: Have or have access to material required to manage fatality operations as required by the incident:
–
–
–
–
–
–
–
–
–
–
–

–
–
–
–

Protective clothing (e.g., gloves, boots, coats, hard hats, rain suits, respirators)
Body bags (appropriate number and type)
Refrigerated storage
Tents
Storage for equipment/supplies and bodies
Paint for numbering
Flags for marking locations
Plastic toe tags
Biohazard bags and boxes
Photography equipment
Gridding, laser survey, and global positioning systems
Communication devices: radio and cell phones
Equipment for scene documentation
Decontamination unit
Radiation survey equipment

E2: Have or have access to systems to record and track fatalities under the leadership of the coroner/medical examiner.
–

–

Database for the centralization of information. Consideration should be given to the inclusion of these elements:
□□ A centralized information clearinghouse for reporting deaths
□□ A centralized information clearinghouse for collating data. Either a software program or a series of preprinted forms should be designed to accurately track refrigerated storage, funeral home capacity, and
the whereabouts and status of the deceased
Death reporting system that can demonstrate cross-agency collaboration and information sharing of mortality
data (e.g., transmit death certificate data including cause of death data to appropriate federal agencies)

U.S. Department of Health and Human Services
Centers for Disease Control and Prevention

Public Health Preparedness Capabilities:
National Standards for State and Local Planning

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CAPABILITY 5: Fatality Management
Function 2: Activate public health fatality management operations
Resource Elements (continued)
EQUIPMENT AND TECHNOLOGY (E)

–

–
–

Tracking system for recovery activities. Consideration for the data gathering system should be given to the
inclusion of these elements:
□□ Where human remains are found
□□ How fragmented portions are tracked
□□ How case numbers are correlated
□□ How antemortem data (obtained from family members) can be cross-referenced with other case
numbers assigned to recovered human remains
□□ How to distinguish disaster cases from other caseloads
System should enable the cross-leveling of data between several operational areas, such as the morgue, the
family assistance centers, and the incident site, or any location where case data is entered
System should have redundant backup capabilities to ensure that information is not lost due to unexpected
system failure or other type of event/incident

Function 3: Assist in the collection and dissemination of antemortem data
Assist, if requested, the lead jurisdictional authority and jurisdictional and regional partners to gather and disseminate
antemortem data71 through a Family Assistance Center Model72 or other mechanism.

Tasks

This function consists of the ability to perform the following tasks:
Task 1: Coordinate with partners for the establishment of a mechanism (e.g., Family Assistance Center) to collect antemortem
data.
Task 2: Coordinate with partners to identify and assemble the resources required to collect and communicate antemortem data.
Task 3: Coordinate with partners and assist, if needed, in the collection and dissemination of antemortem data to families of the
deceased and law enforcement officials. (For additional or supporting detail, see Capability 6: Information Sharing)
Task 4: Coordinate with partners to support electronic recording and reporting of antemortem data through electronic systems
and/or other information sharing platforms. (For additional or supporting detail , see Capability 6: Information Sharing)

Performance Measure(s)

At present there are no CDC-defined performance measures for this function.

Resource Elements

Note: Jurisdictions must have or have access to the resource elements designated as Priority.

PLANNING (P)

P1: (Priority) Written plans should include a procedure for the collection of antemortem data. Consideration should be given
to the inclusion of these elements:
–

–

Data collection/dissemination methods
□□ Call Center or 1-800 number
□□ Family Reception Center
□□ Family Assistance Center
Staff who can perform the following functions:
□□ Administrative activities
□□ Interviews of families in order to acquire antemortem data
□□ System data entry of antemortem data

U.S. Department of Health and Human Services
Centers for Disease Control and Prevention

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National Standards for State and Local Planning

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CAPABILITY 5: Fatality Management
Function 3: Assist in the collection and dissemination of antemortem data

PLANNING (P)

Resource Elements (continued)
P2: Written plans should include family notification procedures and protocols in the event that public health has a lead role
in the incident. Consideration should be given to the inclusion of the following elements:
–
–
–
–

EQUIPMENT AND TECHNOLOGY (E)

SKILLS AND TRAINING (S)

–

Where the notification occurs
Which family members are notified and how they are contacted
Assurance that the spokesperson is releasing accurate information that was officially issued by the coroner’s/
medical examiner’s office
Informing families about identification methods being used for the incident including what they involve and
their reliability (e.g., fingerprints and DNA)
Handling and release of decedent’s personal effects

S1: Public health staff participating in fatality management activities should be trained on plans and procedures and
jurisdictional fatality management plans and understand their role(s), if any, during a public health response with
fatalities.
Recommended trainings include the following:
–
–
–

Providing Relief to Families after a Mass Fatality: Roles of the Medical Examiner’s Office and the Family Assistance
Center, Department of Justice’s Office of Justice Programs, the Office for Victims of Crime:
http://www.ojp.usdoj.gov/ovc
Creating and Operating A Family Assistance Center: A Toolkit for Public Health:
http://www.apctoolkits.com/family-assistance-center/
National Transportation Safety Board Training Center: http://www.ntsb.gov/tc/sched_courses.htm
□□ Family Assistance (TDA301)
□□ Advanced Skills in Disaster Family Assistance (TDA405)
□□ Mass Fatality Incidents for Medicolegal Professionals (TDA403)

E1: Have or have access to a central repository/database for the collection, recording, and storage of antemortem and
postmortem data.

Function 4: Participate in survivor mental/behavioral health services
Coordinate with the lead jurisdictional authority and jurisdictional and regional partners to support the provision of non-intrusive,
culturally sensitive mental/behavioral health support services to family members of the deceased, incident survivors, and
responders, if requested.

U.S. Department of Health and Human Services
Centers for Disease Control and Prevention

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National Standards for State and Local Planning

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CAPABILITY 5: Fatality Management
Function 4: Participate in survivor mental/behavioral health services
Tasks

This function consists of the ability to perform the following tasks:
Task 1: Coordinate with partners to assemble the required staff and resources to provide non-intrusive mental/behavioral health
services to responders.
Task 2: Coordinate with partners to facilitate availability of culturally appropriate assistance (e.g., addressing language barriers
and religious or cultural practices).
Task 3: Coordinate with Emergency Support Function 8 partners to support the provision of mental/behavioral health services to
family members of the deceased and incident survivors as needed.

Performance Measure(s)

At present there are no CDC-defined performance measures for this function.

Resource Elements

Note: Jurisdictions must have or have access to the resource elements designated as Priority.
P1: (Priority) Written plans should include processes and protocols developed in conjunction with jurisdictional mental/
behavioral health partners to identify services to provide to survivors after an incident involving fatalities. Written
plans should include a contact list of pre-identified resources that could provide mental/behavioral health support to
responders and families according to the incident.73,74 Consideration should be given to the inclusion of the following
elements:

SKILLS AND TRAINING (S)

PLANNING (P)

–
–
–
–
–

Mental/behavioral health professionals
Spiritual care providers
Hospices
Translators
Embassy and Consulate representatives when international victims are involved

P2: (Priority) Written plans should include list of staff selected in advance of an incident that could potentially fill the fatality
management roles adequate to a given response.75
P3: Written plans should include processes and protocols to identify services to provide to responders and family members
of the deceased after an incident involving fatalities. Consideration should be given to the inclusion of the following
elements:
–– Determining who and what agencies/businesses (among the local county/jurisdiction) may be available to assist
with the organization and operation of services following an incident resulting in fatalities
□□ Providing medical and mental/behavioral assistance to responders
□□ Providing medical and mental/behavioral assistance to families
–– Determining what cultural, religious and family practices are prominent (among the local jurisdiction) and may
require additional consideration/accommodation when managing fatalities
S1: Public health staff participating in fatality management should be trained on jurisdictional fatality management plans
and procedures, and understand their role(s), if any, during a public health response that includes fatalities.
Recommended trainings include the following:
–
–
–

Trauma, Death, and Death Notification: A Seminar for Professional Counselors and Victim Advocates (1996):
http://www.ojp.usdoj.gov/ovc/publications/infores/death.htm
Providing Relief to Families After a Mass Fatality: Roles of the Medical Examiner’s Office and the Family Assistance
Center, Department of Justice’s Office of Justice Programs, the Office for Victims of Crime:
http://www.ojp.usdoj.gov/ovc
Light Our Way: A Guide for Spiritual Care in Times of Disaster for Disaster Response Volunteers, First Responders
and Disaster Planners, Emotional and Spiritual Care Committee and the Light Our Way Task Force of National
Voluntary Organizations Active in Disaster: http://www.ldr.org/care/Light_Our_Way.pdf

U.S. Department of Health and Human Services
Centers for Disease Control and Prevention

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CAPABILITY 5: Fatality Management
Function 5: Participate in fatality processing and storage operations
Assist the lead jurisdictional authority and partners in ensuring that human remains and associated personal effects are safely
recovered, processed, transported, tracked, stored, and disposed of or released to authorized person(s), if requested.

Tasks

This function consists of the ability to perform the following tasks:
Task 1: Make recommendations to incident management/jurisdictional lead agency on procedures for the safe recovery, receipt,
identification, decontamination, transportation, storage, and disposal of human remains. Recommendations can also
include an assessment of the need for temporary burial, procurement of public property for temporary burial, and
security/privacy requirements of the processing facility.
Task 2: Assist, if needed or requested, in multi-specialty forensic analysis to identify human remains and determine the cause and
manner of death. (For additional or supporting detail, see Capability 12: Public Health Laboratory Testing, and Capability 13:
Public Health Surveillance and Epidemiological Investigation)
Task 3: Coordinate with partners to support electronic death reporting. (For additional or supporting detail, see Capability 6:
Information Sharing)
Task 4: Coordinate with partners to facilitate the collection and reporting of mortality information (e.g., vital records). (For
additional or supporting detail, see Capability 6: Information Sharing)

Performance Measure(s)

At present there are no CDC-defined performance measures for this function.

Resource Elements

Note: Jurisdictions must have or have access to the resource elements designated as Priority.
P1: (Priority) Written plans should include protocols that ensure that the health department, through healthcare coalitions
or other mechanisms, supports the coordination of healthcare organization fatality management plans with the
jurisdictional fatality management plan.
Suggested resources
–

PLANNING (P)

–

FY10 Hospital Preparedness Funding Opportunity Announcement, Section 1.5.6 Fatality Management:
http://www.phe.gov/Preparedness/planning/hpp/Documents/fy10_hpp_guidance.pdf
Joint Commission Emergency Management Standard EM.02.02.11.7

P2: Written plans should include a protocol for identifying required data elements for electronic death reporting according to
requirements of state death certificates and coroner/medical examiner. Consideration should be given to the following
elements:
– Incident details (e.g., date, time, location, and situation)
– Victim identification (e.g., name, date of birth, gender, ethnicity, height, weight, address, and medical history)
– Social security number verification
– Other people involved (e.g., names of family members and friends)
– Location/types of injuries
– Cause of death (e.g., presumed/actual or underlying)
– Death details (e.g., date, time, location, and manner)
– Human remains processing details
– Human remains storage location
– Health provider/responder details
– Survivor interview details
– Human remains disposal procedures
(For additional or supporting detail, see Capability 6: Information Sharing)

U.S. Department of Health and Human Services
Centers for Disease Control and Prevention

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National Standards for State and Local Planning

53

CAPABILITY 5: Fatality Management
Function 5: Participate in fatality processing and storage operations

EQUIPMENT AND TECHNOLOGY (E)

SKILLS AND TRAINING (S)

Resource Elements (continued)
S1: Public health staff participating in fatality management should be trained on fatality management plans and procedures
(e.g., Standard Operating Procedures), and understand their role(s), if any, during a public health response that includes
fatalities.
Recommended trainings (primarily for medical examiners and morticians) include the following:
–

–

Radiological Terrorism: A Tool Kit for Public Health Officials:
http://emergency.cdc.gov/radiation/publichealthtoolkit.asp
□□ Guidelines for Handling Decedents Contaminated with Radioactive Materials (document and video)
□□ Satellite Broadcast: Preparing for Radiological Population Monitoring and Decontamination
The Medical Examiner and Coroner’s Guide for Contaminated Deceased Body Management:
http://thename.org/index.php?option=com_docman&task=doc_download&gid=13&Itemid=26

E1: Have or have access to material and equipment required to process, store, and/or dispose of human remains.
Consideration should be given to the following equipment:
–
–
–
–
–
–
–
–
–
–
–

Portable x-ray unit
Morgue equipment
Medical instruments for autopsies
Radiation survey equipment
Portable autoclave
Gloves, gowns, personal protective equipment
Digital cameras
Specimen containers and preservatives
Refrigerated storage
Computers/printers
Death certificates

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Centers for Disease Control and Prevention

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CAPABILITY 6: Information Sharing
Information sharing is the ability to conduct multijurisdictional, multidisciplinary
exchange of health-related information and situational awareness data among
federal, state, local, territorial, and tribal levels of government, and the private sector.
This capability includes the routine sharing of information as well as issuing of public
health alerts76 to federal, state, local, territorial, and tribal levels of government and
the private sector in preparation for, and in response to, events77 or incidents78 of
public health significance.79
This capability consists of the ability to perform the following functions:
Function 1: Identify stakeholders to be incorporated into information flow
Function 2: Identify and develop rules and data elements for sharing
Function 3: Exchange information to determine a common operating picture

Function 1: Identify stakeholders to be incorporated into information flow
Identify stakeholders within the jurisdiction across public health, medical, law enforcement, and other disciplines that should
be included in information exchange, and identify inter-jurisdictional public health stakeholders that should be included in
information exchange. Determine the levels of security clearance needed for information access across and between these
stakeholders.

Tasks

This function consists of the ability to perform the following tasks:
Task 1: Prior to and as necessary during an incident, identify intra-jurisdictional stakeholders across public health, public safety,
private sector, law enforcement, and other disciplines to determine information-sharing needs.
Task 2: Prior to and as necessary during an incident, identify inter-jurisdictional public health stakeholders to determine
information sharing needs.
Task 3: Prior to and as necessary during an incident, work with elected officials, identified stakeholders (both inter- and intrajurisdictional) and private sector leadership to promote and ensure continual connection (e.g., ongoing standing
meetings, webinars, and teleconferences) and use continuous quality improvement process to define and redefine
information-sharing needs.

Performance Measure(s)

At present there are no CDC-defined performance measures for this function.

Resource Elements

Note: Jurisdictions must have or have access to the resource elements designated as Priority.

PLANNING (P)

P1: (Priority) Written plans should include processes to engage stakeholders that may include the following: 80,81
–
–
–
–
–
–

–

Law enforcement
Fire
Emergency Medical Services
Private healthcare organizations (e.g., hospitals, clinics, large corporate medical provider organizations and
urgent care centers)
Fusion centers
For states: local health departments, tribes and territories
Individuals who have or may need a security clearance, based on functional role

Suggested resources
– FBI-CDC Criminal and Epidemiological Investigation Handbook:
http://www2a.cdc.gov/phlp/docs/crimepihandbook2006.pdf
U.S. Department of Health and Human Services
Centers for Disease Control and Prevention

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CAPABILITY 6: Information Sharing
Function 1: Identify stakeholders to be incorporated into information flow
Resource Elements (continued)
– Joint Public Health Law Enforcement Investigations: Model Memorandum of Understanding, created by Public

PLANNING (P)

Health and Law Enforcement Emergency Preparedness Workgroup, CDC and Bureau of Justice Assistance:
http://www.nasemso.org/Projects/DomesticPreparedness/documents/JIMOUFinal.pdf

P2: (Priority) Written plans should include a role-based public health directory that will be used for public health alert
messaging. The directory profile of each user includes the following elements:82
–
–
–

Assigned roles
Multiple device contact information
Organizational affiliation

Suggested resource
––

CDC’s Public Health Information Network: www.cdc.gov/phin

EQUIPMENT AND TECHNOLOGY (E)

P3: Written plans should include processes for stakeholder communication, including frequency of standing meetings and
method for requesting additional meetings.
E1: Have or have access to a database of public health department contact information updated quarterly.83 The database
may be paper-based or electronic.
E2: Have or have access to equipment that may be needed to access information when clearances are required.

Function 2: Identify and develop rules and data elements for sharing
Define minimum requirements for information sharing for the purpose of developing and maintaining situational awareness.
Minimum requirements include the following elements:
• When data should be shared
• Who is authorized to receive data
• Who is authorized to share data
• What types of data can be shared
• Data use and re-release parameters
• What data protections are sufficient
• Legal, statutory, privacy, and intellectual property considerations

U.S. Department of Health and Human Services
Centers for Disease Control and Prevention

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National Standards for State and Local Planning

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CAPABILITY 6: Information Sharing
Function 2: Identify and develop rules and data elements for sharing
Tasks

This function consists of the ability to perform the following tasks:
Task 1: Prior to and as necessary during an incident, identify, through public health agency legal counsel (and counsel to other
agencies and jurisdictions as appropriate), current jurisdictional and federal regulatory, statutory, privacy-related and
other provisions, laws, and policies that authorize and limit sharing of information relevant to emergency situational
awareness. Such laws and policies may include Health Insurance Portability and Accountability Act (HIPAA), Office of
the National Coordinator Health IT Information Technology Policy, HHS Information Management Policy, and specific
requirements of current memoranda of understanding and memoranda of agreements; these laws may address privacy,
civil liberties, intellectual property, and other substantive issues.
Task 2: Prior to and as necessary during an incident, identify routine or incident-specific data requirements for each stakeholder.
Task 3: Prior to and as necessary during an incident, identify public health events and incidents that, when observed, will
necessitate information exchange. (For additional or supporting detail, see Capability 3: Emergency Operations Coordination)
Task 4: Prior to, during, and after an incident, utilize continuous quality improvement or have a processes and a corrective action
system to identify and correct unintended legal and policy barriers to sharing of situational awareness information that
are within the jurisdictional public health agency’s control (e.g., legal and policy barriers, opportunities to shorten the
amount of time to share data).

Performance Measure(s)

At present there are no CDC-defined performance measures for this function.

Resource Elements

Note: Jurisdictions must have or have access to the resource elements designated as Priority.
P1: (Priority) Written plans should include a listing of data-exchange requirements for each stakeholder (including the use
of common terminology, definitions, and lexicon by all stakeholders) that adhere to available national standards for data
elements to be sent and data elements to be received.
P2: (Priority) Written plans should include health information exchange protocols for each stakeholder that identify
determinants for exchange and which may include the following elements:

PLANNING (P)

–
–
–
–
–
–
–
–
–
–

Unusual cluster(s) or illness that threaten closure of institutional settings (e.g., illness among healthcare workers
or prisoners)
High burden of illness or a cluster of illness confined to a specific population (e.g., racial or ethnic group, or
vulnerable populations)
Illness burden that is expected to overwhelm local medical or public health resources
A public health laboratory finding of interest (e.g., a novel virus identified by lab) that is not picked up clinically
or through other surveillance
Large numbers of patients with similar and unusual symptoms
Large number of unexplained deaths
Higher than expected morbidity and mortality associated with common symptoms and/or failure of patients to
respond to traditional therapy
Simultaneous clusters of similar illness in noncontiguous areas
Received threats or intelligence
Incidents in other jurisdictions that raise possible risk in home jurisdiction (e.g., elevation of pandemic influenza
alert level)

P3: Written plans should include communications processes and protocols to communicate with identified stakeholders
(e.g., intra-jurisdictional public health, inter-jurisdictional public health, medical, mental/behavioral health, and law
enforcement).

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CAPABILITY 6: Information Sharing
Function 2: Identify and develop rules and data elements for sharing
Resource Elements (continued)

PLANNING (P)

P4: Written plans should include memoranda of understanding or letters of agreement with agencies and stakeholders for
participation and information sharing.
P5: Written plans should include processes to ensure that the jurisdiction adheres to applicable state and federal
constitutional and statutory privacy and civil liberties provisions (e.g., Information Control or Collection Plan).
P6: Written plans should include processes and procedures for exchanging information when security clearances apply (e.g.,
when sharing information with the Federal Bureau of Investigation or state bureau of investigation).
P7: Written plans should include documentation where and if state laws and regulations prohibit sharing of information to
the federal level and inter-jurisdictionally.

EQUIPMENT AND TECHNOLOGY (E)

SKILLS AND TRAINING (S)

P8: Written plans should include processes and frequency for data exchange in both routine and incident-specific settings,
including requirements for data exchange with CDC at a frequency as determined by the type of incident and phase of
the incident, as well as jurisdictional standards.
S1: All public health personnel should receive awareness-level training in the pertinent laws and policies regarding
information sharing and in procedures to assure adherence to them (e.g., transport of data and use of personal
identifiable information).

E1: Information systems should follow industry or national system-independent data standards as identified by CDC
E2: Written conversions to convert non-standard formats or terminologies into federally accepted standards for
communication
Suggested resource
– CDC’s Public Health Information Network: www.cdc.gov/phin

Function 3: Exchange information to determine a common operating picture
Share information (both send and receive) within the public health agency, with other identified intra-jurisdictional stakeholders,
and with identified inter-jurisdictional stakeholders, following available national standards84 for data vocabulary, storage,
transport, security, and accessibility.

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CAPABILITY 6: Information Sharing
Function 3: Exchange information to determine a common operating picture
Tasks

This function consists of the ability to perform the following tasks:
Task 1: Prior to and during an incident, collaborate with and participate in jurisdictional health information exchange (e.g., fusion
centers, health alert system, or equivalent). (For additional or supporting detail, see Capability 3: Emergency Operations
Coordination)
Task 2: Prior to and during an incident, maintain data repositories that are able to support data exchange with other regional and
federal public health entities. Store data according to jurisdictional and/or federal standards for formatting, vocabulary,
and encryption. (State and local jurisdictions)
Task 3: Prior to and during an incident, request, send, and receive data and information using encryption that meets
jurisdictional and/or federal standards. (State and local jurisdictions)
Task 4: Verify authenticity with message sender or information requestor.
Task 5: Prior to and during an incident, if necessitated by the situation, acknowledge receipt of information or public health alert.

Performance Measure(s)

At present there are no CDC-defined performance measures for this function.

Resource Elements

Note: Jurisdictions must have or have access to the resource elements designated as Priority.
P1: (Priority) Written plans should include a protocol for the development of public health alert messages that include the
following elements: 85

PLANNING (P)

–
–
–
–
–

Time sensitivity of the information
Relevance to public health
Target audience
Security level or sensitivity
The need for action may include
□□ Awareness
□□ Request a response back
□□ Request that specific actions be taken

P2: Written plans should include a process for information system development and maintenance86 that take into account
the following elements:
––
––
––
––
––

–

Controls and safeguards for data access levels
Data structure definitions and specification of databases (structured/unstructured data). Structured healthcare
data should utilize the latest applicable federal standards.
Ownership of the data
Data quality and data reliability
Security and privacy of patient health information as applicable
□□ Consent, security, and privacy procedures
□□ Access permissions, including data release and reuse agreements
□□ Additional protections against data theft such as encryption, data loss, and back-up storage
Authentication service to authenticate requestors and data submissions from various locations

P3: Written plans for jurisdictions considering participation in an information exchange process such as a fusion center
should address the following elements:
–
–

Clearly defined intelligence requirements that prioritize and guide planning, collection, analysis, and
dissemination efforts
Clear delineation of roles, responsibilities, and requirements of each level and sector of government involved in
the fusion process

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CAPABILITY 6: Information Sharing
Function 3: Exchange information to determine a common operating picture
Resource Elements (continued)
Suggested resources
–
–
–

Health Security Intelligence Enterprise Strategy: https://cs.hsin.gov/HPH/default.aspx
Public Health and Medical Integration for Fusion Centers: An Appendix to the Baseline Capabilities for State and
Major Urban Area Fusion Centers: http://it.ojp.gov/documents/baselinecapabilitiesa.pdf
Integrating Health Security Capabilities into Fusion Centers: https://cs.hsin.gov/HPH/default.aspx

P4: Written plans should include processes that indicate how healthcare providers in the jurisdiction shall be able to
exchange information with electronic public health case-reporting systems, syndromic surveillance systems, or
immunization registries according to the Centers for Medicare and Medicaid Services (CMS) Electronic Health Record
Incentive Program rules and any additional applicable federal standards.87 This electronic sharing includes but is not
limited to the following elements:
–
–
–

Electronic sharing of laboratory test results
Immunization registries
Syndromic surveillance data

Suggested resources
The Office of the National Coordinator for Health Information Technology:
http://healthit.hhs.gov/portal/server.pt?open=512&mode=2&objID=3006&PageID=20401
– CDC’s Public Health Information Network: www.cdc.gov/phin
P5: Written plans should include a process for verifying that received messages are from a trusted source.
PLANNING (P)

–

P6: Written plans should include a process to acknowledge receipt of information and to be able to accept
acknowledgement from stakeholders.
P7: Written plans should include a procedure in place that ensures that public health alert messages are received by multiple
people, at least one of whom has responsibility to process the message 24/7/365.
P8: Written plans should include a public health alerting message template that includes the following elements:88
–
–
–
–
–
–
–
–
–

Subject or title
Description
Background
Request or recommendations (action requested)
Who to contact
Where to go for more information
Who it went to (e.g., specific roles)
Different templates for every level of alert with different criteria for each
Distribution method

P9: Written plans should include a template for Information Sharing Access Agreements via a memorandum of
understanding, memorandum of agreement, or other letter of agreement with data-sharing partners, which should
consider the following:
–
–

Breach notification procedures, particularly if data is not stored in an encrypted state
Maintenance of Health Insurance Portability and Accountability (HIPAA) Security Rule compliance, when
potential Personally Identifiable Information must be shared

P10: Written plans should include a process for standardized electronic data exchange with partners according to information
exchange standards established by Public Health Information Network.
Suggested resource
–

CDC’s Public Health Information Network: www.cdc.gov/phin

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CAPABILITY 6: Information Sharing
Function 3: Exchange information to determine a common operating picture

SKILLS AND TRAINING (S)

Resource Elements (continued)
S1: Identify staff that meets jurisdictionally defined competencies for a Public Health Informatician as defined in
Competencies for Public Health Informaticians -200989 (or updated versions of this document) to participate in health
information exchange.90

E1: Have or have access to electronic systems capable of handling routine day-to-day information data transmission as
well as emergency notification and situational awareness. When conveying personal health information or syndromic
surveillance information the system should meet the following standards:91

EQUIPMENT AND TECHNOLOGY (E)

–

Federal standards and specifications, (e.g., messaging guides) when applicable92
(For additional or supporting detail, see Capability 13: Public Health Surveillance and Epidemiological Investigation)
– Applicable patient privacy-related laws and standards, including state or territorial laws, and Health Insurance
Portability and Accountability, Health Information Technology for Economic and Clinical Health, National
Institute of Standards and Technology, and the Office of the National Coordinator standards such as:
□□ Data must be encrypted during transit according to jurisdictional and, if available, national standards93,94
□□ Data protections based on the types of data shared such as:
o All data exchanges should abide by the National Institute of Standards and Technology/Federal
Information Security Management Act requirements for the integrity, confidentially and
availability appropriate for the data sensitivity level (e.g., low, medium,
and high).
o All communication containing health data (personally identifiable information and nonpersonally identifiable information) should take place over transport layer security/secure
socket layers using authentication appropriate for the data sensitivity level (e.g., userid/
password, and secureID)
o For more sensitive data, public key infrastructure should be used to authenticate all parties and
to encrypt the data (e.g., mutual authentication SSL, XMLEncryption, NIST FIPS 140-1-compliant
encryption scheme)
□□ Software storing data must have the ability to encrypt and, based on data exchange packages, some
exchanges may require data to be encrypted while at rest95,96
□□ Data storage and retrieval must be compliant with the Nationwide Privacy and Security Framework for
Electronic Exchange of Individually Identifiable Health Information97
□□ Should be able to generate an audit log for a user-specified time period
– Recipient systems be patched and maintained with recent security controls (e.g., strong system administrator
password policies and anti-malware patches)
(State and local jurisdictions)
E2: Have or have access to secondary systems for information sharing and public health alerting in the event that the primary
system is unavailable (State and local jurisdictions)
E3: Have or have access to a communication and alerting system that can handle both public health alert messaging and
non-urgent messaging (State and local jurisdictions)

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Centers for Disease Control and Prevention

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CAPABILITY 7: Mass Care
Mass care is the ability to coordinate with partner agencies to address the public health,
medical, and mental/behavioral health needs of those impacted by an incident at a
congregate location.98 This capability includes the coordination of ongoing surveillance
and assessment to ensure that health needs continue to be met as the incident evolves.
This capability consists of the ability to perform the following functions:
Function 1: Determine public health role in mass care operations
Function 2: Determine mass care needs of the impacted population
Function 3: Coordinate public health, medical, and mental/behavioral health services
Function 4: Monitor mass care population health

Function 1: Determine public health role in mass care operations
In conjunction with Emergency Support Function #6, #8, and #11 partners, emergency management, and other partner agencies,
determine the jurisdictional public health roles and responsibilities in providing medical care, health services, and shelter services
during a mass care incident.

Tasks

This function consists of the ability to perform the following task:
Task 1: At the time of an incident, activate pre-determined public health roles (e.g., population monitoring, environmental health
and safety assessment, accessibility for populations with special needs, and need for decontamination) needed in the
mass care response in coordination with Emergency Support Function #6 and #8 partners.

Performance Measure(s)

At present there are no CDC-defined performance measures for this function.

Resource Elements

Note: Jurisdictions must have or have access to the resource elements designated as Priority.

PLANNING (P)

P1: Written plans should include a process to work in conjunction with Emergency Support Function #6 , #8, and #11
partners, emergency management, and other partner agencies (e.g., jurisdictional Safety Officer, HazMat, radiation
control authority, emergency medical services, healthcare organizations, fire service, American Red Cross, Federal
Emergency Management Agency, and animal control) to establish written jurisdictional strategies for mass care
addressing the fulfillment of minimum roles and responsibilities at both general and functional needs shelters. Strategies
may include memoranda of understanding, memoranda of agreement, or letters of agreement with partner agencies if
needed. Minimum roles and responsibilities include the following elements:
–
–
–
–
–
–
–
–
–
–

Provision of medical services
Provision of mental/behavioral health services
Provision of radiological, nuclear, and chemical screening and decontamination services
Conduction of and reporting on human health surveillance
Assessment of facility accessibility for populations with special needs
Operation oversight, set-up, and closure of congregate location(s)
Registration of congregate location users
Removal of sanitation and waste
Provision of service animal and pet shelter and care
Provision of environmental health and safety inspections

Suggested resource
– State Radiation Control Programs: http://www.crcpd.org/Map/RCPmap.htm
(For additional or supporting detail, see Capability 8: Medical Countermeasure Dispensing, Capability 11: Non-Pharmaceutical
Interventions, and Capability 13: Public Health Surveillance and Epidemiological Investigation)

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CAPABILITY 7: Mass Care
Function 1: Determine public health role in mass care operations
Resource Elements (continued)

PLANNING (P)

P2: Written plans should include processes to address the functional needs of at-risk99 individuals, which may include
memoranda of understanding or agreement or letters of agreement with partner agencies if needed. At -risk
accommodations may include but are not limited to the following elements:
–
–
–
–

Functional and medical caregivers
Social services
Utilization of universal design principles in signage and accessibility
Language and sign language interpreters

P3: Written plans should include processes to disseminate situational awareness information to emergency management
and to alert partner organizations in a mass care response. Processes and information include the following elements: 100
–
–
–
–
–
–

Contact information of at least one representative from each organization
Who will notify organizations
How organizations will be notified
How receipt of notification will be confirmed
How organizations will confirm their participation in the mass care response.
What procedures are in place to assure that communication will work properly during an emergency (e.g.,
regular updating of contact lists, regular drills)
(For additional or supporting detail, see Capability 3: Emergency Operations Coordination and Capability 6: Information
Sharing)

Function 2: Determine mass care needs of the impacted population
In conjunction with Emergency Support Function #6, #8, and #11 partners, emergency management and other partner agencies,
determine the public health, medical, mental/behavioral health needs of those impacted by the incident.

Tasks

This function consists of the ability to perform the following tasks:
Task 1: At the time of an incident, coordinate with response partners to utilize pre-existing jurisdictional risk assessment,
environmental data, and health demographic data to identify population health needs in the area impacted by the
incident. (For additional or supporting detail, see Capability 1: Community Preparedness )
Task 2: At the time of an incident, coordinate with response partners to complete a facility-specific environmental health and
safety assessment of the selected or potential congregate locations.
Task 3: During the incident, coordinate with partner agencies to assure food and water safety inspections at congregate
locations. (For additional or supporting detail, see Capability 13: Public Health Surveillance and Epidemiological Investigation)
Task 4: During the incident, coordinate with partners to assure health screening of the population registering at congregate
locations. (For additional or supporting detail, see Capability 10: Medical Surge)

Performance Measure(s)

At present there are no CDC-defined performance measures for this function.

