3440.10 with Changes - Navy Medicine - U.S. Navy
3440.10 with Changes - Navy Medicine - U.S. Navy
3440.10 with Changes - Navy Medicine - U.S. Navy
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DEPARTMENT OF THE NAVY<br />
BUREAU OF MEDIONE AND SURGERY<br />
2300 E STREET NW<br />
WASHINGTON DC 20372-5300 IN REPlY REFER TO<br />
BUMEDINST <strong>3440.10</strong> CH-I<br />
BUMED-M3/5<br />
12 Dec 2011<br />
BUMED INSTRUCTION <strong>3440.10</strong> CHANGE TRANSMITTAL I<br />
From: Chief, Bureau of <strong>Medicine</strong> and Surgery<br />
Subj: NAVY MEDICINE FORCE HEALTH PROTECTION EMERGENCY MANAGEMENT<br />
PROGRAM<br />
Ref: (a) BUMEDINST <strong>3440.10</strong><br />
Encl: (1) Revised pages 7 through II (Tables 2 through 4) of original enclosure (1) to<br />
reference (a)<br />
(2) Revised pages 19 through 23 of original enclosure (1) to reference (a)<br />
1. Purpose. To issue an updated list of Bureau of <strong>Medicine</strong> and Surgery (BUMED) approved<br />
and issued Emergency Management Program (EMP) equipment and a revised listing of <strong>Navy</strong><br />
medical treatment facilities (MTFs) <strong>with</strong> EMP tier designations. Enclosure (1) is an updated<br />
listing of MTFs by EMP tier designation and regional alignment, and enclosure (2) is the current<br />
list of approved EMP equipment.<br />
2. Scope and Applicability. Reference (a) is the <strong>Navy</strong> <strong>Medicine</strong> Force Health Protection (FHP)<br />
EMP manual, which established the BUMED capability for all-hazards preparedness. It applies<br />
to all BUMED activities, <strong>with</strong> the exception of mobile, expeditionary, afloat, or deployed<br />
medical forces. This change transmittal updates the basic instruction and carries the same scope<br />
and applicability.<br />
3. Action. Replace pages 7 through 11 (Tables 2 through 4) of enclosure (1) to reference (a)<br />
<strong>with</strong> enclosure (1) of this change transmittal. Replace pages 19 through 23 of enclosure (1) to<br />
reference (a) <strong>with</strong> enclosure (2) of this change transmittal.<br />
4. Retain. For record purposes, keep this change transmittal in front of the basic instruction.<br />
M. L. NATHAN<br />
Distribution is electronic only via the <strong>Navy</strong> <strong>Medicine</strong> Web site at:<br />
hI tps:llwww.mcd .navy.miI/Pagcs/Def au It .aspx
3. Scope and Applicability<br />
BUMEDINST <strong>3440.10</strong><br />
20 Nov 2008<br />
a. Scope. This instruction defines responsibilities and authority of Chief, BUMED and<br />
responsibilities of subordinate commands in implementing and sustaining a comprehensive FHP<br />
EMP per references (a) and (b) and in coordination <strong>with</strong> reference (c). It also establishes<br />
capabilities for all-hazards preparedness, mitigation, prevention, response, and recovery to<br />
sustain mission readiness, save lives, reduce human suffering, and protect property. This<br />
instruction serves as the HSS companion to references (c) and (d).<br />
(1) All BUMED activities shall follow Federal Regulatory Code for worker safety in this<br />
program as designated in references (e) through (g).<br />
(2) In accordance <strong>with</strong> reference (a), BUMED-M3/5 shall develop a CBRNE readiness<br />
assessment and reporting process.<br />
(3) <strong>Navy</strong> <strong>Medicine</strong> collaborates closely <strong>with</strong> Commander, Naval Installations Command<br />
(CNIC) and Headquarters Marine Corps (HQMC) in aligning goals and objectives through<br />
common FHP EMP standards and policy.<br />
(4) This instruction establishes a <strong>Navy</strong> <strong>Medicine</strong> FHP EMP and unifies the HSS<br />
component of these programs to promote efficiency and eliminate duplication.<br />
b. Applicability. Applies to all BUMED activities. This instruction does not apply to<br />
mobile, expeditionary, afloat, or other deployable medical forces or personnel when in a<br />
deployed status.<br />
4. Definitions<br />
a. Medical Treatment Facility (MTF). A single health care (Naval Medical Center, Naval<br />
Hospital, Branch Medical Clinic, or Naval Dental Clinic) or multiple medical and dental<br />
facilities under a single commanding officer (CO) or officer in charge (OIC).<br />
b. Emergency Management. A risk-based, comprehensive, and continual process to prepare<br />
for, mitigate, prevent, respond to, and recover from an incident that threatens life, property,<br />
operations, or the environment.<br />
5. Background. The Department of Defense (DoD) and its components are key participants in<br />
the national strategy of deterrence, protection, prevention, and defense against any and all threats<br />
to DoD assets and the homeland, and response to and recovery from the consequences of events<br />
caused by those threats.<br />
a. The terrorist attacks on the United States in the fall of 2001 resulted in an historic<br />
restructuring of the Federal Government’s strategies on homeland defense and civil support, <strong>with</strong><br />
rapidly evolving concepts of defense against all forms of disasters and a unified approach to<br />
incident management. These principles are incorporated in references (h) through (j), which<br />
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BUMEDINST <strong>3440.10</strong><br />
20 Nov 2008<br />
stress coordination, cooperation, and interoperability across all Federal, State, tribal, and local<br />
jurisdictions, and implementation of an incident management system. DoD installations<br />
represent local, Federal level jurisdictions, and are vital to overall military operational success.<br />
The protection of installation resources and personnel is paramount to military readiness. The<br />
