Managing Emergency Preparedness

Required Documents

• Jurisdiction's All-Hazards Emergency Operations Plan (EOP) with public health annexes
• Hazard Vulnerability Analysis (HVA) / Threat and Hazard Identification and Risk Assessment (THIRA)
• CDC PHEP capability self-assessment (annual operational readiness review)
• HSEEP-compliant After-Action Reports (AARs) and Improvement Plans (IPs) from exercises and real-world events
• MCM/SNS reception, storage, and distribution plan
• EMAC and local mutual aid agreements
• Healthcare Coalition (HCC) MOU and regional preparedness plan
• Public Health EOC SOPs and activation criteria
• Continuity of Operations Plan (COOP) for the health department

Step 1 — Conduct Hazard Vulnerability Analysis

Identify and prioritize threats using a structured methodology:

• Use THIRA/SPR (Threat and Hazard Identification and Risk Assessment / Stakeholder Preparedness Review) per FEMA guidance, or the Kaiser Permanente HVA tool adapted for public health.
• Assess each hazard on three dimensions:
  • Probability: Historical frequency, scientific evidence, and intelligence assessments.
  • Severity: Potential magnitude of health impact (morbidity, mortality, displacement, infrastructure damage).
  • Preparedness: Current capability to respond (plans, training, equipment, partnerships).
• Risk score = Probability × Severity × (1 − Preparedness). Higher scores indicate higher priority for planning.
• Standard hazard categories for public health: infectious disease outbreak/pandemic, natural disaster (hurricane, earthquake, flood, wildfire), chemical release (industrial accident, terrorism), radiological/nuclear event, food/water contamination, mass casualty incident, cyberattack on health infrastructure.
• Rank hazards and allocate planning effort proportionate to risk scores.

Step 2 — Develop and Maintain the Emergency Operations Plan

The EOP is the master planning document. Structure per CPG 101 (FEMA Comprehensive Preparedness Guide 101):

• Basic Plan: Purpose, scope, situation overview, assumptions, concept of operations, roles and responsibilities, direction and control.
• Functional Annexes: One per PHEP capability area — Emergency Operations Coordination, Community Preparedness, Information Sharing, Medical Countermeasure Dispensing, Mass Care, Fatality Management, etc.
• Hazard-Specific Annexes: Pandemic influenza, chemical terrorism, hurricane response, radiological event, etc.
• Appendices: Contact rosters, resource inventories, maps, SOPs, mutual aid agreements.

Plan maintenance cycle:

• Annual review: Full EOP reviewed for currency — contact information, organizational changes, policy updates, lesson-learned incorporation.
• Post-event update: Within 90 days of any real-world activation, incorporate AAR findings.
• Post-exercise update: Within 60 days of each exercise, address improvement plan items.

Step 3 — Build and Sustain Workforce Readiness

• Maintain an EOC staffing roster with at least 2-deep coverage for every ICS position.
• All EOC staff must complete: ICS-100, ICS-200, ICS-700, ICS-800. Section chiefs and above: ICS-300, ICS-400.
• Conduct training on jurisdiction-specific plans, SOPs, and communication systems at least annually.
• Maintain a Medical Reserve Corps (MRC) or equivalent volunteer registry with: enrollment, background checks, credential verification, and activation protocols.
• Implement a responder health and safety program: mental health screening, respiratory protection program, prophylaxis planning for first responders.
• Track workforce credentials and training currency in a readiness management system (e.g., ESAR-VHP, state registry).

Step 4 — Exercise the Plan per HSEEP

HSEEP (Homeland Security Exercise and Evaluation Program) provides the standard exercise methodology:

• Progressive exercise cycle: Discussion-based (seminars, workshops, TTX) → Operations-based (drills, functional exercises, full-scale exercises). Each exercise builds on findings from the prior one.
• Annual exercise requirement per PHEP cooperative agreement: at least one operations-based exercise per year testing a PHEP capability.
• Multi-year Training and Exercise Plan (MTEP): 3-5 year plan that systematically tests all priority capabilities against all priority hazards.
• For each exercise:
  • Develop an Exercise Plan (ExPlan) with objectives linked to PHEP capabilities.
  • Conduct the exercise with trained evaluators using Exercise Evaluation Guides (EEGs).
  • Produce a formal AAR within 60 days identifying strengths, areas for improvement, and root causes.
  • Develop an Improvement Plan (IP) with corrective actions, timelines, responsible parties.
  • Track IP completion through the jurisdiction's corrective action tracking system.

