PHEP Cooperative Agreement

The Funding Opportunity Announcement (FOA) is what ultimately leads to a cooperative agreement between the the Feds and an Awardee. The 2017 HPP/PHEP FOA is "for the continued purpose of strengthening and enhancing the capabilities of state, local, and territorial public health and health care systems to respond effectively (mitigate the loss of life and reduce the threats to the community’s health and safety) to evolving threats and other eme rgencies within the United States and territories and freely associated states."

It provides "clear expectations and priorities for awardees and health care coalitions (HCCs) to strengthen and enhance the readiness of the public health and the health care delivery system to save lives during emergencies that exceed the day-to -day capacity and capability of the public health and medical emergency response systems."

provides funds to ensure that HPP awardees focus on activities that advance progress toward meeting the goals of the 2017-2022 Health Care Preparedness and Response Capabilities and document progress in establishing or maintaining ready health care systems through strong HCCs and to ensure that PHEP awardees continue to advance development of effective public health emergency management and response programs as outlined in the Public Health Preparedness Capabilities: National Standards for State and Local Planning.

Important!  Remember, the cooperative agreement is a contract between the CDC and the Awardee, not between the Awardee and the local health department . PHEP cooperative agreement requirements and recommendations only enforceable on the sub grantee – the local health department (LHD) – if they are specifically stated in the LHD's sub grant from the state (Awardee).

But, if the statement "the LHD Must" is within the cooperative agreement, the Awardee Must include the requirement within the coalition's sub grant.
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2017-2018 phep cooperative agreement domain one strategy

strengthen community resilience

Resilient communities develop, maintain, and leverage collaborative relationships among government, community organizations, and individual households that enable them to more effectively respond to and recover from disasters and emergencies. Awardees must conduct the following activities that sustain or expand community resilience. These activities must be actionable, realistic, and support the achievement of readiness outputs and intended outcomes.

  • Partner with stakeholders by developing and maturing health care coalitions
  • Characterize the probable risks to the jurisdiction and the HCC
  • Characterize populations at risk
  • Engage communities and health care systems
  • Operationalize response plans.

2017-2018 hpp cooperative agreement domain two strategy

strengthen incident management

HPP and PHEP awardees must conduct the following activities to strengthen emergency operations management throughout all phases of an incident.

  • Coordinate emergency operations
  • Standardize the incident command structure (ICS) for public health
  • Establish incident command structures for health care organizations and HCCs
  • Ensure HCC integration and collaboration with ESF-8
  • Expedite fiscal and administrative preparedness procedures

PHEP awardees must develop and establish an incident management framework consistent with the National Incident Management System (NIMS). Awardees must use the National Response Framework (NRF) to guide governments at all levels including state, local, territorial, and tribal government planning. All levels of government must be prepared under NRF to conduct an all-hazards incident response. Emergency operations plans should use incident command to implement elements of the NRF in scalable and flexible ways.

In addition, awardees must coordinate emergency operations with appropriate staff to address all potential hazards. In addition to command staff and support function staff, PHEP awardees must have available lists of staff who have been identified in advance for a medical or public health response. Awardees must also have operational plans or annexes that address resource management; communications and information management; emergency public warning and information; medical surge and non-pharmaceutical interventions; and first responder and volunteer management.

2017-2018 hpp cooperative agreement domain three strategy

strengthen information management

HPP and PHEP awardees must conduct the following activities to strengthen information sharing among public health and medical preparedness and response partners and enhance emergency public information and warning.

  • Share situational awareness across the health care and public health systems
  • Share emergency information and warnings across disciplines, jurisdictions, and HCCs and their members
  • Conduct external communication with the public.

Coordinate Emergency Information Sharing between Public Health and Health Care

ASPR and CDC recognize and value the distinct roles and responsibilities of HPP and PHEP awardees, HCCs, and their members, as well as emergency management and other response partners.

HPP and PHEP awardees must identify reliable, resilient, interoperable, and redundant information and communication systems and platforms, including those for bed availability, EMS data, and patient tracking, and provide access to HCC members and other stakeholders.

The following are factors that HCCs, in coordination with HPP and PHEP awardees and other public health agency members, should consider when developing processes and procedures to rapidly acquire and share clinical knowledge:

  • Processes and procedures should address a variety of emergencies such as chemical, biological, radiological, nuclear, or explosive (CBRNE), trauma, burn, pediatrics, or highly infectious disease outbreaks
  • Approaches to improve patient management, particularly at facilities that may not care for certain types of patients regularly

Sharing accurate and timely information is critical during an emergency. Accordingly, by the end of the five-year project period each HCC must assist its members with developing the ability to rapidly alert and notify their employees, patients, and visitors. Alerts and notifications should update stakeholders on the emergency situation, protect stakeholders’ health and safety, and facilitate provider-to-provider communication.

By the end of the five-year project period, the HCC, in coordination with its public health agency members and HPP and PHEP awardees, must also develop processes and procedures to rapidly acquire and share clinical knowledge between health care providers and between health care organizations during responses.

More Detail! More information about sharing emergency information procedures and platforms can be found in Capability 2, Objectives 2 and 3 of the Health Care Preparedness and Response Capabilities!
 

No PHEP Specific Requirements.

More Detail! More information about sharing emergency information procedures and platforms can be found in Capability 2, Objectives 2 and 3 of the Health Care Preparedness and Response Capabilities!
Joint HPP-PHEP Requirement: Coordinate Public Messaging

Accurate and timely communication with the public is important during a response to a public health emergency. Accordingly, by the end of Budget Period 2, each HCC and its members, in collaboration with HPP and PHEP awardees, should agree upon and plan for the type of information that will be disseminated by either the HCC or its individual members to the public during an emergency.