effectiveness of emergency management planning will directly impact the success of operations<br />
of all supported installation personnel and commands.<br />
b. Reference (c) is the principal issuance <strong>with</strong>in the <strong>Navy</strong> for implementing ashore FHP<br />
EMPs directed by references (a) and (k) under an “all-hazards” approach. Reference (c) replaces<br />
the disaster preparedness construct previously employed by the <strong>Navy</strong>. The intent of the <strong>Navy</strong><br />
<strong>Medicine</strong> FHP EMP is to provide seamless HSS to both the <strong>Navy</strong> and Marine Corps<br />
installations.<br />
c. Substantial overlap of capabilities exists <strong>with</strong>in the HSS area of programs that address<br />
EM, ATFP, CIP, and CBRNE Installation Protection Programs (IPPs). This policy coordinates<br />
and streamlines capability development across these programs.<br />
6. Policy. BUMED policy is to ensure that all-hazard emergencies will not be a decisive factor<br />
in degrading mission readiness or effectiveness. BUMED fully supports references (c) and (d),<br />
and other programs designed to protect installations, active duty personnel, their dependents, and<br />
tenant civilians at those installations, while further assisting installation commanders in responding<br />
to, and recovering from, the consequences of such events.<br />
a. The <strong>Navy</strong> <strong>Medicine</strong> FHP EMP shall serve as the principal guidance <strong>with</strong>in BUMED and<br />
BUMED activities for implementing all-hazards EM as directed by references (a) and (b).<br />
b. BUMED activities shall develop a local, all-hazards EM plan that supports the installation<br />
EM plans and is aligned <strong>with</strong> <strong>Navy</strong> and/or Marine Corps regional plans as required by<br />
references (a) through (d).<br />
c. Within the United States, its territories, and possessions, commanders of BUMED<br />
activities shall be prepared to assist civil authorities under local immediate response or through<br />
Civil Authority (CA) as outlined in reference (l) and Defense Support in reference (i).<br />
d. MTFs shall implement the Hospital Incident Command System (HICS) as the official<br />
type of Incident Command System (ICS), which meets requirements of references (h) and (m)<br />
and is delineated in reference (n), which can be located at www.emsa.ca.gov/hics/hics.asp.<br />
7. Responsibilities<br />
a. Director, <strong>Navy</strong> <strong>Medicine</strong> Office of Operations, Plans, Force Protection/Force Health<br />
Protection (BUMED-M3/5), is designated the Program Manager, <strong>Navy</strong> <strong>Medicine</strong> FHP EMP and<br />
is responsible for the overall program planning, coordination, oversight, and management.<br />
BUMED-M3/5 serves as the BUMED principal coordinator of expertise in addressing HSS for<br />
EM, MTF ATFP, certain health sector aspects of the DoD CIP, CIV-MIL operations, and FHP<br />
EMP issues. Specific responsibilities include:<br />
3
BUMEDINST <strong>3440.10</strong><br />
20 Nov 2008<br />
(1) Developing and maintaining an overarching and unifying policy for FHP EMP HSS.<br />
(2) Establishing a framework for support and oversight of BUMED commands and<br />
activities covered under this instruction. Such oversight and support shall include, but not be<br />
limited to:<br />
(a) Analysis of vulnerabilities of BUMED activities from all-hazards incidents.<br />
(b) Definition of program standards and requirements.<br />
(c) Response capability analysis for readiness and preparedness.<br />
(d) Risk-based prioritization of program capabilities.<br />
(e) EM plans development.<br />
(f) Resource identification and procurement.<br />
(g) Exercise development and evaluation.<br />
(h) Incorporation of lessons learned from the <strong>Navy</strong> <strong>Medicine</strong> Lessons Learned<br />
(NMLL) Data Base.<br />
(i) Centralized HSS FHP EMP sustainment.<br />
(3) Determining expected competencies for personnel supporting installation HSS<br />
programs.<br />
(4) Identifying education and training requirements for BUMED activity personnel to<br />
support these competencies.<br />
(5) Determining materiel requirements and standards in support of the FHP EMP.<br />
(6) Maintaining appropriate liaison <strong>with</strong> and collaborating <strong>with</strong> appropriate Service and<br />
DoD offices, and other Federal agencies to further standards development, coordination,<br />
integration, interoperability, and information sharing related to EM.<br />
b. The Deputy Chief of Staff, Current and Future Medical Operations (BUMED-M3/M5)<br />
shall ensure full coordination and collaboration across BUMED activities for the FHP EMP.<br />
Direct supervision provided by the Assistant Deputy Chief of Staff, Operations (BUMED-M3B).<br />
c. The Staff Judge Advocate (BUMED-M00J) shall provide legal consultation, as needed,<br />
throughout <strong>Navy</strong> <strong>Medicine</strong> to successfully implement the program.<br />
4
BUMEDINST <strong>3440.10</strong><br />
20 Nov 2008<br />
d. The Deputy Chief of Staff, Manpower Personnel (BUMED-M1) shall ensure integration<br />
of <strong>Navy</strong> <strong>Medicine</strong> personnel into overall program objectives and shall leverage, where possible,<br />
Reserve capabilities to promote and facilitate effective installation level FHP HSS.<br />
e. The Deputy Chief of Staff, Installations and Logistics (BUMED-M4) shall assist in the<br />
management of medical logistics and health care and support facilities requirements. Provides<br />
safety and occupational and health, including industrial hygiene, policy support FHP EMP.<br />
