(A324) Emergency Management Preparedness and Response Planning in the US: Aphis Foreign Animal Disease Preparedness and Response Plan (FAD PREP)

The United States Department of Agriculture (USDA) Animal and Plant Health Inspection Service (APHIS) Veterinary Services (VS) is charged with monitoring, controlling, and responding to select reportable diseases and all foreign animal diseases. Emergency Management and Diagnostics (EM&D) oversees Foreign Animal Disease (FAD) preparedness and response. In order to effectively prepare for and respond to FADs, such as highly pathogenic avian influenza and foot-and-mouth disease, VS develops plans, strategies, and policies to effectively combat an intrusion. USDA APHIS VS has made significant gains in preparedness and response planning. However, much remains to be done especially in surveillance, diagnostic tools, and vaccines. There are significant needs for novel medical technologies to improve diagnostic capabilities and offer additional approaches for FAD response.

Climate change has increased the frequency and severity of weather-related disasters such as hurricanes, exposure to heat and cold temperatures, flooding events, and wildfires. Between 1980 and 2020, the United States incurred 285 separate billion-dollar weather-related disasters.1 In 2020, there were 22 billion-dollar events, including seven hurricanes, three tornadoes, eight severe weather events, two hail storms, a historic drought, and a wildfire.1 Prior studies have repeatedly demonstrated that exposure to natural disasters has significant effects on the 1.4 million nursing home (NH) residents around the US.2 Recognizing that the effects of most disasters are local but require the assistance of federal and state agencies, it is imperative that stakeholders assess for vulnerabilities and strengthen their preparedness to respond to all-hazards disasters.2, 3 In 2017, the Institute of Healthcare Improvement (IHI) and the John A. Hartford Foundation introduced a framework for evaluating age-friendly healthcare systems based on four evidence-based core elements.4 We believe that this 4M's paradigm (What Matters, Medication, Mentation, and Mobility) provides a foundation upon which to consider a more nuanced approach to NH disaster preparedness. Specifically, this requires the application of the 4M model to all phases of disasters (i.e., prevention, mitigation, preparedness response, and recovery). Research has found that the consistent use of evidence-based strategies and assessment approaches across care settings, as envisioned by the 4Ms framework, improves the quality of outcomes.5 We propose that such an approach has the potential to improve disaster preparedness in NHs. This commentary describes the 4M's paradigm and how it might guide emergency planning and decision making in NHs facing complex disasters. We also propose the addition of a fifth M that is relevant to disaster planning: Marshaling Staff and Resources. The increased frequency of cold and hot temperature extremes has served to accelerate the rate and severity of weather-related disasters.6 The number of affected has increased five-fold in the past 50 years, well beyond the proportional rate of population growth (Figure 1).7 NH residents represent a clustered group of individuals at the highest risk for adverse health effects following a disaster.8 In the U.S., almost half of the adults living in NHs reside in one of the 18 hurricane-prone Atlantic and Gulf coastal states.9 NH residents are at risk of physical and psychological harm from disasters for a variety of reasons. First, most NH residents have significant functional limitations. They require assistance with their activities of daily living (ADL), have significant vision/hearing impairments, or live with other conditions, such as Alzheimer's disease or related dementias, that may compromise their ability to respond appropriately and quickly during emergencies.10-12 These impairments limit health reserve, potentially magnifying the impact of disasters and forced relocation.13-15 A second major concern that increases the risk for NH residents is increased acuity. As the length of stay has decreased in acute care hospitals, NHs have increasingly become responsible for caring for medically complex post-acute patients. Finally, older adults (50%–90%) report experiencing at least one traumatic event during their lifetime.16, 17 A resident's trauma history influences both risk and resilience during disasters and it is important to note that NHs represent a clustered group of older adults.18 These factors complicate transitions of care under optimal circumstances, let alone in the chaos and infrastructure breakdown that usually accompanies a disaster. Source: Meehl, 2001 (Reference 13) For decades the National Response Framework (NRF) has guided the response to disasters and emergencies in the U.S., operating through a system designed to coordinate the multiple entities needed to maintain critical functions. The NRF relies on each entity to develop procedures to protect those who rely on its care and services and to work in coordination with other critical organizations and service providers.19 Gaps related to the safety of NH residents became evident during the hurricanes of 2004 and 2005, including Hurricane Katrina. In 2006 the U.S. Office of the Inspector General documented numerous cases of poor NH preparedness, even though 94% of NHs nationwide met the federal preparedness standards at the time.20 Concerted efforts followed to include NHs as health care facilities within the National Incident Management System, as part of the NRF, and to bolster regulatory requirements for NHs to develop plans to maintain residents' health and safety in a disaster.21 In the past two decades, emergency management has become recognized as a critical element of NH operations. However, recent studies and reports continue to raise questions about NH preparedness and integration within the infrastructure envisioned by the NRF, and to suggest regulatory compliance is not enough to protect NH residents in disasters.22-27 To improve overall NH disaster preparedness, a framework that combines key concepts of resident care and coordination with critical resources outside the NH is required. Developed initially for acute settings, the 4M framework recognizes varied organizational capacities and more fully addresses institutional practices and processes based on six steps: (1) Understand your current state; (2) Describe care consistent with the 4Ms; (3) Design or adapt your workflow; (4) Provide care; (5) Study your performance, and (6) Improve and sustain care.4 Figure 2 describes the 4M categories and how the six steps are intended to create an age-friendly environment that optimizes the care for those with chronic medical illness. To our knowledge, the 4M's paradigm has not been utilized in disaster preparedness. Table 1 provides a schematic of how the 4M framework might be applied to the prevention, response, and recovery stages of a disaster. Each category is addressed below: Source: Modified from Institute of Healthcare Improvement For What Matters, care providers need to align care with an individual's goals and preferences. From a disaster preparedness perspective, it is imperative to document each resident's care preference goals in advance. Ideally, this