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CAPABILITY 7: Mass Care
Function 2: Determine mass care needs of the impacted population
Resource Elements

Note: Jurisdictions must have or have access to the resource elements designated as Priority.
P1: (Priority) Written plans should include an assessment form to be used in shelter environmental health inspections,
including at a minimum the following elements:
–
–
–
–
–
–
–

Identification of barriers for disabled individuals
Structural integrity
Facility contamination (e.g., radiological, nuclear, or chemical)
Adequate sanitation (e.g., toilets, showers, and hand washing stations) and waste removal
Potable water supply
Adequate ventilation
Clean and appropriate location for food preparation and storage

Suggested resources
–
–
–

CDC Environmental Health Assessment Form for Shelters: http://www.bt.cdc.gov/shelterassessment/
Federal Emergency Management Agency Shelter Operations Management Toolkit, “Opening a Shelter” section,
p.3-4: http://www.fema.gov/pdf/emergency/disasterhousing/dspg-MC-ShelteringHandbook.pdf
CDC Disaster Surveillance Tools: http://www.emergency.cdc.gov/disasters/surveillance

PLANNING (P)

P2: (Priority) Written plans should include a list of pre-identified site(s) that have undergone an initial assessment to
determine their adequacy to serve as congregate locations (based on the size, scope, and nature of potential incidents
and jurisdictional risk assessment).101
P3: Written plans should include a process and protocol to conduct facility assessments, including but not limited to the
following elements:
–
–
–
–
–

Process for contacting lead shelter operation organization
Access to equipment (e.g., radiation detection devices) needed for assessment
When the assessment will occur during set-up
Time frame in which necessary corrective actions will be taken
Repeat assessment after incident occurs (assessment should occur within 48 hours after a site opens)

Suggested resource
– CDC Shelter Assessment Tool:
http://www.emergency.cdc.gov/shelterassessment/pdf/shelter-tool-form.pdf
P4: Written plans should include processes or written agreements, which may include memoranda of understanding
or letters of agreement to adopt or amend jurisdictional restaurant/food service requirements for food and water
assessments at shelters, or written processes for coordinating assessments of food and food sources. Plans should include
the following processes:
–
–
–
–
–
–
–
–
–
–
–

Assure food safety
Assure safety of potable water
Assure wastewater is properly managed
Ensure proper management of solid waste
Assure air quality is controlled
Identify and assess general safety issues
Monitor housekeeping, cleaning, and sanitation
Identify and assist with vector/pest control issues
Monitor safety and sanitation of childcare
Ensure that personal hygiene amenities (e.g., soap, hot water, and hand sanitizer) are provided
Assure hygiene education is provided to response partners and volunteers handling food

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CAPABILITY 7: Mass Care
Function 2: Determine mass care needs of the impacted population
Resource Elements (continued)
Suggested resources
–
–

PLANNING (P)

–

–
–

U.S. Food and Drug Administration Food Code for regulating restaurants and food services (e.g., at nursing
homes):
http://www.fda.gov/Food/FoodSafety/RetailFoodProtection/FoodCode/FoodCode2009/default.htm
Food service standard operating procedures (National Food Service Management Institute NFSMI/U.S.
Department of Agriculture): http://sop.nfsmi.org/sop_list.php
Accidental Radioactive Contamination of Human Food and Animal Feeds: Recommendations for State and Local
Agencies, U.S. Food and Drug Administration:
http://www.fda.gov/downloads/MedicalDevices/DeviceRegulationandGuidance/GuidanceDocuments/
UCM094513.pdf
Red Cross Basic Food Safety Course: http://redcrossla.org/training/disaster-services-classes
Basic Food Safety®, ServSafe: http://www.servsafe.com/foodsafety/

P5: Written plans should include procedures for how the public health agency will coordinate with the lead service agency
(e.g., emergency management or social services) for the provision of specialty food items to address the nutritional
needs/requirements of young children, the elderly, and other at-risk populations.
P6: Written plans should include procedures for referral of individuals to health services at the congregate location, medical
facilities, specialized shelters, or other sites. (For additional or supporting detail, see Capability 6: Information Sharing and
Capability 10: Medical Surge)

SKILLS AND TRAINING (S)

S1: Have or have access to personnel who are skilled in the use of Geographical Information Systems or other mapping
systems.
S2: Personnel conducting shelter safety assessments should receive training for conducting an environmental health and
safety assessment.
Suggested resources
–
–

Federal Emergency Management Agency Environmental Health Training in Emergency Response:
http://cdp.dhs.gov/resident/ehter.html.
CDC Shelter Assessment Tool Training: http://www.emergency.cdc.gov/shelterassessment/training.asp

S3: Training for registration staff to recognize the need to make referrals to health services, specialized shelters, or medical
facilities, as appropriate.

EQUIPMENT AND TECHNOLOGY (E)

S4: Facility Assessment Training: http://www.emergency.cdc.gov/shelterassessment/training.asp
E1: (Priority) Have or have access to a tool for health screening of individuals during shelter registration. The following are
suggested elements for inclusion:
–
–
–
–
–
–
–

Immediate medical needs
Assistive device needs
Mental health needs
Sensory impairment or other disability
Medication use
Need for assistance with activities of daily living
Substance abuse

Suggested resources
–
–
–

Initial Intake and Assessment Tool (HHS/American Red Cross):
http://www.acf.hhs.gov/ohsepr/snp/docs/disaster_shelter_initial_intake_tool.pdf
CDC Field Triage Decision Scheme: http://www.cdc.gov/fieldtriage/pdf/triage%20scheme-a.pdf
http://www.aap.org/disasters/pdf/Standards-Disaster-Shelter-Care.pdf

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CAPABILITY 7: Mass Care
Function 2: Determine mass care needs of the impacted population
EQUIPMENT AND TECHNOLOGY (E)

Resource Elements (continued)
E2: Have or have access to Geographical Information System or other system (e.g., zip code sorting) to identify the location of
at-risk populations (e.g., nursing homes, non-English speaking communities, populations with chronic conditions) within
the jurisdiction, and to compare their locations to pre-identified shelter locations and incident impact areas.

Function 3: Coordinate public health, medical, and mental health mass care services
Coordinate with partner agencies to provide access to health services, medication and consumable medical supplies (e.g., hearing
aid batteries and incontinence supplies), and durable medical equipment for the impacted population.

Tasks

This function consists of the ability to perform the following tasks:
Task 1: At the time of the incident, coordinate with healthcare partners to assure medical and mental/behavioral health services
are accessible at or through congregate locations. (For additional or supporting detail, see Capability 1: Community
Preparedness and Capability 10: Medical Surge)
Task 2: At the time of the incident, coordinate with providers to facilitate access to medication and assistive devices for
individuals impacted by the incident. (For additional or supporting detail, see Capability 8: Medical Countermeasure
Dispensing, Capability 9: Medical Materiel Management and Distribution, and Capability 10: Medical Surge)
Task 3: At the time of the incident, if applicable, coordinate with jurisdictional HazMat resources or other lead agency to assure
provision of population monitoring and decontamination services, including the establishment of tracking systems of
contaminated or possibly contaminated (e.g., radiological, nuclear, or chemical) individuals who may enter congregate
locations. (For additional or supporting detail, see Capability 3: Emergency Operations Coordination)
Task 4: During an incident, disseminate and promote accessible information regarding available mass care health services to the
public. (For additional or supporting detail, see Capability 4: Emergency Public Information and Warning)
Task 5: During an incident, coordinate with agencies to accommodate and provide care (e.g., medical care, essential needs, and
decontamination) for service animals within general shelter populations.102
Task 6: At the time of the incident, work with partner agencies in coordinating the location of human sheltering efforts with
household pet sheltering efforts.
Task 7: During and after an incident, coordinate with emergency medical services, local, state, tribal, and federal health agencies,
emergency management agencies, state hospital associations, social services, and participating non-governmental
organizations to return individuals displaced by the incident to their pre-incident medical environment (e.g., prior
medical care provider, skilled nursing facility, or place of residence) or other applicable medical setting. (For additional or
supporting detail, see Capability 10: Medical Surge)
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CAPABILITY 7: Mass Care
Function 3: Coordinate public health, medical, and mental health mass care services
Performance Measure(s)

At present there are no CDC-defined performance measures for this function.

Resource Elements

Note: Jurisdictions must have or have access to the resource elements designated as Priority.
P1: (Priority) Written plans should include memoranda of understanding, memoranda of agreement, or letters of agreement
with medication providers, including but not limited to the following elements:
– Requesting medication from providers
– Bringing medication to congregate locations
– Storing and distributing medication at congregate locations
– Referring and transporting individuals to pharmacies and other providers for medication
(For additional or supporting detail, see Capability 8: Medical Countermeasure Dispensing, Capability 9: Medical Materiel
Management and Distribution, and Capability 10: Medical Surge)
P2: (Priority) Written plans should include a scalable congregate location staffing model based on number of individuals,
resources available, competing priorities, and time frame in which intervention should occur that is incident-driven and,
at a minimum, includes the ability to provide the following elements:
–
–
–
–
–

Medical care services
Management of mental/behavioral disorders
Environmental health assessments (e.g., food, water, and sanitation)
Data collection, monitoring, and analysis
Infection control practices and procedures

PLANNING (P)

Suggested resources
–

Memoranda of understanding, memoranda of agreement, or letters of agreement with mental/behavioral health
specialists to provide mental/behavioral health services to individuals registering at congregate locations (either
at congregate locations or through referral)
(For additional or supporting detail, see Capability 10: Medical Surge and Capability 15: Volunteer Management)
P3: (Priority) Written plans should include procedures to coordinate with partner agencies to transfer individuals from
general shelters to specialized shelters or medical facilities if needed, including the following procedural elements:
– Patient information transfer (e.g., current condition and medical equipment needs)
– Physical transfer of patient
(For additional or supporting detail, see Capability 10: Medical Surge )
P4: (Priority) Written plans should include a process to coordinate with partner agencies to monitor populations103 at
congregate locations, including but not limited to the following processes:104
–
–
–
–

Establishing registries for exposed or potentially exposed individuals for long-term health monitoring
Separate shelter facilities for monitoring individuals at congregate locations
Identifying, stabilizing and referring individuals who need immediate medical care or decontamination
Prioritization of at-risk populations at congregate locations that have specific needs after a radiation incident
(e.g., children, elderly, and pregnant women)

Suggested resources
–
–
–

Population Monitoring in Radiation Emergencies:
http://emergency.cdc.gov/radiation/pdf/population-monitoring-guide.pdf
Radiation Emergency Medical Management: http://www.remm.nlm.gov/
Conference of Radiation Control Program Directors State Radiation Control Programs:
http://www.crcpd.org/Map/RCPmap.htm

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CAPABILITY 7: Mass Care
Function 3: Coordinate public health, medical, and mental health mass care services
Resource Elements (continued)
P5: (Priority) Written plans should include a scalable congregate location staffing matrix identifying at least one back-up for
each population monitoring and decontamination response role. Skill sets at a minimum should include the following
elements:
–
–
–
–

The ability to manage population monitoring operation
The ability to monitor arrivals for external contamination and assess exposure
The ability to assist with decontamination services
The ability to assess exposure and internal contamination

Suggested resources
–
–
–
–
–

Report on Workshop on Operating Public Shelters During a Radiation Emergency :
http://www.naccho.org/topics/environmental/radiation/index.cfm
Virtual Community Reception Center: http://www.emergency.cdc.gov/radiation/crc/vcrc.asp
Population Monitoring in Radiation Emergencies: A Guide for State and Local Public Health Partners:
http://www.emergency.cdc.gov/radiation/pdf/population-monitoring-guide.pdf
Map of State Radiation Control Programs: http://www.crcpd.org/Map/RCPmap.htm
Radiation Emergency Assistance Center Training: http://orise.orau.gov/reacts/

PLANNING (P)

P6: Written plans should include memoranda of understanding, memoranda of agreement, or letters of agreement with
medical supply/equipment providers, including but not limited to the following elements:
–
–
–

Processes to bring supplies and equipment to the congregate locations
Accountability for equipment during the mass care response
Processes to return equipment to providers when no longer needed

P7: Written plans should include a process to coordinate, if requested, with response partners (e.g., HazMat, Radiation Control
Authority, and Emergency Medical Services) responsible for decontamination of individuals at congregate locations.
Processes should include but are not limited to the following elements:
–
–
–

Coordination with organizations trained in decontamination
Establishment of decontamination stations, including handicap-accessible stations, at congregate locations
Delivery of decontamination supplies (e.g., shower supplies, plastic bags to collect possibly contaminated
materials, medication, and medical supplies) to congregate locations
– Removal or storage of contaminated materials away from congregate location populations
(For additional or supporting detail, see Capability 11: Non-Pharmaceutical Interventions)
P8: Written plans should include agreements with response partners for animal care (e.g., service animal trainers, Board
of Animal Health, and National Veterinarian Response Teams) to assist with specialized care for service animals at
congregate locations.
P9: Written plans should include a process to coordinate with response partners (e.g., service animal trainers, Board of Animal
Health and National Veterinarian Response Teams) for animal sheltering and care at congregate locations. Plans should
include but are not limited to the following elements:
–
–
–
–
–

Pre-identified locations that can serve as temporary shelters for small and large pets
Pre-arranged contracts for food, water, bedding supply, and other equipment needed for designated animal
shelter locations
Protocols for coordination of animal medical evaluations (e.g., for injuries, HazMat exposures, and diseases)
Plan for the quarantine of animals
Pre-arranged jurisdictional veterinary support (e.g., from veterinary teaching hospitals, jurisdictional Animal
Response Teams, and animal day care centers) via contracts or other mechanisms

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CAPABILITY 7: Mass Care
Function 3: Coordinate public health, medical, and mental health mass care services

PLANNING(P)

Resource Elements (continued)
Suggested resource
–

American Veterinary Medical Association, Emergency Preparedness and Response,
http://www.avma.org/disaster/emerg_prep_resp_guide.pdf

P10: Written plans should include processes for service animal decontamination at congregate locations, including provision
of washing stations for owners to conduct pet decontamination.

SKILLS AND TRAINING (S)

S1: Radiation training for mass care responders
Suggested resource
–

CDC’s Radiation Emergency Training and Education: http://emergency.cdc.gov/radiation/training.asp

S2: Personnel that will be involved with animal care services should have access to the following training:
–
–

Federal Emergency Management Agency Animals in Disaster—Module A: Awareness and Preparedness (IS10)
http://www.training.fema.gov/emiweb/Is/is10.asp and Animals in Disaster—Module B: Community Planning
(IS11) http://training.fema.gov/EMIWEB/IS/IS11.asp
Humane Society of the United States, 2009 Disaster Training Program:
http://www.hsus.org/hsus_field/hsus_disaster_center/disaster_training_dates_2007.html

Function 4: Monitor mass care population health
Monitor ongoing health-related mass care support, and ensure health needs continue to be met as the incident response evolves.

Tasks

This function consists of the ability to perform the following tasks:
Task 1: During an incident, in coordination with partner agencies, monitor facility-specific environmental health and safety,
including screening for contamination (e.g., radiological, nuclear, biological, or chemical), and assure any identified
deficiencies are corrected.
Task 2: During an incident, conduct surveillance at congregate locations to identify cases of illness, injury, and exposure within
mass care populations. (For additional or supporting detail, see Capability 13: Public Health Surveillance and Epidemiological
Investigation)
Task 3: During an incident, identify updated health needs as part of the agency’s/jurisdictional situational awareness update, and
refer those updates through the public health incident management system for additional local, state, regional, or federal
assistance as necessary. (For additional or supporting detail, see Capability 3: Emergency Operations Coordination)
Task 4: After an incident, in conjunction with partner agencies, de-escalate health response as appropriate to the mass care
situation, including creating and executing a health resource demobilization plan. (For additional or supporting detail, see
Capability 3: Emergency Operations Coordination and Capability 10: Medical Surge)

Performance Measure(s)

At present there are no CDC-defined performance measures for this function.

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CAPABILITY 7: Mass Care
Function 4: Monitor mass care population health
Resource Elements

Note: Jurisdictions must have or have access to the resource elements designated as Priority.
P1: (Priority) Written plans should include a process to conduct ongoing shelter population health surveillance, including
the following elements:
– Identification or development of mass care surveillance forms and processes
– Determination of thresholds for when to start surveillance
– Coordination of health surveillance plan with partner agencies’ (e.g., Red Cross) activities
(For additional or supporting detail, see Capability 14: Public Health Surveillance and Epidemiological Investigation)
P2: (Priority) Written plans should include templates for disaster-surveillance forms, including Active Surveillance and Facility
24-hour Report forms.
Suggested resources
PLANNING (P)

–
–
–
–

CDC Public Health Assessment and Surveillance After a Disaster:
http://www.emergency.cdc.gov/disasters/surveillance/pdf/CASPER_toolkit_508%20COMPLIANT.pdf
Active Surveillance form, Natural Disaster Morbidity Surveillance Individual Form:
http://www.emergency.cdc.gov/disasters/surveillance/pdf/NaturalDisasterMorbiditySurveillanceIndividualForm.
pdf
Facility 24-hour Report Forms, Natural Disaster Morbidity Surveillance Tally Sheet:
http://www.emergency.cdc.gov/disasters/surveillance/pdf/NaturalDisasterMorbiditySurveillanceTallySheet.pdf
Facility 24-hour Report Forms, Natural Disaster Morbidity Surveillance Summary Report Form:
http://www.emergency.cdc.gov/disasters/surveillance/pdf/
NaturalDisasterMorbiditySurveillanceSummaryReportForm.pdf

P3: Written plans should include demobilization procedures, including but not limited to105 the following elements:

EQUIPMENT AND TECHNOLOGY (E)

– Processes to inform responding agencies of demobilization
– Responsibilities/agreements for reconditioning and return of equipment when no longer needed
– Time frame for ending mass care health services upon shelter closure notice
(For additional or supporting detail, see Capability 3: Emergency Operations Coordination)
E1: Have of have access to electronic database or other data storage system to document, at a minimum, the number and
type of health needs addressed, and disposition (e.g., hospitalized or sent home) of individuals using mass care health
services.

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CAPABILITY 8: Medical Countermeasure Dispensing
Medical countermeasure dispensing is the ability to provide medical countermeasures
(including vaccines, antiviral drugs, antibiotics, antitoxin, etc.) in support of treatment
or prophylaxis (oral or vaccination) to the identified population in accordance with
public health guidelines and/or recommendations.
This capability consists of the ability to perform the following functions:
Function 1: Identify and initiate medical countermeasure dispensing strategies
Function 2: Receive medical countermeasures
Function 3: Activate dispensing modalities
Function 4: Dispense medical countermeasures to identified population
Function 5: Report adverse events

Function 1: Identify and initiate medical countermeasure dispensing strategies
Notify and coordinate with partners to identify roles and responsibilities consistent with the identified agent or exposure and
within a time frame appropriate to the incident.

Tasks

This function consists of the ability to perform the following tasks:
Task 1: Prior to an incident, and if applicable during an incident, engage subject matter experts (e.g., epidemiology, laboratory,
radiological, chemical, and biological) including federal partners, to determine what medical countermeasures are
best suited and available for the incidents most likely to occur based on jurisdictional risk assessment. (For additional
or supporting detail, see Capability 12: Public Health Laboratory Testing and Capability 13: Public Health Surveillance and
Epidemiological Investigation)
Task 2: Prior to an incident, and if applicable during an incident, engage private sector, local, state, regional, and federal partners,
as appropriate to the incident, to identify and fill required response roles (For additional or supporting detail, see Capability
3: Emergency Operations Coordination and Capability 15: Volunteer Management)

Performance Measure(s)

At present there are no CDC-defined performance measures for this function.

Resource Elements

Note: Jurisdictions must have or have access to the resource elements designated as Priority.
P1: (Priority) Written plans should include standard operating procedures that provide guidance to identify the medical
countermeasures required for the incident or potential incident. Consideration should be given to the following
elements:
PLANNING (P)

–

–
–
–
–
–

Number and location of people affected by the incident, including a process to collect and analyze medical and
social demographic information of the jurisdiction’s population to plan for the types of medications, durable
medical equipment, or consumable medical supplies that may need to be provided during an incident, including
supplies needed for the functional needs of at-risk individuals.106
Agent or cause of the incident
(For additional or supporting detail, see Capability 12: Public Health Laboratory Testing)
Severity of the incident
Potential medical countermeasures
(For additional or supporting detail, see Capability 13: Public Health Surveillance and Epidemiological Investigation)
Time line for establishing medical countermeasure dispensing operations
Personnel and staffing mix

Suggested resources
–

CDC Emergency Preparedness and Response: http://emergency.cdc.gov

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Centers for Disease Control and Prevention

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CAPABILITY 8: Medical Countermeasure Dispensing
Function 1: Identify and initiate medical countermeasure dispensing strategies
Resource Elements (continued)
–
–
–
–
–

PLANNING (P)

–

Federal Emergency Management Agency National Response Framework Incident Annexes:
http://www.fema.gov/emergency/nrf/incidentannexes.htm
Radiation Emergency Medical Management website:
http://www.remm.nlm.gov
CDC Radiation Emergency website (medical countermeasures):
http://emergency.cdc.gov/radiation/countermeasures.asp
Management of Persons Contaminated with Radionuclides Handbook:
http://www.ncrponline.org/Publications/161press.html
Medical Management of Radiological Casualties Handbook, Second Edition:
http://www.afrri.usuhs.mil/www/outreach/pdf/2edmmrchandbook.pdf
Conference of Radiation Control Program Directors: www.crcpd.org

P2: Written plans should be developed by jurisdictional level, multidisciplinary planning groups who meet on a regular basis
and contain representatives who would respond during a public health or emergency incident.107,108 Planning group
members could include the following constituencies:
–
–
–
–
–
–
–
–
–
–
–
–
–

Public health departments
Jurisdictional Emergency Management/Office of Homeland Security
Law enforcement
Private businesses (including pharmacies)
Emergency medical services (both public and private)
Hospitals and clinics
Medical professional organizations
Military installations
Metropolitan Medical Response System participants
Volunteer groups (e.g., Red Cross and Salvation Army)
Radiation-specific group, (e.g., Radiation Control Programs, U.S. Environmental Protection Agency, or State
Environmental Agency). (The Conference of Radiation Control Program Directors provides a list of state radiation
control programs at http://www.crcpd.org/Map/RCPmap.html)
Private organizations such as retailers with supply chains and package delivery services (e.g., U.S. Postal Service,
UPS, FedEx, and DHL)
U.S. Department of Health and Human Services Regional Emergency Coordinators

Group will meet on a regular basis to review the medical countermeasures plans and ensure participants understand
their roles and responsibilities. Evidence of the meetings include the following elements:

SKILLS AND TRAINING (S)

– Defined roles and responsibilities
– Sign off agreement of the protocols
(For additional or supporting detail, see Capability 1: Community Preparedness and Capability 3: Emergency Operations
Coordination)
S1: Staff participating in dispensing operations should understand jurisdictional medical countermeasure dispensing
requirements, plans, and procedures.
–
–

CDC Emergency Use Authorization Online Course: http://emergency.cdc.gov/training/eua/index.html
Receiving, Distributing, and Dispensing Strategic National Stockpile Assets, A Guide for Preparedness, version
10.02, Chapter 12: Dispensing Oral Medications: https://www.orau.gov/snsnet/guidance.htm

S2: Staff participating in dispensing operations should understand/be knowledgeable of responder groups’ roles and
procedures during an incident requiring medical countermeasure dispensing. Suggested trainings include the following:

– Division of Strategic National Stockpile (DSNS) in CDC’s Office of Public Health Preparedness and Response
(For additional or supporting detail, see Capability 9: Medical Materiel Management and Distribution)
□□ DSNS extranet: http://emergency.cdc.gov/stockpile/extranet (password protected site)
□□ Key Differences for State and Local Planners (DSNS Emergency Use Authorization Guidance):
https://www.orau.gov/snsnet/guidance.htm

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CAPABILITY 8: Medical Countermeasure Dispensing
Function 1: Identify and initiate medical countermeasure dispensing strategies
Resource Elements (continued)
SKILLS AND TRAINING (S)
EQUIPMENT AND TECHNOLOGY (E)

Partnering with Federal Agencies: Closed Point Of Dispensing Option (DSNS):
https://www.orau.gov/snsnet/closedpod.htm
□□ Taking Care of Business: An Introduction to Becoming a Closed Point of Dispensing (DSNS):
https://www.orau.gov/snsnet/resources/videos/TCB_Video.htm
□□ Hospitals, Treatment Centers, and Public Health: Partners in Emergency Planning and Response (DSNS):
https://www.orau.gov/snsnet/av/HTC_PHP.htm
Military
□□ Public Health Emergency Management Within the Department of Defense:
http://www.dtic.mil/whs/directives/corres/pdf/620003p.pdf
□□

–

E1: Have or have access to a reporting system. Considerations for the system include the following elements:
–

Ability to receive orders for delivery of medical materiel from receiving, staging and storing warehouse to points
of dispensing (dispensing locations) or treatment sites
– Ability to provide status reports to the emergency operations center on distribution and dispensing activities,
such as shipments received, stock levels, additional assets needed, number of regimens provided, and any
irresolvable problems
– How, where, and by what system (e.g., e-mail, phone call, fax, or radio message) to request additional resources
(For additional or supporting detail, see Capability 6: Information Sharing)

Function 2: Receive medical countermeasures
Identify dispensing sites and/or intermediary distribution sites109 and prepare these modalities to receive medical
countermeasures in a time frame applicable to the agent or exposure.

Tasks

This function consists of the ability to perform the following tasks:
Task 1: Assess the extent to which current jurisdictional medical countermeasure inventories can meet incident needs. (Targeted
at state and local jurisdictions) (For additional or supporting detail, see Capability 9: Medical Materiel Management and
Distribution)
Task 2: Request additional medical countermeasures from private, jurisdictional, and/or federal partners using established
procedures, according to incident needs. (For additional or supporting detail, see Capability 9: Medical Materiel Management
and Distribution)
Task 3: Identify and notify any intermediary distribution sites based on the needs of the incident, if applicable. (For additional or
supporting detail, see Capability 9: Medical Materiel Management and Distribution)

Performance Measure(s)

At present there are no CDC-defined performance measures for this function.

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CAPABILITY 8: Medical Countermeasure Dispensing
Function 2: Receive medical countermeasures
Resource Elements

Note: Jurisdictions must have or have access to the resource elements designated as Priority.
P1: (Priority) Written plans should include protocols to request additional medical countermeasures, including memoranda
of understanding or other letters of agreement with state/local partners. Consideration should be given to the following
elements:

PLANNING (P)

–
–
–
–

Assessment of local inventory/medical countermeasure caches
Identification of local pharmaceutical and medical-supply wholesalers
Identification of a decision matrix guiding the process of requesting additional medical countermeasures if local
supplies are exhausted. Matrix should take into account the Stafford Act and U.S. Department of Health and
Human Services Regional Emergency Coordinators.
If jurisdictions decide to purchase their own medical countermeasures, they are required to meet regulatory
standards (abide by U.S. Food and Drug Administration standards including current good manufacturing
practices, have appropriate Drug Enforcement Administration registrations, and be responsible to fund and track
medical countermeasures rotation)

Suggested resource
–

U.S. Food and Drug Administration Current Good Manufacturing Practices/Compliance:
http://www.fda.gov/Drugs/GuidanceComplianceRegulatoryInformation/Guidances/ucm064971.htm

P2: Written plans should include processes and protocols for medical countermeasure storage. Consideration should be
given to the following:
–

EQUIPMENT AND TECHNOLOGY (E)

–
–
–

CDC Technical Assistance Review of Strategic National Stockpile Plans recommendations for receiving medical
countermeasures
Storage maintenance of cleanliness and packaging of controlled substances
Storage considerations for cold chain management and redundancy systems
Sites receiving vaccines must meet the requirements of the jurisdiction’s vaccine provider agreement

E1: Have or have access to a system (hardware and software) to receive and manage inventory; system can be manual or
automated.110
–
–

System should be able to track, at a minimum, the name of the drug, National Drug Code, lot number, dispensing
site or treatment location, and inventory balance.
System must also have a backup which can be inventory management software, electronic spreadsheets, or
paper.

E2: Have or have access to material required to receive medical countermeasures.
–
–
–
–

Material-handling equipment (e.g., pallet jacks, handcarts/dollies, and forklifts)
Primary and backup cold chain management equipment (e.g., refrigerators and thermometers)
Ancillary medical supplies
Administrative supplies

Function 3: Activate dispensing modalities
Ensure resources (e.g., human, technical, and space) are activated to initiate dispensing modalities111 that support a response
requiring the use of medical countermeasures for prophylaxis and/or treatment.

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CAPABILITY 8: Medical Countermeasure Dispensing
Function 3: Activate dispensing modalities
Tasks

This function consists of the ability to perform the following tasks:
Task 1: Activate dispensing strategies, dispensing sites, dispensing modalities and other approaches, as necessary, to achieve
dispensing goals commensurate with the targeted population.
Task 2: Activate staff that will support the dispensing modality in numbers necessary to achieve dispensing goals commensurate
with the targeted population. (For additional or supporting detail, see Capability 15: Volunteer Management)
Task 3: If indicated by the incident, implement mechanisms for providing medical countermeasures for public health responders,
critical infrastructure personnel,112 and their families, if applicable. (For additional or supporting detail, see Capability 14:
Responder Safety and Health)
Task 4: Initiate site-specific security measures for dispensing locations, if applicable. (For additional or supporting detail, see
Capability 9: Medical Materiel Management and Distribution)
Task 5: Inform public of dispensing operations including locations, time period of availability, and method of delivery. (For
additional or supporting detail, see Capability 4: Emergency Public Information and Warning)
Note: State jurisdictions are expected to ensure attainment of Tasks 1 through 5 by their local communities.

Performance Measure(s)

This function is associated with the following CDC-defined performance measure:
Measure 1: Composite performance indicator from the Division of Strategic National Stockpile (DSNS) in CDC’s Office of Public
Health Preparedness and Response.
This indicator can be found on the DSNS extranet: http://emergency.cdc.gov/stockpile/extranet (password protected
site).

Resource Elements

Note: Jurisdictions must have or have access to the resource elements designated as Priority.
P1: (Priority) Written plans should include written agreements (e.g., memoranda of agreement, memoranda of
understanding, mutual aid agreements or other letters of agreement) to share resources, facilities, services, and other
potential support required during the medical countermeasure dispensing activities.113
P2: (Priority) Written plans should include processes and protocols to govern the activation of dispensing modalities.114,115

PLANNING (P)

–

–

Identify multiple dispensing modalities that would be activated depending on the incident characteristics (e.g.,
identified population and type of agent/exposure). Consideration should be given to the following elements:
□□ Traditional public health operated (e.g., open points of dispensing)
□□ Private organizations (e.g., closed points of dispensing)
□□ Pharmacies
□□ Provider offices and clinics
□□ Military/tribal
□□ Incarcerated population
□□ Other jurisdictionally approved dispensing modalities
Initiate notification protocols with the dispensing locations. The following information should be determined for
the sites:
□□ Dispensing site name/identifier
□□ Demand estimate (number of people planning to visit the site)
□□ Required throughput
□□ Staff required to operate one shift
□□ Number of shifts of distinct staff

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CAPABILITY 8: Medical Countermeasure Dispensing
Function 3: Activate dispensing modalities
Resource Elements (continued)

–
–

Staff availability
Total number of staff required to operate the dispensing location through the whole incident
Plan for functional needs of at-risk individuals (e.g., wheelchair access for handicapped)
Identify, assess, prioritize, and communicate legal and liability dispensing barriers to those with the authority to
address issues. Consideration should be given to the following elements:
□□ Clinical standards of care
□□ Licensing
□□ Civil liability for volunteers
□□ Liability for private sector participants
□□ Property needed for dispensing medication
□□
□□

Suggested resource
–

Receiving, Distributing, and Dispensing Strategic National Stockpile Assets: A Guide for Preparedness, Version
10.02, Chapter 12: Dispensing Oral Medications:
https://www.orau.gov/snsnet/resources/SNSPlanningGuideV10.02.pdf

PLANNING (P)

P3: Written plans should include security measures, processes, and protocols for dispensing sites.116,117 Consideration should
be given to the following elements:
–
–
–
–
–
–

Activating and badging security personnel118,119
Safeguarding dispensing site property
Protecting dispensing site personnel
Controlling traffic at and around dispensing sites
Conducting crowd control at and around dispensing sites
Collaborating with law enforcement and emergency management

Suggested resource
–

CDC Strategic National Stockpile Technical Assistance Review, Section 6:
https://www.orau.gov/snsnet/guidance.htm

P4: Written plans should include a list of pre-identified private partners for private sector dispensing, if applicable, and
written standard operating procedures that provide guidance for when and how public health must communicate with/
notify private sector dispensing locations according to the incident scenario and how private sector dispensing locations
can request medical countermeasures.120,121
P5: Written plans should include pre-defined communication messages including a set of messages to be used in the
case of a novel agent. Messages should be coordinated from federal to state to local according to jurisdictional
protocol.122,123,124,125,126 (For additional or supporting detail, see Capability 4: Emergency Public Information and Warning)
Suggested resources
–
–
–

Strategic National Stockpile Public Information and Communication Resources:
https://www.orau.gov/snsnet/functions/PIC.htm
Receiving, Distributing, and Dispensing Strategic National Stockpile Assets: A Guide for Preparedness, Version
10.02, Chapter 6: Public Information and Communications:
https://www.orau.gov/snsnet/resources/SNSPlanningGuideV10.02.pdf
CDC Strategic National Stockpile Technical Assistance Review, Section 5:
https://www.orau.gov/snsnet/guidance.htm

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CAPABILITY 8: Medical Countermeasure Dispensing
Function 3: Activate dispensing modalities
Resource Elements (continued)
EQUIPMENT AND TECHNOLOGY (E)

E1: Have or have access to material required to dispense medical countermeasures, including the following:
–
–
–
–
–
–

Dispensing sites materiel-handling equipment (e.g., pallet jacks, handcarts/dollies, and forklifts)
Cold chain management equipment
Personal protective equipment
Ancillary medical supplies
Administrative supplies
Specialized items (e.g., scales for weighing children, mixing equipment for pediatric portions, and Broselow
tapes), if necessary

E2: Have or have access to systems to support the development of staffing models. The following models are suggested
prototypes for consideration:
– RealOpt: http://www2.isye.gatech.edu/medicalor/research.htm#realopt
– Bioterrorism and Epidemic Outbreak Response Model: http://www.ahrq.gov/research/biomodel.htm
(For additional or supporting detail, see Capability 15: Volunteer Management Capability)

Function 4: Dispense medical countermeasures to identified population
Provide medical countermeasures to individuals in the target population, in accordance with public health guidelines and/or
recommendations for the suspected or identified agent or exposure.

Tasks

This function consists of the ability to perform the following tasks:
Task 1: Maintain dispensing site inventory management system to track quantity and type of medical countermeasures present
at the dispensing site.
Task 2: Screen and triage individuals to determine which medical countermeasure is appropriate to dispense to individuals if
more than one type or subset of medical countermeasure is being provided at the site. (For additional or supporting detail,
see Capability 10: Medical Surge)
Task 3: Distribute pre-printed drug/vaccine information sheets that include instructions on how to report adverse events.
Task 4: Monitor dispensing site throughput and adjust staffing and supplies as needed in order to achieve dispensing goals
commensurate with the targeted population.
Task 5: Document doses of medical countermeasures dispensed, including but not limited to: product name and lot number,
date of dispensing, and location of dispensing (e.g., address and zip code).
Task 6: Report aggregate inventory and dispensing information to jurisdictional authorities at least weekly during an incident,
but potentially more frequently based on incident needs.
Task 7: Determine the disposition of unused medical countermeasures within the jurisdictional health system according to
jurisdictional policies.
Note: State jurisdictions are expected to ensure attainment of Tasks 1 through 7 by their local communities.