Additionally, by the end of the five year project period, the HCC, in collaboration with HPP and PHEP awardees, should provide public information officer (PIO) training to those who are designated to act in that capacity during an emergency for HCC members and are in need of such training. This training should include health risk communication training.

Health care organizations, as well as HCCs and public health departments, should work with their community’s Joint Information Center (JIC) to ensure information is accurate, consistent, linguistically and culturally appropriate, and disseminated to the community using one voice during an emergency.

Additionally, ASPR and CDC recommend that HPP and PHEP awardees coordinate public messaging and information sharing regarding monitoring and tracking of cases of persons under investigation during infectious disease outbreaks with PIOs for various response partners to ensure maximum coordination and consistency of messaging.

More Detail! More information about sharing emergency information procedures and platforms can be found in Capability 2, Objective 3 of the Health Care Preparedness and Response Capabilities!
PHEP Specific Requirement:

PHEP awardees must ensure information sharing systems are in place. These systems must include redundant equipment, appropriately trained public health information officers (PIOs) and other personnel, procedures for media notification, message development, and plans describing how the public can contact the public health department for up-to-date information on incidents. This can include call centers, help desks, and other available communication platforms.

2017-2018 hpp cooperative agreement domain four strategy

strengthen countermeasures and mitigation

HPP and PHEP awardees should conduct the following activities that strengthen access to and administration of medical and other countermeasures for pharmaceutical and non-pharmaceutical interventions and strengthen mitigation strategies.

  • Manage access to and administration of pharmaceutical and non-pharmaceutical interventions
  • Ensure safety and health of responders
  • Operationalize response plans.

Following an emergency, effective care cannot be delivered without available staff and appropriate countermeasures. Accordingly, managing access to and administration of countermeasures and ensuring the safety and health of clinical and other personnel are important priorities for preparedness and continuity of operations.

While PHEP funding plays an important role in medical countermeasure (MCM) planning and procuring and dispensing MCMs for the community, including at-risk populations, HPP funding assists in planning for closed points of dispensing (POD) and ensuring that health careworkers and their families are protected during emergencies.


MCM Distribution and Dispensing Plans

A number of federally funded programs exist to enhance preparedness for and response to a public health emergency, including CDC’s Strategic National Stockpile (SNS), CHEMPACK program, and Cities Readiness Initiative (CRI). HPP and PHEP awardees, including HCCs and their members, must understand their jurisdictional MCM distribution plans by the end of Budget Period 1, either through participation in jurisdictional MCM operational readiness reviews or briefings provided by the jurisdiction’s MCM coordinator.

Additionally, in jurisdictions participating in the CHEMPACK program, CRI, or other local and state plans for maintaining treatment or prophylaxis caches, HPP and PHEP awardees and each HCC must be engaged in the development, training, and exercising of these MCM distribution and dispensing plans by the end of Budget Period 1. Additionally by the end of Budget Period 1, each HCC should collaborate with local public health departments and PHEP awardees to assist its members with closed points of dispensing (POD) plans. Local public health departments supported by PHEP funding are responsible for general population POD planning with assistance from the state.

 

Conducting an assessment of the supply chain’s integrity is one strategy to help HPP awardees and HCCs identify equipment and supply needs that will be in demand during an emergency and develop strategies to address potential shortfalls.

Public health departments coordinate medical material management and distribution when a public health emergency overwhelms the routine community supply chain. Public health’s role includes:

  • Formalizing partnerships with private and public warehouse facilities and shipping companies
  • Planning for potential nonmedical and medical distribution, dispensing, and administration
  • Distributing and dispensing nonmedical and medical countermeasures
  • Ensuring availability of medical countermeasures to individuals at greatest risk of morbidity and mortality from an influenza pandemic

These activities are described in more detail in CDC’s Public Health Preparedness Capabilities: National Standards for State and Local Planning, specifically, Capability 8: Medical Countermeasure Dispensing and Capability 9: Medical Materiel Management and Distribution..

As described in those capabilities, PHEP awardees must ensure they can support medical countermeasure distribution and dispensing (MCMDD) for all-hazards events ranging from a terrorist attack, an influenza pandemic, or an emerging infectious disease such as Ebola or Zika. CDC provides the 50 states and the four directly funded localities of Chicago, Los Angeles County, New York City, and Washington, D.C. with dedicated funding through CRI to ensure they have MCM distribution and dispensing plans in place and can effectively execute those plans in response to public health emergencies. Initially, CRI planning was specific to a large-scale biologic attack with anthrax as the primary threat consideration, which requires the dispensing of life-saving antibiotics or other countermeasures to affected populations within 48 hours. Current planning has evolved to encompass improved MCM planning and operational readiness for all hazards. Successfully executing an MCM mission is critical to ensuring the nation’s public health security during any large public health emergency.

To improve all-hazards MCM distribution and dispensing planning and response capabilities, CDC strongly encourages that PHEP awardees make 75% of their CRI funds available to CRI jurisdictions within 90 days of the start of the budget period, beginning in Budget Period 2. CRI jurisdictions are independent planning jurisdictions that include the counties and municipalities within the defined metropolitan statistical area (MSA). CDC recognizes that this funding allocation may present challenges to some awardees and will consider exceptions on a case-by-case basis.

To comply with PAHPRA and the priority resource planning and other elements specified in Capabilities 8 and 9, all 62 PHEP awardees must have plans in place for demonstrating operational readiness to receive, stage, distribute, and dispense MCMs including medications and medical supplies received from the SNS. PHEP awardees are required to complete the following MCM activities.