f. Deputy Chief of Staff, Resource Management/Comptroller (BUMED-M8) shall assist<br />
through facilitation of programs, plans, and budget initiatives in support of this program.<br />
g. <strong>Navy</strong> <strong>Medicine</strong> Manpower, Personnel, Training and Education Command (NAVMED<br />
MPT&E) shall allocate sufficient resources to establish and improve FHP HSS EM education<br />
and training dealing specifically <strong>with</strong> CBRNE/all-hazards prevention and mitigation,<br />
preparedness, response, and recovery measures for all medical personnel.<br />
h. CO, <strong>Navy</strong> and Marine Corps Public Health Center (NMCPHC) shall:<br />
(1) Provide technical and scientific subject matter expertise (SME) reach-back support,<br />
as appropriate.<br />
(2) Provide occupational medicine and industrial hygiene support to include the<br />
Respiratory Protection Program.<br />
(3) Serve as the disease and syndromic surveillance hub for the <strong>Navy</strong> and Marine Corps.<br />
i. Naval Operational <strong>Medicine</strong> Institute (NOMI) shall serve as the archival site (NMLL<br />
System) for after action reports (AAR) and lessons learned from exercise assessments conducted<br />
involving MTFs in support of the FHP EMP, per reference (o).<br />
j. NAVMED Regional (NAVMEDREG) commanders shall support BUMED activities<br />
<strong>with</strong>in their respective areas of responsibility (AOR) in training, implementation, inventory<br />
management, sustainment issues, and evaluation as directed.<br />
(1) Appoint a full-time command emergency management officer (EMO) in accordance<br />
<strong>with</strong> enclosure (1), section 5.<br />
(2) Ensure hazard vulnerability assessments (HVAs) are conducted at MTFs at least<br />
every 3 years, <strong>with</strong> results addressed and coordinated <strong>with</strong> BUMED-M3/5. This program shall<br />
be coordinated <strong>with</strong> the Chief of Naval Operations (CNO) Installation Vulnerability Assessments<br />
(IVA), Marine Corps IVA programs, and Joint Staff Installation Vulnerability Assessments<br />
(JSIVA).<br />
k. <strong>Navy</strong> <strong>Medicine</strong> Inspector General (BUMED-M00IG) shall include inspection and<br />
organizational assessments of command FHP EMP; including currency of the command EM<br />
Plan and compliance <strong>with</strong> the <strong>Navy</strong> <strong>Medicine</strong> FHP EMP program objectives.<br />
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BUMEDINST <strong>3440.10</strong><br />
20 Nov 2008<br />
(1) Review HVAs conducted at MTFs annually and ensure results are addressed and<br />
incorporated into the command EM Plan, used to drive training exercise objectives, and<br />
coordinated <strong>with</strong> BUMED-M3/5.<br />
(2) Inspect for adherence to FHP EMP program objectives, such as proper accounting of<br />
command response capabilities for readiness; proper storage and maintenance of equipment and<br />
pharmaceuticals; currency of training and exercises; execution of the Respiratory Protection<br />
Program (RPP); and use of standard information management tools in program management.<br />
l. MTF Commanders shall:<br />
(1) Implement an HSS FHP EMP consistent <strong>with</strong> this instruction and supporting<br />
publications.<br />
(a) Commands providing support through proximate subordinate clinics shall develop<br />
programs that support installation requirements and leverage all available resources in preparedness,<br />
prevention, mitigation, response, and recovery operations.<br />
(b) Satellite MTFs so remote from parent commands that timely response support<br />
would not be feasible through those parent commands may, subject to CO’s discretion, develop<br />
activity EM plans that are separate from parent command programs (referred to as “independent<br />
programs”). MTFs <strong>with</strong> independent programs shall be subject to all requirements established<br />
by this and subordinate instructions from parent MTFs.<br />
(2) Appoint a Command or Activity EMO:<br />
(a) Commanders of Tier 1, 2, and 3 facilities, as delineated in enclosure (1), section<br />
1, shall designate EMOs in writing. EMOs at Tier 1 and 2 facilities shall be full-time in that<br />
position while EMOs at a Tier 3 activity may fulfill their role as a single collateral duty, as<br />
delineated in enclosure (1), section 1. They will be responsible for overall command<br />
implementation and management of the HSS FHP EMP.<br />
(b) MTF commanders shall designate a representative to the Installation Emergency<br />
Management Working Group (EMWG) per reference (c).<br />
(c) Commanders of parent MTFs shall designate a representative to the Regional<br />
EMWG per reference (c).<br />
(d) OICs of Tier 4 clinics that participate in parent MTF integrated FHP EMPs shall<br />
designate an activity EMO responsible for clinic EM implementation and management. The<br />
EMO shall also serve as principle liaison <strong>with</strong> local (community medical) EM committees, and<br />
parent command EM committees.<br />
(3) Establish a multi-disciplinary MTF EMWG comprised of command, subordinate<br />
activity, tenant commands, and ad hoc outside representatives to provide planning and<br />
coordination of EM activities through the EMO. The EMWG shall replace any existing activity<br />
Disaster Preparedness Committee.<br />
6
NAVY MEDICINE<br />
FORCE HEALTH PROTECTION<br />
EMERGENCY MANAGEMENT PROGRAM MANUAL<br />
TABLE OF CONTENTS<br />
BUMEDINST <strong>3440.10</strong> CH-2<br />
25 Apr 2012<br />
SECTION 1 - EMERGENCY MANAGEMENT PROGRAM STANDARDS ....................... 2<br />