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CAPABILITY 8: Medical Countermeasure Dispensing
Function 4: Dispense medical countermeasures to identified population
Performance Measure(s)

This function is associated with the following CDC-defined performance measure:
Measure 1: Composite performance indicator from the Division of Strategic National Stockpile (DSNS) in CDC’s Office of Public
Health Preparedness and Response.
This indicator can be found on the DSNS extranet: http://emergency.cdc.gov/stockpile/extranet (password protected
site).

Resource Elements

Note: Jurisdictions must have or have access to the resource elements designated as Priority.
P1: (Priority) Written plans should include processes and protocols to govern the dispensing of medical countermeasures to
the target population.127
–

–

PLANNING (P)

–
–

Protocol for screening and triaging patients, taking into consideration an assessment of patient characteristics
(e.g., age, weight, clinical manifestations, available medical history, and drug or food allergies, assessment of
radiation exposure duration and time since exposure, presence of radioactive contamination on the body or
clothing, intake of radioactive materials into the body, identification of the radioactive isotope, removal of
external or internal contamination) to determine the medical countermeasure to dispense
Ensure that the permanent medical record (or log/file) of the recipient indicates the following information as
deemed necessary:
□□ The date the medical countermeasure was dispensed
□□ Information on the medical countermeasure including, but not limited to, product name, national drug
control number, and lot number
□□ The name and address of the person dispensing the medical countermeasure. Federal dispensing law
requires: name/address of dispenser, prescription number, date of prescription, name of prescriber,
name of patient (if stated on prescription), directions for use, and cautionary statements.
□□ The edition date of the information statement (e.g., pre-printed drug information sheets) distributed
Ensure medical countermeasure recipient receives the information sheet matching the medical countermeasure
dispensed
Data recording protocols to report the data at an aggregate level to state/federal entities. Considerations
should be given to population demographics (e.g., sex, age group, and if an at-risk individual) and dispensing
information (e.g., medical countermeasure name, location, and date)

P2: Written plans should include protocols for the storage, distribution, disposal, or return of unused medical
countermeasures, including plans for maintaining integrity of medical countermeasures during storage and/or
distribution within the jurisdictional health system.
P3: Written plans should include protocols to request additional staffing and supplies if necessary to the incident. (For
additional or supporting detail, see Capability15: Volunteer Management)
P4: Written plans should include dispensing modality security measures, processes and protocols.128,129 Consideration should
be given to the following elements:
––
––
––
––
––
––

Activating and badging security personnel130,131
Safeguarding dispensing site property
Protecting dispensing site personnel
Controlling traffic at and around dispensing sites
Conducting crowd control at and around dispensing sites
Collaborating with law enforcement and emergency management

Suggested resource

–– CDC Strategic National Stockpile Technical Assistance Review, Section 6:
https://www.orau.gov/snsnet/guidance.htm

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CAPABILITY 8: Medical Countermeasure Dispensing
Function 4: Dispense medical countermeasures to identified population

EQUIPMENT AND TECHNOLOGY (E)

SKILLS AND TRAINING (S)

Resource Elements (continued)
S1: Public Health staff should be trained on jurisdictional medical countermeasure dispensing systems (e.g., registry or
database) and inventory management protocols.132,133
––
––
––

Medical countermeasures dispensing training offered by the state/local jurisdictions
Extranet for the Division of Strategic National Stockpile in CDC’s Office of Public Health Preparedness and
Response: http://emergency.cdc.gov/stockpile/extranet (password protected site)
National Association of County and City Health Officials, Advanced Practice Centers Toolkits:
http://www.naccho.org/toolbox/

E1: Information sheets (e.g., drug or vaccine information sheets) for the medical countermeasure dispensed. Consideration
should be given to size of the identified population and languages identified within the identified population.
E2: Data forms and information sheets required by an Emergency Use Authorization for the medical countermeasure
dispensed to provide to recipients.
E3: Have or have access to system to track dispensing and manage inventory; system can be manual or automated.134,135
System must also have a backup which can be inventory management software, electronic spreadsheets, or paper.

Function 5: Report adverse events
Report adverse event notifications (e.g., negative medical countermeasure side effects) received from an individual, healthcare
provider, or other source.

Tasks

This function consists of the ability to perform the following tasks:
Task 1: Activate mechanism(s) for individuals and healthcare providers to notify health departments about adverse events. (For
additional or supporting detail, see Capability 6: Information Sharing)
Task 2: Report adverse event data to jurisdictional and federal entities according to jurisdictional protocols. (For additional or
supporting detail, see Capability 6: Information Sharing)
Note: Tasks 1 and 2 apply to all jurisdictions; states are expected to ensure attainment of Tasks 1 and 2 by their local communities.

Performance Measure(s)

At present there are no CDC-defined performance measures for this function.

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CAPABILITY 8: Medical Countermeasure Dispensing
Function 5: Report adverse events
Resource Elements

Note: Jurisdictions must have or have access to the resource elements designated as Priority.
P1: (Priority) Written plans should include processes and protocols to govern reporting of adverse events.136 The following
items should be considered in the plans:
–

PLANNING (P)

–
–
–

–

Guidance and communications messages/campaign that articulates the importance of adverse reporting
regardless of suspected cause
Process to ensure individuals receive the information sheet about potential adverse events of the medical
countermeasure dispensed and how to report adverse events
Triage protocols when receiving notifications of adverse events
Protocols when receiving notifications of adverse events. Information required to document adverse events
includes the following:
□□ Patient, provider, and reporter demographics
□□ Adverse event
□□ Relevant diagnostic tests/laboratory data
□□ Recovery status
□□ Vaccine(s)/pharmaceutical(s) received, including receipt location, date, vaccine/pharmaceutical type, lot
number, and dose number
Utilize existing federal and jurisdictional adverse event reporting system, processes and protocols

EQUIPMENT AND TECHNOLOGY (E)

SKILLS AND TRAINING (S)

P2: Written plans should include memoranda of agreement, memoranda of understanding, mutual aid agreements, letters of
agreement and/or contracts with other entities (e.g., agencies and jurisdictions) to support activities and share resources,
facilities, services, and other potential support required for responding to, reporting, and/or investigating adverse events.
(For additional or supporting detail, see Capability 1: Community Preparedness)
S1: (Priority) Public Health staff should be trained on federal as well as their jurisdiction’s adverse event reporting system,
processes and protocols.
Suggested systems for training include the following:
–
–
–
–

MedWatch: https://www.accessdata.fda.gov/scripts/medwatch/medwatch-online.htm
Vaccine Adverse Events Reporting System: https://vaers.hhs.gov
Adverse Event Reporting System, U.S. Food and Drug Administration:
http://www.fda.gov/Drugs/GuidanceComplianceRegulatoryInformation/Surveillance/AdverseDrugEffects/
default.htm
Drug Abuse Warning Network: https://dawninfo.samhsa.gov/default.asp

E1: Have access to national systems to report adverse events. Current national systems include the following:
–
–
–

Vaccine Adverse Event Reporting System: https://vaers.hhs.gov
Adverse Event Reporting System, U.S. Food and Drug Administration:
http://www.fda.gov/Drugs/GuidanceComplianceRegulatoryInformation/Surveillance/AdverseDrugEffects/
default.htm
Drug Abuse Warning Network: https://dawninfo.samhsa.gov/default.asp

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CAPABILITY 9: Medical Materiel Management and Distribution
Medical materiel management and distribution is the ability to acquire, maintain (e.g.,
cold chain storage or other storage protocol), transport, distribute, and track medical
materiel (e.g., pharmaceuticals, gloves, masks, and ventilators) during an incident and
to recover and account for unused medical materiel, as necessary, after an incident.137
This capability consists of the ability to perform the following functions:
Function 1: Direct and activate medical materiel management and distribution
Function 2: Acquire medical materiel
Function 3: Maintain updated inventory management and reporting system
Function 4: Establish and maintain security
Function 5: Distribute medical materiel
Function 6: Recover medical materiel and demobilize distribution operations

Function 1: Direct and activate medical materiel management and distribution
Coordinate logistical operations and medical materiel requests when an incident exceeds the capacity of the jurisdiction’s normal
supply chain, including the support and activation of staging operations to receive and/or transport additional medical materiel.
This should be accomplished at the request of the incident commander and in coordination with jurisdictional emergency
management.

Tasks

This function consists of the ability to perform the following tasks:
Task 1: Prior to an incident, identify receiving sites for responses of varying sizes and durations.
Task 2: Prior to an incident, identify transportation assets from commercial and/or government sources and create a
transportation asset list.
Task 3: Prior to and when applicable during an incident, Identify and coordinate with medical materiel suppliers and distributors
within the jurisdiction to assess resource availability and potential distribution challenges (e.g., transport of materiel
through restricted areas).
Task 4: Prior to and when applicable during an incident, identify staffing needs for receiving sites (e.g., numbers and skills of
personnel). (For additional or supporting detail, see Capability 15: Volunteer Management)
Task 5: During an incident, monitor medical materiel levels at supporting medical and health-related agencies and organizations
by collecting data on materiel availability at least once per week, but potentially more frequently as determined by
incident needs. (For additional or supporting detail, see Capability 10: Medical Surge)
Task 6: During an incident at the request of the incident commander, activate receiving sites dependent on incident needs.138
(For additional or supporting detail, see Capability 3: Emergency Operations Coordination )
Task 7: During an incident at the request of the incident commander, select transportation assets from pre-identified asset list,
dependent on incident needs.

Performance Measure(s)

This function is associated with the following CDC-defined performance measure:
Measure 1: Composite performance indicator from the Division of Strategic National Stockpile (DSNS) in CDC’s Office of Public
Health Preparedness and Response.
This indicator can be found on the DSNS extranet: http://emergency.cdc.gov/stockpile/extranet (password protected
site).

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CAPABILITY 9: Medical Materiel Management and Distribution
Function 1: Direct and activate medical materiel management and distribution
Resource Elements

Note: Jurisdictions must have or have access to the resource elements designated as Priority.
P1: (Priority) Written plans should include documentation of primary and backup receiving sites that take into consideration
federal Strategic National Stockpile recommendations.139,140 Written plans should include the following elements:
–
–
–
–
–
–
–

Type of site (commercial vs. government)
Physical location of site
24-hour contact number
Hours of operation
Inventory of material-handling equipment on-site and list of minimum materials that need to be procured and/
or delivered at the time of the incident141,142
Inventory of office equipment on-site and list of minimum materials that need to be procured and/or delivered
at the time of the incident143,144
Inventory of storage equipment (e.g., refrigerators and freezers) on-site and list of minimum materials/supplies
that need to be procured and/or delivered at the time of the incident

PLANNING (P)

P2: (Priority) Written plans should include transportation strategy.145,146 If public health will be transporting material using
their own vehicles, plan should include processes for cold chain management, if necessary to the incident. If public
health will be using outside vendors for transportation, there should be a written process for initiating transportation
agreements (e.g., contracts, memoranda of understanding, formal written agreements, and/or other letters of
agreement). Transportation agreements should include, at a minimum, the following elements:
–
–
–
–
–
–

Type of vendor (commercial vs. government)
Number and type of vehicles, including vehicle load capacity and configuration
Number and type of drivers, including certification of drivers
Number and type of support personnel
Vendor’s response time
Vendor’s ability to maintain cold chain, if necessary to the incident

In addition to this process, public health should have written evidence of a relationship with outside transportation
vendors.147,148 This relationship may be demonstrated by a signed transportation agreement or documentation of
transportation planning meeting with the designated vendor.
P3: (Priority) Written plans should include protocols for medical and health-related agencies and organizations to report
medical materiel levels to public health at least weekly, but potentially more frequently. (For additional or supporting
detail, see Capability 6: Information Sharing)
P4: Written plans should include a list of, and points of contact for, medical materiel suppliers and distributors within the
jurisdiction.
P5: Written plans should include a process to collect and analyze medical and social demographic information of the
jurisdiction’s population to plan for the types of medications, durable medical equipment, or consumable medical
supplies that may need to be provided during an incident, including supplies needed for the functional needs of at-risk
individuals.149 (For additional or supporting detail, see Capability 1: Community Preparedness)
P6: Written plans should include processes for activating personnel, taking the following into consideration:
– Process for personnel badging150,151
– Process for training personnel, including the provision of job-action sheets for just-in-time training152
– Process for requesting additional personnel from outside the jurisdiction, if needed153
(For additional or supporting detail, see Capability 15: Volunteer Management)

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CAPABILITY 9: Medical Materiel Management and Distribution
Function 1: Direct and activate medical materiel management and distribution
PLANNING (P)

Resource Elements (continued)
P7: Written plans should include a list of key stakeholders (including points of contact at dispensing sites, treatment
locations, intermediary distribution sites, and/or closed sites) and protocols for communicating the activation of
medical materiel management and distribution to these stakeholders. Written plans should also include protocols for
stakeholders to request medical materiel from health departments.154,155,156

S1: Public health staff should understand their role in emergency response.
Suggested resources

SKILLS AND TRAINING (S)

–
–

Federal Emergency Management Agency Emergency Support Function #8 – Public Health and Medical Services
(IS-808): http://training.fema.gov/EMIWeb/IS/IS808.asp
Public Health Worker Competencies for Emergency Response, by K. Gebbie and J. Merrill. 2002. J Public Health
Management Practice. 8(3) 73-81.

S2: Public health staff participating in medical materiel efforts should understand the following roles, and job-action
sheets157 should be available: 158,159,160
–
–
–
–

Logistics161
Security coordination
Receiving site leader (if applicable)
Distribution leader (if applicable)162,163

Suggested resources
–
–

Receiving, Distributing, and Dispensing Strategic National Stockpile Assets: A Guide for Preparedness, version
10.02, August 2006: https://www.orau.gov/snsnet/resources/SNSPlanningGuideV10.02.pdf
Strategic National Stockpile Conferences and Training: https://www.orau.gov/snsnet/conferences.htm

EQUIPMENT AND TECHNOLOGY (E)

E1: Have or have access to transportation assets for transporting and distributing medical materiel.
E2: Have or have access to interoperable systems for coordinating medical materiel distribution.

Function 2: Acquire medical materiel
Obtain medical materiel from jurisdictional caches and request materiel from jurisdictional, private, regional, or federal partners,
as necessary.

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CAPABILITY 9: Medical Materiel Management and Distribution
Function 2: Acquire medical materiel
Tasks

This function consists of the ability to perform the following tasks:
Task 1: Request and accept medical materiel from jurisdictional, private, regional, or federal partners in alignment with National
Incident Management System standards and incident needs.
Task 2: Maintain integrity of medical materiel in accordance with manufacturer specifications164 during acquisition and storage.

Performance Measure(s)

This function is associated with the following CDC-defined performance measure:
Measure 1: Composite performance indicator from the Division of Strategic National Stockpile (DSNS) in CDC’s Office of Public
Health Preparedness and Response.
This indicator can be found on the DSNS extranet: http://emergency.cdc.gov/stockpile/extranet (password protected
site).

Resource Elements

Note: Jurisdictions must have or have access to the resource elements designated as Priority.
P1: (Priority) Written plans should include a process to request medical materiel (initial request and re-supply requests),
including memoranda of understanding and mutual aid agreements with state/local partners if applicable.165,166,167 These
plans should consider the following elements:
–
–
–

PLANNING (P)

–
–

–
–

Assessment of local inventory/medical countermeasure caches168
Identification of local pharmaceutical and medical-supply wholesalers
Assessment of asset request trigger indicators, thresholds, and validation strategies to guide decisionmaking169,170,171,172
A process for requesting medical countermeasures through the Emergency Management Assistance Compact
A process for requesting medical countermeasures from the federal level, which takes into account
□□ Stafford Act vs. non-Stafford Act declarations
□□ National Emergencies Act
□□ Coordination between federal and state resources, including memoranda of understanding between
CDC and the state173
□□ Role of U.S. Department of Health and Human Services Regional Emergency Coordinators, if necessary
to the incident:
http://www.phe.gov/Preparedness/responders/rec/Pages/contacts.aspx
A process for justifying medical countermeasure requests174
If sites decide to purchase their own medical countermeasures, they are required to meet regulatory standards
(i.e., abide by U.S. Food and Drug Administration standards including current good manufacturing practices
(cGMP), have appropriate Drug Enforcement Administration registrations, and be responsible to fund and track
medical countermeasures rotation)

Suggested resources
–

Requesting Strategic National Stockpile Assets:
https://www.orau.gov/snsnet/functions/requesting.htm
– Sample Memorandum of Agreement. Receiving, Distributing, and Dispensing Strategic National Stockpile Assets:
A Guide for Preparedness, Version 10.02, Appendix I:
https://www.orau.gov/snsnet/resources/SNSPlanningGuideV10.02.pdf
– U.S. Food and Drug Administration Current Good Manufacturing Practices/Compliance:
http://www.fda.gov/Drugs/GuidanceComplianceRegulatoryInformation/Guidances/ucm064971.htm
(For additional or supporting detail, see Capability 1: Community Preparedness)

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CAPABILITY 9: Medical Materiel Management and Distribution
Function 2: Acquire medical materiel

PLANNING (P)

Resource Elements (continued)
P2: Written plans should include a protocol for medical materiel storage taking into consideration, if applicable, the following
elements:
–
–
–
–

Maintenance of cleanliness and packaging
Storage of controlled substances
Maintenance of cold chain during storage
Requirements of the jurisdiction’s vaccine provider agreement

S1: Public health staff participating in medical materiel efforts should understand protocols for requesting, receiving, and
distributing medical materiel.
Suggested resources

SKILLS AND TRAINING (S)

–

–
–
–

Extranet for the Division of Strategic National Stockpile in CDC’s Office of Public Health Preparedness and
Response: http://emergency.cdc.gov/stockpile/extranet (password protected site)
□□ Receiving, Distributing, and Dispensing Strategic National Stockpile Assets: A Guide for Preparedness,
version 10.02, August 2006
□□ Strategic National Stockpile Local Technical Assistance Review User Guide
□□ Strategic National Stockpile State Technical Assistance Review User Guide
Strategic National Stockpile Receiving, Staging, and Storing Course
CDC Emergency Use Authorization Online Course
Food and Drug Administration Emergency Use Authorization of Medical Products Guidance:
http://www.fda.gov/RegulatoryInformation/Guidances/ucm125127.htm

S2: Public health staff participating in medical materiel efforts should be trained on cold chain management techniques,
including the use of temperature monitoring equipment.
Suggested resources
–
–
–
–
–

Jurisdictional cold chain management procedures
CDC National Center for Immunization and Respiratory Diseases’ Vaccine Storage and Handling Toolkit:
http://www2a.cdc.gov/vaccines/ed/shtoolkit/pages/introduction.htm
Pink Book’s Storage and Handling Information:
http://www.cdc.gov/vaccines/pubs/pinkbook/downloads/appendices/C/storage-handling.pdf
Cold chain standards (International Safe Transit Association STD-7E and STD-20 for Thermal Lane Data packaging,
International Air Transportation Association manual Chapter 17)
U.S. Army Medical Department Cold Chain Management Processes and Procedures for all Medical Temperature
Sensitive Products: http://www.usamma.army.mil/cold_chain_management.cfm

S3: Logistics personnel should understand how to apply supply chain tools if applicable to the incident.
Suggested resources
–
–

Enhanced Logistics Intra-Theater Support Tool: http://www.dis.anl.gov/pubs/60467.pdf
Logistics and Process Analysis Tool: http://www.dis.anl.gov/projects/lpat.html

S4: Designated personnel with pharmaceutical licenses should be identified if appropriate to the incident and, if necessary,
to comply with jurisdictional laws and regulations to assist in medical materiel management throughout the life of the
materiel. This includes acquisition, receipt, storage, transport, recovery, disposal of, and return or loss.  

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CAPABILITY 9: Medical Materiel Management and Distribution
Function 2: Acquire medical materiel
EQUIPMENT AND TECHNOLOGY (E)

Resource Elements (continued)
E1: Have or have access to receiving site materiel-handling equipment for medical materiel acquisition.175 Examples include
pallet jacks, handcarts/dollies, and forklifts.
E2: Have or have access to equipment for maintaining and monitoring temperature, if indicated by the incident [e.g.,
refrigerator (used solely for storing materiel), Temp-Tell, Vaxi-Cool, or other equipment as suggested by cold chain
management guidance].

Function 3: Maintain updated inventory management and reporting system
Maintain inventory system for the jurisdiction’s medical materiel for the life of the materiel, including acquisition, receipt, storage,
transport, recovery, disposal, and return or loss.  

Tasks

This function consists of the ability to perform the following tasks:
Task 1: Conduct initial inventory and update inventory management system with incoming and outgoing medical materiel, and
materiel that is recovered, returned, or disposed of.
Task 2: Provide inventory status reports to jurisdictional, state, regional, and federal authorities at least weekly during an
incident, but potentially more frequently. (For additional or supporting detail, see Capability 6: Information Sharing)
Task 3: Track re-supply requests for medical materiel. (For additional or supporting detail, see Capability 3: Emergency Operations
Coordination)

Performance Measure(s)

This function is associated with the following CDC-defined performance measure:
Measure 1: Composite performance indicator from the Division of Strategic National Stockpile (DSNS) in CDC’s Office of Public
Health Preparedness and Response.
This indicator can be found on the DSNS extranet: http://emergency.cdc.gov/stockpile/extranet (password protected
site).

Resource Elements

PLANNING (P)

Note: Jurisdictions must have or have access to the resource elements designated as Priority.
P1: (Priority) Written plans should include protocols for reporting to jurisdictional, state, regional, and federal authorities. At
a minimum, report should include the following elements:
–

Amount of materiel received (including receipt date/time and name of individual who accepted custody of
materiel)
– Amount of materiel distributed
– Amount of materiel expired
– Current available balance of materiel
(For additional or supporting detail, see Capability 6: Information Sharing)

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CAPABILITY 9: Medical Materiel Management and Distribution
Function 3: Maintain updated inventory management and reporting system
P2: Written plans should include protocols for dispensing sites, treatment locations, intermediary distribution sites, and/
or closed sites to request additional medical materiel in accordance with National Incident Management System
protocol.176,177 At a minimum, request should include the following elements:

SKILLS AND TRAINING (S)

– Date of request
– Date materiel is required
– Receiving site location
– Distribution strategy (e.g., distribution through established channels or direct-ship from vendor)
(For additional or supporting detail, see Capability 3: Emergency Operations Coordination)
S1: Inventory management personnel should be trained and able to use inventory management system.178,179

EQUIPMENT AND TECHNOLOGY (E)

PLANNING (P)

Resource Elements (continued)

E1: Have or have access to a system to manage inventory; system can be manual or automated, electronic, or paperbased.180,181,182
–
–

At a minimum, system should be able to track the name of drug, quantity, National Drug Code, lot number,
dispensing site or treatment location, expiration date, and unit configuration of issue (e.g., case, box, or bottles)
System must also have a backup which can be inventory management software, electronic spreadsheets, or
paper.

Suggested resources
–
–

Receive, Stage and Store Inventory Tracking System: https://rits.cdc.gov/sitemap/index.htm
Division of Strategic National Stockpile Inventory Management System in CDC’s Office of Public Health
Preparedness and Response

Function 4: Establish and maintain security
In coordination with emergency management and jurisdictional law enforcement, secure personnel and medical materiel during
all phases of transport and ensure security for receiving site and distribution personnel.

Tasks

This function consists of the ability to perform the following tasks:
Task 1: Identify receiving sites from pre-identified locations and determine which sites may require increased security (such as
controlled-substance storage areas).
Task 2: At the time of the incident, if necessary, identify additional receiving sites and determine which sites may require
increased security (such as controlled-substance storage areas).
Task 3: Identify, acquire, and maintain security measures183 at receiving sites and during transportation to points of dispensing, if
applicable to the incident. (For additional or supporting detail, see Capability 3: Emergency Operations Coordination)
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CAPABILITY 9: Medical Materiel Management and Distribution
Function 4: Establish and maintain security
Performance Measure(s)

This function is associated with the following CDC-defined performance measure:
Measure 1: Composite performance indicator from the Division of Strategic National Stockpile (DSNS) in CDC’s Office of Public
Health Preparedness and Response.
This indicator can be found on the DSNS extranet: http://emergency.cdc.gov/stockpile/extranet (password protected
site).

Resource Elements

PLANNING (P)

Note: Jurisdictions must have or have access to the resource elements designated as Priority.
P1: (Priority) Written plans should include processes and protocols that address the maintenance of physical security
of medical countermeasures throughout acquisition, storage, and distribution,184,185 and include, at a minimum, the
following elements:
–
–
–
–

Contact information for security coordinator
Coordination with law enforcement and security agencies to secure personnel and facility
Acquisition of physical security measures (e.g., cages, locks, and alarms) for materiel within the receiving site
Maintenance of security of medical materiel in transit186,187

SKILLS AND TRAINING (S)

S1: Designated personnel with current Drug Enforcement Administration license should be identified to sign for controlled
substances throughout chain of custody of medical materiel.188,189

EQUIPMENT AND TECHNOLOGY (E)

P2: Written plans should include an inventory of security measures at receiving sites and list of minimum security measures
that need to be procured and/or delivered at the time of the incident. Lists should be updated at the time of the incident
to reflect incident-specific needs.

E1: Have or have access to physical security measures (e.g., cages, locks, and alarms) for maintaining security of materiel
within the receiving site.

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CAPABILITY 9: Medical Materiel Management and Distribution
Function 5: Distribute medical materiel
Distribute medical materiel to modalities (e.g., dispensing sites, treatment locations, intermediary distribution sites, and/or closed
sites).

Tasks

This function consists of the ability to perform the following tasks:
Task 1: Determine allocation and distribution strategy, including delivery locations, routes, and delivery schedule/frequency,
based on incident needs.
Task 2: Maintain integrity of medical materiel in accordance with established safety and manufacturer specifications190 during all
phases of transport and distribution.

Performance Measure(s)

This function is associated with the following CDC-defined performance measure:
Measure 1: Composite performance indicator from the Division of Strategic National Stockpile (DSNS) in CDC’s Office of Public
Health Preparedness and Response.
This indicator can be found on the DSNS extranet: http://emergency.cdc.gov/stockpile/extranet (password protected
site).

Resource Elements

Note: Jurisdictions must have or have access to the resource elements designated as Priority.
P1: (Priority) Written plans should include an allocation and distribution strategy including delivery locations, routes, and
delivery schedule/frequency, and should take into consideration the transport of materials through restricted areas.
The strategy should also consider whether recipients will be responsible for acquiring materiel from an intermediary
distribution site or if the health department is responsible for delivering materiel.191,192

PLANNING (P)

Suggested resources
–
–

Receiving, Distributing, and Dispensing Strategic National Stockpile Assets: A Guide for Preparedness, version
10.02, Chapter 9: Controlling Strategic National Stockpile Inventory:
https://www.orau.gov/snsnet/resources/Chapter9_ac.pdf
Receiving, Distributing, and Dispensing Strategic National Stockpile Assets: A Guide for Preparedness, version
10.02, Chapter 11: Distributing Strategic National Stockpile Assets:
https://www.orau.gov/snsnet/resources/Chapter11_ac.pdf

P2: Written plans should include a list of key stakeholders (including points of contact at dispensing sites, treatment
locations, intermediary distribution sites, and/or closed sites) and protocols for communicating the distribution strategy
to these stakeholders.

SKILLS AND TRAINING (S)

P3: Written plans should include agreements with dispensing sites, treatment locations, intermediary distribution sites,
and/or closed sites to ensure they record readings of temperature-controlled items in accordance with cold-chain
management standards.
S1: Public health staff involved in medical materiel distribution should understand protocols for handling materiel and
understand the allocation and distribution strategy.

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CAPABILITY 9: Medical Materiel Management and Distribution
Function 6: Recover medical materiel and demobilize distribution operations
Recover remaining medical materiel in accordance with jurisdictional policies and federal regulations and demobilize distribution
operations as required by incident needs.

Tasks

This function consists of the ability to perform the following tasks:
Task 1: Recover materiel and equipment according to jurisdictional policies and federal regulations.
Task 2: Determine the disposition of unused (unopened) medical materiel, unused pharmaceuticals, and durable items within
the jurisdictional health system according to jurisdictional policies.
Task 3: Dispose of biomedical waste materials generated by medical materiel management operations according to
jurisdictional policies.
Task 4: Scale down distribution operations by deactivating receiving sites and releasing personnel as appropriate to evolving
incident needs and in accordance with National Incident Management System protocol. (For additional or supporting
detail, see Capability 10: Medical Surge and Capability 15: Volunteer Management)
Task 5: Document incident findings as part of after action report process.

Performance Measure(s)

This function is associated with the following CDC-defined performance measure:
Measure 1: Composite performance indicator from the Division of Strategic National Stockpile (DSNS) in CDC’s Office of Public
Health Preparedness and Response.
This indicator can be found on the DSNS extranet: http://emergency.cdc.gov/stockpile/extranet (password protected
site).

Resource Elements

Note: Jurisdictions must have or have access to the resource elements designated as Priority.

PLANNING (P)

P1: (Priority) Written plans should include protocols for the storage, distribution, disposal, or return of unused (unopened)
medical materiel, unused pharmaceuticals, and durable items, including plans for maintaining integrity of medical
materiel during storage and/or distribution within the jurisdictional health system.
P2: Written plans should include protocols for demobilizing operations, including release of personnel, closure of receiving
sites, and recovery of biomedical waste in coordination with emergency management.
P3: Written plans should include protocols for completing an after-action report in compliance with National Incident
Management System protocol and Homeland Security Exercise and Evaluation Program guidance. Report should include
a timeline with critical time points to validate process operations.193
Suggested resources
–
–
–

Homeland Security Exercise and Evaluation Program: https://hseep.dhs.gov/pages/1001_HSEEP7.aspx
Public Health Emergency Preparedness Cooperative Agreement/Division of Strategic National Stockpile/
Technical Assistance Reviews, Drills & Exercises Guide (January 2011)
Division of Strategic National Stockpile Drill, Exercise and After Action Report Reporting:
https://www.orau.gov/snsnet/resources/guidance/Drill-Ex-Data-Collection-Qs-2011-01-03_ac.pdf

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CAPABILITY 9: Medical Materiel Management and Distribution
Function 6: Recover medical materiel and demobilize distribution operations
Resource Elements (continued)
S1: Public health staff participating in medical materiel efforts should understand established protocols for disposal of
unused (unopened) medical materiel, unused pharmaceuticals, and durable items.
Suggested resources

SKILLS AND TRAINING (S)

–
–
–
–
–

Jurisdictional protocols for disposing of biomedical waste materials
Sample Memorandum of Agreement. Receiving, Distributing, and Dispensing Strategic National Stockpile Assets:
A Guide for Preparedness, Version 10.02, Appendix I:
https://www.orau.gov/snsnet/resources/SNSPlanningGuideV10.02.pdf
Sharps disposal: http://www.safeneedledisposal.org/resslaws.html
Transfer of title document
Medical Waste Management System Training Program:
http://www.inquisit.org/mwms

S2: Public health staff participating in medical materiel efforts should understand established protocols for after-action
reporting.
Suggested resources
–
–
–
–

A Federal Emergency Management Agency Introduction to Exercises (IS 120.a):
http://training.fema.gov/EMIWeb/IS/IS120A.asp
Federal Emergency Management Agency Exercise Evaluation and Improvement Planning (IS 130):
http://training.fema.gov/EMIWeb/IS/IS130.asp
Public Health Emergency Preparedness Cooperative Agreement/Division of Strategic National Stockpile/
Technical Assistance Reviews, Drills & Exercises Guide (January 2011)
Division of Strategic National Stockpile Drill, Exercise and After Action Report Reporting:
https://www.orau.gov/snsnet/resources/guidance/Drill-Ex-Data-Collection-Qs-2011-01-03_ac.pdf

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CAPABILITY 10: Medical Surge
Medical surge is the ability to provide adequate medical evaluation and care during
events that exceed the limits of the normal medical infrastructure of an affected
community.194 It encompasses the ability of the healthcare system to survive a hazard
impact and maintain or rapidly recover operations that were compromised.195
This capability consists of the ability to perform the following functions:
Function 1: Assess the nature and scope of the incident
Function 2: Support activation of medical surge
Function 3: Support jurisdictional medical surge operations
Function 4: Support demobilization of medical surge operations

Function 1: Assess the nature and scope of the incident
In conjunction with jurisdictional partners, coordinate with the jurisdiction’s healthcare response through the collection and
analysis of health data (e.g., from emergency medical services, fire service, law enforcement, public health, medical, public works,
utilization of incident command system, mutual aid agreements, and activation of Emergency Management Assistance Compact
agreements) to define the needs of the incident and the available healthcare staffing and resources.

Tasks

This function consists of the ability to perform the following task:
Task 1: At the time of an incident, participate in a unified incident management structure. (For additional or supporting detail, see
Capability 3: Emergency Operations Coordination)
Task 2: At the time of an incident, complete a preliminary assessment of the incident and document initial resource needs
and availability (e.g., personnel, facilities, logistics, and other healthcare resources). (For additional or supporting detail,
see Capability 3: Emergency Operations Coordination, Capability 7: Mass Care, Capability 9: Medical Materiel Management
and Distribution, Capability 13: Public Health Surveillance and Epidemiological Investigation, and Capability 15: Volunteer
Management)
Task 3: At the time of an incident, provide health-related data to healthcare organizations or healthcare coalitions that will assist
the healthcare organizations or healthcare coalitions in activating their pre-existing plans to maximize scarce resources
and prepare for any necessary shifts into and out of conventional, contingency, and crisis standards of care.

Performance Measure(s)

At present there are no CDC-defined performance measures for this function.