MCM Operational Readiness Reviews

In 2012-2016, with involvement from 19 awardee jurisdictions, national partners, and CDC SMEs, CDC developed, piloted, and implemented a new MCM operational readiness review (ORR) process for assessing state, local, and territorial ability to successfully execute a major public health response requiring the rapid distribution and dispensing of life-saving MCMs. The MCM ORR is intended to identify programmatic strengths and operational gaps for medical countermeasure response planning and operational readiness. CDC has updated the MCM ORR tool based on feedback received during its first full year of implementation in 2015-2016.

Beginning with Budget Period 1, CDC will conduct MCM ORRs on a two-year cycle, reviewing half of the 62 PHEP awardee jurisdictions every year. This process is designed to support and enhance state and local public health departments across the nation in strengthening their MCM capacity. PHEP awardees and local CRI jurisdictions must submit initial ORR self-assessment data in Budget Period 1 using the updated ORR tool to assess their continued progress in advancing MCM capabilities.

State awardees must conduct operational reviews for all CRI planning jurisdictions within a two-year period. State awardees must submit the resulting MCM ORR data from their CRI reviews to CDC using a web-based data collection system. CDC’s MCM regional field advisors will attend one MCM ORR per CRI MSA to observe and provide feedback.

As part of the operational readiness review process, awardees must provide CDC with supporting documentation regarding their public health preparedness capabilities, exercises, performance measures, program requirements, and other information relative to medical countermeasure distribution and dispensing. CDC encourages awardees to provide CDC with access to relevant documentation using their jurisdictions’ internal shared systems. By Budget Period 3, awardees must develop processes to enable CDC to access jurisdictional documentation using shared systems.

MCM ORR data, including status levels for PHEP awardees and local CRI jurisdictions, may be publicly released.

During interim years, CDC and awardees will address identified improvement areas based on the most recent MCM ORR findings. To help jurisdictions move toward “Established” status levels by June 30, 2022, CDC will work with all 62 PHEP awardees to complete the following activities designed to address identified planning and operational opportunities for improvement.

MCM Technical Assistance Action Plans

All PHEP awardees must submit updated MCM action plans twice each budget period and participate in quarterly conference calls with CDC to discuss action plan activities. The action plans focus on activities designed to address prioritized MCM operational gaps identified during the awardees’ most recent ORRs.

In addition, state awardees must develop MCM action plans for all of their CRI local planning jurisdictions, conduct quarterly conference calls with the CRI jurisdictions, and submit updated MCM action plans to CDC twice each budget period. Each action plan must summarize completed activities in response to areas of improvement identified in the jurisdiction’s most recent MCM ORR.

RSS Site Surveys

PHEP awardees must have updated receipt, stage, and store (RSS) site survey information available in CDC’s Online Technical Resources Assistance Center (On-TRAC) data center. RSS site information is required for the primary and back-up RSS sites (a minimum of at least two locations) and all potential RSS sites in their jurisdictions. Awardees must update RSS site information each year, and the U.S. Marshal Service and CDC must validate each RSS site at least once every three years.

Critical Contacts

PHEP awardees must have available online in CDC’s On-TRAC data center current operational information that identifies points of contact to facilitate time-sensitive, accurate information sharing before a public health emergency. Awardees must review and update the operational critical contact information that is in CDC’s On-TRAC data center at least every six months or as changes occur.

Inventory Management Tracking System and Data Exchange Annual Tests

PHEP awardees must provide inventory counts to CDC during a public health emergency. Awardees may use either CDC’s Inventory Management and Tracking System (IMATS) with the built-in reporting functionality or configure their own inventory management system (IMS) using the Inventory Data Exchange (IDE) Specification guide, enabling them to receive and respond to an inventory request from CDC. PHEP awardees must participate in annual tests that provide MCM inventory counts to CDC to ensure data reports of inventory levels are reliable. More specific details are provided in the 2017-2022 HPP-PHEP Supplemental Guidelines.

Non-Pharmaceutical Interventions

PHEP awardees should coordinate non-pharmaceutical interventions by developing and updating plans that include documentation of the applicable jurisdictional, legal, and regulatory authorities necessary for implementation in routing and incident-specific situations. Such plans must include necessary authorization for interventions with the following elements: individuals, groups, facilities, animals, food products, public works/utilities, and travel through ports of entry for state, local and territorial jurisdictions as appropriate. Plans should include consideration of the legal and planning issues for interventions such as isolation, quarantine, school and child care closures, workplace and community organization/event closure, and restrictions on movement.

HPP and PHEP awardees, HCCs, and their members must equip, train, and provide resources necessary to protect responders, employees, and their families from hazards during response and recovery operations.

Personal protective equipment (PPE), MCMs, workplace violence training, psychological first aid training, and other interventions specific to an emergency are all necessary to protect responders and health care workers from illness or injury and should be readily available to the health care workforce.

Personal Protective Equipment

Awardees and HCCs should manage PPE resources, including stockpiling considerations, vendor-managed inventory, and the potential reuse of equipment; this includes consistent policies regarding the type of PPE necessary for various infectious pathogens, and sharing information about PPE supplies across HCCs, EMS, public health agencies, and other members.

 

PHEP awardees are responsible for ensuring the safety and health of public health department staff who respond to an incident, including a large-scale incident that may require significant personnel from outside the health department. More information is available in Capability 14: Responder Safety and Health in the Public Health Preparedness Capabilities: National Standards for State and Local Planning and in the 2017-2022 HPP-PHEP Supplemental Guidelines. Public health departments must ensure the health and safety of responders through the following activities.

