National Health Security Strategy/

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• National Health Security Strategy/
• Biennial Implementation Plan
• And
• Health Impact of BP Oil Spill
• Dr. Lisa Kaplowitz
• Deputy Assistant Secretary for Policy
• Office of the Assistant Secretary for
  Preparedness and Response
• Department of Health and Human Services
• July 13, 2010

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National Health Security Strategy/ Biennial
Implementation Plan

• Required by Pandemic and All Hazards Preparedness
  Act
• Definition of national health security
• Goals and Strategic Objectives
• Broad roles and responsibilities
• Biennial Implementation Plan

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Definition of National Health Security

• National health security is a state in which the
  Nation and its people are prepared for, protected
  from, and resilient in the face of health threats
  or incidents with potentially negative health
  consequences.

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What is the NHSS?

• First National Strategy for protecting peoples
  health
• Purpose is to galvanize national efforts
• National, not federal, strategy

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NHSS Goals

• Build community resilience
• Strengthen and sustain health and emergency
  response systems

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Goals, Objectives, Capabilities
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Impact and Relevance

• First quadrennial national strategy focused on
  protecting peoples health in the case of a
  national incident with potentially negative
  health consequences
• Provides a vision and strategy so that everyones
  efforts can be leveraged and coordinated to
  obtain same goals
• Aligns with (doesnt duplicate or replace)
  HSPD-8, National Strategy for Homeland Security,
  HSPD-21, PAHPA
• Guides policies, programs, budgets, and
  activities
• Success is dependent on coordinated
  implementation

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Key Themes

• National health security is a shared
  responsibility among virtually all segments of
  society and resilient communities
• Community and other resources and investments
  must be coordinated
• A broad range of community stakeholders (e.g.,
  individuals, NGOs, academia, employers) should be
  consulted for successful implementation
• Implementation must consider legal, fiscal, and
  educational/competency sustainability

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Biennial Implementation Plan

• Determining priority and achievable activities to
  occur in next two years
• Develop process to identify measures for
  community resilience, as well all 10 objectives
• Synthesizing existing information and accounting
  for relevant, existing activities
• Plan broad stakeholder input
• References activities that will be included in
  the next BIP (2012-13) to complete the four years
  covered in the NHSS

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Biennial Implementation Plan

• Brief summary of the NHSS including goals and
  Strategic Objectives
• A chapter dedicated to each Strategic Objective
• Overview of the objective
• Long term outcomes for objective
• Implementation activities
• Conclusions and future directions,
• Concluding chapter on key themes and next steps
  for NHSS implementation
• Appendix on suggested responsible parties
• Release for public comment within 1-2 weeks, with
  at least 4 weeks available for comments from
  individuals and groups

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Biennial Implementation Plan - Challenges

• Want plan to be meaningful, including development
  of appropriate measures of success
• Many measures not yet developed
• Must be National Plan, not federal plan
• Identify responsible parties without unfunded
  mandates
• Must be realistic, achievable within present
  budget constraints
• Federal budget for FY12 being developed now
  clear that cuts are likely in 2012 federal budget
• State and local budgets already constrained
• Hope to have some general plans beyond next 2
  years

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Information and Engagement

• Review the NHSS Website
• http//www.hhs.gov/aspr/opsp/nhss/
• Please send comments and suggestions to
• nhss_at_hhs.gov

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BP Oil Spill/Deepwater Horizon

• Command/control for environmental disasters
• Short term health impacts
• Behavioral health issues
• Long term health impact
• Research issues
• Future planning, response, recovery efforts

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Health Impact of BP Oil Spill/ Deepwater Horizon

• Unprecedented environmental disaster of prolonged
  duration
• Impacting medically underserved area and
  previously traumatized population (Katrina)
• Handled under the National Contingency
  Plan/National Response System/National Response
  Team
• National Response Team Chaired by EPA and
  co-Chaired by Coast Guard
• Little health component beyond monitoring of
  environment, worker training and assuring worker
  safety
• No Stafford Act Declaration for Deepwater Horizon
  Oil Spill
• FEMA funding not available for response and
  recovery activities
• Command/control not under National Response
  Framework

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History

• NCP first developed in 1968 in response to the
  massive oil spill from the oil tanker Torrey
  Canyon
• Provided the first comprehensive national system
  for oil spill reporting and response

The Torrey Canyon
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National Oil Hazardous Substances Pollution
Contingency Plan (NCP)

• NCP describes the national preparedness and
  response system for oil and hazardous materials
• Includes chemical, biological, and radiological
  releases to the environment
• Both accidental and intentional (including
  terrorist) releases
• NCP is a regulation found in 40 CFR 300 and
  administered by the EPA

Chair
Co-Chair
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National Contingency Plan (NCP) Authorities

• Clean Water Act as amended by the Oil Pollution
  Control Act (OPA 90) and earlier clean water
  legislation
• The Comprehensive Environmental Response
  Compensation and Liability Act (CERCLA), a.k.a.
  Superfund, including the Emergency Planning and
  Community Right-to-know Act (EPCRA) amendments