Resource Elements

PLANNING (P)

Note: Jurisdictions must have or have access to the resource elements designated as Priority.
P1: (Priority) Written plans should include documentation of staff assigned and trained in advance to fill public health
incident management roles as applicable to a given response. Health departments must be prepared to staff emergency
operations centers at agency, local, and state levels as necessary.196,197,198 (For additional or supporting detail, see
Capability 3: Emergency Operations Coordination)
P2: (Priority) Written plans should include documentation that all joint (e.g., healthcare organizations, public health, and
emergency management) emergency incidents, exercises, and preplanned (i.e., recurring or special) events operate in
accordance with Incident Command Structure organizational structures, doctrine, and procedures, as defined in the
National Incident Management System.199,200 (For additional or supporting detail, see Capability 3: Emergency Operations
Coordination)
P3: (Priority) Written plans should include process to ensure access into the jurisdiction’s bed-tracking system to maintain
visibility of bed availability across the jurisdiction.
Suggested resources
––

Hospital Preparedness Program, Office of the Assistant Secretary of Preparedness and Response:

U.S. Department of Health and Human Services
Centers for Disease Control and Prevention

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CAPABILITY 10: Medical Surge
Function 1: Assess the nature and scope of the incident
Resource Elements (continued)
––

http://www.phe.gov/preparedness/planning/hpp
Hospital Preparedness Program Guidance FY10:
http://www.phe.gov/preparedness/planning/hpp/Documents/fy10_hpp_guidance.pdf

P4: (Priority) Written plans should include processes to engage in healthcare coalitions and understand the role that each
coalition partner will play to obtain and provide situational awareness.201,202,203 Coalitions are not expected to replace
or relieve healthcare systems of their institutional responsibilities during an emergency, or to subvert the authority and
responsibility of the state or local jurisdiction. The purpose of jurisdictional healthcare coalitions is as follows:
–

PLANNING (P)

–

Integrate plan and activities of all participating healthcare systems into the jurisdictional response plan and the
state response plan
Increase medical response capabilities in the community, region and state
□□ Prepare for the needs of at-risk individuals and the general population in their communities in the event
of a public health emergency
□□ Coordinate activities to minimize duplication of effort and ensure coordination among federal, state,
local and tribal planning, preparedness, response, and de-escalation activities
□□ Maintain continuity of operations in the community vertically with the local jurisdictional emergency
management organizations
□□ Unify the management capability of the healthcare system to a level that will be necessary if the normal
day-to-day operations and standard operating procedures of the health system are overwhelmed, and
disaster operations become necessary
□□ Support sufficient jurisdiction-wide situational awareness to ensure that the maximum number of
people requiring care receive safe and appropriate care, which may involve, but is not limited to,
facilitating the triage and/or distribution of people requiring care to appropriate facilities throughout
the jurisdiction and providing appropriate support to these facilities to support the provision of optimal
and safe care to those individuals

Suggested resource
–

Medical Surge Capacity and Capability: A Management System for Integrating Medical and Health Resources
During Large-Scale Emergencies:
http://www.phe.gov/preparedness/planning/mscc/handbook/pages/default.aspx

P5: (Priority) Written plans should include processes (e.g., MOUs or other written agreements) to work in conjunction
with emergency management, healthcare organizations, coalitions, and other partners to develop written strategies
that clearly define the processes and indicators as to when the jurisdiction’s healthcare organizations and health care
coalitions transition into and out of conventional, contingency, and crisis standards of care.204 Jurisdiction should utilize
the risk assessment to build jurisdiction-specific strategies and triggers.205,206 (For additional or supporting detail, see
Capability 1: Community Preparedness)
Suggested resources
–

Guidance for Establishing Crisis Standards of Care for Use in Disaster Situations: A Letter Report, Institute of
Medicine, 2009. Examples of triggers for action identified (by the Institute of Medicine in 2009) include:
□□ Critical infrastructure disruption
□□ Disruption of facility or community infrastructure and function (e.g., utility or system failure in
healthcare organization, more than one hospital affected in the region, and more than five hospitals
affected or critical-access hospital affected in the state)
□□ Failure of ‘contingency’ surge capacity (i.e., resource-sparing strategies overwhelmed)
□□ Human resource/staffing availability
□□ Emergency medical services call volume twice the usual amount
□□ Emergency department wait time more than 12 hours
□□ Staff illness rate more than 10%
□□ Material resource availability
□□ Less than 5% ventilators available in healthcare organization

U.S. Department of Health and Human Services
Centers for Disease Control and Prevention

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CAPABILITY 10: Medical Surge
Function 1: Assess the nature and scope of the incident
Resource Elements (continued)
Patient care space availability
Overall hospital bed availability less than 5% available or no available beds or less than 12 beds in
healthcare organization
□□ No intensive care unit bed availability in healthcare Organization
□□ Disaster declaration in more than one area hospital in the region or more than two major hospitals in
the state
Mass Medical Care with Scarce Resources: A Community Planning Guide http://www.ahrq.gov/research/mce/
Abbreviated version, The Essentials http://www.ahrq.gov/prep/mmcessentials/
□□
□□

–
–

P6: Written plans should include documentation that public health has participated in/collaborated in the development of
jurisdictional healthcare organizations emergency operations plans and standard operating procedures, incorporating
National Incident Management System and National Response Framework components, principles, and policies in their
planning, training, response, exercises, equipment, evaluation, and corrective actions.207,208,209
Suggested resources

PLANNING (P)

–
–
–
–
–

Medical Surge Capacity and Capability: A Management System for Integrating Medical and Health Resources
During Large-Scale Emergencies:
http://www.phe.gov/preparedness/planning/mscc/handbook/pages/default.aspx
Medical Surge Capacity and Capability: The Healthcare Coalition in Emergency Response and Recovery:
http://www.phe.gov/Preparedness/planning/mscc/healthcarecoalition/Pages/default.aspx
National Health Security Strategy:
http://www.phe.gov/Preparedness/planning/authority/nhss/strategy/Documents/nhss-final.pdf
Homeland Security Presidential Directive 5:
http://www.dhs.gov/xabout/laws/gc_1214592333605.shtm
Hospital Preparedness Exercise Pocket Guide: http://www.ahrq.gov/prep/hosppcktgd/hosppcktgd.pdf

P7: Written plans should include lists and points of contact for potential surge operation partners, including, but not
limited to the following elements:
–
–
–
–

Emergency medical services
Fire service
Law enforcement
Healthcare organizations

P8: Written plans should include a process for ongoing communications and data sharing with 911 and emergency
medical services. This may include requesting and utilizing National Emergency Medical Services Information System
interoperable emergency medical services response data such as the following:
–
–
–
–
–
–
–
–

Incident street address
Complaint reported by dispatch
Provider’s primary impression
Mass casualty incident
Destination/transferred to, name
Type of destination
Reason for choosing destination
Hospital disposition

Suggested resources

– National Emergency Medical Services Information System Data Dictionary Version 3.0 (www.nemsis.org)

–
–

Emergency Medical Services: www.ems.gov
National 911 Program: www.911.gov

U.S. Department of Health and Human Services
Centers for Disease Control and Prevention

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CAPABILITY 10: Medical Surge
Function 1: Assess the nature and scope of the incident
Resource Elements (continued)

EQUIPMENT AND TECHNOLOGY (E)

SKILLS AND TRAINING (S)

S1: Public health personnel who may participate in medical surge operations should be aware of how to use local and state
National Emergency Medical Services Information System and 911 data.
S2: Public health staff who may participate in medical surge operations should be trained to use the jurisdictional bedtracking system to obtain data for jurisdictional situational awareness activities.
S3: Staff should understand the role of the public health department in incident management as described in the following
resources:210,211

– Emergency Support Function #8 – Public Health and Medical Services (IS-808)
–
–
–
–

Introduction to Incident Command System (IS-100.b)
Incident Command System for Single Resources and Initial Action Incidents (IS-200.b)
National Incident Management System, An Introduction (IS-700.a)
National Response Framework, An Introduction (IS-800.b)

E1: Have or have access to a computer with primary and back-up internet connection to access local and state National
Emergency Medical Services Information System, 911 data, or access bed-tracking data. (Does not apply to territories)
E2: Have or have access to the jurisdictional bed-tracking system that complies with current Hospital Preparedness Program
standards.
E3: Bed-tracking data are to be reported in aggregate by the state, therefore the state must have a system that collects
bed-tracking data from the participating healthcare systems, or states may use existing systems to automatically transfer
required data to the HAvBED server using the HAvBED EDXL Communication Schema, found at
https://havbed.hhs.gov/v2/
Suggested resources
–
–

Further information on the HAvBED system can be found at www.ahrq.gov/prep/havbed/
HAvBED Communications Schema: https://havbed.hhs.gov/v2/

Function 2: Support activation of medical surge
Support healthcare coalitions and response partners in the expansion of the jurisdiction’s healthcare system (includes additional
staff, beds and equipment) to provide access to additional healthcare services (e.g., call centers, alternate care systems, emergency
medical services, emergency department services, and inpatient services) in response to the incident.

Tasks

This function consists of the ability to perform the following tasks:
Task 1: If indicated, support the mobilization of incident-specific medical treatment personnel, public health personnel, and nonmedical support personnel to increase capacity (e.g., healthcare organizations and alternate care facilities). (For additional
or supporting detail, see Capability 7: Mass Care and Capability 15: Volunteer Management )
Task 2: During an incident, assist healthcare organizations and healthcare coalitions in the activation of alternate care facilities if
requested.
Task 3: During an incident, assist in the expansion of the healthcare system (inclusive of healthcare coalitions), which includes
hospitals and non-hospital entities (e.g., call centers, 911/emergency medical services, home health, ambulatory care
providers, long-term care, and poison control centers).
Task 4: At the time of an incident, support situational awareness by utilizing the ongoing real-time exchange of information
among response partners and coalitions (e.g., emergency medical services, fire, law enforcement, public health, and
public works). (For additional or supporting detail, see Capability 6: Information Sharing)
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Centers for Disease Control and Prevention

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CAPABILITY 10: Medical Surge
Function 2: Support activation of medical surge
Tasks (continued)
Task 5: During an incident, provide information to educate the public, paying special attention to the needs of at-risk individuals
(e.g., information is linguistically appropriate, culturally sensitive, and sensitive to varied literacy levels) regarding changes
to the availability of healthcare services. (For additional or supporting detail, see Capability 1: Community Preparedness,
Capability 2: Community Recovery, and Capability 4: Emergency Public Information and Warning)

Performance Measure(s)

At present there are no CDC-defined performance measures for this function.

Resource Elements

Note: Jurisdictions must have or have access to the resource elements designated as Priority.
P1: (Priority) Written plans should include the following elements:
–

Documentation of process or protocol for how the health agency will access volunteer resources through the
Emergency System for Advance Registration of Volunteer Health Professionals (ESAR-VHP) and the Medical
Reserve Corps program of credentialed personnel available for assistance during an incident.212
– Documentation of processes for coordinating with health professional volunteer entities (e.g., MRC) and other
personnel resources from various levels. (ESAR-VHP Compliance Requirements)213, 214
(For additional or supporting detail, see Capability 15: Volunteer Management)
P2: (Priority) Written plans should include documentation of the process for how the public health agency will engage in
healthcare coalitions and other response partners regarding the activation of alternate care systems.215 Documentation
should also include the following elements:

PLANNING (P)

–
–
–

Written list of healthcare organizations with alternate care system plans
Written list of home health networks and types of resources available that are able to assist in incident response
List of pre-identified site(s) that have undergone an initial assessment to determine their adequacy to serve as an
alternate care facility
(For additional or supporting detail, see Capability 7: Mass Care)
Suggested resource
–

Disaster Alternate Care Facility Selection Tool: http://www.ahrq.gov/prep/acfselection/index.html

P3: (Priority) Written plans should include processes and protocols to identify essential situational awareness information for
federal, state, local, and non-governmental agencies; private sector agencies; and other Emergency Support Function # 8
partners. Jurisdictional processes to identify essential situational awareness requirements should consider the following
elements:
– Identifying essential information
– Defining required information
– Establishing requirements
– Determining common operational picture elements
– Identifying data owners
– Validating data with stakeholders
(For additional or supporting detail, see Capability 6: Information Sharing)
P4: (Priority) Written plans should include documentation of participation from jurisdictional and regional pediatric
providers and leaders from a variety of settings (e.g., maternal and child health programs, clinic-based, hospital-based,
home healthcare, and rehabilitation) in jurisdictional response planning.216, 217, 218 Plans should include but are not
limited to the following elements:
–
–

Process to identify gaps in the provision of pediatric care
Process to access pediatric providers or pediatric medical liaisons for consultation related to clinical care. In order
to access the appropriate level of care or consultation, plans should include lists of healthcare organizations that
can stabilize and/or manage pediatric traumatic and medical emergencies and that have written inter-facility
transfer agreements that cover pediatric patients.

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Centers for Disease Control and Prevention

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CAPABILITY 10: Medical Surge
Function 2: Support activation of medical surge
Resource Elements (continued)
Suggested resources
–
–
–

Pediatric Hospital Surge Capacity in Public Health Emergencies:
http://www.ahrq.gov/prep/pedhospital/
Coordinating Pediatric Medical Care During an Influenza Pandemic:
http://emergency.cdc.gov/healthcare/pdf/hospital_workbook.pdf
Health Resources and Services Administration’s Emergency Medical Services for Children website:
http://bolivia.hrsa.gov/emsc/

P5: Written plans should include process to connect healthcare organizations and providers with additional volunteers or
other personnel (through ESAR-VHP, the Medical Reserve Corps, or the National Disaster Medical System) resources if
necessary.219 (For additional or supporting detail, see Capability 15: Volunteer Management)
P6: Written plans should include a process to support the integration of Medical Reserve Corps units with local, regional, and
statewide infrastructure.220, 221 Considerations should include the following elements:
Supporting Medical Reserve Corps personnel/coordinators for the primary purpose of integrating the Medical
Reserve Corps structure with the state ESAR-VHP program
– Including Medical Reserve Corps volunteers in trainings that are integrated with that of other local, state, and
regional assets, healthcare systems, or volunteers through the ESAR-VHP program and/or include Medical
Reserve Corps volunteers in exercises that integrate the Medical Reserve Corps volunteers with other local, state,
and regional assets such as healthcare system workers or volunteers that participate in the ESAR-VHP program
(For additional or supporting detail, see Capability 15: Volunteer Management)

PLANNING (P)

–

P7: Written plans should include formal and informal partnerships with jurisdictional volunteer sources (may include
memoranda of understanding, memoranda of agreement, or letters of agreement with partner agencies, if needed).222, 223 
(For additional or supporting detail, see Capability 15: Volunteer Management)
P8: Written plans should include process to coordinate with the applicable U.S. Department of Health and Human Services
Regional Emergency Coordinator to assess these sites and environmental suitability and pre-identify potential federal
medical station sites.
Suggested resource
–

Federal Medical Station Site Selection Criteria: https://www.orau.gov/snsnet

P9: Written plans should include process to coordinate with the applicable U.S. Department of Health and Human Services
Regional Emergency Coordinator to address the need for wrap around services (e.g., biomedical waste and medical waste
disposal) or provide information regarding accessing other services (e.g., food service and waste disposal) at potential
federal medical stations.
P10: Written plans should include processes to disseminate volunteer resources to healthcare organizations and healthcare
coalitions for the establishment of call centers to respond to call volumes. (For additional or supporting detail, see
Capability 15: Volunteer Management )
Suggested resources
–
–

Adapting Community Call Centers for Crisis Support: Adapt existing community call centers to allow callers to
retrieve critical information during a hurricane: http://www.ahrq.gov/prep/callcenters/
CDC, Coordinating Call Centers for Responding to Pandemic Influenza and Other Public Health Emergencies: A
Workbook for State and Local Planners:
http://www.airs.org/files/public/Disaster_CallCenterPandemicWorkbook.pdf

P11: Written plan should include a process to communicate medical surge information to the public.224,225 Plans should
include a process for message clearance and approval.

U.S. Department of Health and Human Services
Centers for Disease Control and Prevention

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CAPABILITY 10: Medical Surge
Function 2: Support activation of medical surge
Resource Elements (continued)
PLANNING (P)

Plans should also take the following into consideration:
– Translation of materials/resources for populations with limited language proficiency
– Development of materials/resources for population with low literacy
– Development of materials/resources that are easy-to-read for population with impaired vision
– Development of materials/resources for the hearing-impaired
(For additional or supporting detail, see Capability 4: Emergency Public Information and Warning)
P12: Written plans should include a process for the local emergency medical services system to request additional resources
(e.g., pediatric equipment and staffing) for the needs of pediatric cases as part of the jurisdictional Emergency Support
Function #8 annex or other documentation. (For additional or supporting detail, see Capability 15: Volunteer Management)
S1: Training for staff involved in personnel management

SKILLS AND TRAINING (S)

Suggested resource
–

S2: Competency identified in jurisdiction to recognize sick infants and children (either through telemedicine arrangements,
neighboring partnerships, or other mechanism). Identify the appropriate personnel to complete training for pediatric
care.
Suggested resources
–
–
–
––

EQUIPMENT AND TECHNOLOGY (E)

Developing and Managing Volunteers (Federal Emergency Management Agency: IS-244):
http://training.fema.gov/EMIWEB/is/is244.asp

American Heart Association, Pediatric Advanced Life Support (comprehensive course):
http://www.heart.org/HEARTORG/CPRAndECC/HealthcareTraining/Pediatrics/Pediatric-Advanced-Life-SupportPALS_UCM_303705_Article.jsp
American Heart Association, Pediatric Emergency Assessment, Recognition, and Stabilization (for those who do
not routinely perform pediatric care):
http://www.americanheart.org/presenter.jhtml?identifier=3052085
National Association of Children’s Hospitals and Related Institutions: www.nachri.org
http://pediatrics.aappublications.org/cgi/content/abstract/peds.2009-1807v1

E1: Promote and assure that equipment, communication, and data interoperability are incorporated into the healthcare
organizations’ acquisition programs. (For additional or supporting detail, see Capability 6: Information Sharing)

Function 3: Support jurisdictional medical surge operations
In conjunction with health care coalitions and response partners, coordinate healthcare resources in conjunction with response
partners, including access to care and medical service, and the tracking of patients, medical staff, equipment and supplies (from
intra or interstate and federal partners, if necessary) in quantities necessary to support medical response operations. 
U.S. Department of Health and Human Services
Centers for Disease Control and Prevention

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CAPABILITY 10: Medical Surge
Function 3: Support jurisdictional medical surge operations
Tasks

This function consists of the ability to perform the following tasks:
Task 1: During an incident, coordinate and maintain communications throughout the incident per jurisdictional authority/
jurisdictional incident management structure with federal, state, local, and non-governmental agencies; private sector
agencies; and other Emergency Support Function #8 partners to maintain situational awareness of the actions of all
parties involved, determine needs, and maintain continuity of services during response operations. (For additional or
supporting detail, see Capability 3: Emergency Operations Coordination and Capability 6: Information Sharing)
Task 2: During an incident, assess resource requirements during each operational period based on the evolving situation and
coordinate with partners, including those able to provide mental/behavioral health services for the community, to obtain
necessary resources (e.g., personnel, facilities, logistics, and other healthcare resources) to support the augmentation
of services during surge operations. (For additional or supporting detail, see Capability 9: Materiel Management and
Distribution)
Task 3: During an incident, coordinate with jurisdictional partners and healthcare coalitions to facilitate patient tracking during
all phases of the incident. (For additional or supporting detail, see Capability 6: Information Sharing)

Performance Measure(s)

At present there are no CDC-defined performance measures for this function.

Resource Elements

Note: Jurisdictions must have or have access to the resource elements designated as Priority.
P1: (Priority) Written plans should include processes and protocols to communicate situational awareness information to
federal, state, local, and non-governmental agencies; private sector agencies; and other Emergency Support Function
#8 partners at least weekly, but potentially more frequently (e.g., as often as once per operational period).226,227,228 (For
additional or supporting detail, see Capability 6: Information Sharing)

PLANNING (P)

P2: (Priority) Written plans should include documentation that public health participates in the development and execution
of healthcare coalition plans to address the functional needs of at- risk individuals.229, 230, 231 Plans should include a
written list of healthcare organizations and community providers that are able to address the functional needs for at-risk
individuals and a process to communicate with healthcare organizations and community providers to maintain a current
list of available services that support the functional needs of at-risk individuals. (For additional or supporting detail, see
Capability 1: Community Preparedness)
P3: (Priority) Written plans should include processes to support or implement family reunification. Considerations should
include the following elements:
–

Capturing and transferring the following known identification information throughout the transport continuum:
□□ Pickup location (e.g., cross streets, latitude & longitude, and/or facility/school)
□□ Gender and name (if possible)
□□ For nonverbal or critically ill children, collect descriptive identifying information about the physical
characteristics or other identifiers of the child.
□□ Keep the primary caregiver (e.g., parents, guardians, and foster parents) with the patient to the extent
possible

P4: Written public health and healthcare coalition documentation should include processes to coordinate the inventory and
requests for resources from jurisdictional, state, federal, and other Emergency Support Function #8 partners, based on the
evolving situation. (For additional or supporting detail, see Capability 9: Materiel Management and Capability 15: Volunteer
Management)
P5: Written plans should include protocols to participate in or coordinate with the jurisdiction’s patient tracking system. (For
additional or supporting detail, see Capability 6: Information Sharing )

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Centers for Disease Control and Prevention

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CAPABILITY 10: Medical Surge
Function 3: Support jurisdictional medical surge operations

EQUIPMENT AND TECHNOLOGY (E)

PLANNING (P)

Resource Elements (continued)
P6: Written plans should include a process to coordinate their patient tracking efforts with local and state emergency medical
services and 911 authorities. (For additional or supporting detail, see Capability 6: Information Sharing)
P7: Written plans should include process to establish a jurisdictional patient-tracking system in conjunction with state and
local emergency management, emergency medical services, healthcare organizations, and other jurisdictional partners. 
–

Jurisdictional patient tracking system should be (1) closely coordinated with state government systems, (2)
interoperable with relevant state and national patient-tracking systems, and (3) consistent with federal and
state-approved privacy protection, regulations and standards for patient tracking systems.
(For additional or supporting detail, see Capability 6: Information Sharing)
E1: Have or have access to electronic or other data storage systems that will be utilized to maintain situational awareness
such as the Joint Patient Assessment and Tracking System. Electronic of other data storage systems must be consistent
with national standards for communication. (For additional or supporting detail, see Capability 6: Information Sharing)
Suggested resource
–

Recommendations for a National Mass Patient and Evacuee Movement, Regulating, and Tracking System:
http://www.ahrq.gov/prep/natlsystem/natlsys.pdf

Function 4: Support demobilization of medical surge operations
In conjunction with other jurisdictional partners, return healthcare system to pre-incident operations by incrementally decreasing
surge staffing, equipment needs, alternate care facilities, and other systems, and transition patients from acute care services into
their pre-incident medical environment or other applicable medical setting.

Tasks

This function consists of the ability to perform the following tasks:
Task 1: During and after an incident, assist in the return movement of patients, to include the following:
–– Assist or coordinate with medical facilities; emergency medical services; local, state, tribal, and federal health
agencies; emergency management agencies; state hospital associations; social services; and participating nongovernmental organizations to assure the return of patients to their pre-incident medical environment (e.g.,
prior medical care provider, skilled nursing facility, or place of residence) or other applicable medical setting.
–– Facilitate the linkage of patients to healthcare services as requested.
Task 2: After an incident, coordinate with partners to demobilize all healthcare resources. (For additional or supporting detail, see
Capability 3: Emergency Operations Coordination, Capability 7: Mass Care, Capability 9: Medical Materiel Management, and
Capability 15: Volunteer Management)
Task 3: After an incident, coordinate with partners to demobilize alternate care facilities, resources obtained through mutual aid
mechanisms, Emergency Management Assistance Compact, and/or federal assistance. (For additional or supporting detail,
see Capability 3: Emergency Operations, Capability 7: Mass Care, Capability 9: Medical Materiel Management, and Capability
15: Volunteer Management)

Performance Measure(s)

At present there are no CDC-defined performance measures for this function.
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Centers for Disease Control and Prevention

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CAPABILITY 10: Medical Surge
Function 4: Support demobilization of medical surge operations
Resource Elements

Note: Jurisdictions must have or have access to the resource elements designated as Priority.
P1: (Priority) Written plans should include a process for the jurisdiction to coordinate with state emergency medical services
to demobilize transportation assets used in the incident.
P2: (Priority) Written plans should include a process to demobilize surge staff to include other state (e.g., MRC) and federal
medical resources (e.g., NDMS). Process should include identification of triggers that would identify the need for
demobilization. (For additional or supporting detail, see Capability 15: Volunteer Management )
P3: Written plans should include processes to assist the lead agency with the facilitation or coordination of medical
transportation for patients requiring assistance.
P4: Written plans should include process to communicate with healthcare organizations and community providers to
maintain a current list of healthcare services that are available to provide information to patients if requested.

PLANNING (P)

P5: Written plans should include process to coordinate, if requested by healthcare organizations, case management or other
support to assist the transition to pre-incident medical environment or other applicable medical setting.
P6: Written plan should include processes to communicate with U.S. Department of Health and Human Services Regional
Health Administrators, Regional Emergency Managers, and Regional Emergency Coordinators to address the functional
needs of patients.
P7: Written plans should include a process to coordinate with jurisdictional authorities and partner groups to support
volunteer and other personnel post-deployment medical screening, stress, and well-being assessment and, when
requested or indicated, referral to medical and mental/behavioral health services. (For additional or supporting detail, see
Capability 2: Community Recovery, Capability 14: Responder Safety and Health, and Capability 15: Volunteer Management)
P8: Written plans should include a process for releasing volunteers and other personnel, to be used when the health
department has the lead role in volunteer or other personnel coordination. Plans should include steps to achieve the
following:
– Demobilize volunteers and other personnel in accordance with the incident action plan
– Assure all assigned activities are completed, and/or replacement volunteers are informed of the activities’ status
– Determine whether additional assistance is needed from the volunteer or other personnel
– Assure all equipment is returned by volunteer or other personnel
– Confirm the volunteer and other personnel’s follow-up contact information
(For additional or supporting detail, see Capability 3: Emergency Operations Coordination and Capability 15: Volunteer
Management)
P9: Written plans should include a protocol for conducting exit screening during out-processing, to include collection of the
following:
– Any injuries and illnesses acquired during the response
– Mental/behavioral health needs due to participation in the response
– When requested or indicated, referral of volunteer to medical and mental/behavioral health services.
(For additional or supporting detail, see Capability 14: Responder Safety and Health and Capability 15: Volunteer Management)

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CAPABILITY 11: Non-Pharmaceutical Interventions
Non-pharmaceutical interventions are the ability to recommend to the applicable
lead agency (if not public health) and implement, if applicable, strategies for disease,
injury, and exposure control. Strategies include the following:

•
•
•
•
•
•

Isolation and quarantine
Restrictions on movement and travel advisory/warnings
Social distancing
External decontamination232
Hygiene233
Precautionary protective behaviors234
This capability consists of the ability to perform the following functions:
Function 1: Engage partners and identify factors that impact non-pharmaceutical interventions
Function 2: Determine non-pharmaceutical interventions
Function 3: Implement non-pharmaceutical interventions
Function 4: Monitor non-pharmaceutical interventions

Function 1: Engage partners and identify factors that impact non-pharmaceutical interventions
Identify and engage with health partners, government agencies, and community sectors (e.g., education, social services, faithbased, and business/industry) to identify the community factors that affect the ability to recommend and implement nonpharmaceutical interventions.

Tasks

This function consists of the ability to perform the following tasks:
Task 1: Prior to an incident, identify jurisdictional legal, policy, and regulatory authorities that enable or limit the ability to
recommend and implement non-pharmaceutical interventions, in both routine and incident-specific situations.
Task 2: Prior to an incident, engage healthcare organizations, government agencies, and community sectors (e.g., education,
social services, faith-based, business, and legal) in determining their roles and responsibilities in non-pharmaceutical
interventions on an ongoing basis through multidisciplinary meetings. (For additional or supporting detail, see Capability 1:
Community Preparedness)

Performance Measure(s)

At present there are no CDC-defined performance measures for this function.

Resource Elements

Note: Jurisdictions must have or have access to the resource elements designated as Priority.

PLANNING (P)

P1: (Priority) Written plans should include documentation of the applicable jurisdictional, legal, and regulatory authorities
and policies for recommending and implementing non-pharmaceutical interventions in both routine and incidentspecific situations. This includes but is not limited to authorities for restricting the following elements: 235,236,237,238
–
–
–
–
–
–
–

Individuals
Groups
Facilities
Animals (e.g., animals with infectious diseases and animals with exposure to environmental, chemical,
radiological hazards)
Consumer food products
Public works/utilities (e.g., water supply)
Travel through ports of entry

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Centers for Disease Control and Prevention

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CAPABILITY 11: Non-Pharmaceutical Interventions
Function 1: Engage partners and identify factors that impact non-pharmaceutical interventions
Resource Elements (continued)
Public health departments are strongly encouraged to consult with jurisdictional legal counsel or academic centers for
assistance. If applicable by jurisdictional authority, develop written memoranda of understanding or other letters of
agreement with law enforcement for enforcing mandatory restrictions on movement.
Suggested resources
–

–

CDC Public Health Law Program’s Coordinated Implementation of Community Response Measures (Including
Social Distancing) to Control the Spread of Pandemic Respiratory Disease: A Guide for Developing a MOU for
Public Health, Law Enforcement, Corrections, and the Judiciary:
http://www2a.cdc.gov/phlp/docs/crm%20mou%20Final.pdf
CDC Public Health Law Program’s Social Distancing Law Assessment Template, Appendix A:
http://www2a.cdc.gov/phlp/SDLP/

P2: (Priority) Written plans should include documentation of the following elements: 239, 240, 241, 242
–

PLANNING (P)

–
–

–

Contact information of at least two representatives from each partner agency/organization
□□ Suggested community partners: schools, community organizations (e.g., churches and homeless
shelters), businesses, hospitals, and travel/transportation industry planners
Memoranda of understanding or other written acknowledgements/agreements with community partners
outlining roles, responsibilities, and resources in non-pharmaceutical interventions
Agreements with healthcare providers which must include at a minimum:
□□ Procedures to communicate case definitions determined by epidemiological surveillance
□□ Procedures for reporting identified cases of inclusion to the health department
(For additional or supporting detail, see Capability 13: Public Health Surveillance and Epidemiological Investigation)
Suggested partners: Conference of Radiation Control Program Directors:
http://www.crcpd.org/Map/RCPmap.html, other radiation subject matter experts, health physicists, state
environmental protection agency, U.S. Department of Energy, and U.S. Department of Agriculture

Suggested resources
–
–
–
–
–
–
–

H1N1 Flu: A Guide for Community and Faith-Based Organizations, Sections F, H, I:
http://www.flu.gov/professional/community/cfboguidance.pdf
Pandemic Influenza Community Mitigation Interim Planning Guide for Businesses and Other Employers
(Appendix 4): http://www.flu.gov/professional/community/commitigation.html
Doing Business During an Influenza Pandemic: Human Resource Policies, Protocols, Templates, Tools, & Tips:
http://www.cidrap.umn.edu/cidrap/files/33/cidrap-shrm-hr-pandemic-toolkit.pdf
Coordinated Implementation of Community Response Measures (Including Social Distancing) to Control the
Spread of Pandemic Respiratory Disease: A Guide for Developing a MOU for Public Health, Law Enforcement,
Corrections, and the Judiciary: http://www2a.cdc.gov/phlp/emergencyprep.asp
Flu Guidance, Checklists and Resources: http://www.flu.gov/professional/index.html
Community Strategy for Pandemic Influenza Mitigation:
http://pandemicflu.gov/professional/community/commitigation.html
Business Pandemic Influenza Planning Checklist:
http://pandemicflu.gov/professional/business/businesschecklist.html

Function 2: Determine non-pharmaceutical interventions
Work with subject matter experts (e.g., epidemiology, laboratory, surveillance, medical, chemical, biological, radiological, social
service, emergency management, and legal) to recommend the non-pharmaceutical intervention(s) to be implemented.

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CAPABILITY 11: Non-Pharmaceutical Interventions
Function 2: Determine non-pharmaceutical interventions
Tasks

This function consists of the ability to perform the following task:
Task 1: At the time of the incident, assemble subject matter experts to assess the severity of exposure and/or transmission at
the jurisdictional level, and determine non-pharmaceutical intervention recommendations. (For additional or supporting
detail, see Capability 13: Public Health Surveillance and Epidemiological Investigation)

Performance Measure(s)

At present there are no CDC-defined performance measures for this function.

Resource Elements

Note: Jurisdictions must have or have access to the resource elements designated as Priority.
P1: (Priority) Written plans should include a jurisdictional non-pharmaceutical intervention “playbook” detailing plans for
intervention recommendation and/or implementation, based on potential interventions identified from the jurisdictional
risk assessment. Suggested categories of interventions include isolation, quarantine, school and child care closures,
workplace and community organization/event closure, and restrictions on movement (e.g., port of entry screenings and
public transportation). Each plan should address the following items, at a minimum:
–
–
–
–
–

PLANNING (P)

–
–
–
–

Staff and subject matter expert roles and responsibilities
Legal and public health authorities for the intervention actions
Intervention actions
List of identified locations that have the specific equipment required for, or locations that are easily adaptable for
the intervention
Contact information/notification plan of community partners involved in intervention (e.g., those providing
services or equipment)
Identification of any issues that may be associated with the implementation of individual community-mitigation
measures or the net effect of the implementation of measures (secondary effects)
Intervention-specific methods for information dissemination to the public (e.g. information cards to be
distributed at ports of entry during movement restrictions)
Processes for de-escalation of intervention once it is no longer needed
Documentation of the intervention during an incident

Suggested resources
–

U.S. Department of Health and Human Services Assistant Secretary for Preparedness and Response, Playbooks
for Hurricanes, Aerosolized Anthrax, and Radiological Dispersal Devices:
http://www.phe.gov/Preparedness/planning/playbooks/Pages/default.aspx
– Manual of Protective Action Guides and Protective Actions for Nuclear Incidents, EPA 400-R-92-001:
http://www.epa.gov/rpdweb00/docs/er/400-r-92-001.pdf
– Implementation of Protective Actions for Radiological Incidents at Other Than Nuclear Power Reactors:
http://www.epa.gov/rpdweb00/docs/er/symposium_on_non-npp_incidents.pdf
– National Council on Radiation Protection and Measurements, Report No. 161: Management of Persons
Contaminated with Radionuclides Handbook: http://www.ncrponline.org/Publications/161press.html
– Community Strategy for Pandemic Influenza Mitigation-Appendix 8:
http://www.flu.gov/professional/community/commitigation.html#I
– Faith-Based and Community Organizations Pandemic Influenza Preparedness Checklist:
http://pandemicflu.gov/professional/community/faithcomchecklist.html
– A Framework for Improving Cross-Sector Coordination for Emergency Preparedness and Response: Action Steps
for Public Health, Law Enforcement, the Judiciary and Corrections:
http://www2a.cdc.gov/phlp/docs/CDC_BJA_Framework.pdf
(For additional or supporting detail, see Capability 1: Community Preparedness and Capability 4: Emergency Public Information
and Warning)

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CAPABILITY 11: Non-Pharmaceutical Interventions
Function 2: Determine non-pharmaceutical interventions

SKILLS AND TRAINING (S)

PLANNING (P)

Resource Elements (continued)
P2: Written plans should include a decision matrix indicating questions for public health leadership and recommendation
options, based on pre-existing community risk assessment and incident severity. Decision tree endpoints will link to
sections of the “playbook.” (For additional or supporting detail, see Capability 1: Community Preparedness)

S1: Public health staff that will participate in implementing or recommending non-pharmaceutical interventions should have
awareness-level training in use of the jurisdiction’s non-pharmaceutical decision matrix.
Suggested resource
–

Association of Schools of Public Health, Competency for Decision Making under Emergency Conditions:
http://www.asph.org/userfiles/PreparednessCompetencyModelWorkforce-Version1.0.pdf

S2: Training for public health staff should focus on their roles and responsibilities and resource identification.
Suggested resource
–

Training pages on CDC’s emergency website: http://emergency.cdc.gov/training/ (See: Quarantine and Isolation,
Sanitation and Hygiene, Water-Related Hygiene, Radiation Emergencies)

Function 3: Implement non-pharmaceutical interventions
Coordinate with health partners, government agencies, community sectors (e.g., education, social services, faith-based, and
business), and jurisdictional authorities (e.g., law enforcement, jurisdictional officials, and transportation) to make operational, and
if necessary, enforce, the recommended non-pharmaceutical intervention(s).