should occur upon admission and be updated at the quarterly resident care planning meetings with families' input.28 In addition to having documented care preferences in the form of advance directives, resident care plans should include personalized disaster care plans that includes consideration of the resident's culture and incorporates information about what matters to the resident in the event of a disaster, with resident and family input for those residents who lack decision making capacity. NHs that strive to support their residents in the context of their own life experiences and values recognize that cultural competence is a first step toward addressing and reducing health disparities.29 Cultural competence is a dynamic and continuous developmental process and not an end point where an NH or staff member can claim to achieves competency in another culture.30, 31 Providing person-centered care is central to the 4M model.28 In addition to following regulatory requirements to maintain resident health and safety in disasters, the NH should ensure residents have all possible comforts (e.g., hot food, comfortable bedding, preferred items, and activities) and minimal disruptions to their daily routines, acknowledging that some disruption may be necessary for safety. During a disaster, residents should also be afforded the support of family, friends, and preferred staff members who know what matters to them.32 In order for the staff to identify and implement what matters to each resident, effective communication is crucial. We recommend that the residents' interests, values, and goals be digitally and physically documented in the event of an evacuation or power outage. Documentation is crucial for both quality of life and responsive medical care. From an organizational level, NHs should aggregate resident-level data in their central disaster plan and this information should be updated regularly. Such data would enable NHs to review resident needs before a disaster and organize staff to address needs in a prioritized fashion. Issues pertaining to medications and older adults residing in NHs are well-documented and compounded in the face of disasters. Considerations are both clinical as well as practical. For example, it is essential to assure the timely administration of many medications in order to maintain therapeutic dosage for a wide array of serious health conditions (e.g., congestive heart failure, diabetes, chronic obstructive pulmonary disease) in which missed or altered uptake schedules can easily disrupt bodily functioning and impact the quality of life.33 Previous research following Hurricanes Katrina and Rita noted that one-third of all visits to emergency rooms in the days following the hurricane occurred due to chronic medical illness.34 Among assisted living residents, there was a 12% increase in emergency room visits for individuals with congestive heart failure in the days following Hurricane Irma.35 Many of these increased admissions are a result of inadequate access to necessary medications and therapeutics.34 Older adults residing in NHs consume nearly nine prescribed medications daily36 and the prospect of access to and assurance of medication delivery is layered upon an already widespread list of medication issues including polypharmacy,37 adverse drug reactions, and altered biochemical clearance of medications.38 Disasters that involve heat-related exposure are particularly problematic as they cause dehydration, which will alter the pharmacokinetics of many well-tolerated medications. Beyond medications, access to time-sensitive treatments such as dialysis or wound care must also be considered. Lastly, access to as-needed medications such as antibiotics, anxiolytics, pain medications, and first aid materials needs to be considered as they might be required in the days following a disaster. Mentation is focused on preventing, identifying, treating, and managing dementia, depression, and delirium across care settings. Those who provide care to NH residents acknowledge that managing these conditions is vital during normal day-to-day operations as well as during all stages of a disaster.39 Research suggests that residents with impaired cognition, chronic and acute medical conditions, and mobility and sensory issues have higher morbidity and mortality rates because of their compromised ability when evacuating or sheltering-in-place.40, 41 Given that approximately 48% percent of NH residents are living with Alzheimer's Dementia and Related Dementias, it is important to consider residents' physical safety when developing disaster plans. Changing residents' schedules or environments can evoke agitation, anxiety, and other changes in behavioral and mood symptoms. Without adequate planning, transfer trauma from evacuation can erode cognitive and physical functioning.4, 34, 35 Beyond identifying those with dementia, determining those with preserved cognitive abilities may be particularly helpful in a disaster situation. Recognizing residents' specific abilities (rather than focusing on disability) is critical to supporting person-centered care. Some residents will be willing and able to support other residents by promoting the use of adaptive coping strategies, reducing stress, and providing emotional support when NH staff are focused on other essential preparedness activities. Viewing residents as active members of a disaster preparedness response or recovery plan rather than victims of the disaster can serve to strengthen our existing system of care and support staff during a demanding time.42 At present, pre-disaster mental health programs that build resilience and support mentation concerns are not universally offered or financially supported. Further, mental health resilience programs are not a core component of disaster preparedness activities for the general public or NH staff and residents. Currently, crisis counseling programs are activated reactively after a catastrophic event to address adverse mental health outcomes. Appropriate planning might include opportunities to address these issues proactively to improve resilience. Providing care to improve or maintain the mobility of NH residents is one of the central elements of an age-friendly NH.28 In a disaster, knowing and meeting residents' mobility needs is of utmost concern because responding often requires residents to be physically moved. Previous research has revealed that even under optimal circumstances, NH residents who transition health care environments are at heightened risk of mortality and morbidity from falls. Hoffman and colleagues identified falls as the third leading cause of readmission following hospitalization among a Medicare cohort.43 NH residents are three times more likely to fall than age-matched community-dwellers.44 Research specific to disasters has identified functional impairment and mobility as key factors contributing to increased morbidity and mortality following a hurricane.41 Additional research has highlighted mobility as critical in the decision of whether to evacuate or shelter-in-place.45-47 In qualitative research, NH administrators have discussed the extreme stress of evacuation on residents with mobility limitations, describing hours-long bus trips ending with residents being crowded into hallways or common rooms where they were left in their wheelchairs