  • Distribute and dispense medical and nonmedical countermeasures to public health first responders
  • Purchase PPE, support fit testing, and maintain respiratory protection programs for public and health care sector workforce
  • Promote coordinated training and maintenance of competencies among public health first responders, health care providers (including EMS), and others as appropriate, on the use of PPE and environmental decontamination. Training should follow Occupational Safety and Health Administration (OSHA) guidelines and state regulations
  • Collaborate, develop, and implement strategies to ensure availability of effective supplies of PPE by working with suppliers and coalitions to develop plans for caching or redistribution/sharing
  • Public health agencies, health care organizations, and other HCC members should inform each other and integrate plans for purchasing, caching, and distributing PPE

2017-2018 hpp cooperative agreement domain five strategy

strengthen surge management

Following a public health incident, HPP and PHEP awardees should coordinate to assess the public health and medical needs of the affected community, with PHEP awardees focusing on public health surge needs and HPP awardees and their HCCs focusing on medical surge needs.

While the two programs may focus on different sectors within the community, HPP and PHEP awardees must coordinate these activities jointly.


The following four activities are used to manage public health surge:

  • Address mass care needs, such as shelter monitoring
  • Address surge needs, including family reunification
  • Coordinate volunteers
  • Prevent or mitigate injuries and fatalities.

Management of Public Health Surge | Joint Requirements

Address Health Needs in Congregate Locations (Joint Requirement)

PHEP awardees must coordinate with health care coalitions and their members to address the public health, medical, and mental health needs of those impacted by an incident at congregate locations.

HPP awardees should serve as subject matter experts to PHEP awardees on the health care needs of those impacted by an incident. For example, HPP awardees, HCCs, and HCC members should serve as a planning resource to PHEP awardees and public health agencies as they develop mass shelters. In particular, HPP awardees and HCCs should provide their expertise on the inclusion of medical care at shelter sites.

 

During a public health incident or crisis, families are at risk for becoming disconnected. HPP awardees and HCCs must serve as planning resources and subject matter experts to PHEP awardees and public health agencies as they develop or augment existing response plans for affected populations, including mechanisms for family reunification.

These plans should give consideration to:

  • Information needed to facilitate reunification of families
  • Reunification considerations for children
  • Family notification and initiation of reunification processes.
 

During an infectious disease outbreak, HPP and PHEP awardees, HCCs, and HCC members all have roles in planning for and responding to outbreaks that stress either the capacity or the capability of the public health or health care delivery systems.

ASPR and CDC require that awardees and HCCs coordinate the following activities to ensure the ability to surge to meet the demands during a highly infectious disease response.

  • Establish a common operating picture that facilitates coordinated infectious disease information sharing among all HCC members and relevant stakeholders, including state, local, and territorial public health agencies and their respective preparedness programs, state public health laboratories, communicable disease programs, and health care-associated infections (HAI) programs.
  • PHEP awardees should ensure infectious disease response planning includes state and local emergency management, partners responsible for airports and international points of entry into the United States, including CDC quarantine stations of jurisdiction, public safety, and other relevant agencies and community partners. Planning should include identification and management of potentially infected interstate and international travelers and acquisition and deployment of immunizations and prophylactic medication as appropriate.
  • Develop or update plans to describe how jurisdictional public health departments will:
  • Monitor known cases or exposed persons including how surveillance will be shared,
  • Conduct short- and long-term follow-up of known or suspected households, and
  • Ensure the security of storage and retrieval of sensitive information.
  • Establish key indicators, critical information requirements, and EEI that will assist with timing of notifications, alerting, and coordinating responses to emerging or re-emerging infectious disease outbreaks of significant public health and health care importance, including novel or high-consequence pathogens.
  • Provide real-time information through coordinated information sharing systems (see Capability 2, Objective 3, Activity 4 of the 2017-2022 Health Care Preparedness and Response Capabilities and Capability 6: Public Health Preparedness Capabilities: National Standards for State and Local Planning) and ensure that information is directed to the public and to the many disciplines that comprise the responder community.
  • Coordinate public messaging and information sharing, including information related to monitoring and tracking of persons under investigation (PUIs), among PIOs for jurisdictional public health agencies, as well as PIOs at HCCs and health care organizations.
  • Ensure infectious disease response planning includes state and local emergency management, transportation, public safety, and other relevant agencies and community partners.
  • Continue planning with health care organizations and other stakeholders such as mortuary, autopsy personnel, and medical examiners, to coordinate the management of the deceased when bodies are considered infectious, including addressing the provision of body bags and other supplies, defining assistance, and developing relationships with crematoriums, funeral directors, and other partners to effectively plan for managing the deceased when bodies are considered infectious.
  • Identify, leverage, and share leading practices to optimize infectious disease preparedness and response activities.