Tasks

This function consists of the ability to perform the following tasks:
Task 1: At the time of an incident, activate non-pharmaceutical intervention locations (e.g., isolation or quarantine sites) through
coordination with jurisdictional officials (e.g., law enforcement, medical, and school).
Task 2: At the time of an incident, assist community partners with coordinating support services (e.g., medical care and mental
health) to individuals included in non-pharmaceutical intervention(s). (For additional or supporting detail, see Capability 1:
Community Preparedness, Capability 7: Mass Care, and Capability 10: Medical Surge)
Task 3: At the time of an incident, provide recommendations for voluntary or mandatory closure of congregate locales and
events243 to jurisdictional officials (e.g., emergency management, law enforcement, school, and tribal entities) and
stakeholders (e.g., mall/store owners, faith-based congregations, and convention centers/event coordinators), if needed.
Task 4: At the time of an incident, provide recommendations for voluntary or mandatory restrictions on movement in
conjunction with jurisdictional officials (e.g., emergency management, law enforcement, and transportation), if needed.
Task 5: Upon request, activate jurisdictional processes for managing and detaining passengers at ports of entry244 through
coordination with CDC’s Division of Global Migration and Quarantine, port authorities, and jurisdictional officials as
applicable to the incident.
Task 6: At the time of an incident, assure ability to conduct external decontamination of potentially contaminated or
contaminated individuals.
Task 7: At the time of an incident, educate and inform the public, response agencies and other partners regarding the
recommended intervention(s). (For additional or supporting detail, see Capability 4: Emergency Public Information and
Warning)
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CAPABILITY 11: Non-Pharmaceutical Interventions
Function 3: Implement non-pharmaceutical interventions
Performance Measure(s)

At present there are no CDC-defined performance measures for this function.

Resource Elements

Note: Jurisdictions must have or have access to the resource elements designated as Priority.
P1: (Priority) Written plans should include agreements with healthcare coalitions and other community partners to
coordinate support services to individuals during isolation or quarantine scenarios. 245,246,247,248 (For additional or supporting
detail, see Capability 10: Medical Surge)
P2: (Priority) Written plans should include procedures to support the separation of cohorts of potentially exposed travelers
from the general population at ports of entry. Plans should include but are not limited to the following elements: 249
–
–
–
–
–

Identification of resources (e.g., staff, facilities, and equipment) at or near ports of entry to be used for separation
of cohorts
Scalable plans to accommodate cohorts of various sizes in identified facilities
Local and state Communicable Disease Response Plan compatible with CDC’s Division of Global Migration and
Quarantine guidance 250
Applicable state/local legal authorities for detention, quarantine, and conditional release of potentially exposed
persons and isolation of ill persons
Processes for transportation of cohorts to, and security at, pre-identified sites

Suggested resource

PLANNING (P)

–

Pandemic Influenza Federal Guidance 2008, Appendix B.2:
http://www.pandemicflu.gov/news/guidance031108.pdf

P3: Written plans should include a process for coordinating and/or implementing isolation or quarantine at designated
locations. Plans should include but are not limited to the following elements: 251,252,253
–
–
–
–
–
–
–

Pre-identified sites for housing cohorts under non-pharmaceutical intervention
Memoranda of understanding or letters of agreement with site owners for use of sites
Written agreements for equipment needed at designated sites
Processes for conversion of sites to environment needed for intervention (e.g., converting rooms to negative
pressure rooms)
Time frame for establishing operations at location
Processes for returning the site to normal operation, including decontamination or sanitization, if needed
Documenting expenses for potential reimbursement at either the jurisdictional or federal level

P4: Written plans should include memoranda of understanding or letters of agreement with mental /behavioral health
specialists for provision of services to individuals affected by non-pharmaceutical interventions. Services should include
but are not limited to the following elements:
–
–

Support in identifying individuals in need of mental/behavioral health services (e.g., during isolation or
quarantine)
Agreements to provide services in person or via communication method (e.g., phone, internet, or
teleconference)

P5: Written plans should include protocols to support coordination of population monitoring and external decontamination
of individuals. Protocols should include but are not limited to the following elements:
–
–

Screening based on incident-specific criteria levels determined by radiological/nuclear subject matter experts
Registration of exposed and possibly exposed populations, including collection of name, address, contact
information, and person’s location at the time of the incident, and coordination with organizations trained in
decontamination to establish external decontamination stations at designated sites and remove and/or store
contaminated materials

Suggested resource
–

Population Monitoring in Radiation Emergencies:
http://emergency.cdc.gov/radiation/pdf/population-monitoring-guide.pdf

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Centers for Disease Control and Prevention

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CAPABILITY 11: Non-Pharmaceutical Interventions
Function 3: Implement non-pharmaceutical interventions
Resource Elements (continued)

PLANNING (P)

P6: Written plans should include templates or actual intervention-specific public educational materials, either newly
developed or adapted from existing materials that can be modified at the time of the incident. Materials should include,
at a minimum, content describing the following elements:
–
–
–
–

How the public can access information (e.g., hotlines)
If applicable, when and where the public should, or should not, seek medical care
How to prevent infection/exposure
Hand washing and other protective behaviors as they apply to an incident

Suggested resources
–
–
–
–

Clean Hands Save Lives, CDC:
http://www.cdc.gov/cleanhands/
H1N1 Prevention and Treatment:
http://www.flu.gov/individualfamily/prevention/index.html
Hygiene and Sanitation After a Disaster or Emergency, CDC:
http://emergency.cdc.gov/disasters/floods/sanitation.asp
Protect Yourself and Your Family from Debris Smoke, CDC:
http://www.cdc.gov/nceh/airpollution/airquality/debris_smoke.htm

S1: Training for public health personnel participating in or supporting operations at a radiological emergency community
reception center should cover the following activities: 254,255
–

SKILLS AND TRAINING (S)

–
–

–
–
–

Determining the location of community reception centers based on the amount of space needed, the
anticipated magnitude of the radiation incident, and population needs of the community
Suggested resource
□□ Virtual Community Reception Center: http://www.emergency.cdc.gov/radiation/crc/vcrc.asp
Establishing crowd management operations, including the development of process flow/ triage procedures and
the distribution of patient information sheets during population monitoring
Using on-site equipment to monitor external contamination
Suggested resources
□□ Virtual Community Reception Center: http://www.emergency.cdc.gov/radiation/crc/vcrc.asp
□□ Population Monitoring in Radiation Emergencies: A Guide for State and Local Public Health Partners:
http://www.emergency.cdc.gov/radiation/pdf/population-monitoring-guide.pdf
□□ Radiation Emergency Assistance Center Training/Training Site: http://orise.orau.gov/reacts/
Identifying and addressing functional needs of at-risk populations
Facilitating referrals of individuals experiencing psychological trauma to mental/behavioral services
Establishing and maintaining contacts with federal agencies for equipment, personnel, and expertise

Suggested resources
–
–
–

Radiation Emergencies Virtual Reception Center Application, CDC:
http://emergency.cdc.gov/radiation/crc/vcrc.asp
Handbook for Responding To A Radiological Dispersal Device (Dirty Bomb) First Responder’s Guide:
http://www.crcpd.org/RDD_Handbook/RDD-Handbook-ForWeb.pdf
Population Monitoring in Radiation Emergencies:
http://emergency.cdc.gov/radiation/pdf/population-monitoring-guide.pdf

Function 4: Monitor non-pharmaceutical interventions
Monitor the implementation and effectiveness of interventions, adjust intervention methods and scope as the incident evolves,
and determine the level or point at which interventions are no longer needed.

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CAPABILITY 11: Non-Pharmaceutical Interventions
Function 4: Monitor non-pharmaceutical interventions
Tasks

This function consists of the ability to perform the following tasks:
Task 1: Assess the degree of transmission, contamination, infection and severity of exposure. (For additional or supporting detail,
see Capability 13: Public Health Surveillance and Epidemiological Investigation)
Task 2: Disseminate situational awareness reports256 on impact of the intervention to all agencies involved in the intervention(s).
(For additional or supporting detail, see Capability 3: Emergency Operations Coordination and Capability 6: Information
Sharing)
Task 3: Revise recommendation(s) for non-pharmaceutical interventions as indicated by the incident, including recommending
intervention escalation or de-escalation. (For additional or supporting detail, see Capability 13: Public Health Surveillance
and Epidemiological Investigation)
Task 4: Document non-pharmaceutical implementation actions taken by local jurisdictions and document feedback from
community partners assisting in the intervention(s) as part of the incident After Action Report.

Performance Measure(s)

At present there are no CDC-defined performance measures for this function.

Resource Elements

Note: Jurisdictions must have or have access to the resource elements designated as Priority.

PLANNING (P)

P1: Written plan should describe how the health department will monitor known cases/exposed persons through
community partner assistance, including but not limited to processes to accomplish the following tasks:257
–
–
–

Share surveillance information between community partners and health departments
Support short and long-term follow-up of known or suspected households under voluntary intervention in the
community (2008 Pan Flu Ops Review, Population Monitoring in Radiation Emergencies:
http://emergency.cdc.gov/radiation/pdf/population-monitoring-guide.pdf )
Ensure secure storage and retrieval of sensitive information (For additional or supporting detail, see Capability 6:
Information Sharing)

P2: Written plans should include documentation of feedback related to intervention actions taken by community partners as
part of the incident After Action Report.258,259
Suggested resource

EQUIPMENT AND TECHNOLOGY (E)

–

Homeland Security Exercise and Evaluation Program, Participant Feedback Form:
https://hseep.dhs.gov/hseep_vols/allDocs.aspx?a=P (first document in list)

E1: Have or have access to equipment to support collection and compilation of incident data (e.g., electronic communication
and data storage). (For additional or supporting detail, see Capability 6: Information Sharing)

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CAPABILITY 12: Public Health Laboratory Testing
Public health laboratory testing is the ability to conduct rapid and conventional
detection, characterization, confirmatory testing, data reporting, investigative support,
and laboratory networking to address actual or potential exposure to all-hazards.260
Hazards include chemical, radiological, and biological agents in multiple matrices that
may include clinical samples,261 food, and environmental samples (e.g., water, air, and
soil). This capability supports routine surveillance, including pre-event262 or pre-incident263
and post-exposure activities.
This capability consists of the ability to perform the following functions:
Function 1: Manage laboratory activities
Function 2: Perform sample management
Function 3: Conduct testing and analysis for routine and surge capacity
Function 4: Support public health investigations
Function 5: Report results

Function 1: Manage laboratory activities
Manage and coordinate communications and resource sharing with the jurisdiction’s network of human, food, veterinary, and
environmental testing laboratory efforts in order to respond to chemical, biological, radiological, nuclear, explosive, and other
public health threats.

Tasks

This function consists of the ability to perform the following task:
Task 1: Exchange information and data with laboratories and laboratory networks within the jurisdiction. (For additional or
supporting detail, see Capability 6: Information Sharing)

Performance Measure(s)

This function is associated with the following CDC-defined performance measures:
Measure 1: Time for sentinel clinical laboratories to acknowledge receipt of an urgent message from the CDC Public Health
Emergency Preparedness (PHEP)-funded Laboratory Response Network biological (LRN-B) laboratory
–
–
–
–

Start time: Time CDC PHEP-funded laboratory sends urgent message to first sentinel clinical laboratory
Intermediate stop time: Time at least 50% of sentinel clinical laboratories acknowledged receipt of urgent
message
Intermediate stop time: Time at least 90% of sentinel clinical laboratories acknowledged receipt of urgent
message
Stop time: Time last sentinel clinical laboratory acknowledged receipt of urgent message

Measure 2: Time for initial laboratorian to report for duty at the CDC PHEP-funded laboratory
–
–

Start time: Date and time that a public health designated official began notifying on-call laboratorian(s) to
report for duty at the CDC PHEP-funded laboratory
Stop time: Date and time that the initial laboratorian reported for duty at the CDC PHEP-funded laboratory

Resource Elements

PLANNING (P)

Note: Jurisdictions must have or have access to the resource elements designated as Priority.
P1: (Priority) Written plans must include at a minimum the identification of laboratories and laboratory networks within the
jurisdiction264,265 as well as procedures for interaction with the following laboratories and groups:
–
–
–

LRN-B reference laboratories within the jurisdiction
□□ Support and ensure LRN-B reference laboratory communication with all LRN-B sentinel and all other
LRN-B reference laboratories within the jurisdiction
CDC’s LRN chemical (LRN-C) laboratories within the jurisdiction
CDC’s LRN radiological (LRN-R) laboratories within the jurisdiction (if program funds become available)

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CAPABILITY 12: Public Health Laboratory Testing
Function 1: Manage laboratory activities
Resource Elements (continued)
–
–
–

Other state laboratories within the jurisdiction
□□ e.g., non-LRN public health, environmental, agricultural, veterinary, and university laboratories
Federal laboratory networks and member laboratories within the jurisdiction
□□ e.g., the Food Emergency Response Network, National Animal Health Laboratory Network, and the
Environmental Response Laboratory Network
Poison control centers for chemical or radiological exposure incidents, such as food poisoning

P2: (Priority) Written plans must include the following elements:

PLANNING (P)

–
–

Documented procedures for contacting sentinel laboratories in the event of a public health incident 266
Coordination of jurisdiction-wide stakeholders involved in chemical, biological, radiological, nuclear, and
explosive response and their standard response guidelines
□□ e.g., American Society for Testing and Material, Operational Guidelines for Initial Response to a
Suspected BioThreat Agent

P3: Written plans should include processes and protocols for continuity of operations (e.g., Continuity of Operations Plan or
Annex) for chemical laboratory, radiological laboratory, biological laboratory and select agents consistent with federal
guidelines, which are updated on an annual basis.267 Continuity of Operations should include not only the ability to
conduct testing on unknown and unusual agents but also routine testing such as the assurance of newborn screening.268
Plans should address, but are not limited to the following elements:
–
–
–
–

Laboratory maintenance of redundant utilities supplies for testing and support areas for short-term duration
(i.e., 72 hours) in case of localized infrastructure failure
Formal or informal agreements in place with other agencies to take over critical testing
Staff illness
Equipment failure

Suggested resource

EQUIPMENT AND TECHNOLOGY (E)

SKILLS AND TRAINING (S)

–

Association of Public Health Laboratories, Guidelines for the Public Health Laboratory Continuity of Operations
Plan: http://www.aphl.org/aphlprograms/phpr/Documents/PHL_COOP_Guidelines.pdf

S1: Laboratory staff should be aware of current national policy and practice. Maintaining this understanding can be
accomplished through sending one chemistry representative, one radiological representative, and one biological
representative from the jurisdiction to the LRN national meeting. Also, it is recommended if possible, but not required,
that each LRN Laboratory Director also attend LRN national meetings.
S2: At least one individual on staff should be capable of coordinating personnel safety and methods trainings, plans, and
guidance, and outreach to sentinel and first responder communities throughout the jurisdiction. These staff should
coordinate biological, chemical, and radiological activities. Depending on the jurisdiction, these positions may be filled
by one or more individuals with the appropriate experience and training to perform the duties.

E1: Have or have access to a database of current contact information for identified LRN-B advanced sentinel laboratories,
LRN-B reference laboratories, LRN-R laboratories (if program funds become available), and LRN-C laboratories in the
jurisdiction, as well as laboratories both inside and outside the jurisdiction that work with the jurisdictional public health
agency.269

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CAPABILITY 12: Public Health Laboratory Testing
Function 2: Perform sample management
Implement LRN-established protocols and procedures where available and applicable [and other mandatory protocols such as
those for the International Air Transport Association (IATA) and the U.S. Department of Transportation (DOT)] for sample collection,
handling, packaging, processing, transport, receipt, storage, retrieval, and disposal.

Tasks

This function consists of the ability to perform the following tasks:
Task 1: Handle, package, and transport samples following established IATA/DOT and laboratory-specific protocols.
Task 2: Maintain forensic chain-of-custody throughout the sample-management process.

Performance Measure(s)

This function is associated with the following CDC-defined performance measures:
Measure 1: Percentage of LRN clinical specimens without any adverse quality assurance events received at the CDC PHEP-funded
LRN-B laboratory for confirmation or rule-out testing from sentinel clinical laboratories
–
–

Numerator: Number of LRN clinical specimens without any adverse quality assurance events received at CDCPHEP-funded laboratory for confirmation or rule-out testing from sentinel clinical laboratories
Denominator: Total number of LRN clinical specimens received at CDC PHEP-funded laboratory for confirmation
or rule-out testing from sentinel clinical laboratories

Measure 2: Percentage of LRN non-clinical samples without any adverse quality assurance events received at the CDC PHEPfunded LRN-B laboratory for confirmation or rule-out testing from first responders
–
–

Numerator: Number of LRN non-clinical samples without any adverse quality assurance events received at CDC
PHEP-funded laboratory for confirmation or rule-out testing from first responders
Denominator: Total number of LRN non-clinical samples received at CDC PHEP-funded laboratory for
confirmation or rule-out testing from first responders

Measure 3: Ability of the CDC PHEP-funded LRN-C laboratories to collect relevant samples for clinical chemical analysis,
packaging, and shipping those samples
––

Sample Collection, Packing and Shipping Exercise Results (Pass/Did not pass)

Resource Elements

Note: Jurisdictions must have or have access to the resource elements designated as Priority.

PLANNING (P)

P1: Written plans should include procedures and protocols for sample collection, triage, packaging, shipping, transport,
handling, storage and disposal. Sample collection procedure should address 24/7 contact information and submission
criteria.
P2: Written plans should address transportation security and, at a minimum: 270
–
–
–

LRN-B: Select Agent and Toxin Regulations
LRN-C: Chemical Hygiene Plan
LRN-R: Radiation Safety and Security Plan, if program funds become available

P3: Written plans should include a protocol for chain of custody. Forensic chain of custody procedures must meet the
minimum evidentiary control procedure requirements established by federal partners such as the Federal Bureau of
Investigation (e.g., LRN, Integrated Consortium of Laboratory Network).271
P4: Written plans should include procedures in place to maintain sampling and/or shipping supplies stock, or demonstrate
ability to procure or have access to supplies 24/7.272

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CAPABILITY 12: Public Health Laboratory Testing
Function 2: Perform sample management
Resource Elements (continued)
S1: (Priority) Laboratory staff responsible for sample management must maintain certification of laboratory personnel in
a shipping and packaging program that meets national and state requirements (e.g., Sample Collection, Packing and
Shipping; ShipPack).

SKILLS AND TRAINING (S)

S2: Document forensic chain of custody procedures training, with documentation updated a minimum of once per year,
for laboratory and sample submission personnel. Documentation should include training date and manner of delivery
(e.g., formal training or “train the trainer”). Formal training examples: CDC courses and CD or DVD-based courses, with
completion verified by a formal demonstration.
S3: Ensure the ability to provide packaging and shipping training or information on the availability of packaging and
shipping training in DOT/IATA regulations to LRN laboratorians utilizing commercial carriers.
Suggested resources
–

-
-
–

Association of Public Health Laboratories 902-11 SS Preparing Category B Infectious Substances for Transport:
https://www.aphlnet.org/eweb/DynamicPage.aspx?Site=aphl&WebKey=6d83bd79-2883-4c00-b4260fffa422658b
World Health Organization Infectious Substances Shipping Training 
http://www.who.int/ihr/i_s_shipping_training/en/index.html
Saf-T-Pak (http://www.saftpak.com/),
IATA (http://www.eduwhere.com)

S4: Document training on practices for personnel safety while managing samples, with documentation updated a minimum
of once per year, for laboratory personnel. Documentation should include training date and manner of delivery (e.g.,
formal training or “train the trainer”). Formal training examples: CDC courses and CD or DVD-based courses, with
completion verified by a formal demonstration.
S5: Maintain appropriate regulatory requirements, including the following elements:
–
–
–

A valid Select Agent Registration Number (LRN-B labs only)
A valid U.S. Department of Agriculture/Animal and Plant Health Inspection Service/Veterinary Services shipping
permit (LRN-B labs only)
Nuclear Regulatory Commission or state licensing requirements (LRN-R labs only, if program funds become
available)

EQUIPMENT AND TECHNOLOGY (E)

S6: State public health laboratory coordinator or designee should be able to advise on proper collection, packaging, labeling,
shipping, and chain of custody procedures for samples.
E1: Have or have access to sampling and/or shipping supplies stock, along with contingency agreements to procure supplies
24/7.

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CAPABILITY 12: Public Health Laboratory Testing
Function 3: Conduct testing and analysis for routine and surge capacity
Perform, or coordinate with the applicable lead agency, testing of chemical, biological, radiological, nuclear, and explosive
samples, utilizing CDC-established protocols and procedures (e.g., LRN), where available and applicable, to provide detection,
characterization and confirmatory testing to identify public health incidents. This testing may include clinical, food, and
environmental samples.

Tasks

This function consists of the ability to perform the following tasks:
Task 1: Provide LRN-B reference-level testing in clinical, food, and environmental samples for both rapid and conventional
methods.
Task 2: Conduct chemical laboratory testing following LRN-C testing methods.
Task 3: Conduct radiological and nuclear laboratory testing following LRN-R (if program funds become available) testing
methods.

Performance Measure(s)

This function is associated with the following CDC-defined performance measures:
Measure 1: Proportion of LRN-C proficiency tests (core methods) successfully passed by CDC PHEP-funded laboratories
––
––

Numerator: Number of LRN-C core methods successfully proficiency tested by the CDC PHEP-funded laboratory
Denominator: Total number of LRN-C core methods for which the CDC PHEP-funded laboratory is qualified to
test

Measure 2: Proportion of LRN-C proficiency tests (additional methods) successfully passed by CDC PHEP-funded laboratories
––
––

Numerator: Number of LRN-C additional methods successfully proficiency tested by the CDC PHEP-funded
laboratory
Denominator: Total number of LRN-C additional methods for which the CDC PHEP-funded laboratory is trained
to test

Measure 3: Proportion of LRN-B proficiency tests successfully passed by CDC PHEP-funded laboratories
––
––

Numerator: Number of LRN-B proficiency tests successfully passed by CDC PHEP-funded laboratory(s)
Denominator: Total number of LRN-B proficiency tests participated in by CDC PHEP-funded laboratory(s)

Resource Elements

Note: Jurisdictions must have or have access to the resource elements designated as Priority.
P1: (Priority) Written plans should include the following considerations for surge capacity:

PLANNING (P)

–
–

–
–

Options to optimize procedures based on regular and surge personnel, equipment, and facility resources for
short-term (e.g., days) and long-term (e.g., weeks to months) response efforts. Options should also be based on
best practices and models available on the LRN website or other sources.
Triage policies that address how the laboratory will manage surge testing, that may include:
□□ Referral of samples to other jurisdictional laboratories
□□ Prioritization of testing based upon sample type
□□ Prioritization of testing based upon risk or threat assessment
□□ Contingencies to assure newborn screening in a surge situation. Newborn screening can be assured by
memoranda of agreement or contracts with commercial vendors273
Ensuring that laboratory testing and reporting can be performed for extended shifts based on need for Level 1
and Level 2 LRN-C laboratories. (Not applicable for territories)
Ensuring that laboratory testing, quality assurance and control review, and reporting can be performed for
extended shifts based on need for LRN-R laboratories, if program funds become available

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CAPABILITY 12: Public Health Laboratory Testing
Function 3: Conduct testing and analysis for routine and surge capacity

PLANNING (P)

Resource Elements (continued)
P2: (Priority) Written plans should include preventative maintenance contracts and service agreements in place for
equipment and instruments utilized in LRN protocols, procedures, and methods – at a minimum. Plans should also
include protocols to ensure that equipment and instruments utilized in LRN protocols, procedures, and methods have
been inspected and/or certified according to manufacturer’s specifications.
P3: Written plans should include a process that provides guidance for referring suspicious samples (e.g., from sentinel labs or
first responders) to an LRN reference laboratory.
P4: Written plans should include considerations for supply accessibility, including identifying multiple vendors for critical
commercially available reagents/supplies.
P5: Written plans should include processes and procedures to operate at expanded laboratory capacity for surge events and
incidents.
S1: (Priority) Laboratories participating in radiological or nuclear testing must attain LRN-R (if program funds become
available) Proficiency Testing Program Qualified status for all analysis methods transferred by LRN-R through the
following:
–
–

Attending LRN–R training, if program funds become available
Completing the associated laboratory validation exercise, demonstrating performance and precision according
to the minimum standards for each analytical method

S2: (Priority) LRN-B reference laboratories must attain competency for LRN-B testing methods by having the ability to test
for all agents/sample types/tests listed in the high risk environmental sample testing algorithm posted on the secure LRN
website.

SKILLS AND TRAINING (S)

S3: (Priority) All LRN Laboratories (excluding LRN-B sentinel laboratories) must maintain the competency to pass LRN
proficiency tests.
S4: (Priority) Laboratories participating in chemical testing must attain LRN-C Proficiency Testing Program Qualified status,
through the ability to perform the following:
–
–

Core LRN-C methods testing, for all Level 1 (surge capacity laboratories only) and Level 2 analysis methods
transferred by CDC. Core LRN-C methods are identified on the LRN website and updated at least annually.
Validation and qualification of at least one new analysis method per year is required.

S5: Document LRN methods training, with documentation updated a minimum of once per year, for personnel that regularly
perform LRN methods, as well as staff identified as surge-capacity personnel. Documentation should include training
date and manner of delivery (e.g., formal training or “train the trainer”). Formal training: CDC courses and CD or DVDbased courses, with completion verified by a formal demonstration.
S6: If possible, (but not required) send one chemical, one radiological, and one biological laboratory representative to
meetings focused on technical competencies.
S7: Send at least one chemistry representative from each LRN-C Level 1 surge laboratory to participate in the bi-annual LRN-C
Level 1 surge capacity meeting.
S8: Document safety training, with documentation updated a minimum of once per year, for personnel that
regularly perform LRN testing, as well as staff identified as surge-capacity personnel. Documentation should include
training date and manner of delivery (e.g., formal training or “train the trainer”). Formal training: CDC courses and CD or
DVD-based courses, with completion verified by a formal demonstration.
S9: Attain accreditation for LRN-C clinical testing, at a minimum, via an appropriate accreditation body [e.g., at a minimum,
Clinical Laboratory Improvement Amendments (CLIA) or College of American pathologists (CAP)]

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CAPABILITY 12: Public Health Laboratory Testing
Function 3: Conduct testing and analysis for routine and surge capacity
SKILLS AND TRAINING (S)

Resource Elements (continued)
S10: Attain accreditation for LRN-B clinical testing, at a minimum, via an appropriate accreditation body (e.g., at a minimum,
CLIA or CAP)
S11: Attain accreditation for LRN-R clinical testing, at a minimum, via an appropriate accreditation body, if program funds
become available (e.g., at a minimum, CLIA or CAP)

EQUIPMENT AND TECHNOLOGY (E)

E1: Have or have access to a biosafety level 3 laboratory.
E2: Laboratory owns and maintains at least one instrument each for rapid nucleic-acid detection and antigen-based
detection and instruments are listed in the current equipment list (which is updated annually on the secure LRN website).
E3: Level 2 laboratories own and maintain equipment for at least one instrument each for detection of LRN-C agents, that
are listed in the current equipment list (which is updated annually on the secure LRN website), to demonstrate qualified
status for the listed Level 1 (surge capacity laboratories only) and Level 2 methods.
E4: Level 1 laboratories must obtain and maintain additional support equipment and supplies listed in each method.
E5: LRN-R laboratories (if program funds become available) own and maintain equipment and maintain staff for at least one
instrument each for detection of LRN-R agents that are listed in the LRN-R Equipment List (which is updated annually on
the secure LRN website).
E6: Maintain inventory or reliable sources of testing material that includes CDC/LRN provided analyte-specific test kits,
ancillary reagents, control strains, calibration standards, and laboratory supplies required to run LRN analytical methods.
E7: Have or have access to equipment necessary for performing LRN assays.

Function 4: Support public health investigations
Provide analytical and investigative support to epidemiologists, healthcare providers, law enforcement, environmental health,
food safety, and poison control efforts to help determine cause and origin of, and definitively characterize, a public health
incident.

Tasks

This function consists of the ability to perform the following tasks:
Task 1: Establish and maintain the ability to provide analytical support for investigations with first responders and other health
investigation community partners. (For additional or supporting detail, see Capability 13: Public Health Surveillance and
Epidemiological Investigation)
Task 2: Provide investigative consultation and technical assistance to jurisdictional health departments, first responders, and
other health investigation community partners regarding sample collection, management, and safety. (For additional or
supporting detail, see Capability 13: Public Health Surveillance and Epidemiological Investigation)

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CAPABILITY 12: Public Health Laboratory Testing
Function 4: Support public health investigations
Performance Measure(s)

This function is associated with the following CDC-defined performance measures:
Measure 1: Time to complete notification between CDC, on-call laboratorian, and on-call epidemiologist
––

Start time: Date and time that CDC Department of Emergency Operations official began notification of on-call
laboratorian
Stop time: Date and time on-call epidemiologist (after receiving notification from on-call laboratorian) notifies
CDC Department of Emergency Operations that notification drill is complete

––

Measure 2: Time to complete notification between CDC, on-call epidemiologist, and on-call laboratorian
––

Start time: Date and time that CDC Department of Emergency Operations official began notification of on-call
epidemiologist
Stop time: Date and time on-call laboratorian (after receiving notification from on-call epidemiologist) notifies
CDC Department of Emergency Operations that notification drill is complete

––

Resource Elements

Note: Jurisdictions must have or have access to the resource elements designated as Priority.
P1: Written plans should include processes to coordinate activities, gain assistance from, and/or share data with the following
group:
–
–

PLANNING (P)

–
–
–
–
–
–

Poison control centers that can act as resources for chemical exposure incidents, such as food poisoning (For
additional or supporting detail, see Capability 13: Public Health Surveillance and Epidemiological Investigation)
First responders (e.g., police, fire, and hazardous materials teams) who can be initial resources for identifying
overt chemical, radiological, or biological exposure incidents (For additional or supporting detail, see Capability
14: Responder Safety and Health)
Civil Support Teams (CSTs), to establish a technical link between CSTs and the public health biological,
radiological, and chemical laboratories with respect to field analysis of unknown samples
Healthcare providers who may be packaging and shipping samples and subsequently receiving sample results
during a response (For additional or supporting detail, see Capability 7: Mass Care and Capability 10: Medical
Surge )
Epidemiologists who are at the interface between clinicians/hospitals, health departments, and the laboratory
(For additional or supporting detail, see Capability 13: Public Health Surveillance and Epidemiological Investigation)
Veterinary diagnostic or food safety laboratories, if applicable, which serve animal populations and
investigate food products (For additional or supporting detail, see Capability 13: Public Health Surveillance and
Epidemiological Investigation)
Local law enforcement and Federal Bureau of Investigation regional offices for screening and triage procedures
of mixed environmental samples (to include chemical, biological, radiological and explosive materials) (For
additional or supporting detail, see Capability 3: Emergency Operations Coordination)
State emergency operations center and other official components of the state and local emergency response,
including the Emergency Management Assistance Compact274,275 (For additional or supporting detail, see
Capability 3: Emergency Operations Coordination)

SKILLS AND TRAINING (S)

P2: Written plans should include processes to disseminate and receive information to/from select partner agencies as
applicable to the situation.
S1: Public health lab managers and directors should be trained on the CDC Public Health Law Program 101, Forensic
Epidemiology 3.0 curriculum (http://www.cdc.gov/phlp).

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CAPABILITY 12: Public Health Laboratory Testing
Function 5: Report Results
Provide notification of laboratory results and send laboratory data to public health officials, healthcare providers, and other
institutions, agencies, or persons as permitted by all applicable laws, rules, and regulations.

Tasks

This function consists of the ability to perform the following tasks:
Task 1: Notify appropriate public health, public safety, and law enforcement officials (24/7) of presumptive and/or confirmed
laboratory results from clinical, food, or environmental samples that involve a chemical, radiological, or biological threat
agent. (For additional or supporting detail, see Capability 6: Information Sharing)
Task 2: Send presumptive and confirmed chemical, radiological, or biological laboratory results to CDC and all submitters. (For
additional or supporting detail, see Capability 6: Information Sharing)

Performance Measure(s)

At present this function is associated with the following CDC-defined performance measures:
Measure 1: Time for CDC PHEP-funded laboratory to notify public health partners of significant276 laboratory results
–
–

Start time: Time CDC PHEP-funded laboratory obtains a significant laboratory result
Stop time: Time CDC PHEP-funded laboratory completes notification of public health partners of significant
laboratory results (i.e., time when last public health partner was notified, if partners were not notified
simultaneously)

Resource Elements

Note: Jurisdictions must have or have access to the resource elements designated as Priority.

