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Mass Casualty Trauma Triage: Paradigms and Pitfalls
From the Intended Scope and Action: "The focus of this paper is specifically designed to educate emergency planners on the key distinctions of no-notice, dynamic incident scenes with exceedingly large numbers of patients. This will require review of current plans and making necessary modifications to those plans and corresponding training and exercises to ensure preparedness for these types of events. Each community has a unique set of resources and needs and may therefore require different solutions than other jurisdictions. It is important to note that this is a discussion document, and not a consensus document. Therefore, the authors have tried to represent the diversity of opinions where they were significant. This document is also focused on triage and does not account for the broad range of supporting disaster planning required for successful response."
United States. Department of Health and Human Services. Office of the Assistant Secretary for Preparedness and Response
2019-07
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Federal Recovery Programs for Healthcare Organizations
From the Document: "Each year healthcare facilities are directly impacted by disasters. Pre-disaster planning is critical to ensure effective post-disaster recovery. An underemphasized but key component of any disaster plan are the organization's financial and administrative preparedness capabilities. The federal government can provide relief to organizations (including healthcare organizations) via direct reimbursement for expenses and damages and disaster-related loans. This tip sheet provides an overview of eligibility factors, program/grant requirements, and pre- and post-disaster federal financial opportunities for healthcare facilities."
United States. Department of Health and Human Services. Office of the Assistant Secretary for Preparedness and Response
2019-07
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Medical Surge and the Role of Accountable Care Organizations
From the Overview: "Accountable care organizations (ACOs) are groups of healthcare providers and care settings that come together to deliver high-quality care to an assigned patient population. The Centers for Medicare & Medicaid Services (CMS) supports the development of ACOs through the Medicare Shared Savings Program and Innovation Center Models (e.g., the Next Generation ACO Model). Medicaid and commercial insurers have also established various ACO models for their beneficiary populations. ACOs provide incentives for groups of healthcare entities to coordinate care for their assigned patients with the goal of efficiently providing high quality care as measured by reduced inefficiencies and overall healthcare delivery costs. As a relatively new healthcare delivery and payment model, little is known about the role of Medicare ACOs and their participants in the medical surge response to emergencies and disasters. The U.S. Department of Health and Human Services, Office of the Assistant Secretary for Preparedness and Response (ASPR) Technical Resources, Assistance Center, and Information Exchange (TRACIE) conducted five telephone interviews with ACO leaders with beneficiaries in eight states to learn about their perceptions regarding the role of Medicare ACOs in supporting the health and medical response to disasters or emergencies. The interviews sought to assess Medicare ACOs and their participants': (1) role in emergency preparedness and response; (2) capacities and capabilities; (3) factors that challenge involvement; (4) factors that may facilitate engagement; and (5) lessons learned from real-life responses."
United States. Department of Health and Human Services. Office of the Assistant Secretary for Preparedness and Response
2019-07
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Information Memorandum: Definitions and Principles to Inform Human Trafficking Prevention
From the Purpose: "The purpose of this IM [Information Memorandum] is to enhance common understanding of foundational principles of prevention in order to promote increased efforts to prevent all forms of human trafficking. The IM describes key concepts for organizations and communities to consider when integrating prevention strategies, approaches, and services into anti-trafficking efforts. The IM also provides a framework for the development of national, state, tribal, and local collaborations to prevent human trafficking."
United States. Administration for Children and Families; United States. Department of Health and Human Services
2019-04-24
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Cost Analysis of Healthcare Sector Data Breaches Health Sector Cybersecurity Coordination Center (HC3)
From the Executive Summary: "Data breaches can have a significant impact on both the healthcare organization attacked and the individual victims. Healthcare and Public Health Sector (HPH) sector entities face the cost of recovery, lawsuits and the public relations ramifications including loss of customers/patients. Individuals can suffer financial penalties of various sorts as well as the embarrassment of having personal information leaked. As a result, the Federal government has passed several pieces of legislation in order to help protect against and curb data breaches, including regulations and penalties for healthcare organizations that are non-compliant. Costs are either direct or indirect, and mitigation efforts can be viewed in terms of prevention (the preferred method) and post-breach cost reduction. HPH Sector entities are encouraged to factor the cost of breaches into their overall approach towards risk management for both legal and operational efficiency reasons. According to a Ponemon Institute study, the average cost of a breach for a healthcare organization is approximately $8 million, and trending upwards, while another study concluded that a total breach cost can exceed $400 per patient record exposed, elevating the importance of establishing strong risk management practices."