Standard 1 - Program Management .......................................................................................... 3<br />
Standard 2 - Personnel Categorization ...................................................................................... 3<br />
Standard 3 Tiered Implementation ......................................................................................... 4<br />
Table 1. MTF Tiered Personnel Requirements .................................................................. 6<br />
Table 2. NA VMEDREG East MTF Tier Designations ...................................................... 7<br />
Table 3. NA VMEDREG West MTF Tier Designations ..................................................... 9<br />
Table 4. NA VMEDREG NCA MTF Tier Designations .................................................. 11<br />
Standard 4 - Assessments ........................................................................................................ 12<br />
Standard 5 - Interoperability ................................................................................................... 13<br />
Standard 6 - Preparedness ....................................................................................................... 13<br />
Standard 7 Planning .............................................................................................................. 15<br />
Standard 8 - Training .............................................................................................................. 16<br />
Standard 9 Equipment .......................................................................................................... 17<br />
Standard 10 - Exercise and Evaluation ................................................................................... 23<br />
Standard 11 - Mitigation and Prevention ................................................................................ 24<br />
Standard 12 Response ........................................................................................................... 25<br />
Standard 13 - Recovery ........................................................................................................... 26<br />
Standard 14 - Sustainment ...................................................................................................... 26<br />
SECTION 2 - NATIONAL INCIDENT MANAGEMENT SYSTEM (NIMS)<br />
COMPLIANCE ................................................................................................ 27<br />
SECTION 3 - COMMAND AND CONTROL ....................................................................... 33<br />
SECTION 4 - REQUIRED EM PLAN ANNEXES ............................................................... 35<br />
SECTION 5 - NAVY MEDICINE EMP EMO COMPETENCIES AND<br />
STANDARDIZED CIVILIAN CLASSIFICATION ..................................... 37<br />
SECTION 6 - PROCEDURES FOR REQUESTING WAIVERS OR EXCEPTIONS ..... .41<br />
Enclosure (1)
SECTION 1<br />
EMERGENCY MANAGEMENT PROGRAM STANDARDS<br />
BUMEDINST <strong>3440.10</strong><br />
20 Nov 2008<br />
Ref: (a) OPNAVINST 3440.17<br />
(b) CNICINST 3440.17<br />
(c) U.S. Marine Corps CBRNE Installation Preparedness Campaign Plan<br />
(d) DoDINST 1400.32 of 24 Apr 1995<br />
(e) DoDINST 2000.18 of 4 Dec 2002<br />
(f) (U) CJCSI 3110.03C, Joint Strategic Capability Plan (JSCP) - Logistics<br />
(g) (U) Installation Prioritization for J8 JRO CBRND JSAP (J-8A 00052-06)<br />
(h) (U) Program Decision Memorandum, Installation Prioritization Study of 12 Dec 2002<br />
(i) DoD Strategy for Homeland Defense and Civil Support<br />
(j) Chief, BUMED ltr Ser 04UM3M42067 of 20 Oct 2004<br />
(k) BUMEDINST 7050.1A<br />
(l) National Incident Management System (NIMS) of 1 Mar 2004<br />
(m) DoDDIR 6200.3 of 12 May 2003<br />
(n) BUMEDINST 6200.17<br />
(o) SECNAVINST 3400.4<br />
(p) JPEO-CBD USN Approved Family of Systems (FoS) of 21 Aug 2006<br />
(q) Joint Commission Comprehensive Accreditation Manual for Hospitals (EC1.4)<br />
(r) DoDINST 2000.16 of 2 Oct 2006<br />
(s) National Response Framework of Jan 2008<br />
(t) HICS Guidebook, Aug 2006<br />
(u) DoDDIR 3025.15 of 18 Feb 1997<br />
(v) OPNAVINST 3440.16C<br />
(w) DoDINST 6055 series<br />
(x) OPNAVINST 5100.23G<br />
(y) National Response Plan Catastrophic Incident Supplement (NRP-CIS)<br />
(z) OPNAVINST 5090.1C<br />
1. Purpose. To define <strong>Navy</strong> <strong>Medicine</strong> FHP EMP standards aligned <strong>with</strong> those issued by<br />
references (a) through (c) of this section.<br />
2. Background<br />
a. Program standards for the <strong>Navy</strong> FHP EMP are issued in reference (a) of this section.<br />
b. Close alignment of program standards and integration of <strong>Navy</strong> <strong>Medicine</strong> into installation<br />
and regional plans will facilitate interoperability in an all-hazards environment and across the<br />
EM spectrum.<br />
3. Responsibility. BUMED-M3/5 shall establish and maintain FHP EMP standards as<br />
delineated in this manual. NAVMEDREG commanders and MTF commanders shall adopt and<br />
maintain these standards.<br />
2 Enclosure (1)
FHP EMP Standard 1: Program Management<br />
BUMEDINST <strong>3440.10</strong><br />
20 Nov 2008<br />
1. The <strong>Navy</strong> <strong>Medicine</strong> FHP EMP establishes management guidelines that delineate operational<br />
and administrative command responsibilities. BUMED, regional, and MTF EMOs shall be<br />
responsible for preparing for, preventing, mitigating effects of, responding to, and recovering<br />
from all-hazards emergencies. The FHP EMP will be measured against existing standards. A<br />
process for continuous quality improvement will be instituted and monitored through exercise,<br />