or on mats on the floor24, 48, 49 Both sheltering-in-place and evacuation carry risks and mobility is especially critical in disasters requiring a rapid response (e.g., sudden flooding, earthquakes, wildfires) internally (e.g., upstairs) or externally.46 On a systems level, disaster planning for mobility should include maintaining an adequate supply of functioning mobility aids (e.g., wheelchairs, walkers) to meet residents' needs in the NH and receiving facilities. Overall, the success of an NH disaster plan hinges on how well it assesses all residents' mobility risks and secures the spaces, supplies, equipment, and staff members necessary to provide for their safety and comfort as they are transferred. While the age-friendly 4M model provides a person-centric approach to care within healthcare systems, we posit additional considerations unique to the NH setting and specifically in the area of disaster preparedness. With a greater emphasis on the organizational context of care, we propose the addition of "Marshalling of Staff and Resources" as an additional M to the model. Among foremost considerations is the necessity of the NHs to conduct normal operations while facing disaster-related uncertainties. For example, decisions such as whether to evacuate or shelter-in-place require NH administrators to simultaneously consider the primacy of resident safety and care as well as their own requisite staffing and resource availability. Marshaling staff and resources means having the necessary staff, equipment, and supplies available to provide undisrupted care to residents despite emergent conditions. This readiness involves developing internal plans and procedures and also collaborating with outside entities, such as local public health officials, emergency managers, and first responders who can communicate the scope of a threat to the community at large as well as help an NH meet unexpected needs amid an emergency. Research has highlighted the needs and vulnerabilities of NH and other long-term care residents in disasters.22, 50-52 After Hurricane Katrina, the John A. Hartford Foundation funded efforts to better connect NH operators, emergency managers, and other public health and safety officials.53 However, recent work has found that gaps in communication and collaboration continue to exist among these entities,24 all of whom have important interconnecting roles in protecting older adults in disasters. There is evidence that emergency management agencies and long-term care operators collaborated more effectively during the COVID-19 pandemic than during prior hurricane disasters.54 However, much more work is needed to persuade and enable NHs to marshal the resources required to protect the safety and health of residents affected by disasters. Among the core needs of an NH during a disaster situation is the maintenance of nursing and support staff. Direct-care nurse staffing levels are strongly associated with the quality of care within NHs. Nurse staffing can be broken down into licensed (i.e., registered nurses [RNs]; licensed practical/vocational nurses [LPNs]) and unlicensed (i.e., certified nursing assistants [CNAs]) staff. Of the two licensed nurse staff, RNs have the greatest training requirements and are the most costly to employ. A higher skill mix (i.e., a greater ratio of RNs to LPNs and CNAs) is associated with lower avoidable hospitalization rates,55 fewer emergency department visits,56 fewer regulatory health deficiencies.57 Generally, greater staffing levels and lower staff turnover is associated with better quality,58, 59 and several factors influence the availability and retention of direct-care staff in NHs, such as payer mix,60-62 socioeconomic status and rurality of the location,63, 64 and minimum staffing requirements65, 66 in addition to contextual work-environment factors. During disasters, obtaining adequate staffing to evacuate hundreds of medically-frail residents may be difficult.66, 67 Prior work from Hurricane Irma in September 2017 suggests that NHs increase all types of direct-care nurse staffing in preparation for major hurricanes, but that evacuating a facility requires an even greater staffing response.68 Unfortunately, lower-quality NHs increased their staffing levels the least and opted to retain fewer RNs compared to higher-quality NHs during Hurricane Irma.69 Because direct-care staff implements the 4Ms (i.e., resident goal planning and fulfilling preferences/wishes, providing medications and identifying adverse drug-related events, recognizing and managing cognitive and mental health disorders, assisting with transfer and mobility), it is crucial for NHs to maintain adequate staffing levels to meet the needs of residents during disasters. In addition to staffing, the management of resources is vital. Resources such as gasoline for electric generators, non-perishable food items, clean drinking water, a supply of medications and injectables, and clean linens must be properly stored and distributed.52, 70 Management of resources must include a comprehensive evacuation plan given the complex task of evacuating NHs.48, 51, 71-74 This plan should be malleable, as it is influenced by external factors such as the nature of the disaster, the location, and the risk of exposure to the facility. Internal factors also affect an evacuation plan and include destination characteristics (e.g., proximity, availability of beds), transportation (e.g., contract transportation or within-house, consideration of transporting flammable gases such as oxygen), availability of supplies and staff, resident acuity (e.g., management of cognitive, mental, and chronic health issues), and the physical structure of the NH.75 A focus on staffing may be especially important to prevent the worsening of health inequities among NH residents during disasters. Residents who identify as Black or Hispanic/Latinix are disproportionately affected because they tend to reside in lower-quality facilities, which are more likely to have lower staffing rates during disasters.63 Lower-quality facilities are also found in socioeconomically disadvantaged locations, where other disaster response resources may be limited.64, 76 Efforts to address low staffing and poor resource coordination, potentially through reimbursement of disaster-related expenses, may especially benefit minority and socioeconomically disadvantaged residents through improved continuity of care to prevent later hospitalization and mortality.63 NHs care for residents of increased acuity. Combined with cognitive and functional impairments, this acuity makes NH residents susceptible to the detrimental effects of climate change-related disasters. As these disasters increase in frequency and severity, a more proactive approach to preparedness is required. A modified Age-Friendly 4M Framework provides an important person-centered and organizational framework for stakeholders to develop improved disaster preparedness. All authors participated in all elements of this manuscript. None of the authors reported significant conflicts of interest related to this work. David Dosa is an employee of the Providence VAMC. This material is the result of work supported by resources and the use of facilities at the Providence VA Medical Center. The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs or the United States government.