United States. Department of Health and Human Services
2019-04-12
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Critical Access Hospital Requirements CMS Emergency Preparedness Final Rule
From the Document, "The Centers for Medicare & Medicaid Services (CMS) issued the Emergency Preparedness Requirements for Medicare and Medicaid Participating Providers and Suppliers Final Rule to establish consistent emergency preparedness requirements for healthcare providers participating in Medicare and Medicaid, increase patient safety during emergencies, and establish a more coordinated response to natural and human-caused disasters. The U.S. Department of Health and Human Services Office of the Assistant Secretary for Preparedness and Response (ASPR) worked closely with CMS in the development of the rule. This document combines excerpts from the Final Rule, the Interpretive Guidelines and revisions to the Interpretive Guidelines (New 3.6.19) from CMS to provide a consolidated overview document for the Critical Access Hospital (CAH) Requirements."
United States. Department of Health and Human Services. Office of the Assistant Secretary for Preparedness and Response
2019-03-06
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Controlled Substances & Emergency Response Fact Sheet: Frequently Asked Questions
From the Document: "The regulatory landscape around controlled substances is complex and evolving. A myriad of healthcare and public stakeholders are engaged in this field across the spectrum of care, including insurance providers, clinicians, pharmacists, mental health professionals, regulatory bodies such as the Drug Enforcement Agency, and more. During disasters, complexity increases for patients and providers alike, with requirements of transporting, dispensing, refilling, and administering controlled substances frequently taking on a new sense of urgency or manifesting in new ways. These factors affect access to new or continued treatment for patients during a disaster."
United States. Department of Health and Human Services. Office of the Assistant Secretary for Preparedness and Response
2019-03
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Space, Staff, Stuff: Identifying Your Community's Resources
"'Space, Staff, Stuff: Identifying Your Community's Resources' (hereafter referred to as 'Space, Staff, Stuff') is a customizable tool for community planners. This tool helps planners identify their community organizations' roles, responsibilities, and resources and determine potential gaps in their all-hazards planning efforts. It is designed to benefit any community regardless of demographics, infrastructure, current levels of planning, or availability of public health and health care resources."
Centers for Disease Control and Prevention (U.S.); United States. Department of Health and Human Services
2019-03
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Topic Collection: Ambulatory Care and Federally Qualified Health Centers (FQHC) [website]
"During disasters or public health emergencies clinics, community health centers, mental/behavioral healthcare providers, federally-qualified health centers, private physician offices, ambulatory procedure centers, and other outpatient facilities play a critical part in the response by addressing the needs of patients with both acute and chronic conditions. Failures, damage, or compromise to ambulatory care operations can dramatically increase the stress on the emergency medical services and hospital systems and also result in exacerbations of chronic medical conditions that add additional healthcare burdens. The resources in this Topic Collection can help emergency planners in these types of facilities plan for and respond to a variety of incidents. [...] Each resource in this Topic Collection is placed into one or more of the following categories (click on the category name to be taken directly to that set of resources). Resources marked with an asterisk (*) appear in more than one category."
United States. Department of Health and Human Services. Office of the Assistant Secretary for Preparedness and Response
2019-02-15
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Emergency Preparedness- Updates to Appendix Z of the State Operations Manual (SOM)
"The Emergency Preparedness Final Rule (81 Fed. Reg. 63860, September 16, 2016) sets out requirements for all providers and suppliers in regards to planning, preparing and training for emergency situations. The rule includes requirements for emergency plans, policies and procedures, communications and staff training. While there are minor variations based on the specific provider type, the rule is applicable to all providers and suppliers. The emergency preparedness requirement is a Condition of Participation/Condition for Coverage which covers the requirement for facilities to have an emergency preparedness program."