ASPR and CDC also recommend the following joint activities:

  • HCCs and state HAI multidisciplinary advisory groups or similar infection control groups within the state should partner to develop a statewide plan for improving infection control within health care organizations.
  • Jurisdictional public health infection control and prevention programs including HAI programs and HCC members should jointly develop infectious disease response plans for managing individual cases and larger emerging infectious disease outbreaks.
  • HPP and PHEP awardees, HCCs, and their members should collaborate on informatics initiatives to include but are not limited to electronic laboratory reporting, electronic test ordering, electronic case reporting, electronic death reporting, and syndromic surveillance.
  • HPP and PHEP awardees and HCCs should engage with the community to improve understanding of issues related to infection prevention measures, such as:
  • Changes in hospital visitation policies,
  • Social distancing, and
  • Infection control practices in hospitals, such as: PPE use, hand hygiene, source control, and isolation of patients.
  • HPP and PHEP awardees, HCCs, and their members should promote coordinated training and maintenance of competencies among public health first responders, health care providers, EMS, and others as appropriate, on the use of PPE, environmental decontamination, and management of infectious waste. Training should follow OSHA and state regulations.
  • HPP and PHEP awardees, HCCs and their members should collaborate to develop and implement strategies to ensure availability of effective supplies of PPE, including:
  • Working with suppliers and coalitions to develop plans for caching or redistribution and sharing and
  • Informing each other and integrating plans for purchasing, caching, and distributing PPE.
  • HPP and PHEP awardees, HCCs, and their members should sustain planning for the management of PUIs to:
  • Monitor health care personnel who may have had a risk exposure to a PUI by directly treating or caring for a PUI in a health care setting and
  • Clarify roles and responsibilities for key response activities related to the monitoring of PUIs,to include:
  • Assisting or assessing readiness of health care organizations in the event of a PUI and
  • Conducting AARs and testing plans for PUI management to identify opportunities to improve local, state, and national response activities.
More Detail! More information about addressing specialty medical surge for infectious diseases can be found in Capability 4, Objective 9 of the Health Care Preparedness and Response Capabilities!
PHEP Specific Requirement

Conduct Activities Based on State Plans to Manage Public Health Surge

CDC requires PHEP awardees to continuously assess and evaluate the medical and public health needs of the affected community and identify areas where the response effort is not meeting the demands. Awardees must then implement surge plans to address the gaps.

HPP and PHEP awardees must coordinate the identification, recruitment, registration, training, and engagement of volunteers to support the jurisdiction’s response to incidents. To develop competency in implementing plans involving volunteers, awardees should ensure volunteers are included in training, drills, and exercises throughout the five-year project period.

HPP awardees, including HCCs and their members, should work to manage volunteers in the hospital or other health care setting. This includes:

  • Identifying situations that would require volunteers in hospitals. Leverage existing hospital volunteer services and staffing resource mechanisms;
  • Identifying processes to assist with volunteer coordination, including protocols to handle walk-up volunteers and others who cannot participate due to state regulations;
  • Estimating the anticipated number of volunteers and health professional roles based on identified situations and resource needs of the facility;
  • Identifying and addressing volunteer liability, licensure, workers compensation, scope of practice, and third-party reimbursement issues that may deter volunteer use;
  • Leveraging existing government and nongovernmental volunteer registration programs, such as Emergency System for Advance Registration of Volunteer Health Professionals (ESAR-VHP) and Medical Reserve Corps (MRC); and
  • Developing rapid credential verification processes to facilitate emergency response.

Implement Plans that Support the Emergency System for Advance Registration of Volunteer Health Professionals (ESAR-VHP)

It is critical that PHEP awardees coordinate identification, recruitment, registration, training and engagement of volunteers to support the jurisdictional public health agency’s response to incidents. Awardees must ensure volunteers are included in training, drills, and exercises to develop competency at implementing plans as described in the Emergency System for Advance Registration of Volunteer Health Professionals (ESAR-VHP) compliance requirements. Awardees in jurisdictions that do not use spontaneous or other volunteers due to state regulations must describe in their plans how they plan to handle those types of volunteers during an incident.

 
PHEP Specific Requirement

>Community Partnerships for Coordination

With regard to fatalities, PHEP awardees must coordinate with HCCs and other community partners, including law enforcement, emergency management, and medical examiners or coroners to ensure proper tracking, transportation, handling, and storage of human remains and ensure access to mental and behavioral health services for responders and families impacted by an incident.


The following four activities are used to manage medical surge:

  • Conduct health care facility evacuation planning and execute evacuations
  • Address emergency department and inpatient surge
  • Develop alternate care systems
  • Address specialty surge, including pediatrics, chemical, radiation, burn, trauma, behavioral health, and highly infectious diseases.

Management of Medical Surge

 

By the end of Budget Period 1, HPP awardees, HCCs, and HCC members must ensure all health care organizations, public health agencies, and emergency management organizations are included in evacuation, transportation, and relocation planning and execution during exercises and real incidents.

Further, HPP awardees, HCCs, and HCC members must sustain or further develop their evacuation planning and response activities throughout the remainder of the five-year project period.


Coalition Surge Test

To test the ability of the HCC to perform components of the 2017-2022 Health Care Preparedness and Response Capabilities, each HCC must conduct an exercise using the Coalition Surge Test once each budget period. Additional information on HPP exercise requirements and the Coalition Surge Test are provided in the 2017-2022 HPP-PHEP Supplemental Guidelines.

 

HCCs and their members that coordinate during a medical surge response are more likely to effectively manage the emergency without state or federal assets or employing crisis care strategies. However, it is not possible to plan for all worst-case scenarios, and there may be times when the health care delivery system is stressed beyond its maximum surge capacity.

During those scenarios, crisis care strategies may be employed and planned for well in advance. Planning for medical surge should follow the medical surge capacity and capability (MSCC) tiered approach, where successive levels of assistance are activated as the emergency evolves.

Accomplishing these activities will enable the health care delivery system and other organizations that contribute to responses to coordinate efforts before, during, and after emergencies; continue operations; and appropriately surge as necessary.

 

Immediate bed availability (IBA) is defined as the ability of a hospital to provide at least 20 percent bed availability of staffed beds within four hours of a disaster.