Index

The Kidney Community Emergency Response (KCER) Coalition is a group of more than 150 volunteers across the United States who work collaboratively to develop and disseminate disaster preparedness and response information to the kidney community. It is vital for each member of the kidney community to develop and maintain all-hazards disaster plans. Would your practice or dialysis facility be able to run smoothly if your nurses were unable to come to work due to a disaster? What if half the staff was unable to come to work? Incorporating personal and workplace disaster plans can help address these issues. Disaster plans describe the actions to take in response to a natural or manmade disaster; additionally they describe the tasks to be performed—by whom, when, and where. The plans should be comprehensive and cover disaster mitigation, preparedness, response, and recovery. Plans should address potential impacts from all types of hazards, such as tornadoes, floods, earthquakes, hazardous material spills, terrorist attacks, hurricanes, blackouts, and fires. There are 4 steps in the emergency planning process: hazard analysis, plan development, testing the plan, and maintaining/revising the plan. Hazard analysis determines which hazards are likely to impact an area and ranks these hazards according to their likelihood of impact and their potential to impact normal functions. The first step is to identify each hazard and describe it. Next, determine how and why the organization (your family or business) is vulnerable to that hazard. Most emergency management agencies should have current and adequate hazard analyses you could use as a model. Contact your local emergency management agency for a copy of their plans. Disasters can strike anywhere, in any form. A well-prepared staff is pivotal to any workplace disaster plan—whether your office is a dialysis unit or transplant center. The Centers for Medicare & Medicaid Services (CMS) Guide Emergency Preparedness for Dialysis Facilities is an important tool that can help an organization build a disaster plan. The KCER Coalition worked with CMS to update this manual, which will be available in late 2009. Additionally, employees must have personal preparedness plans that include their family, pets, home, and any special needs so that their personal needs can be addressed quickly and in an organized fashion, as healthcare providers are often called on to quickly respond when disasters happen. Without adequate personal disaster plans, employees may be unable or unwilling to work after a disaster. It is important that employees communicate their personal plans to their supervisor or a designee. Business managers need to know if an employee would evacuate given a certain situation, and to where. Most importantly, managers need at least 2 ways to contact each employee. Options would include a mobile telephone number, e-mail address, or through a friend or relative who serves as an out-of-area contact person. Before a disaster, all employees should be trained on preparing adequate personal disaster plans, the facility's business plan, and the plan for patients. Managers should provide written disaster roles, responsibilities, and expectations for each staff position. What hours would employees be expected to work? What are the duties expected of each position? Will any exceptions be made for certain staff members or certain situations? After developing a plan, it should be tested through training and exercises, maintained, and revised. Testing and revising is a continuous cycle. It is vital to incorporate lessons learned from drills and exercises into updated disaster plans. Even the best written disaster plan is inadequate unless everyone is properly trained on the plan. The CMS Conditions for Coverage for End-Stage Renal Disease facilities, effective October 14, 2008 require that staff be able to demonstrate the ability to manage emergencies that are likely to occur in the facility's geographic area. IS-100.HC: Introduction to the Incident Command System (ICS) for Health Care/Hospitals IS-200.HC: Applying ICS to Health Care Organizations IS-700: National Incident Management System (NIMS), An Introduction IS-808: Emergency Support Function (ESF) #8—Public Health and Medical Services Additional courses target hazard preparedness and planning, the National Disaster Medical System (NDMS), personal preparedness, disaster assistance, disaster exercise, and general emergency management principles. Course length varies from 30 minutes to 3 hours. These courses can be accessed at www.training.fema.gov/is. In addition to a cohesive training program, familiarity with the FEMA principles and language of the Incident Command System (ICS), the National Incident Management System (NIMS), and the National Response Framework will better equip dialysis facilities in contacting their local disaster management officials. Ongoing communications with local disaster management, at least annually, is another CMS Conditions for Coverage requirement. Disaster plans should be practiced and revised at least annually. They should also be updated and staff should be trained each time there is a supervisory or leadership change. The disaster plan should be practiced if there is a change in procedure, contact information, or staff turnover. Other goals