United States. Department of Health and Human Services; Centers for Medicare & Medicaid Services (U.S.)
2019-02-01
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Ending the HIV Epidemic: A Plan for America
Factsheet and infographic from the Department of Health and Human Services about a program to end the HIV [human immunodeficiency virus] epidemic: "HHS is proposing a once-in-a-generation opportunity to eliminate new HIV infections in our nation. The multi-year program will infuse 48 counties, Washington, D.C., San Juan, Puerto Rico, as well as 7 states that have a substantial rural HIV burden with the additional expertise, technology, and resources needed to end the HIV epidemic in the United States. Our four strategies - diagnose, treat, protect, and respond - will be implemented across the entire U.S. within 10 years."
United States. Department of Health and Human Services
2019-02
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Interim Report: Evaluation of Occupational Exposures to Opioids, Mental Health Symptoms, Exposure to Traumatic Events, and Job Stress in a City Fire Department
From the Introduction: "In October 2017, a city in Ohio requested a health hazard evaluation (HHE) concerning possible unintentional exposure to opioids among police officers and fire fighters during first responder activities. As one part of the overall HHE request, city and fire department officials were concerned about how responding to the opioid epidemic might affect the mental health of fire fighters, who also provide emergency medical services (EMS) for the city."
Centers for Disease Control and Prevention (U.S.); United States. Department of Health and Human Services; National Institute for Occupational Safety and Health
Chiu, Sophia; Wiegand, Douglas M.; Broadwater, Kendra . . .
2019-02
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Fourth Generation Agents: Safety Awareness for First On-Scene Responders
This document is a quick reference information sheet for first responders dealing with fourth generation agents during an emergency response situation.
United States. Department of Health and Human Services. Chemical Hazards Emergency Medical Management
Fourth Generation Agents Working Group
2019-01-18
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Medical Surge and the Role of Practice-Based Primary Care Providers
"The U.S. Department of Health and Human Services' Office of the Assistant Secretary for Preparedness and Response (ASPR) Technical Resources, Assistance Center, and Information Exchange (TRACIE) worked with Yale New Haven Health System Center for Emergency Preparedness and Disaster Response (YNHHS-CEPDR) to gain insight on the perceived preparedness and response levels of primary care providers across the U.S. This work also allowed the project team to identify opportunities to support primary care provider planning efforts. Following a comprehensive environmental scan and detailed literature review, ASPR TRACIE and YNHHS-CEPDR determined that representatives of primary care provider professional associations could provide additional insight on the status of their members' preparedness and response and the most effective ways to engage their members in healthcare readiness efforts. YNHHS-CEPDR conducted one-on-one interviews with leaders of these membership organizations (listed in table 1) on behalf of ASPR TRACIE to better understand their members' capacity and level of preparedness for and challenges related to disaster response."
United States. Department of Health and Human Services. Office of the Assistant Secretary for Preparedness and Response
2019
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Fourth Generation Agents: Reference Guide
"This guide was developed as part of ongoing preparedness for all hazards and is intended to inform decisions, protect emergency responders, and support response operations if an incident ever occurs involving a fourth generation agent (FGA, also known as A-series or Novichok nerve agents), such as the one used in the United Kingdom in 2018. No illicit use or manufacture of an FGA or other nerve agent is known to have occurred in the United States, and there is no known threat of any nerve agent use in the United States."
National Library of Medicine (U.S.); United States. Department of Defense; United States. Department of Transportation . . .