IBA is built on three pillars: continuous monitoring across the health system; off-loading of patients who are at low risk for untoward events through reverse triage; and on-loading of patients from the disaster. While the goal of IBA is to create capacity within hospitals, other health care partners including home care providers, skilled nursing facilities, long-term care facilities, clinics, and community and tribal health centers, can meet the needs of patients who are discharged early as part of the surge response.

HCCs and their members must plan and respond together to address emergency department and inpatient surge with the goal of ensuring IBA throughout the five-year project period. In particular, HCCs and their members should focus their hospital medical surge capability and IBA activities in these areas:

  • Emergency department beds
  • General medical, general surgical, and monitored beds
  • Critical care beds
  • Surgical intervention units
  • Clinical laboratory and radiology services
  • Health care volunteer management
  • Equipment and supplies
  • Staffing
  • Coordination of ambulance transport with EMS System
 

By the conclusion of the five-year project period, HPP awardees must document their processes to oversee jurisdictional crisis standards of care (CSC) planning and to coordinate all local or regional planning efforts.

HPP awardees must be prepared to submit documentation to their FPOs and ASPR’s Technical Resource, Assistance Center, and Information Exchange (TRACIE) detailing these processes upon request.

Further, HPP awardees must ensure the documentation includes:

  • Efforts undertaken to promote a uniform approach to establishing the ethical and legal frameworks necessary for CSC planning and implementation, for example, liability protections and specific rules and laws that might need modification or suspension to support CSC implementation, such as to broaden scope of practice or relax interstate licensure requirements
  • Efforts undertaken to promote community engagement and discussion related to CSC planning
  • Evidence of jurisdictional support of crisis surge response, including specific methodologies to allow for the expansion of health care service delivery, including establishment of alternate care facilities, adjustment of prescribing practices, and amendment of EMS protocols
  • Efforts undertaken to socialize and describe CSC planning in a whole-of-government context,including discussions with elected officials and other government leaders
  • The process used to ensure provision of consistent and uniform clinical guidance for scarce resource conditions

HCCs also play a role in CSC planning. By the end of the five-year project period, each HPP-funded HCC must document its plan for implementing CSC, integrating EMS, hospital, public health, and emergency management policies related to situations in which the usual delivery of health care services is not possible due to disaster conditions. HCCs must be prepared to submit the documentation regarding this plan to an HPP FPO upon request.

HCCs must include in the documentation:

  • The key stakeholders involved in the planning, including a description of how these stakeholders integrate with each other to ensure a coordinated response to crisis conditions
  • Efforts undertaken to promote provider engagement in CSC planning
  • Activities to support the implementation of crisis care decision-making by EMS agencies, including dispatch, transport, and treatment decisions
  • Activities to support the implementation of crisis care decision-making by hospitals and other health care entities, especially as they relate to managing limited resources and the integration of crisis strategies into surge capacity planning and incident management
More Detail! More information about addressing emergency department and inpatient medical surge can be found in Capability 4, Objective 2, Activity 1 of the Health Care Preparedness and Response Capabilities!
An alternate care system, defined as the use of nontraditional settings and modalities for health care delivery, may be required when demand overwhelms a region or the nation’s health care delivery system for a prolonged period, or an emergency has significantly damaged infrastructure and limited access to health care.

HCCs should plan to provide support, including personnel and supplies, to public health agencies and emergency management organizations that have leadership roles in selecting, establishing, and operating alternative care sites.

Accordingly, HPP awardees and HCCs should plan for the development of alternate care systems, in collaboration with state and local public health agencies and emergency management organizations, prior to the conclusion of the five-year project period. However, the development of an alternate care system does not begin and end with identification of alternate care sites.

HPP awardees and HCCs are encouraged to consider additional factors in their alternate care system activities prior to the conclusion of the five-year project period:

  • Establishment of telemedicine or virtual medicine capabilities
  • Establishment of assessment and screening centers for early treatment
  • Provision of medical care at shelters
  • Assisting with the selection and operation of alternate care sites
More Detail! More information about the development of alternate care systems can be found in Capability 4, Objective 2, Activity 3 of the Health Care Preparedness and Response Capabilities!
 

Each HCC should promote its members’ planning for pediatric medical emergencies and foster relationships and initiatives with emergency departments that are able to stabilize and manage pediatric medical emergencies.

HPP awardees must collaborate with the Emergency Medical Services for Children (EMSC) program within its jurisdiction to better meet the needs of children receiving emergency medical care. The Health Resources and Services Administration (HRSA) administers the EMSC program at the federal level, and HRSA awardees may be state agencies or accredited schools of medicine. This program works to ensure that critically ill and injured children receive optimal pediatric emergency care.

Following are specific areas of collaboration:

  • HPP awardees and the EMSC program awardees within their jurisdictions must provide a joint letter of support indicating that EMSC and HPP are linked at the awardee level. HPP awardees must provide the initial letter of support with their funding applications at the beginning of each budget period throughout the five-year project period.
  • HPP awardees must work with HCCs and EMSC to ensure that all hospitals are prepared to receive, stabilize, and manage pediatric patients. At the end of each budget period, HRSA will provide HPP with data regarding each hospital’s capability to manage pediatric medical emergencies to assist with this work.

EMSC awardee contact information is available in the PERFORMS Resource Library or via HPP FPOs.

 

The health care system must be prepared to manage exposed or potentially exposed patients during a chemical or radiation emergency.

To ensure successful surge management during chemical or radiation emergency events, HCCs and their members should complete the following activities prior to the conclusion of the five-year project period.