of disaster drills and exercises are to clarify roles and responsibilities, improve coordination, identify gaps, train staff, and improve the plan. There are many types of exercises that can achieve these goals. Choose a variety of exercises throughout the year to build a solid exercise program, drill schedule, and/or evaluation program. Discussion-based exercises can be seminars, workshops, tabletop exercises, and games. These exercises are generally less complicated because they do not require actual response activities such as gathering supplies or evacuating. Operations-based exercises focus on activities. Drills (which physically test one specific function), functional exercises, and full-scale exercises simulate the execution of actual response activities. The first step in all exercises is to set objectives that outline goals, the scenario, and how the exercise will be evaluated. A scenario is the story that guides the exercise. The story can be hazard-specific, such as a tornado impact, and serves to apply “what if” scenarios to the implementation of the disaster plan. Disaster plans should be practiced and revised at least annually, and updated each time there is a leadership change. They should be practiced if there is any change in procedure. The KCER Coalition performs annual disaster exercises and quarterly or monthly tests of response mechanisms such as telephone hotlines and reporting systems. Coalition members test the capability to establish communications via e-mail and telephone, collaborate in groups, and solve problems brought on by a disaster scenario. Often these hands-on scenarios reveal the need for additional policies and activities to solidify existing disaster plans. Do not assume your employees can handle the stress of a disaster, whether they are nephrologists, nurses, technicians, or other trained healthcare professionals. Staff may not be able to contact their families, their pets may have been lost, or their homes may have been destroyed. Talking about these potential losses may help mentally prepare staff for a disaster, as well as set the stage to address employee mental-health concerns after a disaster impact. It is important to understand, and convey to all staff members, that working in a disaster response may require irregular and extended working hours and working at a location other than the normal office location. A disaster may also demand that employees perform duties that are not a part of their normal job description. Additionally, disasters can cause intense physical and mental stress. Because the emotional damage of disasters often overshadows the financial and physical damage, it is important to incorporate a mental-health component into disaster plans. Supervisors and other employees should be able to recognize the signs and symptoms of disaster-related stress, know how to identify employees and patients who may need assistance or crisis counseling, and how to provide that assistance. When planning for a disaster, include ways to help employees identify and ease stress in themselves as well as their patients. The KCER Coalition is an active group of individuals working toward establishing and facilitating partnerships that provide a framework for disaster readiness and continuity of care for the kidney community. The Coalition is comprised of healthcare professionals and partners in the community including utility companies, emergency operations personnel, regulatory agencies, and corporations. By uniting, the Coalition is forming working relationships to help provide uninterrupted dialysis and transplant care in the event of disasters. There are 8 Response Teams focusing on different areas of preparedness and response. These teams hold bi-monthly teleconferences and communicate via e-mail distribution lists to develop educational materials, outreach, and response mechanisms for the kidney community. The Coalition has created valuable educational tools for patients and providers, as well as fostered relationships, both on the state and federal level, which will help to ensure continuity of care for kidney patients in times of emergencies. The KCER Coalition is dedicated to the purpose of providing public education and promoting public awareness regarding the needs of kidney patients during emergencies. Community participation is essential to the ongoing success of this Coalition. The analyses upon which this publication is based were performed under Contract Number 500-2006-0076-NW07 entitled End Stage Renal Disease Networks Organization for the State of Florida, sponsored by the Centers for Medicare & Medicaid Services, Department of Health and Human Services. The content of this publication does not necessarily reflect the views or policies of the Department of Health and Human Services, nor does mention of trade names, commercial products, or organizations imply endorsement by the U.S. Government. The author assumes full responsibility for the accuracy and completeness of the ideas presented. This article is a direct result of the HealthCare Quality Improvement Program initiated by the Centers for Medicare & Medicaid Services, which has encouraged identification of quality improvement projects derived from analysis of patterns of care, and therefore required no special funding on the part of this contractor.