Step 5 — Medical Countermeasure Operations Planning

• Develop a plan for receiving, staging, storing, and distributing SNS assets within 48 hours of federal deployment decision.
• Plan for Points of Dispensing (PODs):
  • Open PODs: Community locations (schools, community centers) for mass prophylaxis of the general public. Target throughput: 1,000 people per hour per POD.
  • Closed PODs: Pre-arranged with employers, hospitals, universities to dispense to their populations (reduces open POD burden by 20-40%).
• Develop dispensing SOPs: screening algorithm, medication dispensing protocols (standing orders), adverse event management, documentation (into IIS or MCM tracking system).
• Plan for special populations: homebound individuals, persons with disabilities, non-English speakers, incarcerated populations, homeless individuals.
• Test MCM operations through a functional or full-scale exercise at least every 3 years.

Step 6 — Communication and Information Sharing

• Maintain Health Alert Network (HAN) notification capability for rapid alerting of healthcare providers, emergency management, and the public. Test HAN with a live alert at least quarterly.
• Maintain Crisis and Emergency Risk Communication (CERC) plan with pre-drafted messages for priority hazards, spokesperson designation, media briefing protocols, and social media strategy.
• Ensure interoperable communications: test radio, phone, and digital communication systems with partner agencies (emergency management, law enforcement, hospitals) at least biannually.
• Establish information-sharing protocols with Healthcare Coalitions, EMS, poison control, and state/federal partners.

Checkpoint B — Preparedness Review

• HVA/THIRA completed and updated within the last 2 years
• EOP current with all annexes reviewed within the last 12 months
• EOC staffing roster 2-deep for all ICS positions with training currency verified
• HSEEP-compliant exercise conducted in the current fiscal year
• AAR completed within 60 days of each exercise/event with IP tracked to completion
• MCM/SNS plan tested through exercise within the last 3 years
• HAN tested quarterly with documented results
• Mutual aid agreements current and exercised
• COOP plan in place and tested

Quality Audit

• PHEP capability self-assessment completed for all 15 capabilities per CDC guidance
• HVA risk scores calculated consistently with documented methodology
• EOP follows CPG 101 structure and is accessible to all response staff
• ICS training records verified for all EOC-rostered personnel
• Exercise objectives traceable to PHEP capabilities and HVA priority hazards
• AAR findings tracked through a corrective action system with completion rates reported
• MCM throughput targets documented and achievable based on exercise performance
• Vulnerable population planning addresses access and functional needs per CDC PHEP Capability 1 (Community Preparedness)
• All plans reviewed by legal counsel for consistency with jurisdiction's emergency authority statutes

Guidelines

• Plans that are not exercised are plans that will fail. The exercise program is not a compliance checkbox — it is the mechanism through which plans are tested, staff gain experience, and gaps are identified before real emergencies.
• Preparedness is a perishable capability. Staff turnover, budget cuts, organizational changes, and memory fade degrade readiness continuously. Annual plan reviews and quarterly training are minimum maintenance requirements.
• Access and functional needs populations (persons with disabilities, LEP, transportation-dependent, medically dependent) must be explicitly addressed in every plan — not as an afterthought annex but integrated into operations planning. The Post-Katrina Emergency Management Reform Act (2006) requires this.
• Medical countermeasure planning must account for the entire logistics chain: federal decision to deploy → transportation to state → RSS (Receipt, Stage, Store) operations → last-mile distribution to PODs → administration to individuals. Failure at any link breaks the chain.
• Real-world events are the ultimate exercise. After every activation (no matter how small), conduct an AAR. The small-scale activations build the muscle memory for large-scale responses.
• Coordinate with Healthcare Coalitions for healthcare system preparedness. Health department plans that do not integrate with hospital surge plans, EMS, and long-term care facilities will fail when surge demand crosses organizational boundaries.
• Escalate to the health officer or emergency management director when: an HVA reveals an unmitigated high-risk hazard, exercise performance reveals a critical capability gap, MCM distribution timeline exceeds 48-hour target, or mutual aid agreements lapse without renewal.