assessment, lessons learned, and analysis.<br />
2. All tiered facilities shall designate an EMO as described in this instruction and per reference<br />
(j) of this enclosure. The commander shall also designate the appropriate number of personnel to<br />
properly support and manage the FHP EMP, as well as provide HSS to the installation FHP<br />
EMP. The facility/MTF EMO shall coordinate and work closely <strong>with</strong> the NAVMEDREG<br />
EMOs, regional and installation emergency managers, and CNIC regional CBRNE coordinators.<br />
3. Tenant MTFs shall coordinate <strong>with</strong> the host installation’s FHP EMP as outlined in host-tenant<br />
agreements or support agreement (SA). Coordination shall include active participation in EM<br />
preparedness, prevention, training, mitigation, response, and recovery efforts, as required by<br />
CNIC or USMC regional and/or installation FHP EMPs.<br />
FHP EMP Standard 2: Personnel Categorization<br />
1. The <strong>Navy</strong> <strong>Medicine</strong> FHP EMP categorizes personnel in accordance <strong>with</strong> reference (a) of this<br />
section.<br />
2. The <strong>Navy</strong> <strong>Medicine</strong> FHP EMP focuses on the preparedness and prevention, mitigation,<br />
response, and recovery capabilities of Category 5 personnel to ensure the protection of Category<br />
1-4 personnel, while providing continuity of operations (COOP).<br />
3. The following definitions are provided for the five categories of personnel:<br />
a. Category 1: Emergency-essential U.S. military personnel, DoD civilians, and DoD<br />
contractor (or subcontractor) personnel who perform mission-essential services.<br />
b. Category 2: Other U.S. personnel, including:<br />
(1) U.S. military family members living on or off a military installation.<br />
(2) Non-emergency essential U.S. military personnel, <strong>Navy</strong> civilian employees, and other<br />
persons covered by reference (d) of this section.<br />
(3) <strong>Navy</strong> contractor (and subcontractor) employees other than those performing<br />
emergency-essential <strong>Navy</strong> services.<br />
(4) Employees of other U.S. Government agencies.<br />
(5) Other U.S. Government contractor (and subcontractor) employees.<br />
3 Enclosure (1)
c. Category 3: Other personnel supporting U.S. military operations, including:<br />
BUMEDINST <strong>3440.10</strong><br />
20 Nov 2008<br />
(1) Personnel (non-U.S. citizens) who are employees of the <strong>Navy</strong> or a <strong>Navy</strong> contractor<br />
(or subcontractor), and who are not included in Categories 1 or 2.<br />
(2) Foreign military personnel employed by the host-nation government or by contractors<br />
of the host-nation government.<br />
d. Category 4: Allied/coalition nation personnel, including host-nation personnel and third<br />
country nationals that the U.S. may assist pursuant to an international agreement approved by the<br />
Department of State (DoS) or as directed by the Secretary of Defense (SECDEF), such as<br />
allied/coalition military forces, government officials, and emergency response personnel.<br />
e. Category 5: Emergency first responders/receivers who are U.S. military personnel, DoD<br />
civilians and/or contractor personnel, including, but not limited to:<br />
(1) EM personnel, Fire and Emergency Services personnel, hazardous material<br />
(HAZMAT) teams, Naval Security Forces (NSF), emergency medical service (EMS) personnel,<br />
explosive ordnance disposal (EOD) teams, MTF providers, Public Health Emergency Officers<br />
(PHEO), 911 dispatch center personnel, regional operations center (ROC) and emergency<br />
operations center (EOC) personnel, emergency response teams (ERT) and mass care, mass<br />
fatality, and mortuary affairs personnel.<br />
(2) Personnel designated to perform response/recovery tasks including safety and<br />
occupational health (SOH), industrial hygiene (IH), public works, public affairs, supply/logistics,<br />
and any others designated to perform response or recovery tasks in support of the FHP EMP.<br />
4. The <strong>Navy</strong> <strong>Medicine</strong> FHP EMP shall provide HSS to ensure the ability of Category 1<br />
personnel to continue mission-essential functions for at least 12 hours at either their primary or<br />
alternate site. The <strong>Navy</strong> <strong>Medicine</strong> FHP EMP shall protect Category 1 through 4 personnel<br />
primarily through the utilization of evacuation or shelter-in-place procedures coupled <strong>with</strong> the<br />
proper operational employment of organized, trained, equipped, exercised, evaluated, and<br />
sustained Category 5 personnel.<br />
EMP Standard 3: Tiered Implementation<br />
1. The <strong>Navy</strong> <strong>Medicine</strong> FHP EMP establishes a tiered approach to support a comprehensive EM<br />
Plan. To date, the tiering effort has been focused on <strong>Navy</strong> <strong>Medicine</strong> assets that provide patient<br />
care. The intent of the tiering is to ensure appropriate resource allocations to support mission<br />
requirements and overall FHP.<br />
2. Reference (e) of this section establishes guidance for CBRNE preparedness and response<br />
capabilities on military installations involving weapons of mass destruction.<br />
Reference (f) of this section establishes HSS capability requirements as “unit type codes”<br />
(UTCs) in support of FHP.<br />
4 Enclosure (1)
BUMEDINST <strong>3440.10</strong><br />
20 Nov 2008<br />
3. BUMED-M3/5, in coordination <strong>with</strong> each NAVMEDREG commander and major parent<br />
command, assigned tier designations for all fixed MTFs. BUMED M3/5 will conduct periodic<br />
