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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
  • 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
national health security strategy biennial implementation plan
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

definition of national health security
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.

what is the nhss
What is the NHSS?
  • First National Strategy for protecting people’s health
  • Purpose is to galvanize national efforts
  • National, not federal, strategy
nhss goals
NHSS Goals

Build community resilience

Strengthen and sustain health and emergency response systems

impact and relevance
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

key themes
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

biennial implementation plan
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

biennial implementation plan1
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

biennial implementation plan challenges
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
information and engagement
Information and Engagement

Review the NHSS Website:

Please send comments and suggestions to:

bp oil spill deepwater horizon
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
health impact of bp oil spill deepwater horizon
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
  • 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

national oil hazardous substances pollution contingency plan ncp
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



national contingency plan ncp authorities
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

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.

nrs overview
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


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.


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.

national response center nrc
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
nrs special teams
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
  • USDA, Dept of Interior, Dept of Commerce
nrs funding mechanisms
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.,


oil spill liability trust fund osltf
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
  • 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
the nrf ncp relationship
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:

National Response Framework

National Contingency Plan



And Disaster Declaration s

Secretary DHS


FEMA Administrator




Houma, LA





Unified Area Cmd



ESF 1-15


Mobile, AL


ESF 10











Miami, FL






Houston, TX

NCP = Federal Command/Control

NRF = Federal Support to State/Local

health impacts of oil spill
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
behavioral health
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
behavioral health1
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
seafood safety
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
seafood safety1
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
worker safety
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
long term health impact
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.
role of federal agencies on health issues hhs
Role of Federal Agencies on Health Issues (HHS)
  • NIH/NIEHS – responsible for developing appropriate training
    • Surveillance of any health impact in Gulf Region
    • State surveillance systems
    • Poison Control Center calls
    • BioSense – DoD and VA hospitals mainly
    • 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
role of federal agencies on health issues hhs1
Role of Federal Agencies on Health Issues (HHS)
    • 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
role of federal agencies non hhs
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
coordination with states and regions
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
where do we go from here
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