PLANNING (P)

P1: Written plans should include processes and protocols to ensure proper security and maintenance of records
management system.277,278 (For additional or supporting detail, see Capability 6: Information Sharing)
P2: Written plans should include data-exchange processes, as permitted by all applicable laws, rules and regulations, with
law enforcement, public safety, and other agencies with roles in responding to public health threats. These processes
should address data security and inappropriate disclosure of information.279,280,281 (For additional or supporting detail, see
Capability 6: Information Sharing)
P3: Written plans should include notification procedures that detail the process of reporting results that are suggestive of an
outbreak or exposure to appropriate health investigation partners utilizing secure contact methods per the LRN-B, LRN-C,
or LRN-R (if program funds become available) Notification Policy and/or laboratory-specific policies.282 (For additional or
supporting detail, see Capability 3: Emergency Operations Coordination and Capability 6: Information Sharing)

EQUIPMENT AND TECHNOLOGY (E)

P4: Written plans should include protocols to ensure messaging follows the LRN data messaging and laboratory-specific
policies for determining specific time frames for sending data.
E1: (Priority) Each LRN laboratory will build or acquire and configure a jurisdictional Laboratory Information Management
System (LIMS) with the ability to send testing data to CDC according to CDC-defined standards. (This will reduce
the duplicate entry into multiple data exchange systems, i.e., having to put data into results messenger or other data
exchange systems to be able to send to CDC, public health partners, and other submitters).283,284 Configuring the LIMS
includes the following elements:
–
–
–

Developing project plans with deliverables and a timeline to achieve ability to send and receive data from local
Laboratory Information Management Solution (LIMS) to CDC and other partners
Mapping local codes to federal standards (e.g., LRN-B Test Configuration and Vocabulary Requirements, LRN-B
Laboratory Results Message Guide)
Working with IT support staff or developing contractual agreements with LIMS vendors that are familiar with
federal (e.g., LIMS integration, Public Health Laboratory Interoperability Project) and industry (e.g., logical
observation identities,names, and codes; systematized nomenclature of medicine; HL 7) standards to configure
the LIMS

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CAPABILITY 12: Public Health Laboratory Testing
Function 5: Report results
Resource Elements (continued)

EQUIPMENT AND TECHNOLOGY (E)

–
–

Validating function of LIMS and structure of message by being able to send a test message to CDC
Ensuring health information infrastructure and surveillance systems are able to accept, process, and analyze
standards-based electronic messages from sending electronic health records (EHRs) as defined by Centers for
Medicare & Medicaid Services (42 Code of Federal Regulations Parts 412, 413, 422 et al.) Medicare and Medicaid
Programs; Electronic Health Record Incentive Program; Final Rule (published on July 28, 2010 in the Federal
Register at http://edocket.access.gpo.gov/2010/pdf/2010-17207.pdf ) and the Office of the National Coordinator
for Health Information Technology (45 Code of Federal Regulations Part 170) Health Information Technology:
Initial Set of Standards, Implementation Specifications, and Certification Criteria for Electronic Health Record
Technology; Final Rule (published on July 28, 2010 in the Federal Register at
http://edocket.access.gpo.gov/2010/pdf/2010-17210.pdf and
http://healthit.hhs.gov/portal/server.pt/community/onc_regulations_faqs/3163/faq_3/20765)

E2: Ensure at least one member of each laboratory area represented in the jurisdiction (LRN-B, LRN-C, LRN-R, if program funds
become available) has a working digital certificate for access to electronic results-reporting systems.
E3: Have or have access to at least one working computer for access to LRN and partner electronic reporting systems.
E4: Have or have access to a mechanism (e.g., automated or electronic) for reporting results to LRN-B, LRN-C and LRN-R (if
program funds become available), at a minimum, as appropriate.285

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CAPABILITY 13: Public Health Surveillance and Epidemiological Investigation
Public health surveillance and epidemiological investigation is the ability to create,
maintain, support, and strengthen routine surveillance and detection systems and
epidemiological investigation processes, as well as to expand these systems and
processes in response to incidents286 of public health significance.
This capability consists of the ability to perform the following functions:
Function 1: Conduct public health surveillance and detection
Function 2: Conduct public health and epidemiological investigations
Function 3: Recommend, monitor, and analyze mitigation actions
Function 4: Improve public health surveillance and epidemiological investigation systems

Function 1: Conduct public health surveillance and detection
Conduct ongoing systematic collection, analysis, interpretation, and management of public health-related data to verify a threat
or incident of public health concern, and to characterize and manage it effectively through all phases of the incident.

Tasks

This function consists of the ability to perform the following tasks:
Task 1: Engage and retain stakeholders, which are defined by the jurisdiction, who can provide health data to support routine
surveillance, including daily activities outside of an incident, and to support response to an identified public health threat
or incident.
Task 2: Conduct routine and incident-specific morbidity and mortality surveillance as indicated by the situation (e.g.,
complications of chronic disease, injury, or pregnancy) using inputs such as reportable disease surveillance, vital statistics,
syndromic surveillance, hospital discharge abstracts, population-based surveys, disease registries, and active casefinding. (For additional or supporting detail, see Capability 6: Information Sharing)
Task 3: Provide statistical data and reports to public health and other applicable jurisdictional leadership in order to identify
potential populations at-risk for adverse health outcomes during a natural or man-made threat or incident.
Task 4: Maintain surveillance systems that can identify health problems, threats, and environmental hazards and receive and
respond to (or investigate) reports 24/7.287 (For additional or supporting detail, see Capability 6: Information Sharing)

Performance Measure(s)

This function is associated with the following CDC-defined performance measure:
Measure 1: Proportion of reports of selected reportable diseases received by a public health agency within the jurisdictionrequired time frame288
–
–

Numerator: Number of reports of selected reportable disease received by a public health agency within the
jurisdiction-required time frame
Denominator: Number of reports of selected reportable disease received by a public health agency

Resource Elements

PLANNING (P)

Note: Jurisdictions must have or have access to the resource elements designated as Priority.
P1: (Priority) Written plans should document the legal and procedural framework that supports mandated and voluntary
information exchange with a wide variety of community partners, including those serving communities of color and
tribes.289
P2: (Priority) Written plans should include processes and protocols for accessing health information that follow jurisdictional
and federal laws and that protect personal health information via instituting security and confidentiality policies. (For
additional or supporting detail, see Capability 6: Information Sharing)

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CAPABILITY 13: Public Health Surveillance and Epidemiological Investigation
Function 1: Conduct public health surveillance and detection
Resource Elements (continued)
P3: (Priority) Written plans should include processes and protocols to gather and analyze data from the following:290
–

–

–
–
–

Reportable condition surveillance (i.e., conditions for which jurisdictional law mandates name-based case
reporting to public health agencies). Jurisdictions should plan to receive Electronic Laboratory Reporting for
reportable conditions from healthcare providers using national Meaningful Use standards. 291 (For additional or
supporting detail, see Capability 6: Information Sharing)
Syndromic surveillance systems. Jurisdictions are encouraged to establish or participate in such systems to
monitor trends of illness or injury, and to provide situational awareness of healthcare utilization292
□□ Participation in the CDC BioSense data-sharing program is encouraged (For additional or supporting
detail, see Capability 6: Information Sharing)
Surveillance of major causes of mortality, including the use of vital statistics as a data source (For additional or
supporting detail, see Capability 5: Fatality Management)
Surveillance of major causes of morbidity
Suggested Resource: Natural Disaster Morbidity Surveillance Individual Form:293
http://www.bt.cdc.gov/disasters/surveillance/pdf/NaturalDisasterMorbiditySurveillanceIndividualForm.pdf
Written plans should be able to adapt to include novel and/or emerging public health threats.

PLANNING (P)

Gathering and analyzing data from the following sources should also be taken into consideration:
– Environmental conditions294
– Hospital discharge abstracts
– Information from mental/behavioral health agencies
– Population-based surveys295
– Disease registries
– Immunization registries/Immunization information systems
– Active case finding (e.g., by healthcare logs and record reviews)
(For additional or supporting detail, see Capability 1: Community Preparedness, Capability 6: Information Sharing, and
Capability 10: Medical Surge)
P4: (Priority) Written plans should include procedures to ensure 24/7 health department access (e.g., designated phone line
or contact person in place to receive reports) to collect, review, and respond to reports of potential health threats.296,297
(For additional or supporting detail, see Capability 3: Emergency Operations Coordination)
P5: (Priority) Written plans should include processes and protocols to notify CDC of cases on the Nationally Notifiable
Infectious Disease List within the time frame identified on the list, including immediate notification when indicated.
Electronic exchange of personal health information should meet applicable patient privacy-related laws and standards,
including state or territorial laws. These include the Health Insurance Portability and Accountability Act, the Health
Information Technology for Economic and Clinical Health Act, and standards from the National Institute of Standards
and Technology and the Office of the National Coordinator for Health Information Technology of the U.S. Department of
Health and Human Services. Plans should include procedures to move to electronic case notification using CDC’s Public
Health Information Network Case Notification Message Mapping Guides.
Suggested resource
––

Case Notification Message Mapping Guides:
http://www.cdc.gov/phin/resources/guides/mmghomepagecasenotification.html

P6: Written plans should include a process to conduct surveillance if the primary notifiable surveillance system (i.e., electronic
system) is disrupted during an incident. The process should describe not only electronic back-ups, but also how
surveillance will be conducted if no electricity or electronic infrastructure is available or in place.
Suggested resource
––

Natural Disaster Morbidity Surveillance Individual Form:
http://emergency.cdc.gov/disasters/surveillance/pdf/NaturalDisasterMorbiditySurveillanceIndividualForm.pdf

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CAPABILITY 13: Public Health Surveillance and Epidemiological Investigation
Function 1: Conduct public health surveillance and detection

SKILLS AND TRAINING (S)

Resource Elements (continued)
S1: (Priority) Public health staff conducting data collection, analysis, and reporting in support of surveillance and
epidemiologic investigations should achieve, at a minimum, the Tier 1 Competencies and Skills for Applied
Epidemiologists in Governmental Public Health Agencies.

– When creating new surveillance systems, consideration should be given to securing assistance (e.g., from
–

academic institutions or state-level staff ) from individuals with Tier 2 Competencies and Skills for Applied
Epidemiologists in Governmental Public Health Agencies.
Note: Formal educational degree requirement and masters’ degree supervision requirement is suggested but not
required.

Suggested resources
–
–

Tier 1 Competencies and Skills for Applied Epidemiologists in Governmental Public Health Agencies:
http://www.cste.org/dnn/Portals/0/AEC_Summary_Tier1.pdf
Tier 2 Competencies and Skills for Applied Epidemiologists in Governmental Public Health Agencies:
http://www.cste.org/dnn/Portals/0/AEC_Summary_Tier2.pdf

E1: (Priority) Have or have access to health information infrastructure and surveillance systems that are able to accept,
process, analyze, and share data for surveillance and epidemiological investigation activities. (For additional or supporting
detail, see Capability 6: Information Sharing)
EQUIPMENT AND TECHNOLOGY (E)

–

Electronic exchange of personal health information should meet applicable patient privacy-related laws and
standards, including state or territorial laws. These include the Health Insurance Portability and Accountability
Act, the Health Information Technology for Economic and Clinical Health Act, and standards from the National
Institute of Standards and Technology and the Office of the National Coordinator for Health Information
Technology of the U.S. Department of Health and Human Services. (For additional or supporting detail, see
Capability 6: Information Sharing )

E2: Have or have access to a system compatible with the National Electronic Disease Surveillance System that can determine
or report the following:
–
–
–
–

Electronic case reporting,298 including the data that follows:
□□ Number of case reports received
□□ Case Report Classification: infectious or non-infectious
Integrated Data Repository299
Case Notification,300 including the data that follows:
□□ Number of case notifications sent to CDC
□□ Number of case notifications sent to other jurisdictions
Establish an integrated repository or record locator that enables all condition reports for an individual to be
retrieved and reviewed

E3: Have or have access to equipment that may be necessary to ensure the electronic management and exchange of
information (e.g., laboratory test orders, samples, and results) with hospitals, doctor’s offices, community health centers,
and poison control centers

Function 2: Conduct public health and epidemiological investigations
Identify the source of a case or outbreak of disease, injury, or exposure and its determinants in a population (e.g., time,
place, person, disability status, living status, or other indices) to coordinate and report the summary results of the analysis to
jurisdictional and federal partners, as appropriate.

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CAPABILITY 13: Public Health Surveillance and Epidemiological Investigation
Function 2: Conduct public health and epidemiological investigations
Tasks

This function consists of the ability to perform the following tasks:
Task 1: Conduct investigations of disease, injury or exposure in response to natural or man-made threats or incidents and ensure
coordination of investigation with jurisdictional partner agencies. Partners include law enforcement, environmental
health practitioners, public health nurses, maternal and child health, and other regulatory agencies if illegal activity is
suspected.
Task 2: Provide epidemiological and environmental public health consultation, technical assistance, and information to local
health departments regarding disease, injury, or exposure and methods of surveillance, investigation, and response.301
Task 3: Report investigation results to jurisdictional and federal partners, as appropriate. (For additional or supporting detail, see
Capability 6: Information Sharing)

Performance Measure(s)

This function is associated with the following CDC-defined performance measures:
Measure 1: Percentage of infectious disease outbreak investigations302 that generate reports
– Numerator: Number of infectious disease outbreak investigation reports generated
– Denominator: Number of infectious disease outbreak investigation reports investigated
Measure 2: Percentage of infectious disease outbreak investigation reports that contain all minimal elements303
– Numerator: Number of infectious disease outbreak investigation reports generated containing all minimal
elements
– Denominator: Total number of infectious disease outbreak investigation reports generated
Measure 3: Percentage of acute environmental exposure304 investigations that generate reports
– Numerator: Number of acute environmental exposure investigation reports generated
– Denominator: Number of acute environmental exposures investigated
Measure 4: Percentage of acute environmental exposure reports that contain all minimal elements
– Numerator: Number of acute environmental exposure reports generated containing all minimal elements
– Denominator: Number of acute environmental exposure investigation reports generated

Resource Elements

Note: Jurisdictions must have or have access to the resource elements designated as Priority.
P1: (Priority) Written plans should include investigation report templates that contain the following minimal
elements:305,306,307,308

PLANNING (P)

–

–

–

Context / Background – Information that helps to characterize the incident, including the following:
□□ Population affected (e.g., estimated number of persons exposed and number of persons ill)
□□ Location (e.g., setting or venue)
□□ Geographical area(s) involved
□□ Suspected or known etiology
Initiation of Investigation – Information regarding receipt of notification and initiation of the investigation,
including the following:
□□ Date and time initial notification was received by the agency
□□ Date and time investigation was initiated by the agency
Investigation Methods - Epidemiological or other investigative methods employed, including the following:
□□ Any initial investigative activity (e.g., verified laboratory results)
□□ Data collection and analysis methods (e.g., case-finding, cohort/case-control studies, environmental)
□□ Tools that were relevant to the investigation (e.g., epidemic curves, attack rate tables, and
questionnaires)
□□ Case definitions (as applicable)
□□ Exposure assessments and classification

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CAPABILITY 13: Public Health Surveillance and Epidemiological Investigation
Function 2: Conduct public health and epidemiological investigations
Resource Elements (continued)
Review of reports developed by first responders, lab testing of environmental media, reviews of
environmental testing records, industrial hygiene assessments, questionnaires
Investigation Findings/Results - all pertinent investigation results, including the following:
□□ Epidemiological results
□□ Laboratory results (as applicable)
□□ Clinical results (as applicable)
□□ Other analytic findings (as applicable)
Discussion and/or Conclusions – analysis and interpretation of the investigation results, and/or any conclusions
drawn as a result of performing the investigation. In certain instances, a Conclusions section without a
Discussion section may be sufficient
Recommendations for Controlling Disease and/or Preventing/Mitigating Exposure – specific control measures or
other interventions recommended for controlling the spread of disease or preventing future outbreaks and/or
for preventing/mitigating the effects of an acute environmental exposure
Key investigators and/or report authors – names and titles are critical to ensure that lines of communication with
partners, clinicians ,and other stakeholders can be established.
□□

–

–
–
–

PLANNING (P)

P2: Written plans should include processes for how and when the jurisdiction will conduct investigations of health incidents
(e.g., infectious disease outbreaks, injuries, and other incidents) and environmental public health hazards. Depending on
the investigation, a plan will include at minimum the following information:
–
–
–
–
–
–
–

Trigger points for initiating the investigation (e.g., elements/instances that trigger the start of an investigation)
When the investigation began
Processes for identifying the population(s) at risk
Processes to identify confirmed cases or exposures as well as presumed or probable cases or exposed persons
Processes that ensure the ability to perform contact tracing or identification of exposed persons
Processes that ensure the ability to determine transmission, exposure, and source
Processes to map/geo-code identified and suspect cases, injuries, or exposures within the jurisdiction

P3: Written plans should include processes and protocols for conducting investigations in coordination with other
governmental agencies, key stakeholders, and organizations that support populations at-risk for adverse health
outcomes.
–

Groups for consideration include veterinarians, laboratories, medical examiners, school nurses, food inspectors,
poison control centers, infectious disease physicians, hospitals, school health authorities, other healthcare
providers, emergency responders and other community partners including communities of color, and tribal
representatives.

P4: Written plans should include memoranda of understanding or other letters of agreement authorizing joint investigations
and exchange of epidemiological information with law enforcement and other agencies, as well as defined roles for each
participating agency.
Suggested resources

– FBI-CDC Criminal and Epidemiological Investigation Handbook:
http://www2a.cdc.gov/phlp/docs/crimepihandbook2006.pdf

– Joint Public Health Law Enforcement Investigations: Model Memorandum of Understanding, created by Public
Health and Law Enforcement Emergency Preparedness Workgroup, CDC and Bureau of Justice Assistance:
http://www.nasemso.org/Projects/DomesticPreparedness/documents/JIMOUFinal.pdf

P5: Written plans should include a procedure to ensure that jurisdictional public health departments are provided a uniform
set of jurisdictional health-related data associated with potential exposure to diseases, exposures, or injury conditions.
(For additional or supporting detail, see Capability 6: Information Sharing)

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CAPABILITY 13: Public Health Surveillance and Epidemiological Investigation
Function 2: Conduct public health and epidemiological investigations

SKILLS AND TRAINING (S)

Resource Elements (continued)
S1: (Priority) Maintain staffing capacity to manage the routine epidemiological investigation systems at the jurisdictional
level as well as to support surge epidemiological investigations in response to natural or intentional threats or incidents.
This is accomplished through the following:
–
–
–

Surge staff should be competent in Tier 1 Competencies and Skills for Applied Epidemiologists in Governmental
Public Health Agencies
Consideration should be given to securing assistance (e.g., academic institutions or state-level staff ) from an
individual with Tier 2 Competencies and Skills for Applied Epidemiologists in Governmental Public Health
Agencies
Note: Formal educational degree requirement and masters’ degree supervision requirement is suggested but not
required.

Suggested resources
Tier 1 Competencies and Skills for Applied Epidemiologists in Governmental Public Health Agencies:
http://www.cste.org/dnn/Portals/0/AEC_Summary_Tier1.pdf
– Tier 2 Competencies and Skills for Applied Epidemiologists in Governmental Public Health Agencies:
http://www.cste.org/dnn/Portals/0/AEC_Summary_Tier2.pdf
(For additional or supporting detail, see Capability 15: Volunteer Management)

EQUIPMENT AND TECHNOLOGY (E)

–

E1: Have or have access to jurisdictional health monitoring systems (electronic and/or paper, if applicable) needed to
monitor health status , including criteria for reporting health events and criteria/processes for maintaining and/or
contributing to population health registries.
E2: Have or have access to electronic databases or registries of ill, exposed, and potentially exposed persons; these systems
should be capable of developing Public Health Investigation Reports (See Function 1: Planning Resource Element for
Additional or Supporting Detail) as warranted, utilizing information from clinical, environmental, and/or forensic samples,
and utilizing lab and disease tracking data.
– Databases or registries should include protocols to protect personal health information in conformity with
jurisdictional and federal law and via instituting security and confidentiality policies (For additional or supporting
detail, see Capability 6: Information Sharing)

Function 3: Recommend, monitor, and analyze mitigation actions
Recommend, implement, or support public health interventions that contribute to the mitigation of a threat or incident as well as
monitor the effectiveness of the interventions.

Tasks

This function consists of the ability to perform the following tasks:
Task 1: Determine public health mitigation, including clinical and epidemiological management and actions to be
recommended for the mitigation of the threat or incident based upon data collected in the investigation and on
applicable science-based standards outlined by Morbidity and Mortality Weekly Report, control of Communicable Diseases
Manual, Red Book of Infectious Diseases or, as available, a state or CDC incident annex.
Task 2: Provide information to public health officials to support them in decision making related to mitigation actions. (For
additional or supporting detail, see Capability 6: Information Sharing)
Task 3: Monitor and analyze mitigation actions throughout the duration of the public health threat or incident. (For additional
or supporting detail, see Capability 2: Community Recovery, Capability 5: Fatality Management, Capability 7: Mass Care,
Capability 8: Medical Countermeasure Dispensing, Capability 11: Non-Pharmaceutical Interventions, and Capability 14:
Responder Safety and Health )
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CAPABILITY 13: Public Health Surveillance and Epidemiological Investigation
Function 3: Recommend, monitor, and analyze mitigation actions
Tasks (continued)
Task 4: Recommend additional mitigation activities, based upon mitigation monitoring and analysis, throughout the duration of
the incident, as appropriate.

Performance Measure(s)

This function is associated with the following CDC-defined performance measure:
Measure 1: Proportion of reports of selected reportable diseases for which initial public health control measure(s) were initiated
within the appropriate time frame309
–
–

Numerator: Number of reports of selected reportable diseases for which public health control measure(s) were
initiated within an appropriate time frame
Denominator: Number of reports of selected reportable diseases received by a public health agency

Resource Elements

PLANNING (P)

Note: Jurisdictions must have or have access to the resource elements designated as Priority.
P1: (Priority) Written plans should include protocols for recommending and initiating, if indicated, containment and
mitigation actions in response to public health incidents. Protocols include case and contact definitions, clinical
management of potential or actual cases, the provision of medical countermeasures, and the process for exercising legal
authority for disease, injury, or exposure control.310,311 Protocols should include consultation with the state or territorial
epidemiologist when warranted. (For additional or supporting detail, see Capability 8: Medical Countermeasure Dispensing
and Capability 11: Non-Pharmaceutical Interventions
P2: Written plans should include procedures for monitoring actual performance, and document actions and outcomes
using tools such as data reports or statistical summaries consistent with Morbidity and Mortality Weekly Report and other
criteria.312,313

SKILLS AND TRAINING (S)

P3: Written plans should include procedures to utilize health-related data and statistics from programs within the
jurisdictional public health agency to support recommendations regarding populations at-risk for adverse outcomes
during a natural or intentional threat or incident. (For additional or supporting detail, see Capability 1: Community
Preparedness)
S1: (Priority) Public health staff participating in epidemiological investigations should receive awareness-level training with
the Homeland Security Exercise and Evaluation After Action Report process.

Function 4: Improve public health surveillance and epidemiological investigation systems
Assess internal agency surveillance and epidemiologic investigation both during and after an incident and implement quality
improvement measures that are within jurisdictional public health agency control.

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CAPABILITY 13: Public Health Surveillance and Epidemiological Investigation
Function 4: Improve public health surveillance and epidemiological investigation systems
Tasks

This function consists of the ability to perform the following tasks:
Task 1: Identify issues and outcomes during and after the incident.
Task 2: Conduct post-incident/post-exercise agency evaluation meeting(s) including all active participants (e.g., law
enforcement, volunteer agencies, clinical partners or environmental regulatory agency) to identify internal protocols and
deficiencies that require corrective actions in areas such as programs, personnel, training, equipment, and organizational
structure.
Task 3: Develop an After Action Report/Improvement Plan.
Task 4: Communicate recommended After Action Report Improvement Plan corrective actions to public health leadership.

Performance Measure(s)

At present there are no CDC-defined performance measures for this function.

Resource Elements
PLANNING (P)

S1: Public health epidemiology staff should have awareness-level training of quality improvement processes and
techniques.314

EQUIPMENT AND TECHNOLOGY (E)

P1: (Priority) Written plans should include procedures to communicate the improvement plan to key stakeholders (including
groups representing at-risk populations) and to implement corrective actions identified in the improvement plan.

SKILLS AND TRAINING (S)

Note: Jurisdictions must have or have access to the resource elements designated as Priority.

P2: Written plans should include procedures to re-engage local public health agencies and key stakeholders and at-risk
populations, as applicable, after the acute phase of a threat or incident to ensure that the jurisdiction’s plans and
response reached all necessary populations.

S2: Have access to individual(s) trained to meet competencies for a Public Health Informatician as defined in Competencies
for Public Health Informaticians315 to contribute to information sourcing, use, and reuse for surveillance and
epidemiologic analysis.316

E1: Have or have access to electronic or paper-based tools for data collection, management, and analysis, including methods
for collecting, managing, and analyzing data electronically.

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CAPABILITY 14: Responder Safety and Health
The responder safety and health capability describes the ability to protect public
health agency staff responding to an incident317 and the ability to support the health
and safety needs of hospital and medical facility personnel, if requested.
This capability consists of the ability to perform the following functions:
Function 1: Identify responder safety and health risks
Function 2: Identify safety and personal protective needs
Function 3: Coordinate with partners to facilitate risk-specific safety and health training
Function 4: Monitor responder safety and health actions

Function 1: Identify responder safety and health risks
Assist in the identification of the medical and mental/behavioral health318 risks (routine and incident-specific) to responders and
communicate this information prior to, during, and after an incident.

Tasks

This function consists of the ability to perform the following tasks:
Task 1: Prior to an incident, identify the medical, environmental exposure, and mental/behavioral health risks that may be faced
by staff responding to the public health incident in conjunction with partner agencies and based on jurisdictional risk
assessment. (For additional or supporting detail, see Capability 1: Community Preparedness)
Task 2: Prior to an incident, identify subject matter experts and other informational resources that can be used by public health
staff to make health and safety recommendations to the Incident Safety Officers or lead agency.
Task 3: Prior to an incident, and as applicable during an incident, work with subject matter experts to develop information on
potential acute and chronic health conditions that may develop/occur during and after an exposure.
Task 4: In consultation with the Incident Safety Officer and subject matter experts, participate in the formulation of
recommendations to the Incident Commander regarding responder-specific risks to be addressed in incident action
plans.
Task 5: Distribute safety materials to public health responders through daily briefings at the onset of, and throughout an
incident, in consultation with the Incident Safety Officer and jurisdictional subject matter experts. (For additional or
supporting detail, see Capability 4: Emergency Public Information and Warning)

Performance Measure(s)

At present there are no CDC-defined performance measures for this function.

Resource Elements

Note: Jurisdictions must have or have access to the resource elements designated as Priority.

PLANNING (P)

P1: (Priority) Written plans should include documentation of the safety and health risk scenarios likely to be faced by
public health responders, based on pre-identified jurisdictional incident risks, which are developed in consultation with
partner agencies (e.g., environmental health, occupational health and safety, jurisdictional Local Emergency Planning
Committee, risk-specific subject matter experts).319 This documentation should include the following elements:
–
–
–

Limits of exposure or injury necessitating response
Job-specific worker safety guides320 (e.g., radiation, heat, fire, and infrastructure damage resulting in other
chemical release)
Potential for post-event medical and mental/behavioral health follow-up assessments321

Suggested resources
–
–
–

State Occupational Safety and Health Plans: http://www.osha.gov/dcsp/osp/index.html
Environmental Protection Agency guidelines: http://www.epa.gov/radiation/rert/pags.html
Jurisdictional National Weather Service Office: http://www.weather.gov/stormready/contact.htm

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CAPABILITY 14: Responder Safety and Health
Function 1: Identify responder safety and health risks
Resource Elements (continued)
–
–

–
–
–

Hybrid Single Particle Lagrangian Integrated Trajectory Model:
http://www.arl.noaa.gov/HYSPLIT_info.php
Area Locations of Hazardous Atmospheres Predictive Model for Chemical Emergencies:
http://response.restoration.noaa.gov/topic_subtopic_entry.php?RECORD_KEY(entry_subtopic_topic)=entry_
id,subtopic_id,topic_id&entry_id(entry_subtopic_topic)=518&subtopic_id(entry_subtopic_topic)=24&topic_
id(entry_subtopic_topic)=1
U.S. Department of Transportation, Emergency Response Guidebook (ERG2008):
http://www.tc.gc.ca/media/documents/canutec-eng/erg2008eng.pdf
World Health Organization, Manual for the Public Health Management of Chemical Incidents:
http://www.who.int/environmental_health_emergencies/publications/FINAL-PHM-Chemical-Incidents_web.pdf
Jurisdictional Association for Professionals in Infection Control and Epidemiology:
http://www.apic.org/scriptcontent/custom/members/chapters/chaptermap.cfm?section=chapters

P2: (Priority) Written plans should include documentation that identifies public health roles and responsibilities related
to the jurisdiction’s identified risks, that was developed in conjunction with partner agencies (e.g., state environmental
health, state occupational health and safety, and hazard-specific subject matter experts) and emergency managers. This
documentation should identify the protective equipment, protective actions, or other mechanisms that public health
responders will need to have to execute potential roles. Roles for consideration may include the following elements:

PLANNING (P)

–
–
–

Conducting environmental health assessments
Potable water inspections
Field surveillance interviews

Recommend inclusion of the following groups, at a minimum:
–
–
–

State versions of Environmental Protection Agency
State Radiation Control Programs: http://www.crcpd.org/Map/RCPmap.htm
State Occupational Safety and Health Agency

Suggested resources
–
–
–
–
–
–
–
–
–
–
–
–

Federal Emergency Management Agency, Center for Domestic Preparedness Responder Handbook:
http://cdp.dhs.gov/pdfs/responder_handbook.pdf
Department of Homeland Security, Planning Guidance for Protection and Recovery Following RDD and IND
Incidents: http://ogcms.energy.gov/73fr45029.pdf
CDC National Institute for Occupational Safety and Health, Pocket Guide to Chemical Hazards:
http://www.cdc.gov/niosh/npg/npgsyn-c.html
Jane’s Chem-Bio Handbook
American Conference of Governmental Industrial Hygienists Threshold Limit Values and Biological Exposure
Indices Guide
CDC, Population Monitoring in Radiation Emergencies: A Guide for State and Local Public Health Planners:
http://emergency.cdc.gov/radiation/pdf/population-monitoring-guide.pdf
CDC Radiological Terrorism: Just in Time Training for Hospital Clinicians:
http://emergency.cdc.gov/radiation/justintime.asp
CDC Radiological Terrorism: Tool Kit for Public Health Officials:
http://emergency.cdc.gov/radiation/publichealthtoolkit.asp
Federal Emergency Management Agency, Environmental Health Training in Emergency Response:
https://cdp.dhs.gov/resident/ehter.html
Occupational Safety and Health Administration, Keeping Workers Safe During Clean Up and Recovery Operations
Following Hurricanes, 2005: www.osha.gov/OshDoc/hurricaneRecovery.html.
American Public Health Association (APHA) Policy Statement 20027: Protecting the Health and Safety of Workers
Who Respond to Disasters. APHA Policy Statements, 1948 - present, cumulative:
http://www.apha.org/legislative/policy/policysearch/index.cfm?fuseaction=search_results&YearofPolicy=2002
American Public Health Association Policy Statement 20069: Response to Disasters: Protection of Rescue and
Recovery Workers, Volunteers, and Residents Responding to Disasters:
http://www.apha.org/advocacy/policy/policysearch/default.htm?id=1333

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CAPABILITY 14: Responder Safety and Health
Function 1: Identify responder safety and health risks
SKILLS AND TRAINING (S)

Resource Elements (continued)
S1: Public health staff who will participate in planning for responder risks (e.g. planners, environmental health staff,
preparedness staff, and epidemiologists) should have awareness-level training on population monitoring to identify risks
and recommendations for personal protective equipment.
S2: Public health staff participating in the role of Incident Safety Officer should take the National Incident Management
System ICS-300 course.
S3: Public health staff participating in responses where Level A equipment is to be used should have Level A awareness and
technical response training.

EQUIPMENT AND TECHNOLOGY (E)

E1: Have or have access to Level D basic safety equipment, such as the following:
–
–
–
–
–
–
–
–
–

Coveralls
Gloves
Boots/shoes, chemical-resistant steel toe and shank
Boots, outer, chemical-resistant (disposable)
Safety glasses or chemical splash goggles
Hard hat
Escape mask
Face shield
N95 or dust masks (surgical masks)

If participating in a clinical scenario, public health staff should have or have access to standard precautions, including
gloves, gowns, and masks and goggles or face shields.
Suggested resources
–
–

Occupational Safety and Health Administration, general description and discussion of the levels of protection
and protective gear:
http://www.osha.gov/pls/oshaweb/owadisp.show_document?p_table=STANDARDS&p_id=9767
CDC Guidance for the Selection and Use of Personal Protective Equipment in Healthcare Settings:
www.cdc.gov/ncidod/dhqp/pdf/ppe/PPEslides6-29-04.ppt

Function 2: Identify safety and personal protective needs
Coordinate with occupational health and safety and other subject matter experts, based on incident-specific conditions, to
determine the necessary personal protective equipment, medical countermeasures, mental/behavioral health support services
and other items and services, and distribute these, as applicable, to protect the health of public health responders.

Tasks

This function consists of the ability to perform the following tasks:
Task 1: Prior to an incident, and as applicable during an incident, work with subject matter experts (e.g., state environmental
health, state occupational health and safety, hazard-specific subject matter experts, and emergency managers) to identify
responder safety and health resource requirements (e.g., equipment needs).
Task 2: Prior to an incident, and as applicable during an incident, and in conjunction with subject matter experts, formulate
recommendations to public health responders regarding personal protective equipment that are consistent with local
jurisdictional requirements.
Task 3: Coordinate with partner agencies to provide medical countermeasures and/or personal protective equipment to public
health responders, if indicated by the incident. (For additional or supporting detail, see Capability 8: Medical Countermeasure
Dispensing)
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CAPABILITY 14: Responder Safety and Health
Function 2: Identify safety and personal protective needs
Performance measure(s)

At present there are no CDC-defined performance measures for this function.