reviews of MTF tier designations to ensure applicability to the current <strong>Navy</strong> and Marine Corps<br />
missions, to include such factors as Medical Readiness Review, Base Realignment and Closure<br />
(BRAC) Commission, and Force Reshaping.<br />
4. Reference (a) of this section establishes tiered response as a program standard for the “allhazards”<br />
EM approach. This tiered response prioritizes resource allocation, financial<br />
management, and capability requirements. Each tier equates to a defined capability level that<br />
will provide the basis for organizing, training, and equipping resources.<br />
5. MTFs are divided into four tiers representing (1) high, (2) medium, (3) low, and (4) minimal<br />
response capabilities. MTF tiering is based on the following elements:<br />
a. Installation prioritization per reference (g) of this section.<br />
b. Support to power projection or strategic assets, per references (g) and (h) of this section.<br />
c. Human capital.<br />
d. Scope of response per reference (i) of this section.<br />
e. Geographic (or potential) isolation from additional support capabilities (e.g., distance and<br />
vulnerable transportation infrastructure such as bridges and tunnels).<br />
6. The tier designation determines the type and number of MTF response elements required to<br />
support the FHP EMP. Each specific element will be standardized across all <strong>Navy</strong> <strong>Medicine</strong>.<br />
For example, a decontamination element at a Tier 3 MTF will be organized, trained, and<br />
equipped to the same FHP EMP objectives as a decontamination element at a Tier 1 MTF.<br />
However, the Tier 3 MTF will have a smaller decontamination element footprint than the Tier 1<br />
MTF. See Table 1 for the minimum tiered MTF personnel requirements.<br />
a. Personnel. Personnel will be task-organized into unit identification code (UIC)-based<br />
capabilities areas (see Table 1). Designated active duty and civilian personnel located at an<br />
MTF, independent of expeditionary wartime military augmentation platforms, must participate.<br />
b. Training. All baseline didactic CBRNE training requirements will be met by the <strong>Navy</strong><br />
Knowledge Online-based CBRNE Emergency Medical Preparedness and Response Course<br />
(EMPRC) as directed in reference (j) of this section. Additional practical application,<br />
equipment, and training exercises (e.g., tabletop (TTX), command post exercises (CPX)/field<br />
exercises (FE), and field training exercises (FTX)/full-scale exercises (FSE)) will contribute to<br />
the training qualification standards.<br />
5 Enclosure (1)
BUMEDINST <strong>3440.10</strong><br />
20 Nov 2008<br />
c. Equipment. Equipment to support the FHP EMP will be standardized across <strong>Navy</strong><br />
<strong>Medicine</strong> and listed in the BUMED-M3/5 FoS. Based on the MTF tier, a Basis of Allocation<br />
(BoA) will serve as the template to be developed into Authorized Medical Allowance Lists<br />
(AMAL) managed by <strong>Navy</strong> Medical Logistics Command and Marine Corps Logistics<br />
Command. BUMED-M3/5 will coordinate closely <strong>with</strong> CNIC, Naval Sea Systems Command<br />
(NAVSEA), Naval Facilities Engineering Command Headquarters (NAVFACHQ), and the Joint<br />
Program Executive Office for Chemical and Biological Defense (JPEO-CBD) in maintaining the<br />
FoS and BoA. See FHP EMP Standard 9 (equipment) for more detail.<br />
Table 1. MTF Tiered Personnel Requirements<br />
The following table outlines MTF response capabilities by tier. Total number shown indicates<br />
the minimum number of personnel needed to perform the designated capability/function in the<br />
event of a CBRNE/all-hazards incident.<br />
CAPABILITY AREA TIER 1 TEAM(S) TIER 2 TEAM(S) TIER 3 TEAM(S)<br />
Decontamination<br />
MTF Zone Management<br />
Detection<br />
Transport<br />
Triage/Treatment<br />
Patient Administration<br />
TOTAL<br />
4 (12 members each)<br />
Total = 48<br />
4 (4 members each)<br />
Total = 16<br />
2 (2 members each)<br />
Total = 4<br />
4 (6 members each)<br />
Total = 24<br />
4 (5 members each)<br />
Total = 20<br />
3 (2 members each)<br />
Total = 6<br />
118<br />
2 (12 members each)<br />
Total = 24<br />
2 (4 members each)<br />
Total = 8<br />
2 (2 members each)<br />
Total = 4<br />
4 (4 members each)<br />
Total = 16<br />
2 (5 members each)<br />
Total = 10<br />
2 (2 members each)<br />
Total = 4<br />
66<br />
1 (12 members)<br />
Total = 12<br />
1 (4 members)<br />
Total = 4<br />
1 (2 members each)<br />
Total = 2<br />
2 (4 members each)<br />
Total = 8<br />
1 (5 members each)<br />
Total = 5<br />
1 (2 members each)<br />
Total = 2<br />
6 Enclosure (1)<br />
33
Table 2. NA VMEDREG East MTF Tier Designations<br />
7<br />
BUMEDINST <strong>3440.10</strong> CH-l<br />
12 Dec 2011<br />
Enclosure (1)
Table 3. NA VMEDREG West MTF Tier Designations<br />
9<br />
BUMEDINST <strong>3440.10</strong> CH-l<br />
12 Dec 2011<br />
Enclosure (1 )
Table 4. NA VMEDREG NCA MTF Tier Designations<br />
11<br />
BUMEDINST <strong>3440.10</strong> CH-l<br />
12 Dec 2011<br />
Enclosure (1)
FHP EMP Standard 4: Assessments<br />
BUMEDINST <strong>3440.10</strong><br />
20 Nov 2008<br />
1. The <strong>Navy</strong> <strong>Medicine</strong> FHP EMP identifies minimum MTF assessment standards and methods<br />
in support of the risk management process.<br />
2. Risk management is a continuous process of evaluating evolving threats, vulnerabilities, and<br />
capabilities to maintain the desired level of readiness. This process includes the use of threat<br />
assessments, vulnerability assessments, and EM capability assessments. These assessments<br />
should incorporate information and recommendations from a variety of sources including, but<br />