The United States faces a broad range of threats and hazards, both naturally occurring and manmade. Over the past few decades, efforts to prevent, prepare for, respond to, and recover from these varied threats and hazards have evolved into a patchwork collection of special-purpose plans including the National Oil and Hazardous Substances Pollution Contingency Plan (NCP). These plans govern U.S. policy toward hazardous materials releases and oil spill response. Homeland Security Presidential Directive 5 (HSPD-5), Management of Domestic Incidents, mandates the creation of a National Incident Management System (NIMS) and National Response Plan (NRP) to provide a single, comprehensive national approach to incident management. The NRP is intended to integrate the various prevention, preparedness, response and recovery plans into an all-discipline, all-hazard approach. NIMS provides a standard Incident Command System (ICS) for Federal, State, local and tribal government to work together to prepare for and respond to incidents. NIMS ICS includes a core set of concepts, principles, terminology, technologies, multi-agency coordination systems, unified command, training, identification/management of resources, qualification/certification, and the collection, tracking and reporting of incident information and incident resources. Together, the NRP and NIMS provide a standardized framework to ensure that Federal, State, local, and tribal governments, the private sector, and non-governmental organizations work in partnership to support domestic incident management regardless of cause, size, or complexity of the incident. How does this change what is being done in oil and hazardous materials response? The National Contingency Plan (NCP, 40 CFR 300) notes that “where practicable,” the framework for the response shall use ICS within a Unified Command (UC) system. OSHA regulations (29 CFR 1910.120) also require the use of ICS for emergency response. The response community (federal, state, local, and tribal governments, the private sector, and non-governmental organizations) has been using “ICS” in oil spill/HAZMAT response since the early 1990's in the United States. NIMS ICS will be used when responding to oil HAZMAT spills, however, there are differences in ICS implementation between responders in the response community and NIMS ICS will have stricter requirements to improve uniformity in application. These similarities and differences will be discussed at length in this paper.

Protecting Animal and Human Health and the Nation’s Food Supply through Veterinary Diagnostic Laboratory Testing

Foreign animal disease (FAD) preparedness is a high priority for state and federal governments to ensure the protection of the nation's livestock industry. Highly contagious diseases such as African swine fever (ASF) have been the focus of recent advancements in FAD preparedness, including the development of disease-specific response plans. At the state level, FAD response plans provide a framework to help ensure a rapid and coordinated response that considers the resources and realities of that state; however, preparing a comprehensive plan requires collaboration across multiple agencies and sectors that can be difficult to operationalize. To initiate systematic state-level ASF response plan writing and identify gaps in preparedness, university and industry stakeholders partnered with the Ohio Department of Agriculture and USDA to develop the Ohio African Swine Fever Response Plan Workshop. A linear planning model was used to implement the workshop in May 2021. All planning and workshop activities were conducted fully virtually, prompted by public health restrictions in response to COVID-19. Sixty-four participants, representing multiple sectors and stakeholder groups including state/federal/industry animal health officials, emergency management, environmental protection, and academia, contributed to the workshop. Spanning 3 days, participants identified current response capabilities and areas requiring additional planning for an effective state-level response. The workshop generated recommendations from a multisectoral perspective for subcommittees tasked with developing standard operating procedures for the Ohio ASF Response Plan. The methodology and resources used to plan, implement, and evaluate the workshop are described to provide a model for state-level response planning.