Resource Elements

Note: Jurisdictions must have or have access to the resource elements designated as Priority.
P1: (Priority) Written plans should include recommendations for risk-related personal protective equipment for public
health responders that have been developed in conjunction with partner agencies (e.g., state environmental health, state
occupational health and safety, and risk-specific subject matter experts).
Suggested resources

PLANNING (P)

–
–
–

CDC’s National Institute for Occupational Safety and Health, Pocket Guide to Chemical Hazards:
http://www.cdc.gov/niosh/npg/npgsyn-c.html
U.S. Health and Human Services, Radiation Emergency Medical Management Guide PPE Guidance:
http://www.remm.nlm.gov/onsite.htm
Occupational Safety and Health Administration, general description and discussion of the levels of protection
and protective gear:
http://www.osha.gov/pls/oshaweb/owadisp.show_document?p_table=STANDARDS&p_id=9767

P2: Written plans should include processes (either led by public health agency or delivered via partnerships with the
appropriate lead agency, i.e., state/local occupational safety and health lead) that assure that public health responders
are fit-tested and medically cleared to use personal protective equipment indicated for their particular response role,
both prior to and at the time of the incident.

EQUIPMENT AND TECHNOLOGY (E)

P3: Written plans should include protocols and processes to access (e.g., through mutual aid agreements or other
mechanism) backup/cache equipment for incident response, including identifying sources of additional equipment
and expertise both within and outside of the jurisdiction. These protocols and processes should follow emergency
management request procedures. (For additional or supporting detail, see Capability 9: Medical Materiel Management and
Distribution)
E1: (Priority) Have or have access to personal protective equipment that is consistent with the identified risks in the
jurisdiction and associated job functions of public health response personnel. This equipment should meet nationally
recognized standards as defined by the InterAgency Board for Equipment Standardization and Interoperability (https://
iab.gov).
Note: If public health departments elect to purchase personal protective equipment for their responders, they must
follow state, Occupational Safety and Health Administration, CDC’s National Institute for Occupational Safety and Health,
and other applicable regulations regarding the storage, dissemination, fit testing, and maintenance of such personal
protective equipment.
Suggested resource
–

General description and discussion of the levels of protection and protective gear, OSHA:
http://www.osha.gov/pls/oshaweb/owadisp.show_document?p_table=STANDARDS&p_id=9767

Function 3: Coordinate with partners to facilitate risk-specific safety and health training
In conjunction with partner agencies, facilitate the inclusion of risk-specific physical safety, mental/behavioral health, and personal
protective equipment topics (based on jurisdictional risk assessment) into public health responder training to prepare responders
for the incident.

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CAPABILITY 14: Responder Safety and Health
Function 3: Coordinate with partners to facilitate risk-specific safety and health training
Tasks

This function consists of the ability to perform the following task:
Task 1: Prior to an incident, and as applicable during an incident, work with subject matter experts to determine/recommend
risk-specific training (both training for protective actions as well as training for response to exposure or injury).

Performance Measure(s)

At present there are no CDC-defined performance measures for this function.

Resource elements

Note: Jurisdictions must have or have access to the resource elements designated as Priority.
S1: (Priority) Public health staff required to use N-95 or other respirators as part of their response role should undergo
respiratory function testing.

SKILLS AND TRAINING (S)

Suggested resources
–
–
–

Professional Training and Certification in Spirometry Testing and Respiratory Health Surveillance, a National
Institute for Occupational Safety and Health-approved Program for Health Professionals
National Institute for Occupational Safety and Health Spirometry Initial Training and National Institute for
Occupational Safety and Health Spirometry
Refresher Course
American National Standards Institute/American Industrial Hygiene Association Z88 Accredited Standards
Committee, Respiratory Protection: http://www.aiha.org/insideaiha/standards/Pages/Z88.aspx

S2: (Priority) Public health staff that perform responder functions, as well as staff identified as surge-capacity personnel,
should have documentation of training, with documentation updated a minimum of once per year. Documentation
should include training date and manner of delivery (e.g., formal training or “train the trainer”). Formal training examples
include CDC courses and CD or DVD-based courses, with completion verified by a formal demonstration.
S3: Awareness and technician refresher courses depending upon responder role. [Public health staff participating in
HAZWOPER incidents should have Occupational Safety and Health Administration HAZWOPER initial 40 hour and annual
8 hour refresher training (OSHA 29CFR 1910.120).]

Function 4: Monitor responder safety and health actions
Conduct or participate in monitoring and surveillance activities to identify any potential adverse health effects of public health
responders.

Tasks

This function consists of the ability to perform the following tasks:
Task 1: Conduct or participate in exposure, mental/behavioral health, and medical surveillance of public health incident
responders before, during, and after an incident. (For additional or supporting detail, see Capability 13: Public Health
Surveillance and Epidemiological Investigation)
Task 2: Coordinate with healthcare partners to facilitate access to and promote the availability of medical and mental/behavioral
health services for responders, either on-site or off-site as applicable to the incident.
Task 3: Provide guidance to partner organizations to help conduct monitoring of any responder staff for medical/mental/
behavioral incident-related health outcomes.
Task 4: Utilize surveillance data and other applicable inputs from partner agencies to provide recommendations or
considerations for any changes related to the use of personal protective equipment (e.g., to alter, suspend, or terminate
any activity or personal protective equipment usage judged to improve the outcome or be an imminent danger or
immediately dangerous to life and health). (For additional or supporting detail, see Capability 6: Information Sharing)
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CAPABILITY 14: Responder Safety and Health
Function 4: Monitor responder safety and health actions
Tasks (continued)
Task 5: Support the Public Information Officer and partner agencies to implement risk-communication strategies that
communicate risks to responders after the completion of the acute phase of an incident. Include risks known pre-incident
and those discovered during and after the acute phase. (For additional or supporting detail, see Capability 3: Emergency
Operations Coordination and Capability 4: Emergency Public Information and Warning)

Performance Measure(s)

At present there are no CDC-defined performance measures for this function.

Resource Elements

Note: Jurisdictions must have or have access to the resource elements designated as Priority.
P1: (Priority) Written plans should include process and protocols for how the public health agency, in conjunction with lead
partners (e.g., occupational health and safety) will participate in surveillance activities to monitor levels of environmental
exposure, environmental effects on the responders, and/or incident-related injuries. (For additional or supporting detail,
see Capability 13: Public Health Surveillance and Epidemiological Investigation)
Suggested resources
–

PLANNING (P)

–
–
–
–

Physical Health Status of World Trade Center Rescue and Recovery Workers and Volunteers -New York City, July
2002 - August 2004. Morbidity and Mortality Weekly Report , 53(35): 807-812. September 10, 2005:
www.cdc.gov/mmwr/preview/mmwrhtml/mm5335a1.htm
CDC, Chemical Exposure Assessment Considerations for Use in Evaluating Deepwater Horizon Response Workers
and Volunteers: http://www.cdc.gov/niosh/topics/oilspillresponse/assessment.html
National Institute for Occupational Safety and Health (NIOSH) Deepwater Horizon Data Use and Disclosure:
http://www.cdc.gov/niosh/topics/oilspillresponse/pdfs/NIOSH-Disclosure-English-051110.pdf
NIOSH Deepwater Horizon Initial Roster Form:
http://www.cdc.gov/niosh/topics/oilspillresponse/pdfs/NIOSH-Roster-Form-English-051210.pdf
Procedures for Recruiting Volunteers for Investigative Studies from the NIOSH Deepwater Horizon Response:
http://www.cdc.gov/niosh/topics/oilspillresponse/recruiting.html

P2: Written plans should include a process or protocol to coordinate with partner agencies for medical-readiness screening of
potential public health responders at the time of an incident to detect symptoms that may affect medical readiness (e.g.,
cough, cold, heat stress, and emotional stress).
Suggested resources
–
–

Medical Pre-Placement Evaluation for Workers Engaged in the Deepwater Horizon Response:
http://www.cdc.gov/niosh/topics/oilspillresponse/preplacement.html
Medical Pre-Placement Evaluation Indicators for Health Professionals:
http://www.cdc.gov/niosh/topics/oilspillresponse/indicators.html

EQUIPMENT AND TECHNOLOGY (E)

P3: Written plans should include a process and protocols for how the public health agency (in conjunction with lead
healthcare and mental/behavioral health partners) can promote the availability of medical and mental/behavioral health
services.
E1: (Priority) Have or have access to a registry database of responders who were exposed and/or injured during an incident.
This database should be updated at a frequency appropriate to the incident.

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CAPABILITY 15: Volunteer Management
Volunteer management is the ability to coordinate the identification, recruitment,
registration, credential verification, training, and engagement of volunteers322 to support
the jurisdictional public health agency’s response to incidents of public health significance.
The capability consists of the ability to perform the following functions:
Function 1: Coordinate volunteers
Function 2: Notify volunteers
Function 3: Organize, assemble, and dispatch volunteers
Function 4: Demobilize volunteers

Function 1: Coordinate volunteers
Recruit, identify, and train volunteers who can support the public health agency’s response to an incident. Volunteers identified
prior to an incident must be registered with the Emergency System for Advance Registration of Volunteer Health Professionals
(ESAR-VHP), Medical Reserve Corps, or other pre-identified partner groups (e.g., Red Cross or Community Emergency Response
Teams).

Tasks

The function consists of the ability to perform the following tasks:
Task 1: Prior to an incident, identify the types and numbers of volunteers most likely to be needed in a public health agency’s
response based on the jurisdictional community risk assessment. (For additional or supporting detail, see Capability 1:
Community Preparedness)
Task 2: Prior to an incident, coordinate with existing volunteer programs (e.g., ESAR-VHP, Medical Reserve Corps) and partner
organizations to support the pre-incident recruitment of volunteers that may be needed in a public health agency’s
response.
Task 3: Prior to an incident, assure pre-incident screening and verification of volunteers’ credentials through jurisdictional
ESAR-VHP and Medical Reserve Corps.
Task 4: Prior to an incident and as necessary at the time of an incident, support provision of initial and ongoing emergency
response training for registered volunteers. Training should be supported in partnership with jurisdictional Medical
Reserve Corps unit(s) and other partner groups.

Performance Measure(s)

At present there are no CDC-defined performance measures for this function.

Resource Elements

Note: Jurisdictions must have or have access to the resource elements designated as Priority.

PLANNING (P)

P1: (Priority) Written plans should address anticipated volunteer needs in response to incidents or situations identified in the
jurisdictional risk assessment including the following elements:323
–
–
–
–

Identification of functional roles
Skills, knowledge, or abilities needed for each volunteer task or role
Description of when the volunteer actions will happen
Identification of jurisdictional authorities that govern volunteer liability issues and scope of practice

P2: (Priority) Written plans should include memoranda of understanding or other letters of agreement with jurisdictional
volunteer sources. Suggested partners include but are not limited to the following groups: 324,325
–
–
–

Professional medical organizations (e.g., nursing and allied health)
Professional guilds (e.g., behavioral health)
Academic institutions

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CAPABILITY 15: Volunteer Management
Function 1: Coordinate volunteers
Resource Elements (continued)
–
–
–
–

Faith-based organizations
Voluntary Organizations Active in Disasters
Medical Reserve Corps
Non-profit, private, and community-based volunteer groups

PLANNING (P)

Partnership agreements should include plans for the following:
–
–
–
–
–
–

Partner organizations’ promotion of public health volunteer opportunities
Referral of all volunteers to register with jurisdictional Medical Reserve Corps and/or ESAR-VHP
Policies for protection of volunteer information, including destruction of information when it is no longer
needed (e.g., Red Cross, Community Emergency Response Teams, and member organizations of the National
and State Voluntary Organizations Active in Disasters)
Liability protection for volunteers
Efforts to continually engage volunteers through routine community health activities
Documentation of the volunteers’ affiliations (e.g., employers and volunteer organizations) at local, state, and
federal levels (to assist in minimizing “double counting” of prospective volunteers), and provision for registered
volunteer Identification cards denoting volunteers’ area of expertise

P3: Written plans should include a process to assure that professional volunteer diplomas, licenses, certifications, credentials
and registrations are verified in accordance with state laws (e.g., using the state’s ESAR-VHP).
P4: Written plans should include a process and protocol to address eligibility of volunteers based on pre-existing health
conditions or background screening (either conducted by health department or in conjunction with other partner
agency) to determine if prospective volunteers have any history that would preclude them from doing a certain type of
volunteer activity (e.g., previous convictions, sexual offender registry, or licensing issues).
S1: Documentation (either through a training curriculum or other vehicle) that volunteer training has occurred (either
delivered by the jurisdictional health department or leveraging programs by/in conjunction with other partners including
healthcare facilities and Preparedness and Emergency Response Learning Centers) to ensure that volunteers receive the
jurisdiction-defined training for their assigned responsibilities.
Recommended components of jurisdictional training curriculum include the following:

SKILLS AND TRAINING (S)

–

–
–
–
–
–
–
–
–
–
–
–
–

Psychological first aid and self care
Suggested resources
□□ After an Earthquare: Mental Health Information for Professionals
http://emergency.cdc.gov/disasters/earthquakes/mentalhealth_docs.asp)
□□ Psychological First Aid in Radiation Disasters:
http://www2a.cdc.gov/TCEOnline/registration/detailpage.asp?res_id=2490
Cultural competency component that reflects the jurisdictional demographics
Training to address the functional needs of persons who may be considered in the at-risk population326 during a
disaster response
Medical Reserve Corps Core Competencies
http://www.medicalreservecorps.gov/File/MRC%20TRAIN/Core%20Competency%20Resources/Core_
Competencies_Matrix_April_2007.pdf,
HazMat Awareness trainings
Basic disaster life support (American Medical Association’s National Disaster Life Support Program)
Advanced disaster life support (American Medical Association’s National Disaster Life Support Program)
Cardiopulmonary resuscitation (CPR)
Basic first aid skills
Basic triage skills
MRC-TRAIN: if jurisdiction participates in TRAIN program
(http://www.medicalreservecorps.gov/TRAINResources)
Other online courses as identified by the jurisdiction
U.S. Department of Health and Human Services’ training offerings (e.g., Integrated Training Summit at
http://www.integratedtrainingsummit.org/)

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CAPABILITY 15: Volunteer Management
Function 1: Coordinate volunteers

EQUIPMENT AND TECHNOLOGY (E)

SKILLS AND TRAINING (S)

Resource Elements (continued)
S2: Training for staff involved in personnel management
Suggested resource
–

Federal Emergency Management Agency (FEMA), Developing and Managing Volunteers (FEMA, IS-244):
(http://training.fema.gov/EMIWEB/is/is244.asp).

S3: Prospective volunteers should be offered the following National Incident Management System (NIMS) training:
– Introduction to Incident Command System (ICS-100) and NIMS, An Introduction (IS-700.a) for all volunteers
– ICS for Single Resources and Initial Action Incidents (IS-200.b), Incident Command System (ICS-300) and
Advanced ICS Command and General Staff (ICS-400) for volunteer leaders that will hold key leadership positions.
– NIMS website for courses: http://training.fema.gov/IS/NIMS.asp
E1: Have or have access to a system, be it electronic or manual, which is able to report the number of registered volunteers
by profession and/or skill level.

Function 2: Notify volunteers
At the time of an incident, utilize redundant communication systems where available (e.g., reverse 911 or text messaging) to
request that prospective volunteers participate in the public health agency’s response.

Tasks

The function consists of the ability to perform the following tasks:
Task 1: At the time of an incident, identify the desired skills and quantity of volunteers needed for the incident from the preincident volunteer registration.
Task 2: At the time of an incident, contact pre-incident registered volunteers using multiple modes of communication. (For
additional or supporting detail, see Capability 4: Emergency Public Information and Warning and Capability 6: Information
Sharing)
Task 3: At the time of an incident, notify volunteers who are able and willing to respond of where and how to report.
Task 4: At the time of an incident, coordinate with partner agencies to confirm credentials of responding volunteers. (For
additional or supporting detail, see Capability 6: Information Sharing)
Task 5: At the time of an incident, notify partner agencies of any need for additional volunteers. (For additional or supporting
detail, see Capability 4: Emergency Public Information and Warning and Capability 6: Information Sharing)

Performance Measure(s)

At present there are no CDC-defined performance measures for this function.
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CAPABILITY 15: Volunteer Management
Function 2: Notify volunteers
Resource Elements

Note: Jurisdictions must have or have access to the resource elements designated as Priority.

PLANNING (P)

P1: Written plans should include a template for describing incident conditions to potential volunteers (pre-deployment
briefing) including the following elements:327,328,329
–
–
–
–
–
–

Potential nature of the work site
Potential personal security issues
Potential health safety issues
Local weather
Living/work conditions
Required immunizations or prophylaxis, and the type of identification to bring with them when they report.

P2: Written plans should include a process for how the health agency or applicable lead jurisdictional agency will contact
registered volunteers, identifying those willing and able to respond, and notifying them of where to report (i.e., identified
staging area/reception center). (For additional or supporting detail, see Capability 3: Emergency Operations Coordination,
Capability 4: Emergency Public Information and Warning, and Capability 6: Information Sharing)
P3: Written plans should include a process to confirm credentials of responding volunteers through jurisdiction’s ESAR-VHP
or Medical Reserve Corps. (For additional or supporting detail, see Capability 6: Information Sharing)

EQUIPMENT AND TECHNOLOGY (E)

P4: Written plans should include definition of the volunteer management roles and responsibilities of public health
department staff members.
E1: Have or have access to communications equipment for health department staff to contact volunteer organizations.
–

Suggested equipment includes, but is not limited to phones, computers, ham radios, and/or hand radios. (For
additional or supporting detail, see Capability 6: Information Sharing )

Function 3: Organize, assemble, and dispatch volunteers
Coordinate the assignment of public health agency volunteers to public health, medical, mental/behavioral health,330 and nonspecialized tasks as directed by the incident, including the integration of interjurisdictional (e.g., cross-border or federal) volunteer
response teams into the jurisdictional public health agency’s response efforts.

Tasks

This function consists of the ability to perform the following tasks:
Task 1: If the incident differs from or exceeds the public health agency’s pre-incident-defined volunteer plans, identify additional
volunteers that have the necessary credentials and skills.
Task 2: Assure deployment briefing of public health volunteers, including safety and incident-specific training.

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CAPABILITY 15: Volunteer Management
Function 3: Organize, assemble, and dispatch volunteers
Tasks (continued)
Task 3: Assure tracking and rotation of volunteers as indicated by the incident and by relevant job function.
Task 4: Manage spontaneous volunteers who may request to support the public health agency’s response, either through
incorporating them into the response or by triaging them to other potential volunteer resources.
Task 5: Coordinate state and jurisdictional response roles for federal public health staff deployed to the jurisdiction.

Performance Measure(s)

At present there are no CDC-defined performance measures for this function.

Resource Elements

Note: Jurisdictions must have or have access to the resource elements designated as Priority.
P1: (Priority) Written plans should include a template for briefing volunteers of current incident conditions, including the
following elements:
–
–
–
–
–

Instructions on the current status of the emergency
Volunteers’ role (including how the volunteer is to operate within incident management)
Just-in-time training
Safety instructions
Any applicable liability issues related to the incident and the volunteers’ roles, psychological first aid, and/or
volunteer stress management

P2: (Priority) Written plans should include a process to manage spontaneous volunteers. The process should include, at a
minimum, the following elements:

PLANNING (P)

–

Process to communicate to the public whether spontaneous volunteers should report, and, if so, where and to
whom
– Method to inform spontaneous volunteers how to register for use in future emergency responses
– Method to refer spontaneous volunteers to other organization (e.g., non-profit or Medical Reserve Corps)
(For additional or supporting detail, see Capability 4: Emergency Public Information and Warning)
If spontaneous volunteers will be integrated into a response, the process should include the identification of duties
spontaneous volunteers can perform.
Suggested resources
––
––

Managing Spontaneous Volunteers in Times of Disaster: The Synergy of Structure and Good Intentions:
http://www.nvoad.org/index.php/rl/cat_view/46-volunteer-management-.html
CDC and Association of State and Territorial Health Officials, At-Risk Populations and Pandemic Influenza:
Planning Guidance for State, Territorial, Tribal, and Local Health Departments:
http://www.astho.org/Display/AssetDisplay.aspx?id=401

P3: Written plans should include a process for how the public health agency will coordinate with emergency management or
other jurisdictional lead agency to assure support (e.g., housing, feeding and mental/behavioral health needs) for public
health volunteers.331 (For additional or supporting detail, see Capability 6: Information Sharing )
P4: Written plans should include a process for assigning volunteers to response agencies.
P5: Written plans should include a process for coordinating with volunteer health professional entities and staff from various
levels (e.g., local, state, federal), including but not limited to Medical Reserve Corps, ESAR-VHP and the National Disaster
Medical System.
Suggested resource
–

Medical Surge Capacity and Capability Handbook:
http://www.phe.gov/preparedness/planning/mscc/handbook/pages/default.aspx

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CAPABILITY 15: Volunteer Management
Function 3: Organize, assemble, and dispatch volunteers
Resource Elements (continued)
P6: Written plans should include a request protocol for state and local health departments that should contain, at a
minimum, protocols for the following elements:
Local/ state health department requests for interjurisdictional volunteer assets
Local health department escalation requests for federal public health assets through the state. The request from
local to state should include a clear statement of the role of the requested asset.
– State health department escalation requests for federal public health assets. The request should include a clear
statement of the role of the requested asset.
– State health departments to communicate information received from/about federal response teams to local
health departments
– Communication between state and local health departments about volunteer needs and assignments during an
incident
(For additional or supporting detail, see Capability 6: Information Sharing)

PLANNING (P)

–
–

EQUIPMENT AND TECHNOLOGY (E)

P7: Written plans should include procedures for coordinating support services for responding federal medical stations.
States should work with their U. S. Department of Health and Human Services Regional Emergency Coordinator to
develop support service plans, to include at a minimum the disposal of biohazard medical waste.
E1: Have or have access to a manual or electronic system for tracking volunteer assignment, to include maintenance of a
history of volunteer deployments/volunteer activity in incident responses.
Suggested resource
––

Emergency System for the Advance Registration of Volunteer Health Professionals: www.phe.gov/esarvhp

Function 4: Demobilize volunteers
Release volunteers based on evolving incident requirements or incident-action plan and coordinate with partner agencies to
assure provision of any medical and mental/behavioral health support needed for volunteers to return to pre-incident status.

Tasks

This function consists of the ability to perform the following tasks:
Task 1: Track (record or document) the demobilization of volunteers.
Task 2: Assure coordination of out-processing332 of volunteers.
Task 3: Coordinate with jurisdictional authorities and partner groups to identify community resources that can support volunteer
post-deployment medical screening, stress, and well-being assessment and, when requested or indicated, referral to
medical and mental/behavioral health services. (For additional or supporting detail, see Capability 2: Community Recovery
and Capability 14: Responder Safety and Health)

Performance Measure(s)

At present there are no CDC-defined performance measures for this function.
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CAPABILITY 15: Volunteer Management
Function 4: Demobilize volunteers
Resource Elements

Note: Jurisdictions must have or have access to the resource elements designated as Priority.

PLANNING (P)

P1: (Priority) Written plans should include a process for releasing volunteers, to be used when the public health department
has the lead role in volunteer coordination. The process should include steps to accomplish the following:
– Demobilize volunteers in accordance with the incident action plan
– Assure all assigned activities are completed, and/or replacement volunteers are informed of the activities’ status
– Determine whether additional volunteer assistance is needed from the volunteer
– Assure all equipment is returned by volunteer
– Confirm the volunteer’s follow-up contact information
(For additional or supporting detail, see Capability 4: Emergency Operations Coordination)
P2: (Priority) Written plans should include a protocol for conducting exit screening during out-processing, to include
documentation of the following:
–
–
–

Any injuries and illnesses acquired during the response
Mental/behavioral health needs due to participation in the response
When requested or indicated, referral of volunteer to medical and mental/behavioral health services

Suggested resource
–

Information on post-incident environmental or occupational exposure monitoring: National Institute of
Occupational Safety and Health website http://www.cdc.gov/niosh/
(For additional or supporting detail, see Capability 14: Responder Safety and Health)

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ENDNOTES
Capability 1: Community Preparedness
1

2
3

4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22

23

24
25
26

The term “incident” is used throughout this document. It is defined in the National Incident Management System
Incident Command Structure as “An occurrence either human caused or by natural phenomena, that requires
action to prevent or minimize loss of life or damage to property and/or natural resources.”
Throughout this document, the term “Mental/Behavioral Health” is used as an overarching term to encompass behavioral,
psychosocial, substance abuse and psychological health
“Human Impact” refers to indicators such as: number of fatalities resulting from a particular hazard, Injuries Requiring
Emergency Medical Services Transport, Outpatient Injuries, Hospital ED Visits Due to Injuries, Trauma Center (levels 1&2)
Injuries (excerpt from Hazard Risk) Assessment Instrument, University of California, Los Angeles Center for Public Health and
Disasters)
Adapted from Project Public Health Ready Measure 1.j1
Adapted from Public Health Accreditation Board Proposed Standards and Measures (final draft for beta test - July 2009)
Measure 7.1.2B
Adapted from Project Public Health Ready Measure 1.e2
Adapted from Project Public Health Ready Measure 1.e3
Adapted from Public Health Accreditation Board Proposed Standards and Measures (final draft for beta test - July 2009)
Measure 5.4.1B
Adapted from Project Public Health Ready Measure 1.t2
Adapted from Project Public Health Ready Measure 1.j2
Adapted from Project Public Health Ready Measure 1.t1
Adapted from Project Public Health Ready Measure 1.b4
Adapted from Project Public Health Ready Measure 1.t3
Building Community Resilience for Children and Families:
http://www.nctsnet.org/nctsn_assets/pdfs/edu_materials/BuildingCommunity_FINAL_02-12-07.pdf
Adapted from Public Health Accreditation Board Proposed Standards and Measures (final draft for beta test - July 2009)
Measure 4.1.1B
Adapted from Public Health Accreditation Board Proposed Standards and Measures (final draft for beta test - July 2009)
Measure 4.1.2B
Adapted from Project Public Health Ready Measure 1.w3i
Adapted from Project Public Health Ready Measure 1.w3vii
Adapted from Public Health Accreditation Board Proposed Standards and Measures (final draft for beta test - July 2009)
Measure 4.1.2B
Adapted from Public Health Accreditation Board Proposed Standards and Measures (final draft for beta test - July 2009)
Measure 4.1.2B
Adapted from Project Public Health Ready Measure 1.e3
Social connectedness refers to the personal (e.g., family, friend, neighbor) and professional (e.g., service provider,
community leader) relationships among community residents. From Chandra, A. et al. (2010). “Understanding Community
Resilience in the Context of National Health Security: A Literature Review.” Working Paper WR-737. Available at
http://www.rand.org/pubs/working_papers/2010/RAND_WR737.pdf
People connected to community organizations and other providers of knowledge and resources during an emergency,
perceive themselves to be at higher risk and are therefore more likely to engage in preparedness activities before a disaster.
From Yong-Chan, K., & Jinae, K. (2009). Communication, neighborhood belonging and household hurricane preparedness.
Disasters. As cited in Chandra, A. et al. (2010). “Understanding Community Resilience in the Context of National Health
Security: A Literature Review”. Working Paper WR-737. Available at
http://www.rand.org/pubs/working_papers/2010/RAND_WR737.pdf
Adapted from Public Health Accreditation Board Proposed Standards and Measures (final draft for beta test - July 2009)
Measure 4.1.2B
Adapted from Project Public Health Ready Measure 1.e3
Adapted from Project Public Health Ready Measure 1.j2

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ENDNOTES
Capability 2: Community Recovery
27
28
29
30
31
32
33
34
35
36
37

Institute of Medicine (1988). The Future of Public Health
http://www.cdc.gov/nphpsp/essentialServices.html
Adapted from Project Public Health Ready Measure 1.y1
Adapted from Public Health Accreditation Board Proposed Standards and Measures (final draft for beta test - July 2009)
Measure 5.4.2B
A “public health system” is defined as executing the core functions of public health agencies at all levels of government:
assessment, policy development, assurance (The Future of Public Health, 1988, Institute of Medicine)
Adapted from Project Public Health Ready Measure 1.v1
Adapted from Project Public Health Ready Measure 1.v2
Adapted from Project Public Health Ready Measure 1.v4
Gurwitch, R.H., Pfefferbaum, B., Montgomery, J.M., Klomp, R.W., & Reissman, D.B. (2007). Available at
http://www.nctsnet.org/nctsn_assets/pdfs/edu_materials/BuildingCommunity_FINAL_02-12-07.pdf
“Functional Needs” defined as communication, medical, independence, supervisory, and transportation) of at-risk
individuals
Business; Community Leadership; Cultural and Faith-based Groups and Organizations; Emergency Management;
Healthcare; Social Services; Housing and Sheltering; Media; Mental/behavioral Health; State Office of Aging or its
equivalent; Education and Childcare Settings

Capability 3: Emergency Operations Coordination
38
39

40
41
42
43
44
45
46
47
48
49

The term “event” is used throughout this document. It is defined in the National Incident Management System Incident
Command Structure as “A planned, non-emergency activity (e.g., parades, concerts, or sporting events).”
The term “incident” is used throughout this document. It is defined in the National Incident Management System Incident
Command Structure as “An occurrence either human caused or by natural phenomena, that requires action to prevent or
minimize loss of life or damage to property and/or natural resources.”
Adapted from Public Health Accreditation Board Proposed Standards and Measures (final draft for beta test - July 2009)
Measure 5.4.2B
The term “demobilize” is used throughout this document. It is defined in Incident Command Structure Training Course 300
(manual page 7-4) to refer to “the release and return of resources that are no longer required for the support of an incident”
Federal Emergency Management Agency Incident Types:
http://training.fema.gov/EMIWeb/IS/ICSResource/assets/IncidentTypes.pdf
Adapted from Project Public Health Ready Measure 1.k1
Adapted from Project Public Health Ready Measure 1.k2
Federal Emergency Management Agency Incident Types:
http://training.fema.gov/EMIWeb/IS/ICSResource/assets/IncidentTypes.pdf
Adapted from Project Public Health Ready Measure 1.g2
“Virtual structure” can be defined as a software solution such as webEOC or a just in time modular “go kit” style solution to
creating a physical emergency operations center
http://training.fema.gov/EMIWeb/IS/ICSResource/assets/IncidentTypes.pdf
Public health is not required to produce their own Incident Action Plan when not the lead agency

Capability 4: Emergency Public Information and Warning
50

51
52
53

The term “incident” is used throughout this document. It is defined in the National Incident Management System Incident
Command Structure as “An occurrence either human caused or by natural phenomena, that requires action to prevent or
minimize loss of life or damage to property and/or natural resources.”
Adapted from Public Health Accreditation Board Proposed Standards and Measures (final draft for beta test - July 2009)
Measure 3.2.2 B
Adapted from Project Public Health Ready Measure 1.i3
Adapted from Project Public Health Ready Measure 1.l2v-vii

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ENDNOTES
54
55
56
57
58
59
60
61
62

See Administration Manage/Specialist for examples of job description: http://www.fema.gov/pdf/pao/field_guide.pdf
Approved by the jurisdictional approving authority (health officer or Incident Commander)
Adapted from Public Health Accreditation Board Proposed Standards and Measures (final draft for beta test - July 2009)
Measure3.2.2 B
Adapted from Public Health Accreditation Board Proposed Standards and Measures (final draft for beta test - July 2009)
Measure 3.2.4 B
“Secure” is defined as message information that can only be accessed by the intended receiver e.g. https, login/password.
Adapted from Project Public Health Ready Measure 1.l2v-vii
Adapted from Public Health Accreditation Board Proposed Standards and Measures (final draft for beta test - July 2009)
Measure 3.2.5 B
Adapted from Public Health Accreditation Board Proposed Standards and Measures (final draft for beta test - July 2009)
Measure 3.2.5 B
Adapted from Public Health Accreditation Board Proposed Standards and Measures (final draft for beta test - July 2009)
Measure 3.2.5 B

Capability 5: Fatality Management
63
64
65
66
67
68
69
70
71

72
73
74
75

Adapted from Project Public Health Ready Measure 1.q1
Gavin, Cynthia, and John Nesler. Critical Aspects of Mass Fatality Planning for State and Local Governments. In Death in
Large Numbers: The Science, Policy, and Management of Mass Fatality Events.
Adapted from Public Health Accreditation Board Proposed Standards and Measures (final draft for beta test - July 2009)
Measure 7.2.3B
Adapted from Project Public Health Ready Measure 1.q1
Adapted from Project Public Health Ready Measure 1.q1
Adapted from Project Public Health Ready Measure 1.q2
Adapted from Public Health Accreditation Board Proposed Standards and Measures (final draft for beta test - July 2009)
Measure 5.4.1B
Adapted from Project Public Health Ready Measure 1.q2
Ante-mortem data is “Information about the missing or deceased person that can be used for identification. This
includes demographic and physical descriptions, medical and dental records, and information regarding their last known
whereabouts. Ante-mortem information is gathered and compared to post-mortem information when confirming a victim’s
identification.” (National Association of County and City Health Officials Advance Practice Center Toolkit ‘Creating and
Operating a Family Assistance Center: A Toolkit for Public Health).
Defined by the National Mass Fatalities Institute:
http://www.ncbi.nlm.nih.gov/bookshelf/br.fcgi?book=nap12798&part=fatalmgmt
Adapted from Project Public Health Ready Measure 1.t2
Adapted from Public Health Accreditation Board Proposed Standards and Measures (final draft for beta test - July 2009)
Measure 7.2.2B
Adapted from Public Health Accreditation Board Proposed Standards and Measures (final draft for beta test - July 2009)
Measure 2.2.3B

Capability 6: Information Sharing
76

77

An “alert” is a time sensitive tactical communication sent to parties potentially impacted by an incident to increase their
preparedness and response. Alerts can convey 1) urgent information for immediate action, 2) interim information with
actions that may be required in the near future, or 3) information that requires minimal or no action by responders. A Health
Alert is an alert, issued by a public health agency or public health partner to a collection of people and organizations with
which the sender has a response relationship.
The term “event” is used throughout this document. It is defined in Incident Command Structure as “A planned, nonemergency activity (e.g., parades, concerts, or sporting events).”