not limited to, HVA, JSIVA CNO IVA, CIP planning and assessments, and COOP planning.<br />
These assessments will assist in resource allocation and prioritization.<br />
a. Threat Assessments. MTF commanders, in conjunction <strong>with</strong> regional and installation<br />
commanders, shall utilize existing threat and vulnerability assessment methods to analyze the<br />
threats potentially impacting their commands at least annually.<br />
(1) Focus on the command’s overarching EM and ATFP programs.<br />
(2) Utilize appropriate SMEs for the areas being assessed.<br />
(3) Consider the range of identified and projected response capabilities needed for a<br />
natural or man-made hazard, including a terrorist or criminal act against the installation, its<br />
personnel, facilities, and other critical assets.<br />
(4) Identify responses to threats and vulnerabilities and solutions for enhanced protection<br />
of personnel and resources.<br />
(5) Provide threat and vulnerability-based analysis of the command’s FHP EMP.<br />
(6) Report, prioritize, and track assessments in time to support and coordinate the budget<br />
process at BUMED-M3/5.<br />
(7) Classify assessments in accordance <strong>with</strong> the appropriate security classification<br />
guidance.<br />
b. Ensure that EM personnel are trained to maximize the use of threat assessments and<br />
intelligence derived from civil and military law enforcement and public safety agencies and<br />
departments as well as EM, meteorological, environmental, and public health processes and<br />
procedures.<br />
c. EM Capability Assessments and Status. The <strong>Navy</strong> <strong>Medicine</strong> FHP EMP will utilize a<br />
comprehensive capabilities assessment and status process to determine the status of an MTF’s<br />
required EM capabilities <strong>with</strong> respect to readiness and preparedness. The process will examine:<br />
12 Enclosure (1)
BUMEDINST <strong>3440.10</strong><br />
20 Nov 2008<br />
(1) MTF capability to utilize threat assessments along <strong>with</strong> installation and MTF HVAs<br />
to determine risk posed by all hazards.<br />
EMP.<br />
(2) MTF capability to reduce the assessed risk through the implementation of the FHP<br />
(3) The availability of resources to support plans as written.<br />
(4) The frequency and extent to which plans have been reviewed, trained, and exercised.<br />
(5) The proper utilization of exercise assessments and AARs in the improvement of the<br />
FHP EMP.<br />
(6) Written agreements (e.g., SA) <strong>with</strong> supporting/supported organizations per reference<br />
(k) of this section.<br />
(7) Use of operational risk management.<br />
FHP EMP Standard 5: Interoperability<br />
1. The <strong>Navy</strong> <strong>Medicine</strong> FHP EMP requires interoperability standards and methods as set forth in<br />
reference (a) of this section, and in support of references (b), (c), and (l) of this section.<br />
2. Interoperability must include the standardization of systems, procedures, and terms to the<br />
maximum extent possible. The goal is compatibility of tactics, techniques, and procedures<br />
(TTP), especially command, control, and communications (C3) among regional and installation<br />
EM assets and applicable Federal, State, tribal, local, and/or private (or host nation (HN)) EM<br />
agencies and departments.<br />
3. MTF commanders or their representatives shall participate in regional and installation EM<br />
planning, training, and exercises and encourage reciprocal participation by these entities in their<br />
EM planning, training, and exercises.<br />
FHP EMP Standard 6: Preparedness<br />
1. The <strong>Navy</strong> <strong>Medicine</strong> FHP EMP establishes minimum preparedness standards as required by<br />
references (a) and (m) of this section, and in support of reference (b) of this section. These<br />
standards include the proper organization, manning, C3 <strong>with</strong> Federal, State, tribal, local, and/or<br />
private (or HN) agencies and departments, and functional area relationships.<br />
2. The preparedness tasks of planning, training, FoS selection and BoA, exercise, training,<br />
evaluation, and assessments are covered <strong>with</strong>in other standards outlined in this instruction.<br />
a. Public Health Emergency Officers (PHEO). MTF commanders shall assist operational<br />
commanders who request nomination of a PHEO for designation by that commander, in<br />
accordance <strong>with</strong> reference (m) of this section. The PHEO shall serve as a member of the<br />
13 Enclosure (1)
BUMEDINST <strong>3440.10</strong><br />
20 Nov 2008<br />
installation or <strong>Navy</strong> region Military Biological Advisory Committee (MBAC) in support of<br />
reference (b) of this section, and is the principal advisor determining the existence of and the<br />
actions required to respond to a public health emergency (PHE) either onboard or potentially<br />
affecting installation(s) assigned to the specific <strong>Navy</strong> or USMC installation, region, or activity.<br />
b. EM Working Group (EMWG). MTF commanders shall establish and maintain an<br />
EMWG to assist the MTF emergency manager in the development, execution, exercise, and<br />
assessment of the MTF FHP EMP. The EMWG will actively participate in <strong>Navy</strong> or Marine<br />
Corps region and installation EM activities and planning programs.<br />
c. Mass Warning and Notification. MTF commanders shall develop capabilities to rapidly<br />
warn and notify personnel as necessary. Per reference (a) of this section, Category 2 through 4<br />