  • Coordinate training for their members on the provision of wet and dry decontamination and screening to differentiate exposed from unexposed patients (especially in radiation emergency events)
  • Ensure involvement and coordination with regional HAZMAT resources (where available) including EMS, fire service, health care organizations, and public health agencies (for public messaging)
  • Assist members with distribution of available, including mobilization of CHEMPACKs when necessary
  • Consider participating in a joint community reception center exercise with public health partners
 

HPP awardees, their HCCs, and HCC members must plan to coordinate a response to large burn and trauma emergencies in collaboration with all burn and trauma systems within their jurisdictions, boundaries, or that may partner with them.

This must be noted in the HCC response plan by the end of Budget Period 2. HPP awardees must also be prepared to submit this documentation to an FPO upon request.

Given the limited number of burn specialty hospitals and trauma centers, an emergency affecting large numbers of burn or trauma patients will require HCC and awardee involvement to ensure those patients that can benefit the most from burn and trauma services receive priority for transfer. Additionally, HCCs can assist with patient distribution to coordinate the availability of critical trauma and burn response resources, such as operating rooms, surgeons, anesthesiologists, operating room nurses, and surgical equipment and supplies.

 

Emergencies may cause severe emotional impacts on survivors, their families, and responders and may additionally cause substantial destabilization of patients with existing behavioral health issues.

Consequently, by the conclusion of the five-year project period, ASPR encourages HPP awardees to:

  • Develop and use behavioral health support and strike teams to support affected populations
  • Plan for widespread information dissemination to help providers, patients, families, and the community understand the symptoms and signs of acute stress responses and collaborate with HCCs to communicate when and where individuals should seek treatment
  • Provide ongoing support to their inpatient and outpatient behavioral health members
  • Assist with the provision of psychological first aid to those impacted, including health care workers
 

HPP awardees, HCCs, and their members have roles in planning for and responding to infectious disease outbreaks that stress either the capacity or the capability of the health care delivery system.

Prior to the end of the five year project period:

  • Awardees, HCCs, and their members must expand existing Ebola concept of operations plans (CONOPs) to enhance preparedness and response for all infectious disease emergencies that stress the health care delivery system
  • HCCs must include HAI coordinators and quality improvement professionals at the health care facility and jurisdictional levels in their activities, including planning, training, and exercises/drills; also include HCC leaders in state HAI coordination work groups
  • HCCs should develop a uniform process of continuous screening for newly presenting, hospitalized, and other patients and integrate information with electronic health records (EHRs) where possible, throughout HCC member facilities and organizations
  • HCCs should coordinate visitor policies for infectious disease emergencies at member facilities to ensure uniformity
  • HCCs should develop and exercise plans to coordinate patient distribution for highly pathogenic respiratory viruses and other highly transmissible infections, including complicated and critically ill infectious disease patients, when tertiary care facilities or designated facilities are not available
 
More Detail! More information about addressing specialty surge can be found in Capability 4, Objectives 4 through 9 of the Health Care Preparedness and Response Capabilities!

2017-2018 hpp cooperative agreement domain six strategy

strengthen Biosurveillance (PHEP Only)

As defined by Homeland Security Presidential Directive 21 (HSPD-21), biosurveillance involves active data-gathering with appropriate analysis and interpretation of biosphere data that might relate to disease activity and threats to human or animal health — whether infectious, toxic, metabolic, or otherwise, and regardless of intentional or natural origin — to achieve early warning of health threats, early detection of health events, and overall situational awareness of disease activity. PHEP awardees must ensure coordination among preparedness, laboratory, and epidemiology programs through the following activities to strengthen biosurveillance.

Public Health Informatics (Surveillance and Investigation)

PHEP awardees should consider updating essential systems that strengthen epidemiological surveillance and investigation capability with modern technological tools and make them more versatile in meeting the demands for timely, population-specific, and geographically specific surveillance information. To meet these expectations, CDC encourages PHEP awardees to consider two key strategies:

  • Enhance the public health information system workforce: Prioritize implementation of targeted cross-cutting workforce training and development opportunities to maintain functionality and increase capacity of public health information systems, such as electronic death registration systems.
  • Advance electronic information exchange: Public health informatics capacity includes specific actions to both receive and transmit data electronically using standards-based messaging; awardees should focus their efforts on improving information sharing and coordinate information technology goals, investments, and work plans with input from state laboratory directors, state epidemiologists, information technology or informatics directors, or specifically designated individuals empowered by these authorities by:
  • Participating in CDC’s National Notifiable Diseases Surveillance System (NNDSS) Modernization to increase NNDSS case reports submitted electronically to CDC using HL7 messaging,
  • Advancing ELR to improve overall surveillance, timeliness, and accuracy of case reporting, confirmation to state and local public health, and subsequent information sharing with CDC,
  • Participating in the National Syndromic Surveillance Program (NSSP) to increase the proportion of emergency department visits monitored by jurisdictions,
  • Implementing electronic test ordering (ETOR) to accept electronic test orders and to return findings electronically, and
  • Implementing electronic case reporting (eCR) consistent with national standards to accept and process electronically transmitted reportable disease information from electronic health records.

The 2017-2022 HPP-PHEP Supplemental Guidelines includes additional information related to public health informatics.

Electronic Death Registration (EDR)

Awardees using PHEP funds for EDR must ensure they are developing or advancing state-based EDR systems that can provide more timely public health mortality surveillance information to CDC’s National Center for Health Statistics (NCHS) and state epidemiologists. Awardees using PHEP funds to support existing EDR systems must prioritize goals and objectives in their work plans that advance the use and geographic coverage of current death reporting systems. Awardees using PHEP funds to build operational EDR systems must prioritize development of scalable plans designed to initially implement an EDR system. More information is available in the 2017-2022 HPP-PHEP Supplemental Guidelines.