In the National Incident Management System (NIMS) Document dated March 1, 2004, all federal, state, local, tribal, private sector and non-governmental personnel with a direct role in emergency management and response were required to be NIMS and Incident Command System (ICS) trained. National standards for qualification and certification of emergency response personnel were established under NIMS to ensure that personnel possess the minimum knowledge, skills, and experience necessary to execute incident management and emergency response activities safely and effectively. Most recently documented in the National Response Framework, all mid-level managers of federal, state, and local governmental personnel are encouraged to complete ICS-300 and ICS-400 training in fiscal year 2007. Although these standards will greatly improve the ability for governmental personnel to respond in emergencies, private sector personnel are not regulated to participate in the same qualification and certification process. At this time, NIMS has no legal authority to place these requirements on industry personnel, such as members of oil spill management teams. The resulting imbalance of qualification and certification requirements between these two groups could severely hinder oil spill response efforts in the near future by causing miscommunication in the Unified Command during critical points in the response, including when setting response objectives and sharing resources. However, the solution cannot be to pass further governmental regulations on an already highly-regulated community. The NIMS Integration Center should consider utilizing the existing partnerships in individual regions, particularly through the Area Committee and the Area Maritime Security Committee, to solve this issue before it becomes a significant problem in the middle of a large-scale response effort.

Annals of the New York Academy of SciencesVolume 1026, Issue 1 p. xiii-xv Introduction BOB H. BOKMA, Corresponding Author BOB H. BOKMA National Center for Import and Export, Veterinary Services, Animal and Plant Health Inspection Service, United States Department of Agriculture, Riverdale, Maryland 20737, USAAddress for correspondence: Bob H. Bokma, National Center for Import and Export, Veterinary Services, Animal and Plant Health Inspection Service, United States Department of Agriculture, 4700 River Road, Unit 39, Riverdale, MD 20737. Voice: 301-734-8066; fax: 301-734-3222. bob.h.bokma@aphis.usda.govSearch for more papers by this authorEDMOUR F. BLOUIN, EDMOUR F. BLOUIN Department of Veterinary Pathobiology, Oklahoma State University, Stillwater, Oklahoma 74078, USASearch for more papers by this authorE PAUL GIBBS, E PAUL GIBBS Department of Pathobiology, College of Veterinary Medicine, University of Florida, Gainesville, Florida 32611, USASearch for more papers by this author BOB H. BOKMA, Corresponding Author BOB H. BOKMA National Center for Import and Export, Veterinary Services, Animal and Plant Health Inspection Service, United States Department of Agriculture, Riverdale, Maryland 20737, USAAddress for correspondence: Bob H. Bokma, National Center for Import and Export, Veterinary Services, Animal and Plant Health Inspection Service, United States Department of Agriculture, 4700 River Road, Unit 39, Riverdale, MD 20737. Voice: 301-734-8066; fax: 301-734-3222. bob.h.bokma@aphis.usda.govSearch for more papers by this authorEDMOUR F. BLOUIN, EDMOUR F. BLOUIN Department of Veterinary Pathobiology, Oklahoma State University, Stillwater, Oklahoma 74078, USASearch for more papers by this authorE PAUL GIBBS, E PAUL GIBBS Department of Pathobiology, College of Veterinary Medicine, University of Florida, Gainesville, Florida 32611, USASearch for more papers by this author First published: 12 January 2006 https://doi.org/10.1196/annals.1307.051Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat Volume1026, Issue1Impact of Ecological Changes on Tropical Animal Health and Disease ControlOctober 2004Pages xiii-xv RelatedInformation

EFSA's assistance for the 2015 Codex Committee on Residues of Veterinary Drugs in Food (CCRVDF) in relation to rBST

BackgroundAgriculture emergency responders always will require equipment and supplies. A rapid and effective logistical response depends upon having the right item in the right quantity at the right time at the right place for the right price in the right condition to the right responder. Established in 2004 by U.S. Homeland Security Presidential Directive 9, the National Veterinary Stockpile (NVS) within the U.S. Department of Agriculture (USDA), Animal and Plant Health Inspection Service, Veterinary Services is the nation's repository of critical veterinary supplies, equipment, vaccines, and services appropriate to respond to the most damaging animal diseases affecting human health and the economy. An overview of the NVS program, its capabilities, training and exercise strategy, and outreach to stakeholders will be presented.The NVS ProgramThe goals of the NVS program are to deploy countermeasures against the 17 most damaging animal disease threats within 24 hours, and to help states/tribes/territories plan, train, and exercise the receipt, processing, and distribution of NVS countermeasures. To meet these goals, the NVS program heavily relies upon science-based logistics to identify animal vaccines and other countermeasures to respond, and sound business processes to purchase, hold, maintain, and deploy the countermeasures. Significant resources also are dedicated to the NVS outreach activities, which interface directly with federal/state/tribe/territory animal health stakeholders. NVS team members work hand-in-hand with these leaders to help develop written NVS-specific plans for their jurisdictions, provide logistics training, and sponsor discussion-based and operations-based exercises in accordance with the Homeland Security Exercise and Evaluation Program.ConclusionThe USDA NVS exists to provide states/tribes/territories the countermeasures they need to respond to catastrophic animal disease outbreaks created by either terrorists or nature. As logistical experts, the NVS team develops plans for logistical emergency response, manages their supply chain of countermeasures, and helps stakeholders improve logistical response capabilities.

