Oct 22, 2007 (CIDRAP News) – The White House recently issued a lengthy homeland security directive aimed at bolstering the response of federal, state, and local public health systems to national emergencies such as bioterrorist attacks, influenza pandemics, and natural disasters.
The directive, titled "Homeland Security Presidential Directive 21 (HSPD 21)," will "transform our national approach to protecting the health of the American people against all disasters," the document states.
"Ultimately, the Nation must collectively support and facilitate the establishment of a discipline of disaster health," the directive asserts.
The directive was published on the White House Web site on Oct 18 and is the latest in a series of executive orders issued since Sep. 11, 2001, to protect the nation in the event of terrorist attacks or other "catastrophic health events."
The directive says strategic improvements across government levels can better prepare the nation to "deliver appropriate care to the largest possible number of people, lessen the impact on limited healthcare resources, and support the continuity of society and government."
The directive covers four main topics: biosurveillance, countermeasure stockpiling and distribution, mass-casualty care, and community resilience. Each area contains specific actions and timelines.
The directive calls on the secretary of the Department of Health and Human Services (HHS) to establish a national epidemiologic surveillance system that builds on existing networks and provides public health agencies with incentives to build new systems where there are gaps.
HHS, with the assistance of other federal agencies, has been asked to establish a federal epidemiologic surveillance advisory committee task force within 180 days. The task force will include federal, state, local, and private sector representatives.
Countermeasure stockpiling and distribution
Among several measures to improve distribution plans and more closely manage stockpiles, the directive orders HHS and the Department of Homeland Security (DHS) to develop templates to help communities dispense medical countermeasures within 48 hours of an official order. The initial template should be published within 270 days and include performance standards to measure state and local response, along with a system for annually evaluating local readiness.
Within 180 days after the template actions are completed, HHS and DHS will start collecting and using performance data on state and local distribution systems to guide future decisions on public health preparedness grants.
HHS, with assistance other federal agencies, will develop within 270 days plans to help states and localities that aren't able to sufficiently deploy countermeasures in a catastrophic health event.
To better manage the nation's Strategic National Stockpile (SNS) of drugs and medical supplies, HHS will ensure transparency concerning stockpiling priorities and, with input from other federal agencies, will establish a system within 180 days to annually review SNS inventories.
Within 180 days, HHS and other federal agencies will develop protocols for sharing countermeasures and medical goods between the SNS and other federal stockpiles and will explore developing reciprocal stockpile-sharing arrangements with other countries and international organizations.
Also, within 90 days HHS will establish a process for sharing information about the SNS with government agencies and health officers who need to know and have proper clearance.
The directive orders HHS, in coordination with the Defense, Veterans, and Homeland Security departments, to engage the help of state, local, academic, professional, and private groups in reviewing the nation's disaster medical system and surge capacity. Within 270 days, HHS is to submit a report on gaps in those two areas and give the White House a plan that addresses key deficits.
HHS has also been asked to define, within 180 days, how federal facilities can be factored more effectively into medical surge-capacity plans.
To address potential legal, regulatory, or other barriers to public health preparedness, HHS, working with other agencies, must within 120 days submit a report on possible regulatory or legislative solutions to the White House.
Recognizing that addressing mental health consequences of a disaster—the "worried well"—can contribute to a more effective public health response, the White House asked the HHS and other agencies to put together a federal advisory committee on disaster mental health within 180 days. The directive states that a report from the committee is due within 180 days after the group is formed.
HHS, along with the Defense, Commerce, Labor, Education, Veterans, and Homeland Security departments, is ordered to develop a plan to promote community preparedness and present it to the White House in 270 days.
DHS and HHS are assigned to develop a risk-awareness briefing for state and county officials within 150 days and, within 180 days, establish a mechanism to regularly update the public health risk briefings.
Within 180 days, HHS and DHS will develop and maintain a process for coordinating federal grant programs for public health and medical preparedness.
To further bolster preparedness, HHS and other agencies have been asked within the next year to develop core curricula and training exercises on disaster preparedness for federal executive departments and agencies. The materials are to designed to be usable by state and local governments as well as education and the private sector.
The directive calls for setting up, within the next year, the "National Center for Disaster Medicine and Public Health" at the Uniformed Services University of the Health Sciences in Bethesda, Md. The center is to lead federal efforts to develop core curricula, training, and research in various aspects of civilian and military medical preparedness.
The White House has asked HHS, within 180 days, to commission the Institute of Medicine to lead a forum to engage government officials, academic experts, professional societies, and private stakeholders in developing "a strategy for long-term enhancement of disaster pubic health and medical capacity" and the propagation of related training.
Within 120 days, HHS will submit to the White House a plan to use current funding programs to create incentives for private health facilities to enact preparedness measures that don't increase healthcare costs.
The directive also establishes an Office for Emergency Medical Care within HHS to promote and fund emergency medicine research, promote regional emergency medicine partnerships, and promote local preparedness.
Oct 18 Homeland Security Presidential Directive 21