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National Response System (NRS) Overview
National Response Team (NRT) Nationwide
responsibilities for interagency planning,
policy, coordination for oil hazardous
materials incidents. 13 Regional Response Teams
(RRTs) Develops regional policies for ensures
an effective, coordinated response among all
levels of government and the private sector.
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NRS Overview

• On-Scene Coordinators (OSCs)
• Coordinate all containment, removal, and disposal
  efforts/resources.
• Other NRS components
• National Response Center
• Area Committees
• State/Local Governments
• Special Teams
• Private Sector
• Joint Response Teams with neighboring countries

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NRT MISSION
To provide technical assistance, resources and
coordination on preparedness, planning, response
and recovery activities for emergencies involving
hazardous substances, pollutants and
contaminants, hazmat, oil, weapons of mass
destruction in natural and technological
disasters and other environmental nationally
significant incidents.
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Response Management

• The 4 key features of the NRS are
• EPA and USCG coordinate and direct the response,
  EPA for inland areas, USCG for the coastal zone.
• Other federal agencies with appropriate
  jurisdiction and expertise support the lead
  agency.
• Activities are done in partnership with state and
  local officials.
• Industry is responsible for being prepared for,
  responding to, and paying for cleanup and damages
  from pollution incidents.
• The NRS uses the Incident Command System to bring
  these parties together to manage response
  actions.

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National Response Center(NRC)

• Receives all reports of releases involving oil
  and hazardous substances including,
  infrastructure security breaches, suspicious
  activities, and terrorist related events
  involving hazardous substances oil that trigger
  federal notification requirements
• Approximately 30,000 incident notifications each
  year
• Notifies Federal and State OSCs
• Notifies DHS/NOC EPA/USCG Headquarters
• Preparedness role supports NRS planning
  activities

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NRS Special Teams

• EPA teams
• Environmental Response
• Radiologic Emergency Response Team
• National Decontamination Team
• National Counterterrorism Evidence Response Team
• USCG teams
• National Strike Force
• Public Information Assist team
• NOAA and EPA Scientific Support Coordinators
• OSHA Specialized response Teams
• CDC/ATSDR
• NIEHS
• USDA, Dept of Interior, Dept of Commerce

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NRS Funding Mechanisms

• Oil Spills
• OPA 90
• Oil Spill Liability
• Trust Fund (OSLTF)

• Hazardous Substances
• The Comprehensive
• Environmental Response,
• Compensation, and Liability
• Act (CERCLA), a.k.a.,
• Superfund

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Oil Spill Liability Trust Fund (OSLTF)

• Decision for use of OSLTF made by Coast Guard and
  EPA
• OSLTF Emergency Fund established to provide
  funding for
• Emergency response actions to protect public
  health, safety and environment
• Natural Resource Damage Assessments (NRDA)
  initiation
• Compensation for claimants who demonstrate that
  oil pollution caused damages

• As delineated by the OPA, uses of the OSLTF
  include
• Response costs incurred by the Coast Guard and
  EPA
• State access for response activities
• Payments to federal, state, and Indian tribe
  trustees to conduct natural resource damage
  assessments and restorations
• Payment of claims for uncompensated response
  costs and damages
• Research and development
• Other specific appropriations

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Superfund

• Administered by EPA
• Can be accessed in three ways
• FOSC
• Claims Process
• Claims can be submitted by individuals or states
• Response actions must be preauthorized for
  reimbursement
• Local Government Reimbursement (LGR) program

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The NRF-NCP Relationship

• NRS (OSCs, RRTs, NRT, etc.) responds under NCP on
  daily basis for more routine oil and hazardous
  materials incidents
• When DHS leads incident under NRF, NRS assets are
  activated under NRF Emergency Support Function
  (ESF) 10 Oil and Hazardous Materials Response
  Annex
• In some cases, NRS may respond initially under
  its own authorities pending an ESF 10
  activation, then transition to Stafford Act
  authority and funding
• ESF 10 uses NRT and RRTs to coordinate response
  among ESF 10 Primary/Support Agencies at
  national and regional levels as needed
• National Response Team http//www.nrt.org

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National Contingency Plan
National Response Framework
WHITE HOUSE
Emergency And Disaster Declaration s
Secretary DHS
NIC
FEMA Administrator
Governor
Governor
UCG FCO DCO SCO (JFO) (EOC)
STATE EOC
Unified Area Cmd FOSC State RP
STATE EOC
ESF 1-15
PARISH AND COUNTY EOC
PARISH AND COUNTY EOC
NCP Federal Command/Control
NRF Federal Support to State/Local
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Health Impacts of Oil Spill

• IOM Workshop in New Orleans June 22-23, 2010
  provide input and advice on addressing short and
  long term health impacts
• Medically underserved area, population previously
  impacted by Katrina
• Short term impacts
• Respiratory mainly workers working near spill
  site
• Skin contact with oil
• Headache, nausea
• Ingestion not being seen
• Behavioral health short and long term
• Long term impacts unknown