2019-01
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Separated Children Placed in Office of Refugee Resettlement Care
"In the spring of 2018, the Department of Justice (DOJ) and Department of Homeland Security (DHS) implemented a 'zero-tolerance policy' for certain immigration offenses. As a result, DHS separated large numbers of alien families, with adults being held in Federal detention while their children were transferred to the care of the Office of Refugee Resettlement (ORR) within the Department of Health and Human Services (HHS). On June 26, 2018, in a class action lawsuit, 'Ms. L v. U.S. Immigration and Customs Enforcement (ICE)', a Federal District Court ordered the Federal Government to identify and reunify separated families who met certain criteria. Given the potential impact of these actions on vulnerable children and ORR operations, the Office of Inspector General (OIG) conducted this review to determine the number and status of separated children (i.e., children separated from their parent or legal guardian by DHS) who have entered ORR care, including but not limited to the subset of separated children covered by 'Ms. L v. ICE.' In a separate review, OIG is examining challenges that ORR-funded facilities have faced in reunifying separated children. On the basis of those findings, OIG plans to recommend solutions to improve ORR program operations."
United States. Department of Health and Human Services. Office of Inspector General
2019-01
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The Exchange, Issue 8, 2019
"In this issue of The Exchange, we discuss the challenges experienced by hospital support services staff involved in recent no-notice incidents (e.g., mass shootings). ASPR [Assistant Secretary for Preparedness and Response] TRACIE [Technical Resources, Assistance Center, and Information Exchange] interviewed healthcare practitioners and subject matter experts from the hospital nutrition, blood, and pharmacy fields to present a snapshot for planning consideration and to highlight how these professionals overcame challenges and incorporated lessons learned into their plans and policies."
United States. Department of Health and Human Services. Office of the Assistant Secretary for Preparedness and Response
2019
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Capacity-Building Toolkit for Including Aging & Disability Networks in Emergency Planning
"As natural and human-caused emergencies increase, the nation works to address the reality that emergencies do not discriminate in terms of impacted populations. Using the social determinants of health, it is possible to predict which populations are less likely to be prepared to effectively respond to, cope with, and recover from an emergency based on preexisting vulnerabilities. [...] The purpose of the Capacity-Building Toolkit for Including Aging and Disability Networks in Emergency Planning (hereafter, the 'Toolkit') is to serve as a resource to guide the aging and disability networks in increasing their ability to plan for and respond to public health emergencies and disasters. For organizations already engaged in emergency planning, this Toolkit can help expand and improve their capabilities. For organizations new to emergency planning, this Toolkit will help orient them to the process. Both goals are accomplished through content that guides programs that serve people with access and functional needs, including older adults and people with disabilities, through the emergency planning process of preparedness, response, recovery, and mitigation activities."
National Association of County & City Health Officials (U.S.); United States. Department of Health and Human Services. Office of the Assistant Secretary for Preparedness and Response; Association of State and Territorial Health Officials (U.S.)
2019?
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Opioids: Frequently Asked Questions
"On October 21, 2018, the Secretary of the Department of Health and Human Services (HHS) renewed the determination that a 'public health emergency' exists as a result of the opioid crisis. This type of declaration allows federal and state agencies to waive certain funding requirements, make temporary staff assignments, modify certain practices, and modify deadlines. HHS also released a 5-Point Strategy to Combat the Opioid Crisis, designed to help communities fight the epidemic. Prior to the renewal, at least eight states declared a formal emergency, public health emergency, or made a similar type of pronouncement to address this public health crisis at the state level. Several states are currently using the Centers for Medicare & Medicaid coverage and reimbursement policy to tackle the epidemic. [...] This ASPR TRACIE [Office of the Assistant Secretary for Preparedness and Response Technical Resources, Assistance Center, and Information Exchange] fact sheet was developed to provide answers to some of the most frequently asked questions that affect our audience (e.g., regional ASPR staff, healthcare coalitions, healthcare entities, healthcare providers, emergency managers, and public health practitioners). It does not represent official agency policy, nor is it meant to be all encompassing, but rather it serves as a snapshot of the challenges facing the healthcare emergency field at this time."
United States. Department of Health and Human Services. Office of the Assistant Secretary for Preparedness and Response
2019-01
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Fourth Generation Agents: Medical Management Guidelines
"These guidelines were developed as part of ongoing preparedness for all hazards and are intended to support fire, EMS [emergency medical services], and hospital staff in the medical management of patients if an incident occurs involving a fourth generation agent (FGA, also known as A-series or Novichok nerve agents), such as the one used in the United Kingdom (U.K.) in 2018. No illicit use or manufacture of an FGA or other nerve agent is known to have occurred in the United States (U.S.), and there is no known threat of any nerve agent use in the U.S. This document is divided into two sections: pages 5-7 include recommendations for fire and EMS responders and pages 8-11 include recommendations for hospital staff, with some repetition between the two. As part of ongoing standard preparedness, jurisdictions should update their existing plans with this information and integrate it into in-service training curricula."
