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National Health Security Strategy/Biennial Implementation Plan

AndHealth Impact of BP Oil Spill

Dr. Lisa KaplowitzDeputy Assistant Secretary for Policy

Office of the Assistant Secretary for Preparedness and ResponseDepartment 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 people’s 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 people’s health in the case of a national incident with potentially negative health consequences

• Provides a vision and strategy so that everyone’s efforts can be leveraged and coordinated to obtain same goals

• Aligns with (doesn’t 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@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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NATIONAL RESPONSE SYSTEM NATIONAL RESPONSE TEAM

NRTNRT

OceaniaOceania

AlaskaAlaska

CaribbeanCaribbean

X

VIII

IX VII

VI

V

IV

III

II

I

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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:

1. EPA and USCG coordinate and direct the response, EPA for inland areas, USCG for the coastal zone.

2. Other federal agencies with appropriate jurisdiction and expertise support the lead agency.

3. Activities are done in partnership with state and local officials.

4. 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 MechanismsOil 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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Unified Area CmdFOSC State RP

UCGFCO DCO SCO

(JFO) (EOC)

NIC

NCP = Federal Command/Control

STATE EOC

PARISH AND COUNTY EOC

FEMA Administrato

r

STATE EOC

PARISH AND COUNTY EOC

National Contingency Plan

National Response Framework

Governor Governor

UICHouston,

TX

UIC Houma,

LA

UIC Mobile,

AL

UICMiami,

FL

ESF 1-15

ESF 9

EPA COORD

USCG-D8/7USCG-DWH

ESF 10

FEMA COORD

FEMA-R4/6USCG-D8/7

NPSDOD

NRF = Federal Support to State/Local

Secretary DHS

WHITE HOUSE

EmergencyAnd Disaster Declaration s

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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/gulfoilspill2010/2010gulfoilspill/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/gulfoilspill2010/2010gulfoilspill/health_surveillance.asp

•http://www.hhs.gov/gulfoilspill/index.html

•http://www.restorethegulf.gov/