Lessons learned and public scrutiny resulting from the Gulf Coast hurricane disasters in 2005 led the Federal Emergency Management Agency (FEMA) to restructure its national incident response guidance. The National Response Framework (NRF) replaced the National Response Plan (NRP) in early 2008. The updated Framework has focused the attention of emergency management planning to, among other things, updating Emergency Operations Plans (EOPs) on a State and local jurisdictional level, utilizing an Emergency Support Function (ESF) model.Since 2005, compliance mandates under the National Incident Management System (NIMS) have required local government entities to revise and update emergency operations plans to incorporate NIMS components. With the introduction of the NRF in 2008, the ESF model is now the recommended standard for local government EOPs under the NIMS compliance objectives. The ESF model provides for a coordinated response effort and mutual aid options local agencies may receive from State and Federal resources in the wake of an emergency. It also works to ensure that local entities themselves have a careful accounting of all of their own resources and capabilities to avoid another slow and inadequate response that was at the heart of the Hurricanes Katrina and Rita tragedies in 2005.

Use of slaughter condemnation data to detect cattle health events in near real-time

IntroductionInfectious disease outbreaks have historically led to widespread disruptions in routine essential health services. Disruptions due to COVID-19 responses led to excess deaths, including among women and children. This review...

Lawrence Livermore National Laboratory (LLNL), in collaboration with the Department of Homeland Security (DHS) and the United States Department of Agriculture (USDA), Animal and Plant Health Inspection Services (APHIS) has developed advanced rapid diagnostics that may be used within the National Animal Health Laboratory Network (NAHLN), the National Veterinary Services Laboratory (Ames, Iowa) and the Plum Island Animal Disease Center (PIADC). This effort has the potential to improve our nation's ability to discriminate between foreign animal diseases and those that are endemic using a single assay, thereby increasing our ability to protect animal populations of high economic importance in the United States. Under 2005 DHS funding we have developed multiplexed (MUX) nucleic-acid-based PCR assays that combine foot-and-mouth disease virus (FMDV) detection with rule-out tests for two other foreign animal diseases Vesicular Exanthema of Swine (VESV) and Swine Vesicular Disease (SVD) and four other domestic viral diseases Bovine Viral Diarrhea Virus (BVDV), Bovine Herpes Virus 1 (BHV-1 or Infectious Bovine Rhinotracheitus IBR), Bluetongue virus (BTV) and Parapox virus complex (which includes Bovine Papular Stomatitis Virus BPSV, Orf of sheep, and Pseudocowpox). Under 2006 funding we have developed a Multiplexed PCR [MUX] porcine assay for detection of FMDV with rule out tests for VESV and SVD foreign animal diseases in addition to one other domestic vesicular animal disease vesicular stomatitis virus (VSV) and one domestic animal disease of swine porcine reproductive and respiratory syndrome (PRRS). We have also developed a MUX bovine assay for detection of FMDV with rule out tests for the two bovine foreign animal diseases malignant catarrhal fever (MCF), rinderpest virus (RPV) and the domestic diseases vesicular stomatitis virus (VSV), bovine viral diarrhea virus (BVDV), infectious bovine rhinotracheitus virus (BHV-1), bluetongue virus (BTV), and the Parapox viruses which are of two bovine types bovine papular stomatitis virus (BPSV) and psuedocowpox (PCP). This document provides details of signature generation, evaluation, and testing, as well as the specific methods and materials used. A condensed summary of the development, testing and performance of the multiplexed assay panel was presented in a 126 page separate document, entitled 'Development and Characterization of A Multiplexed RT-PCR Species Specific Assay for Bovine and one for Porcine Foot-and-Mouth Disease Virus Rule-Out'. This supplemental document provides additional details of large amount of data collected for signature generation, evaluation, and testing, as well as the specific methods and materials used for all steps in the assay development and utilization processes. In contrast to last years effort, the development of the bovine and porcine panels is pending additional work to complete analytical characterization of FMDV, VESV, VSV, SVD, RPV and MCF. The signature screening process and final panel composition impacts this effort. The unique challenge presented this year was having strict predecessor limitations in completing characterization, where efforts at LLNL must preceed efforts at PIADC, such challenges were alleviated in the 2006 reporting by having characterization data from the interlaboratory comparison and at Plum Island under AgDDAP project. We will present an addendum at a later date with additional data on the characterization of the porcine and bovine multiplex assays when that data is available.