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78

79
80
81
82
83
84
85
86
87

88
89

90

91
92

93
94
95
96
97

The term “incident” is used throughout this document. It is defined in Incident Command Structure as “An occurrence
eitherhuman caused or by natural phenomena, that requires action to prevent or minimize loss of life or damage to
property and/or natural resources.”
Adapted from Public Health Accreditation Board Proposed Standards and Measures (final draft for beta test - July 2009)
Measure 3.2.2B
Adapted from Project Public Health Ready Measure 1.I1ii
Adapted from Project Public Health Ready Measure 1.I1iii
Adapted from Project Public Health Ready Measure 1.I1v
Adapted from Project Public Health Ready Measure 1.I1v
Suggested source for up to date national standards: CDC Public Health Information Network: www.cdc.gov/phin
Adapted from Project Public Health Ready Measure 1.l2iii
Adapted from Project Public Health Ready Measure 1.l1viii
Centers for Medicare and Medicaid Services (42 CFR Parts 412, 413, 422 et al.) Medicare and Medicaid Programs; Electronic
Health Record Incentive Program; Final Rule (published on July 28, 2010 in the Federal Register at
http://edocket.access.gpo.gov/2010/pdf/2010-17207.pdf ) and the Office of the National Coordinator for Health Information
Technology Health Information Technology Standards, Implementation Specifications, and Certification Criteria and
Certification Programs for Health information Technology (45 Code of Federal Regulations Part 170) viewable at
http://ecfr.gpoaccess.gov/cgi/t/text/text-idx?c=ecfr&sid=7c3390b0a0d2aecc6951346873b39efd&rgn=div5&view=text&nod
e=45:1.0.1.4.77&idno=45. The latest updates to these standards will be made available at www.cdc.gov/phin.
Adapted from Project Public Health Ready Measure 1.l3ii
Centers for Disease Control and Prevention and University of Washington’s Center for Public Health Informatics.
Competencies for Public Health Informaticians. Atlanta, GA: U.S .Department of Health and Human Services, Centers for
Disease Control and Prevention. 2009. This document is available online at http://www.cdc.gov/InformaticsCompetencies
and at http://cphi.washington.edu/resources/competencies.html.
Individuals with informatician competencies may be available from governmental IT service units; other health agencies;
major medical centers; biomedical informatics programs at local universities; public health informatics programs at
universities (typically those with Schools of Public Health); private consulting firms; and vendors of health information
technology. It is suggested that discussions regarding desired competencies from the Competency list, and attitudes of
impartiality regarding commercial products be assessed prior to engagement.
Adapted from Project Public Health Ready Measure 1.l1viii
See www.cdc.gov/phin for more information. These should include addressing requirements of Centers for Medicare and
Medicaid Services (CMS) and the Office of the National Coordinator for Health Information Technology (ONC) related to
the Meaningful Use privacy objectives of the CMS Incentive Program for Electronic Health Records. CMS & ONC regulations
of January, 2011 are posted at http://healthit.hhs.gov/portal/server.pt/community/healthit_hhs_gov__meaningful_
use_announcement/2996 or at http://edocket.access.gpo.gov/2010/pdf/2010-17207.pdf and http://edocket.access.gpo.
gov/2010/pdf/2010-17210.pdf respectively). Additional information is available at the Office of the National Coordinator for
Health Information Technology Health Information Technology Standards, Implementation Specifications, and Certification
Criteria and Certification Programs for Health information Technology (45 Code of Federal RegulationsPart 170) viewable at
http://ecfr.gpoaccess.gov/cgi/t/text/text-idx?c=ecfr&sid=7c3390b0a0d2aecc6951346873b39efd&rgn=div5&view=text&nod
e=45:1.0.1.4.77&idno=45. The latest updates to these standards will be made available at www.cdc.gov/phin.
Note Meaningful Use Stage 1 Requirements at Endnote 91
Valid encryption processes for data in motion are those which comply, as appropriate, with NIST SP 800-52, 800-77, or 800113, or others which are Federal Information Processing Standards (FIPS) 140-2 validated
Note Meaningful Use Stage 1 Requirements at Endnote 91
Adapted from Project Public Health Ready Measure 1.l3i
http://healthit.hhs.gov/portal/server.pt/community/healthit_hhs_gov__privacy___security_framework/1173

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Capability 7: Mass Care
98
99

100
101
102
103
104
105

Excludes shelter-in-place
At-Risk Population: Populations whose members may have additional needs before, during, and after an incident in
functional areas, including but not limited to: maintaining independence, communication, transportation, supervision,
medical care. Individuals in need of additional response assistance may include those who have disabilities; who live
in institutionalized settings; who are elderly; who are children; who are from diverse cultures; who have limited English
proficiency; or who are non-English speaking; or who are transportation disadvantaged (U.S. Department of Health and
Human Services).
Adapted from Project Public Health Ready Measure 1.l2x
Adapted from Project Public Health Ready Measure 1.p1ii
Americans with Disabilities Act, Title II
Population monitoring includes registration, screening, decontamination, and long-term follow-up.
Adapted from Project Public Health Ready Measure 1.p4
Adapted from Project Public Health Ready Measure 1.p4

Capability 8: Medical Countermeasure Dispensing
106 Those who have, in addition to their medical needs, other functional needs that may interfere with their ability to access or
receive medical care.
107 Adapted from Public Health Accreditation Board Proposed Standards and Measures (final draft for beta test - July 2009)
Measure 2.3.4B
108 Adapted from Public Health Accreditation Board Proposed Standards and Measures (final draft for beta test - July 2009)
Measure 4.1.2B
109 Intermediary distribution sites are locations where medical countermeasures are taken before they reach a point of
dispensing. In some cases, medical countermeasures will remain in custody of public health. In others, custody will be
transferred to other partners and these partners will be responsible for dispensing the medical countermeasures.
110 Adapted from Project Public Health Ready Measure 1.o2
111 Dispensing modalities are the strategies or methods that a jurisdiction can utilize to provide the countermeasures (e.g.
point of dispensing locations, drive-through pick-up locations, pushing medications to private businesses)
112 As defined by the incident and the jurisdiction
113 Adapted from Public Health Accreditation Board Proposed Standards and Measures (final draft for beta test - July 2009)
Measure 2.3.4B
114 Adapted from Public Health Accreditation Board Proposed Standards and Measures (final draft for beta test - July 2009)
Measure 2.2.1B
115 Adapted from Strategic National Stockpile Local Technical Assistance Review Users Guide Measure 10.1
116 Adapted from Strategic National Stockpile Local Technical Assistance Review Users Guide Measure 6.3
117 Adapted from Strategic National Stockpile Local Technical Assistance Review Users Guide Measure 6.4
118 Adapted from Strategic National Stockpile Local Technical Assistance Review Users Guide Measure 6.5
119 Adapted from Strategic National Stockpile State Technical Assistance Review Users Guide Measure 6.3
120 Adapted from Strategic National Stockpile Local Technical Assistance Review Users Guide Measure 11.1
121 Adapted from Strategic National Stockpile Local Technical Assistance Review Users Guide Measure 12.3
122 Adapted from Public Health Accreditation Board Proposed Standards and Measures (final draft for beta test - July 2009)
Measure2.4.4B
123 Adapted from Strategic National Stockpile Local Technical Assistance Review Users Guide Measure 5.2
124 Adapted from Strategic National Stockpile Local Technical Assistance Review Users Guide Measure 5.4
125 Adapted from Strategic National Stockpile State Technical Assistance Review Users Guide Measure 5.2
126 Adapted from Strategic National Stockpile State Technical Assistance Review Users Guide Measure 5.3
127 Adapted from Project Public Health Ready Measure 1.o1
128 Adapted from Strategic National Stockpile Local Technical Assistance Review Users Guide Measure 6.3
129 Adapted from Strategic National Stockpile Local Technical Assistance Review Users Guide Measure 6.4
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130
131
132
133
134
135
136

Adapted from Strategic National Stockpile Local Technical Assistance Review Users Guide Measure 6.5
Adapted from Strategic National Stockpile State Technical Assistance Review Users Guide Measure 6.3
Adapted from Strategic National Stockpile Local Technical Assistance Review Users Guide Measure 8.2
Adapted from Strategic National Stockpile State Technical Assistance Review Users Guide Measure 8.2
Adapted from Strategic National Stockpile Local Technical Assistance Review Users Guide Measure 8.1
Adapted from Strategic National Stockpile State Technical Assistance Review Users Guide Measure 8.1
Adapted from Project Public Health Ready Measure 1.o3

Capability 9: Medical Materiel Management and Distribution
137 The term “incident” is used throughout this document. It is defined in National Incident Management System Incident
Command Structure as “An occurrence either human caused or by natural phenomena, that requires action to prevent or
minimize loss of life or damage to property and/or natural resources.”
138 This decision can be based on a number of factors, including, but not limited to, size of the incident, size and quantity of
materiel to be acquired and distributed, necessity of cold chain management.
139 Adapted from Strategic National Stockpile Local Technical Assistance Review Users Guide Measure 7.2
140 Adapted from Strategic National Stockpile State Technical Assistance Review Users Guide Measure 7.2
141 Adapted from Strategic National Stockpile Local Technical Assistance Review Users Guide Measure 7.14
142 Adapted from Strategic National Stockpile State Technical Assistance Review Users Guide Measure 7.14
143 Adapted from Strategic National Stockpile Local Technical Assistance Review Users Guide Measure 7.15
144 Adapted from Strategic National Stockpile State Technical Assistance Review Users Guide Measure 7.15
145 Adapted from Strategic National Stockpile Local Technical Assistance Review Users Guide Measure 9.5
146 Adapted from Strategic National Stockpile State Technical Assistance Review Users Guide Measure 10.5
147 Adapted from Strategic National Stockpile Local Technical Assistance Review Users Guide Measure 9.3
148 Adapted from Strategic National Stockpile State Technical Assistance Review Users Guide Measure 10.3
149 Those who have, in addition to their medical needs, other functional needs that may interfere with their ability to access or
receive medical care.
150 Adapted from Strategic National Stockpile Local Technical Assistance Review Users Guide Measure 6.4
151 Adapted from Strategic National Stockpile State Technical Assistance Review Users Guide Measure 6.3
152 Adapted from Public Health Accreditation Board Proposed Standards and Measures (final draft for beta test - July 2009)
Measure 8.1.2B
153 This could include personnel from neighboring jurisdictions all the way up to a Strategic National Stockpile task force.
154 Adapted from Public Health Accreditation Board Proposed Standards and Measures (final draft for beta test - July 2009)
Measure 2.4.1B
155 Adapted from Strategic National Stockpile Local Technical Assistance Review Users Guide Measure 11.1
156 Adapted from Strategic National Stockpile State Technical Assistance Review Users Guide Measure 12.3
157 Adapted from Project Public Health Ready Measure 1.i3
158 Adapted from Strategic National Stockpile Local Technical Assistance Review Users Guide Measure 2.2
159 Adapted from Strategic National Stockpile Local Technical Assistance Review Users Guide Measure 7.13
160 Adapted from Strategic National Stockpile State Technical Assistance Review Users Guide Measure 7.13
161 Ideally a logistician, but could also be someone with experience in warehousing or supply chain management
(i.e., public works)
162 Adapted from Strategic National Stockpile Local Technical Assistance Review Users Guide Measure 9.1
163 Adapted from Strategic National Stockpile State Technical Assistance Review Users Guide Measure 10.1
164 This includes temperature control, cleanliness, packaging, handling, chain of custody, and other pertinent protocols.
165 Adapted from Project Public Health Ready Measure 1.x3
166 Adapted from Strategic National Stockpile State Technical Assistance Review Users Guide Measure 3.4
167 Adapted from Strategic National Stockpile State Technical Assistance Review Users Guide Measure 3.6
168 Adapted from Project Public Health Ready Measure 1.x4
169 Adapted from Project Public Health Ready Measure 1.x5
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170 Adapted from Public Health Accreditation Board Proposed Standards and Measures (final draft for beta test - July 2009)
Measure 2.2.2B
171 Adapted from Strategic National Stockpile Local Technical Assistance Review Users Guide Measure 3.1
172 Adapted from Strategic National Stockpile State Technical Assistance Review Users Guide Measure 3.2
173 Adapted from Strategic National Stockpile State Technical Assistance Review Users Guide Measure 3.1
174 Adapted from Strategic National Stockpile Local Technical Assistance Review Users Guide Measure 3.3
175 These may be included in the contracts and memoranda of understanding with receiving sites.
176 Adapted from Strategic National Stockpile Local Technical Assistance Review Users Guide Measure 3.4
177 Adapted from Strategic National Stockpile Local Technical Assistance Review Users Guide Measure 3.5
178 Adapted from Strategic National Stockpile Local Technical Assistance Review Users Guide Measure 8.2
179 Adapted from Strategic National Stockpile State Technical Assistance Review Users Guide Measure 8.2
180 Adapted from Project Public Health Ready Measure 1.o2
181 Adapted from Strategic National Stockpile Local Technical Assistance Review Users Guide Measure 8.1
182 Adapted from Strategic National Stockpile State Technical Assistance Review Users Guide Measure 8.1
183 This can be personnel (e.g., state police, county sheriff, city police, and private security staff ) or other measures
(e.g., locks, alarms)
184 Adapted from Strategic National Stockpile Local Technical Assistance Review Users Guide Measure 6.3
185 Adapted from Strategic National Stockpile State Technical Assistance Review Users Guide Measure 6.4
186 Adapted from Strategic National Stockpile Local Technical Assistance Review Users Guide Measure 6.2
187 Adapted from Strategic National Stockpile State Technical Assistance Review Users Guide Measure 6.2
188 Adapted from Strategic National Stockpile Local Technical Assistance Review Users Guide Measure 8.5
189 Adapted from Strategic National Stockpile State Technical Assistance Review Users Guide Measure 8.4
190 This includes temperature control, cleanliness, packaging, handling, chain of custody, and other pertinent protocols.
191 Adapted from Strategic National Stockpile Local Technical Assistance Review Users Guide Measure 9.2
192 Adapted from Strategic National Stockpile State Technical Assistance Review Users Guide Measure 10.2
193 Adapted from Project Public Health Ready Measure 3

Capability 10: Medical Surge
194
195
196
197
198
199
200
201

202
203

The term “adequate” implies a system, process, procedure, or quantity that will achieve a defined response objective.
Public health, medical, and mental/behavioral health
Adapted from Project Public Health Ready Measure 1. i2
Adapted from Project Public Health Ready Measure 1. i1
Adapted from Public Health Accreditation Board Proposed Standards and Measures (final draft for beta test - July 2009)
Measure 2.3.3B
Adapted from Project Public Health Ready Measure 1. a2
Adapted from Public Health Accreditation Board Proposed Standards and Measures (final draft for beta test - July 2009)
Measure 2.3.4B
Situational awareness involves capturing, analyzing, and interpreting data to inform decision making in a continuous and
timely cycle. National health security calls for both routine and incident-related situational awareness. Situational awareness
requires not only coordinated information collection to create a common operating picture (COP), but also the ability to
process, interpret, and act upon this information. Action, in turn, involves making sense of available information to inform
current decisions and making projections about likely future developments. Situational awareness helps identify resource
gaps, with the goal of matching available and identifying additional resources to current needs. Ongoing situational
awareness provides the foundation for successful detection and mitigation of emerging threats, better use of resources, and
better outcomes for the population.
Adapted from Public Health Accreditation Board Proposed Standards and Measures (final draft for beta test - July 2009)
Measure 4.1.1B
Adapted from Project Public Health Ready Measure 1. a2, 1.k

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204 These indicators at the healthcare organization, community or regional level are those that indicate stress on the system in
order to anticipate when resources are being overwhelmed so demands can be managed through additional resources or
adaptive strategies.
205 Adapted from Public Health Accreditation Board Proposed Standards and Measures (final draft for beta test - July 2009)
Measure 2.2.2B
206 Adapted from Project Public Health Ready Measure 1.e1, 1.f1
207 Adapted from Public Health Accreditation Board Proposed Standards and Measures (final draft for beta test - July 2009)
Measure2.3.4B
208 Adapted from Project Public Heath Ready Measure 1.h3, 1.k1
209 Incorporates Joint Commission on the Accreditation of Healthcare Organizations Emergency Management Standard EM
01.01.01
210 Adapted from Project Public Health Ready Measure 1.b2i
211 Adapted from Project Public Health Ready Measure 1.b2ii
212 Adapted from Project Public Health Ready Measure 1.i4
213 Adapted from Public Health Accreditation Board Proposed Standards and Measures (final draft for beta test - July 2009)
Measure 2.3.3B
214 Adapted from Project Public Health Ready Measure 1.i4
215 Adapted from Public Health Accreditation Board Proposed Standards and Measures (final draft for beta test - July 2009)
Measure 4.1.1B
216 National Commission on Children and Disasters Interim Report, 2009:
http://www.acf.hhs.gov/nccd/20091014_508IR_partII.pdf
217 Adapted from Public Health Accreditation Board Proposed Standards and Measures (final draft for beta test - July 2009)
Measure 2.3.3B
218 Post Katrina Emergency Management Reform Act, Title VI, National Emergency Management:
http://frwebgate.access.gpo.gov/cgi-bin/getdoc.cgi?dbname=109_cong_public_laws&docid=f:publ295.109.pdf
219 Adapted from Public Health Accreditation Board Proposed Standards and Measures (final draft for beta test - July 2009)
Measure2.3.3B
220 Adapted from Project Public Health Ready Measure 1.i4
221 Adapted from Public Health Accreditation Board Proposed Standards and Measures (final draft for beta test - July 2009)
Measure 2.3.3B
222 Adapted from Project Public Health Ready Measure 1.i4
223 Adapted from Public Health Accreditation Board Proposed Standards and Measures (final draft for beta test - July 2009)
Measure 2.3.4B
224 Adapted from Public Health Accreditation Board Proposed Standards and Measures (final draft for beta test - July 2009)
Measure 3.2.2B, 3.2.5B, 7.2.3B
225 Adapted from Project Public Health Ready Measure 1.l2i, 1.l2ii, 1.l2iii
226 Adapted from Public Health Accreditation Board Proposed Standards and Measures (final draft for beta test - July 2009)
Measure 2.4.1B
227 Adapted from Public Health Accreditation Board Proposed Standards and Measures (final draft for beta test - July 2009)
Measure 3.2.2B
228 Adapted from Project Public Health Ready Measure 1.l2x
229 Adapted from Public Health Accreditation Board Proposed Standards and Measures (final draft for beta test - July 2009)
Measure 7.1.1B
230 Adapted from Public Health Accreditation Board Proposed Standards and Measures (final draft for beta test - July 2009)
Measure 7.2.3B
231 Adapted from Project Public Health Ready Measure 1.j2

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Capability 11: Non-Pharmaceutical Interventions
232 “Removal of radioactive materials from people, materials, surfaces, food, or water. For people, external decontamination is
done by removal of clothing and washing the hair and skin.”
http://emergency.cdc.gov/radiation/pdf/population-monitoring-guide.pdf
233 “Hygiene” is defined as “Behaviors that can improve cleanliness and lead to good health, such as frequent hand washing,
face washing, and bathing with soap and water”. http://www.cdc.gov/healthywater/hygiene/
234 “Personal protective behaviors” is defined as “Personal behaviors to prevent the transmission of infection, such as coughing
into your elbow, cover sneezing, hand washing, keeping your hands away from your face.”
http://www.cdc.gov/flu/professionals/infectioncontrol/resphygiene.htm
235 Adapted from Public Health Accreditation Board Proposed Standards and Measures (final draft for beta test - July 2009)
Measure 2.1.4 B
236 Adapted from Public Health Accreditation Board Proposed Standards and Measures (final draft for beta test - July 2009)
Measure 4.1.2 B
237 Adapted from Public Health Accreditation Board Proposed Standards and Measures (final draft for beta test - July 2009)
Measure A 2.2 B
238 Adapted from Public Health Accreditation Board Proposed Standards and Measures (final draft for beta test - July 2009)
Measure 6.1.1 B
239 Adapted from Public Health Accreditation Board Proposed Standards and Measures (final draft for beta test - July 2009)
Measure A 2.2 B
240 Adapted from Public Health Accreditation Board Proposed Standards and Measures (final draft for beta test - July 2009)
Measure 2.1.4 B
241 Adapted from Project Public Health Ready Measure 1.g2
242 Adapted from Project Public Health Ready Measure 1.x1
243 The term “event” is used throughout this document. It is defined in Incident Command Structure as “A planned, nonemergency activity (e.g., parades, concerts, or sporting events)”.
244 Place where persons and goods are allowed to pass into and out of a country (airports, water ports, and land border
crossings) and where customs officers are stationed to inspect or appraise imported goods.
245 Adapted from Public Health Accreditation Board Proposed Standards and Measures (final draft for beta test - July 2009)
Measure 2.2.1 B
246 Adapted from Public Health Accreditation Board Proposed Standards and Measures (final draft for beta test - July 2009)
Measure 2.3.4 B
247 Adapted from Project Public Health Ready Measure 1.u1
248 Adapted from Project Public Health Ready Measure 1.u2ii-iv
249 Adapted from Project Public Health Ready Measure 1.u3
250 CDC Division of Global Migration and Quarantine Airport Template Communicable Disease Response Plan
251 Adapted from Project Public Health Ready Measure 1.s1
252 Adapted from Project Public Health Ready Measure 1.t1
253 Adapted from Project Public Health Ready Measure 1.t2
254 Adapted from Project Public Health Ready Measure 1.x3
255 Adapted from Project Public Health Ready Measure 1.f2v
256 As defined by the National Health Security Strategy 2010, “Situational awareness involves capturing, analyzing, and
interpreting data to inform decision making in a continuous and timely cycle. National health security calls for both routine
and incident-related situational awareness. Situational awareness requires not only coordinated information collection
to create a common operating picture, but also the ability to process, interpret, and act upon this information. Action, in
turn, involves making sense of available information to inform current decisions and making projections about likely future
developments. Situational awareness helps identify resource gaps, with the goal of matching available and identifying
additional resources to current needs. Ongoing situational awareness provides the foundation for successful detection and
mitigation of emerging threats, better use of resources, and better outcomes for the population.”
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257 Adapted from Project Public Health Ready Measure 1.p4
258 Adapted from Public Health Accreditation Board Proposed Standards and Measures (final draft for beta test - July 2009)
Measure 2.2.3 B
259 Adapted from Public Health Accreditation Board Proposed Standards and Measures (final draft for beta test - July 2009)
Measure 4.1.1 B

Capability 12: Public Health Laboratory Testing
260 All-hazard incidents include those deliberately released with criminal intent, as well as those that may be present as a result
of unintentional or natural occurrences.
261 The term “sample” is used throughout this document. It is used generically to refer to anything that can be termed a sample
or specimen.
262 The term “event” is used throughout this document. It is defined in the National Incident Management System Incident
Command Structure as “A planned, non-emergency activity (e.g., parades, concerts, or sporting events).
263 The term “incident” is used throughout this document. It is defined in National Incident Management System Incident
Command Structure as “An occurrence either human caused or by natural phenomena, that requires action to prevent or
minimize loss of life or damage to property and/or natural resources”.
264 Adapted from Project Public Health Ready Measure 1.n1iv
265 Adapted from Public Health Accreditation Board Proposed Standards and Measures (final draft for beta test - July 2009)
Measure 2.3.2B
266 Adapted from Project Public Health Ready Measure 1.n1iii
267 Adapted from Project Public Health Ready Measure 1.v1
268 Newborn Screening Saves Lives Act of 2007: http://thomas.loc.gov/cgi-bin/query/z?c110:S.634:
269 Adapted from Project Public Health Ready Measure 1.n1iv
270 Adapted from Project Public Health Ready Measure 1.n1i
271 Adapted from Project Public Health Ready Measure 1.n4
272 Adapted from Project Public Health Ready Measure 1.n1ii
273 Newborn Screening Saves Lives Act of 2007: http://thomas.loc.gov/cgi-bin/query/z?c110:S.634:
274 Adapted from Project Public Health Ready Measure 1.n3
275 Adapted from Public Health Accreditation Board Proposed Standards and Measures (final draft for beta test - July 2009)
Measure 2.1.4B
276 Any significant result (e.g., positive or negative) obtained from testing a clinical specimen or non-clinical sample that
requires notification to CDC and other key partners. Refer to the CDC/Laboratory Response Network Policy Statement on
Notification of Officials of Significant Laboratory Results (LGE-00010) and agency specific protocols.
277 Adapted from Project Public Health Ready Measure 1.n2
278 Adapted from Project Public Health Ready Measure 1.n4
279 Adapted from Project Public Health Ready Measure 1.n2
280 Adapted from Project Public Health Ready Measure 1.n3
281 Adapted from Project Public Health Ready Measure 1.n4
282 Adapted from Project Public Health Ready Measure 1.n3
283 Adapted from Project Public Health Ready Measure 1.n2
284 Adapted from Public Health Accreditation Board Proposed Standards and Measures (final draft for beta test - July 2009)
Measure A1.5B
285 Adapted from Project Public Health Ready Measure 1.n2

Capability 13: Public Health Surveillance and Epidemiological Investigation
286 The term “incident” is used throughout this document. It is defined in the National Incident Management System Incident
Command Structure as “An occurrence either human caused or by natural phenomena, that requires action to prevent or
minimize loss of life or damage to property and/or natural resources.”
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287 Adapted from Public Health Accreditation Board Proposed Standards and Measures (final draft for beta test - July 2009)
Measure 1.1.1B
288 For the purposes of CDC’s Public Health Emergency Preparedness program, awardee-required timeframe is determined as
follows: Time requirements for disease reporting by providers and labs to public health agencies are typically determined at
the awardee level through statute or regulation (e.g., “Providers should report measles within 24 hours to their local public
health department”.). In some awardee jurisdictions, reporting timeframes for select diseases differ depending on whether
reported by providers or labs. Awardees are requested to ensure that calculations of timeliness of reporting for each case of
disease are compared against the appropriate required timeframe.
289 Adapted from Project Public Health Ready Measure 1.n3
290 Adapted from Project Public Health Ready Measure 1.m1i -m1ii
291 Centers for Medicare and Medicaid Services (42 Code of Federal Regulations Parts 412, 413, 422 et al.) Medicare and
Medicaid Programs; Electronic Health Record Incentive Program; Final Rule (published on July 28, 2010 in the Federal
Register at http://edocket.access.gpo.gov/2010/pdf/2010-17207.pdf ) and the Office of the National Coordinator for Health
Information Technology Health Information Technology Standards,Implemsntation Specifications, and Certification Criteria
and Certification Programs for Health information Technology(45 CFR Part 170) viewable at http://ecfr.gpoaccess.gov/cgi/t/
text/text-idx?c=ecfr&sid=7c3390b0a0d2aecc6951346873b39efd&rgn=div5&view=text&node=45:1.0.1.4.77&idno=45. The
latest updates to these standards will be made available at www.cdc.gov/phin.
292 See http://www.cdc.gov/ncphi/disss/nndss/syndromic.htm. Systems should seek to address at minimum the Core
Business Model and Electronic Health Record Requirements for Syndromic Surveillance (International Society for Disease
Surveillance, http://www.syndromic.org/) and accept electronic information using the latest version of the Public Health
Information Network Syndromic Surveillance Messaging Guide, and Centers for Medicare and Medicaid Services (CMS) and
Office of the National Coordinator for Health Information Technology electronic transmission standards established for
the Meaningful Use objective for the CMS Incentive Program for Electronic Health Records “Capability to submit electronic
surveillance data to public health agencies.” (As of January, 2011 the latest regulations are posted at http://edocket.access.
gpo.gov/2010/pdf/2010-17207.pdf and http://edocket.access.gpo.gov/2010/pdf/2010-17210.pdf ). For updates, consult
www.cdc.gov/phin.
293 Can be found at http://www. emergency.cdc.gov/disasters/surveillance/
294 Such as wind direction, ground/ surface water, and soil/sediment
295 See: Behavioral Risk Factor Surveillance System, www.cdc.gov/brfss, and the Gulf States Population Survey,
http://www.cdc.gov/OSELS/ph_surveillance/gsps.html.
296 Adapted from Project Public Health Ready Measure 1.m2vii
297 Adapted from Public Health Accreditation Board Proposed Standards and Measures (final draft for beta test - July 2009)
Measure 1.1.1B
298 Capable of receiving/processing/sending or routing electronic case reports in an automated process
299 Capable of tracking a single person across surveillance models/systems
300 Capable of processing/sending electronic case notification to CDC using current national data standards
301 Adapted from Public Health Accreditation Board Proposed Standards and Measures (final draft for beta test - July 2009)
Measure 2.1.6S
302 Infectious disease outbreak investigations include food-borne outbreaks but not HIV, STD, tuberculosis
303 Minimal elements: Context / Background, Initiation of Investigation, Investigation Methods, Investigation Findings/Results,
Discussion and/or Conclusions, Recommendations, Key investigators and/or report authors
304 Acute environmental exposure: Discrete, sudden and/or generally unexpected exposure to a non-infectious agent that
could potentially cause adverse symptoms, conditions, illness, or disease in a human population
305 Adapted from Project Public Health Ready Measure 1.f2
306 Adapted from Project Public Health Ready Measure 1.m2i-m2iv
307 Adapted from Project Public Health Ready Measure 1.m4i
308 Adapted from Project Public Health Ready Measure 1.r1i-r1ii

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ENDNOTES
309 Appropriate timeframe refers to a timeframe for intervention(s) or control measures with meaningful public health
relevance. Although individual cases may vary in practice, appropriate timeframes for each of the six diseases (Botulism,
E. coli, Hepatitis A (acute), Measles, Meningococcal Disease, Tularemia) have been standardized for the purpose of this
performance measure.
310 Adapted from Project Public Health Ready Measure 1.o9iii
311 Adapted from Public Health Accreditation Board Proposed Standards and Measures (final draft for beta test - July 2009)
Measure 2.2.1B
312 Adapted from Public Health Accreditation Board Proposed Standards and Measures (final draft for beta test - July 2009)
Measure 9.1.4B
313 Adapted from Public Health Accreditation Board Proposed Standards and Measures (final draft for beta test - July 2009)
Measure 9.1.5B
314 Adapted from Project Public Health Ready Measure 2.e4
315 CDC and University of Washington’s Center for Public Health Informatics. Competencies for Public Health Informaticians:
http://cphi.washington.edu/resources/competencies.html.
316 Individuals with informatics competencies may be available from governmental IT service units; other health agencies;
major medical centers; biomedical informatics programs at local universities; public health informatics programs at
universities (typically those with Schools of Public Health); private consulting firms; and vendors of health information
technology.

Capability 14: Responder Safety and Health
317 For the purposes of this capability, responders are defined as public health agency staff. Dependent on the jurisdiction, the
definition of responder may also include first receivers in the form of hospital and medical staff.
318 Mental health refers to behavioral health, mental health, and psychological health.
319 Adapted from Project Public Health Ready Measure 1.e2
320 Protective Action Guides suggest precautions that authorities can take during an emergency to keep people from receiving
an amount of radiation that may be dangerous to their health. For more information, please see “Protective Action Guides”:
http://www.epa.gov/rpdweb00/rert/pags.html.
321 Adapted from Project Public Health Ready Measure 1.s1

Capability 15: Volunteer Management
322 Throughout the document, the term “volunteer” refers only to individuals or groups volunteering in support of the public
health agency’s response, including public health, medical and non-medical personnel.
323 Adapted from Project Public Health Ready Measure 1.w4
324 Adapted from Project Public Health Ready Measure 1.w3ii
325 Adapted from Project Public Health Ready Measure 1.w3i
326 At-risk populations may include those who may have additional needs in one or more of the following functional areas:
communication, medical care, maintaining independence, supervision, and transportation. In addition to those individuals
specifically recognized as at-risk in the Pandemic and All-Hazards Preparedness Act (i.e., children, senior citizens, and
pregnant women), individuals who may need additional response assistance include those who have disabilities, live
in institutionalized settings, are from diverse cultures, have limited English proficiency or are non-English speaking, are
transportation disadvantaged, have chronic medical disorders, and have pharmacological dependency.
327 Adapted from Project Public Health Ready Measure 1.w3iii
328 Adapted from Project Public Health Ready Measure 1.w3v
329 Adapted from Project Public Health Ready Measure 1.w3vii
330 Throughout this document, the term “mental/behavioral health” is used as a general term to encompass behavioral,
psychosocial and psychological health.
331 Adapted from Project Public Health Ready Measure 1.w3iv
332 Out-processing refers to return of equipment, operational debriefing, and any transfer of command or responsibilities.

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The document was developed by the Division of State and Local Readiness in the Office of Public Health
Preparedness and Response (OPHPR), Centers for Disease Control and Prevention (CDC).
Rear Admiral Ali. S. Khan, M.D., M.P.H.
OPHPR Director and Assistant Surgeon General
Christine Kosmos, B.S.N., M.S.
Director, Division of State and Local Readiness, OPHPR
Christa-Marie Singleton, M.D., M.P.H.
Associate Director for Science, Division of State and Local Readiness, OPHPR
Project Team
Darren Collins
Kim Del Guercio, M.P.H.
Kristin Kostus
Jason Leone
Anjali Patel, M.P.H.
Andrea Robinson
Nikolas Shumock
Gideon Slifkin
Other CDC Contributors
Subject Matter Experts across CDC
Seth Foldy, MD, MPH, FAAFP
Director, Public Health Informatics and Technology Program Office,
Office of Surveillance, Epidemiology, and Laboratory Services, CDC
Special Thanks
American Hospital Association
Association of Public Health Laboratories
Association of State and Territorial Health Officials
Council of State and Territorial Epidemiologists
National Association of County and City Health Officials
National Emergency Management Association
National Public Health Information Coalition
U.S. Department of Health and Human Services
• Office of the Assistant Secretary for Preparedness and Response
U.S. Department of Homeland Security
• Federal Emergency Management Agency Grant Programs Division
• Office of Health Affairs
U.S. Department of Transportation
• National Highway Safety Transportation Agency

This document is available at www.cdc.gov/phpr/capabilities.
For more information on CDC’s preapredness and emergency response activities, visit the website of the
Office of Public Health Preparedness and Response at www.cdc.gov/phpr.

U.S. Department of Health and Human Services
Centers for Disease Control and Prevention

Public Health Preparedness Capabilities:
National Standards for State and Local Planning