National Library of Medicine (U.S.); United States. Department of Defense; United States. Department of Health and Human Services . . .
2019-01
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National Health Security Strategy 2019-2022
"The 2019-2022 NHSS [National Health Security Strategy] is focused on three overarching objectives. As health security threats continue to emerge and evolve, these objectives are intended to be flexible and adaptable. 1. Prepare, mobilize, and coordinate the Whole-of-Government to bring the full spectrum of federal medical and public health capabilities to support SLTT [state, local, tribal, and territorial] authorities in the event of a public health emergency, disaster, or attack. [...] 2. Protect the nation from the health effects of emerging and pandemic infectious diseases and chemical, biological, radiological, and nuclear (CBRN) threats. [...] 3. Leverage the capabilities of the private sector."
United States. Department of Health and Human Services
2019?
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National Health Security Strategy Implementation Plan 2019-2022
"The National Health Security Strategy (NHSS) 2019-2022 provides a vision for strengthening our nation's ability to prevent, detect, assess, prepare for, mitigate, respond to, and recover from 21st century health threats. This NHSS Implementation Plan (IP) guides whole-ofgovernment action to support federal, and state, local, tribal, and territorial (SLTT) partners--as well as public and private partners, non-governmental organizations (NGOs), academia, professional associations, communities, families/family units, and individuals--to advance the capabilities needed to address current risks and prepare for an array of new, evolving threats."
United States. Department of Health and Human Services. Office of the Assistant Secretary for Preparedness and Response
2019?
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Information Security for Executives: Role-Based Training for Executives [presentation]
These are presentation slides of the course on Information Security for Executives offered by the Department of Health and Human Services.
United States. Department of Health and Human Services
2019
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Final Report of the Federal Commission on School Safety
From the Disclaimer: "The Federal Commission on School Safety was designed to both research and recommend solutions to advance the safety of our schools. The Commission's observations and recommendations are contained in this report. The Commission recognizes that the problem of school violence is long-standing and complex and that there are certain limits to what the federal government can do. This Commission was not established to provide a single solution to this problem, nor did the Commissioners set out to mandate uniform policy to every community. In fact, it is our considered belief that doing so would prove counterproductive. There can be no 'one-size-fits-all' approach for an issue this complex. [...] In the pages that follow, the Commission makes recommendations that address multiple aspects of school safety. It does so based on the insights, experiences, and expertise of a wide range of individuals. The recommendations are predicated on the policies already working in state and local communities. They outline steps we all can take--families, communities, schools, houses of worship, law enforcement, medical professionals, government, and others. Each of us has a role to play in improving the safety of our students and the security of our schools. Only by working together can we help prevent future tragedies and, when those incidents do occur, mitigate their effects and continue to learn from them."
United States. Department of Education; United States. Department of Justice; United States. Department of Health and Human Services . . .
