Chapter Appendix A - Recommendations
Section Public Health and Medical Support
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Critical Challenge: Public Health and Medical Support
Lesson Learned: In coordination with the Department of Homeland Security and other homeland security partners, the Department of Health and Human Services should strengthen the Federal government’s capability to provide public health and medical support during a crisis. This will require the improvement of command and control of public health resources, the development of deliberate plans, an additional investment in deployable operational resources, and an acceleration of the initiative to foster the widespread use of interoperable electronic health records systems.
Recommendations:
57. HHS should lead a unified and strengthened public health and medical command for Federal disaster response.
a. HHS should develop a comprehensive plan to identify, deploy and track Federal public health and medical assets (human, fixed and materiel) for use during a catastrophic event. HHS should assume primary control of the public health and medical support effort, coordinating the activities of supporting agencies from a central location. The Secretary of HHS should be aware of, and in charge of coordinating, all Federal medical and public health assets available for use. All Federal departments must support and facilitate HHS in the execution of its responsibilities to coordinate all Federal public health and medical assets. Medical operations are highly dependent on efficient inter-agency cooperation and the successful completion of tasks is dependent on a fully integrated Federal effort.
b. HHS in coordination with OMB and DHS should draft proposed legislation for submission to Congress, to transfer NDMS from DHS to HHS. As the agency charged in HSPD-5 with the overall coordination of disaster response in America, DHS should clearly articulate the operational requirements for disaster medical assistance. HHS should then be responsible for building and maintaining the appropriate operational capability: it should guide, direct, and develop the NDMS and integrate it into other HHS operational elements. NDMS is a critical component to the success of any Federal disaster response requiring medical support. As such, public health professionals and emergency medical responses should be managed and overseen by HHS which has the greatest health experience and expertise. Thus, NDMS should be returned to the direct command of HHS. It should be understood that the development of these capabilities will take time and in most cases will be grown to full capacity incrementally.
c. HHS should organize, train, equip, and roster medical and public health professionals in pre-configured and deployable teams. These personnel should be comprised of officers of the Commissioned Corps of the U.S. Public Health Service, the Medical Reserve Corps (MRC), the NDMS, health care providers within DOD and the VA, and volunteer health professionals from the private sector. This is consistent with the HHS efforts to enhance the medical and public health response to meet future challenges by transforming the United States Public Health Service Commissioned Corps. This will enable a critical emergency response resource to address public health challenges more quickly and efficiently. The Commissioned Corps will increase its ranks, streamline its assignment and deployment process, and increase its ability to recruit the best and the brightest to defend the Nation’s public health. HHS announced administrative steps toward this end. HHS has also drafted legislation in this area and forwarded it to OMB for Administration review and clearance. HHS should be given appropriate authorities to carry out this responsibility and should establish and test a system to quickly and efficiently identify, credential and assign personnel to missions.
58. HHS should ensure coordination and oversight of emergency, bioterrorism, and ongoing public health preparedness needs. In a public health emergency, the Secretary of HHS should have the integrated support of the public health and public health emergency preparedness programs. Within HHS, two Staff Division and seven Operating Division Assistant Secretary level positions oversee some aspect of public health programs, many of which have overlapping functions in an emergency response. The Secretary of HHS should review this issue and determine how best to ensure the integration of all relevant HHS information and functions during a public health emergency.
59. The Surgeon General should routinely communicate public health, as well as individual and community preparedness guidance to the general population. While there are other prominent and capable Federal health officials, the Surgeon General’s stature and credibility should be used to repeatedly and proactively deliver a consistent public health preparedness message to the public. This will not only help to increase personal, community and national disaster preparedness, it will also make the Surgeon General a more effective and credible source of guidance during public health emergencies.
60. Create and maintain a dedicated, full time, and equipped response team composed of Commissioned Corps officers of the U.S. Public Health Service. The size of this team would be determined by the Corps’ senior leadership, and be sufficient to meet the response needs as set forth by the Secretary. This team, overseen by the Surgeon General, could rapidly and effectively deploy to any event requiring medical and public health expertise and remain on station as long as needed. Other Corps officers, NDMS, the MRC, and the private sector could augment the team under the Surgeon General’s command as required.
61. DHS and HHS should look for the means to increase the capacities and capabilities of local and State health infrastructures. Local and State health departments are the foundation upon which the National public health preparedness rests. HHS and DHS provide Federal grants to local and State health departments, but additional funding is needed in view of the threats to the Nation from: weapons of mass destruction; biological agents; pandemic influenza and natural disasters. Grant funds from HHS and DHS should be synchronized to maximize the benefit to local and State health departments. Furthermore, all grant funding must be targeted toward increasing needed capabilities and then be reviewed to grade State and local performance according to the Presidential Management Agenda.
62. Accelerate the HHS initiative to foster widespread use of interoperable electronic health (EHR) records systems, to achieve development and certification of systems for emergency responders within the next 12 months. The adoption of interoperable EHR systems will support first responders and health providers and dramatically improve the quality and efficacy of care to displaced patients across a population. The President signed an Executive Order, Incentives for the Use of Health Information Technology and Establishing the Position of the National Health Information Technology Coordinator, on April 27, 2004, that provides guidance for the development of a nationwide interoperable health information technology.
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