Border Health Surveillance

PHEP awardees in jurisdictions located on the United States-Mexico border or the United States-Canada border must conduct activities that enhance border health, particularly regarding disease detection, identification, investigation, and preparedness and response activities related to emerging diseases and infectious disease outbreaks whether naturally occurring or due to bioterrorism. This focus on cross- border preparedness reinforces the U.S. public health and health system preparedness whole-of- community approach which is essential for local-to-global threat risk management and response to actual events regardless of source or origin.

Disaster Epidemiology Training

CDC recommends that PHEP awardees participate in disaster epidemiology training initiatives as determined by jurisdictional priorities. Following are recommended activities and tools.

  • Rapid Response Registry (RRR): RRR is used to quickly register victims of disasters and provide services, information, or long-term monitoring. The RRR toolkit and technical support from SMEs with ATSDR are available to assist with implementation
  • Emergency Responder Health Monitoring and Surveillance System (ERHMS): ERHMS is designed to provide real-time data and recommendations on health and safety issues that arise among responders involved in an emergency response. The system includes specific recommendations and tools for all phases of a response (pre-deployment, deployment, and post-deployment)
  • Incorporate information from the ATSDR's Assessment of Chemical Exposures (ACE) into training initiatives. ACE can be used to conduct epidemiological assessments after a chemical incident. The ACE toolkit is a helpful resource to assist local authorities in responding to or preparing for a chemical release and has been implemented in several recent disasters.

More detailed information and resources are available in the 2017-2022 HPP-PHEP Supplemental Guidelines.

Collaborate with Poison Control Centers

CDC recommends that PHEP awardees implement processes for using poison control center data for public health surveillance. Such data can be particularly helpful in 1) providing situational awareness during a known public health threat, 2) identifying an emerging public health threat, 3) identifying unmet public health communication needs following a public health threat, or 4) providing surveillance for specific exposures or illnesses of concern to the health department. Detailed information and resources can be found in the 2017-2022 HPP-PHEP Supplemental Guidelines.

Response Plans for Chemical, Biological, Radiological, Nuclear, and Explosive Threats

Awardees can use PHEP funding to maintain personnel needed to address chemical, biological, radiological, nuclear and explosive (CBRNE) threats through hiring, training, exercising, and otherwise implementing response plans. In addition, awardees should describe in their MYTEPs specific plans to address identified gaps during the project period, and collaborate with HPP awardees to coordinate joint training and exercise opportunities.

State Health Official Input Letter

To ensure strong state systems for detection of threats and injuries, states must plan and coordinate their allocated resources across several domains. PHEP awardees must submit an application letter signed by the jurisdiction’s state health official on official agency letterhead confirming the PHEP director, the epidemiology lead, and the public health laboratory director, or their designated representatives, have provided input into plans, strategies, and investment priorities within epidemiology, surveillance, and laboratory work plans. Awardees who are unable to obtain effective input from these stakeholders must submit a separate attachment with their funding applications describing the reasons why and the steps taken to address them. CDC will work with awardees to help resolve issues as necessary. An optional letter template is available in the PERFORMS Resource Library.

2017-2018 funding restrictions

what awardees must not do, or may do only under specified conditions

phep/hpp overarching funding restrictions and conditions

  • May use funds only for reasonable program purposes, including personnel, travel, supplies, and services.
  • May supplement but not supplant existing state or federal funds for activities described in the budget.
  • May use funds only for reasonable program purposes, including travel, supplies, and services.
  • May purchase basic (non-motorized) trailers with prior approval from the CDC OGS.
  • May use funds for overtime for individuals directly associated (listed in personnel costs) with the award (with prior approval).

NOTE: The direct and primary recipient in a cooperative agreement program must perform a substantial role in carrying out project outcomes and not merely serve as a conduit for an award to another party or provider who is ineligible.

PHEP Specific Funding Restrictions

  • PHEP awardees cannot use funds to purchase vehicles to be used as means of transportation for carrying people or goods, such as passenger cars or trucks and electrical or gas-driven motorized carts.
  • PHEP awardees can (with prior approval) use funds to lease vehicles to be used as means of transportation for carrying people or goods, e.g., passenger cars or trucks and electrical or gas-driven motorized carts.
  • PHEP awardees can (with prior approval) use funds to purchase material-handling equipment (MHE) such as industrial or warehouse-use trucks to be used to move materials, such as forklifts, lift trucks, turret trucks, etc. Vehicles must be of a type not licensed to travel on public roads.
  • PHEP awardees can use funds to purchase caches of antibiotics for use by first responders and their families to ensure the health and safety of the public health workforce.
  • PHEP awardees can use funds to support appropriate accreditation activities that meet the Public Health Accreditation Board’s preparedness-related standards.

phep cooperative agreement appropriations

the phep cooperative agreement is a contract between the the cdc and the states

bParati Public Health Emergency Preparedness Program National Map Image

PHEP Base Funding 2004-2017

2017: $546,940,949
 
2016: $546,940,949 (accounts for PHEP restoration under Zika Act)
 
2015: $546,940,949
 
2014: $548,182,450
 
2013: $519,471,972
 
2012: $554,803,057
 
2011: $523,215,590
 
2010: $611,341,225
 
2009: $618,830,835
 
2008: $629,146,071
 
2007: $791,779,743
 
2006: $699,013,268
 
2005: $809,956,000
 
2004: $809,956,000