2018-12-18
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Guidelines for the Prevention and Treatment of Opportunistic Infections in HIV-Infected Adults and Adolescents: Recommendations from the Centers for Disease Control and Prevention, the National Institutes of Health, and the HIV Medicine Association of the Infectious Diseases Society of America
"Opportunistic infections (OIs) were the first clinical manifestations that alerted clinicians to the occurrence of the acquired immunodeficiency syndrome (AIDS). 'Pneumocystis' pneumonia (PCP), toxoplasma encephalitis, cytomegalovirus (CMV) retinitis, cryptococcal meningitis, tuberculosis, disseminated 'Mycobacterium avium' complex (MAC) disease, and pneumococcal respiratory disease, as well as certain cancers such as Kaposi sarcoma and central nervous system lymphoma, have been hallmarks of AIDS. These OIs, and many more, occurred on average 7 to 10 years after infection with HIV. Until effective antiretroviral therapy (ART) was developed, patients generally survived only 1 to 2 years after the initial manifestation of AIDS. HIV-related OIs have been defined as infections that are more frequent or more severe because of HIV mediated immunosuppression. Starting in the late 1980s, the use of chemoprophylaxis, immunization, and better strategies for managing OIs improved quality of life and lengthened survival of persons with HIV. Early antiretroviral drugs and treatment strategies added further benefit. However, the introduction of highly effective combination ART in the mid-1990s has had the most profound influence on reducing OI-related morbidity and mortality in persons with HIV. Despite the availability of multiple safe, effective, and simple ART regimens, and a corresponding steady decline in the incidence of OIs, the Centers for Disease Control and Prevention (CDC) estimates that more than 40% of Americans with HIV are not effectively virally suppressed. As a result, OIs continue to cause preventable morbidity and mortality in the United States."
Centers for Disease Control and Prevention (U.S.); National Institutes of Health (U.S.); United States. Department of Health and Human Services
2018-12-17
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Health Resources and Services Administration Has Controls and Strategies to Mitigate Hurricane Preparedness and Response Risk
"Three major hurricanes hit the United States between August and September of 2017. On September 8, 2017, the President signed the first Federal Disaster Assistance package of the 2017 hurricane season following Hurricane Harvey. On February 9, 2018, the President signed into law the Bipartisan Budget Act of 2018, which provided disaster relief totaling approximately $89.3 billion. The Department of Health and Human Services received $5.97 billion ($1.07 billion for discretionary programs), of which the Health Resources and Services Administration (HRSA) received $60 million. Our objectives were to identify HRSA's potential risks for preparing for and responding to hurricanes and other natural disasters and to determine whether HRSA has designed and implemented controls and strategies to mitigate these potential risks."
United States. Department of Health and Human Services. Office of Inspector General
Jarmon, Gloria L.
2018-12
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Tips for Healthcare Facilities: Major Earthquakes and Cascading Events: Potential Health and Medical Implications (Summary)
"This tip sheet summarizes the ASPR [Assistant Secretary for Preparedness and Response] TRACIE [Technical Resources, Assistance Center, and Information Exchange] document, Major Earthquakes & Cascading Events: Potential Health and Medical Implications, which provides a high-level overview of the potential significant health and medical response and recovery needs facing areas affected by a major earthquake with or without additional cascading events."
United States. Department of Health and Human Services. Office of the Assistant Secretary for Preparedness and Response
2018-12
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Ensuring Language Access and Effective Communication During Response and Recovery: A Checklist for Emergency Responders
"As an emergency responder, it is critical for you to be prepared to effectively reach all members of the community during emergency response and recovery efforts. Survivors may include individuals with access and functional needs, such as persons with limited English proficiency (LEP) and persons with disabilities. Access to federally funded emergency response and recovery services must be provided to persons with LEP and persons with disabilities in accordance with federal civil rights laws, including Title VI of the Civil Rights Act of 1964 and Section 504 of the Rehabilitation Act of 1973. These services may include providing language access services to provide meaningful access and auxiliary aids and services to ensure effective communication."
United States. Department of Health and Human Services
2018-11-29
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ASPR TRACIE Technical Assistance Request: Resources Specific to the Amish Community
This document includes "information related to pertussis outbreaks, specifically as it pertained to lessons learned regarding past outbreaks and vaccination programs in the Amish community."
United States. Department of Health and Human Services. Office of the Assistant Secretary for Preparedness and Response
2018-11-15
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ASPR TRACIE Technical Assistance Request: Hepatitis a Outbreaks: Best Practices and Lessons Learned
This technical assistance request provides a list of resources on best practices and lessons learned related to hepatitis A outbreaks. "Section I in this document includes best practices and lessons learned specific to hepatitis A outbreaks. Section II provides additional resources related to hepatitis A outbreaks in the United States."
United States. Department of Health and Human Services. Office of the Assistant Secretary for Preparedness and Response
2018-11-15
