Mitigation-Preparedness-Response-Recovery Federal Partners: (SAMMC, DHS, CDC):

1. To provide leadership and services for San Antonio and Bexar County to prevent illness and injury, promote healthy behaviors, and protect against health hazards. Key Services • National Incident Management System • Incidents begin locally, are managed locally on a daily basis, preferably at the local level (organizational and geographically). • Women/ Children Health Promotion • Healthcare enforcement, free clinics, screenings, school presentations, young parent classes, family planning • Immunizations • Social work services, mental health • Venereal disease mitigation • Environmental Protection • Inspections: Food, water, livestock, restaurants • Disease Control: Quarantine, confinement measures • Disinfestation (vector control) • Emergency Preparedness • Strategic National Stockpile • Decontamination • Primary emergency response responsibilities • Coordinates health and medical care and EMS support. • Disseminates public health information and education. • Inspection of food and water supplies. • Develops and publishes emergency public health regulations and orders. • Coordinates collection, identification, and interment of deceased victims. • Coordinates disaster mental health services to disaster victims, emergency workers, and/or others suffering trauma due to the emergency incident/disaster. • Responsibilities to be done in conjunction with San Antonio • Fire Department HAZMAT team • Maintains inventory of radiological equipment. • Provides response forces to include personnel with current training in radiological monitoring and decontamination. • Assists in response to radiological incidents and terrorist incidents involving radiological materials. • Makes notifications concerning radiological incidents to state and federal authorities. • Mitigation-Preparedness-Response-Recovery • Federal Partners: (SAMMC, DHS, CDC): • Receive the SNS from CDC. • Coordinate with partners to identify pandemics and disease. • Distribute SNS to all regional partners. • Conduct lessons learned with public health assets. • State Partners: (TDPS, TDSHS) • Coordinate medical volunteers. • Enforce state public health code and laws. • Conduct lessons learned with state partners. • Ensure rebuilding is IAW health zoning laws. • Local Partners: (City of San Antonio & Bexar County) • Community engagement and education. • Community health. • Disease control. • Food and water inspection. • Mental health. US Department of Homeland Security. (2008) National incident management system. Washington, D.C. City of San Antonio Metro Health District. (n.d.). Retrieved from https://www.sanantonio.gov/Health.aspx FEMA. (2014, July 14). Federal Emergency Management Agency. Retrieved from http://www.fema.gov/media-library/assets/documents/32230?id=7371 Office of Emergency Management San Antonio. (2014). Basic Plan. Retrieved from www.saoemprepare.com

2. San Antonio Metro Health Coordination Phase 1 COA/Action Plan Phase 1 • Pre-test all Metro Health personnel for TB, review testing procedures. • Deploy Public Health assets to Lackland AFB to contain outbreak of TB. • Pre-stage testing equipment at local clinics and hospitals. • Communicate with community partners to include: hospitals, community leaders. Deploy epidemiologist to explore any/all outbreak scenarios. • Coordinate with SAMMC to determine requirements and • identify shortfalls. • Coordinate with DHS and immigration officials to determine • location of children who have left LacklandAFB. • Coordinate with TDSHS and TDPS to request support to fill short-falls. • Coordinate with CDC to acquire SNS assets. Coordination Phase 2 COA/Action Plan Phase 2 • Request the Mayor of San Antonio to request the state governor to assign Bexar County Health Authority powers in accordance with state code. Powers include: testing, quarantine, and decontamination. • San Antonio Emergency Operation Cell begins coordination with all local agencies: pandemic/ communicable disease. • Openly discuss TB mitigation and screening plans with all local organizations, media outlets, and community leaders. • Prepare emergency screening clinics and quarantine facilities for use. • Deploy SNS to Federal and Bexar County partners. • Activate clinics and quarantine facilities are fully operational. • Conduct selective compulsory TB testing (schools, government organizations) as well encourage use of free testing clinics throughout San Antonio area. • Utilize volunteers to perform screenings, follow-up on no show re-screening. • US Department of Homeland Security. (2008) National incident management system. Washington, D.C. • City of San Antonio Metro Health District. (n.d.). Retrieved from https://www.sanantonio.gov/Health.aspx • FEMA. (2014, July 14). Federal Emergency Management Agency. Retrieved from http://www.fema.gov/media-library/assets/documents/32230?id=7371 • Office of Emergency Management San Antonio. (2014). Basic Plan. Retrieved from www.saoemprepare.com

3. PHASE I: Incident International Communities WHO President DP DHHS US Department of State Department of Homeland Security CDC TX GOV DP Northern Command Texas Dept. Public Safety Texas Dept . State Health Services SOC Legend Communication Notification Decision Point San Antonio Metro Health Mayor DP SAMMC Lackland AFB

4. WHO PHASE II: Response Plan International Communities President CDC US Department of State SEC DEF DHS (Lead Agency) TX GOV Northern Command Texas Dept . State Health Services Texas Dept. Public Safety SOC AFB San Antonio Metro Health Legend Communication Notification Decision Point STRAC Group STRAC Media SAMMC