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Behavioral Health

• Already being seen
• Suicide
• Increased call to hot lines
• Extend over prolonged period of time
• People just now recovering from mental behavioral
  health issues related to Katrina and Rita
• Concern about impact of recurrent trauma
• Multiple sources of concern
• Loss of livelihood
• Loss of way of life
• Concern about need to move families
• Long term health concerns

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Behavioral Health

• Need for system in place now
• Psychologic first aid
• Appropriate messaging
• Cultural and linguistically appropriate
• Single 1-800 telephone help line
• Collaboration among federal government, state
  governments, non-profit organizations
• Need to involve local communities and community
  leaders
• Funding for services
• Recognition of need for services for at least 5
  years

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Seafood Safety

• NOAA responsible for closing open water to
  fishing has closed all waters with oil
• States responsible for shellfish regulation off
  shore and fishing in state waters concern about
  economic impact of closing waters to fishing and
  shellfish
• FDA responsible for assuring that seafood sold or
  processed is safe
• NOAA, FDA and impacted states have agreed on
  reopening protocol
• NOAA, FDA working with states on testing of fish
  in areas outside spill area to assure no seafood
  contamination
• Certain areas already reopened to fishing

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Seafood Safety

• Concern about dispersants
• Do not accumulate in fish
• No evidence for concern for seafood
• Oil
• Need to determine specific components of oil
• Tailor seafood testing to contents of oil
• Concern about long term impact
• Oil remains in water for prolonged periods,
  including sinking to bottom

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Worker Safety

• Risk depends on specific oil exposure
• At source volatile substances, increased
  respiratory risk
• As volatile substances evaporate, oil becomes
  weathered
• Shore oil is weathered with limited or no
  respiratory risk mainly contact risk
• OSHA, EPA and NOAA monitoring exposure levels of
  air/water
• OSHA and NIOSH (CDC) have developed single set of
  guidelines for worker protection, including
  respiratory protection
• Biggest risks to date HEAT, injury

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Long Term Health Impact

• Unknown
• Few studies done after prior oil spills legal,
  funding barriers
• One suggests respiratory impact 2 years later
• Opportunity now to look at long term health
  impact
• Appropriate study design
• Community engagement
• Duration unknown could be beyond 20 years
• Workers most likely to have health impact
• Need to assess non-worker community members as
  well.

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Role of Federal Agencies on Health Issues (HHS)

• NIH/NIEHS responsible for developing
  appropriate training
• CDC/NCEH/ATSDR
• Surveillance of any health impact in Gulf Region
• State surveillance systems
• Poison Control Center calls
• BioSense DoD and VA hospitals mainly
• http//emergency.cdc.gov/gulfoilspill2010/2010gulf
  oilspill/health_surveillance.asp
• NIOSH
• Monitoring worker health and safety
• Rostering workers all workers going through
  training and badged over 33,000 rostered to date
• FDA
• Assure safety of seafood sold or processed

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Role of Federal Agencies on Health Issues (HHS)

• SAMHSA
• Collaborating with states and non-profits on
  assuring assessment and management of behavioral
  health issues
• Assistant Secretary for Health (ASH)
• Responsible for recovery activities
• ASPR
• NDMS clinic in Venice, LA
• Coordinating activities of HHS agencies and
  offices (all above plus CMS, ACF, financial and
  legislative services, Office of the Secretary) as
  well as OSHA
• Contract with IOM for advice/monitoring of long
  term health impacts
• Coordinate with states and localities
• Address funding issues services, long term
  health monitoring

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Role of Federal Agencies (non-HHS)

• OSHA
• Set safety and training standards for workers
• Work in close collaboration with NIOSH
• NOAA
• Monitor seawater
• Close affected areas to fishing
• EPA
• Monitor air, surface water
• Share command with Coast Guard
• USCG (component of DHS)
• Incident Command responsible for command for
  entire response
• Secretary of Navy responsible for recovery
  activities

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Coordination with States and Regions

• State Health Departments
• Weekly federal/state calls FDA, CDC, ASPR
• Collaborate on surveillance data/monitor health
  impacts
• Collaboration with FDA/NOAA on issue of reopening
  areas to fishing, shellfish
• Communications/messaging media,
  Incident/Unified Command, providers, communities
• Identify trusted messengers state and local
  leaders
• Unified messages
• State Mental Health Coordinators
• Collaboration with SAMSA, non-profits (ARC),
  local communities
• Telephone crisis lines
• Regions regional coordination essential
• Regional Health Administrators Regions 4 and 6

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Where Do We Go From Here

• Transition from response to recovery
• Health/public health issues time of transition
  unclear
• Most issues when well capped
• Appropriate long term studies of health impact of
  oil spill
• Workers use rostering database
• Community
• Need to design study now World Trade Center
  follow-up hindered by lack of information on
  workers and exposures
• Appropriate monitoring of results role of IOM
• Assure long term behavioral health support at
  least 5 years
• Reopen waters to fishing and shellfish

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• http//www.nrt.org/
• http//emergency.cdc.gov/gulfoilspill2010/2010gulf
  oilspill/health_surveillance.asp
• http//www.hhs.gov/gulfoilspill/index.html
• http//www.restorethegulf.gov/