personnel must receive warning and notification <strong>with</strong>in 15 minutes of an event and Category 1<br />
and 5 personnel must receive warning and notification <strong>with</strong>in 5 minutes of an event. Outside the<br />
U.S., its territories, and possessions, this task shall include warning and notification of sponsored<br />
family members living off base. These capabilities should integrate <strong>with</strong> the mass warning and<br />
notification system(s) employed by the local community (or HN) to the extent possible. Mass<br />
warning and notification systems shall be constructed in accordance <strong>with</strong> Unified Facilities<br />
Criteria (UFC) 4-021-01 (Design, Operations, and Maintenance: Mass Notification Systems).<br />
d. Regional Operations Center (ROC). MTF commanders shall designate, in writing,<br />
trained and qualified personnel capable of assisting, advising, and/or serving as liaison to the<br />
ROC in the event of activation.<br />
e. Emergency Operations Centers (EOC). MTF commanders shall designate and assign in<br />
writing, trained and qualified personnel capable of assisting, advising, and/or serving as liaison<br />
to the installation EOC in the event of activation.<br />
f. Communications. MTF commanders shall develop operable communications across the<br />
Category 5 functional areas. Interoperable communications are highly recommended (see EM<br />
Standard 5). Commanders should pursue procedure-based solutions to interoperability<br />
challenges, including the use of liaison officers at the ROC, EOC, and Incident Command Post<br />
(ICP) levels, whenever appropriate.<br />
g. Written Agreements (WAs). MTF commanders shall coordinate <strong>with</strong> regional, installation,<br />
and local EM resources in the development of WAs as necessary per reference (k) of this<br />
section. These WAs should outline cooperative measures where MTF Category 5 personnel may<br />
assist the civilian community and vice versa in response to and recovery from all-hazards natural<br />
and man-made emergencies, including CBRNE events.<br />
h. Civil-Military (CIV-MIL) Operations. MTF commanders shall coordinate <strong>with</strong> regional<br />
and installation commanders in the development of relationships <strong>with</strong> the appropriate Federal,<br />
State, tribal, local, and/or private (or HN) EM-related agencies and departments to identify and<br />
update responsible points of contact, emergency protocols, and expectations in the event of an<br />
emergency onboard or affecting a <strong>Navy</strong> <strong>Medicine</strong> MTF or installation. This task<br />
14 Enclosure (1)
BUMEDINST <strong>3440.10</strong><br />
20 Nov 2008<br />
should also include MTF EM coordination <strong>with</strong> nearby military installations of other Services<br />
including the U.S. Coast Guard, and local medical community organizational planning such as<br />
through local emergency planning committees.<br />
i. Joint Information Center (JIC). MTF commanders shall coordinate <strong>with</strong> region and<br />
installation EM staffs to identify and update points of contact for public affairs, risk communication,<br />
emergency protocols, and media expectations.<br />
FHP EMP Standard 7: Planning<br />
1. The <strong>Navy</strong> <strong>Medicine</strong> FHP EMP establishes minimum planning standards as required by<br />
reference (a) of this section. Planning is critical to preparedness, prevention, mitigation,<br />
response, and recovery from an emergency. The MTF EM Plan must be coordinated <strong>with</strong> the<br />
installation plan, if the MTF is a tenant command, or <strong>with</strong> the regional plan, if the MTF is a<br />
stand-alone installation.<br />
2. All <strong>Navy</strong> <strong>Medicine</strong> MTF EM Plans shall be reviewed at least annually and provided to the<br />
immediate superior in command (ISIC). Elements of the MTF EM Plan must be coordinated<br />
<strong>with</strong> the applicable <strong>Navy</strong> and USMC region, and installation-specific EM Plans and exercises.<br />
The MTF EM Plan should also be coordinated <strong>with</strong> Federal, State, tribal, local, other-Service, or<br />
HN, and/or private response and/or recovery partners.<br />
3. Evacuation planning, shelter-in-place planning, and shelter development procedures should<br />
be based upon applicable DoD, Department of Homeland Security (DHS), and American Red<br />
Cross (ARC) guidelines. Evacuation, rather than procurement and employment of protective<br />
equipment, is the primary means of addressing hazards faced by Category 2 personnel. In<br />
overseas locations, evacuations will follow established U.S. DoS evacuation procedures.<br />
4. Per reference (b) of this section, <strong>Navy</strong> region and installation commanders shall develop<br />
plans and procedures to direct Category 2 through 4 personnel to safe locations, shelters, or to a<br />
shelter-in-place should evacuation not be an option. When shelter-in-place is utilized, the goal<br />
will be to protect at least 90 percent of personnel <strong>with</strong>in 15 minutes. MTF commanders and<br />
EMOs shall communicate regularly and coordinate closely <strong>with</strong> region or installation EM<br />
planning processes.<br />
5. Additional aspects of planning that must be incorporated are:<br />
a. Assistance to requesting commanders in identifying a PHEO per reference (n) of this<br />
section.<br />
b. Participation in the MBAC per reference (c) of this section.<br />
c. Liaison <strong>with</strong> the installation EOC and ROC.<br />
15 Enclosure (1)
FHP EMP Standard 8: Training<br />
BUMEDINST <strong>3440.10</strong><br />
20 Nov 2008<br />
1. The <strong>Navy</strong> <strong>Medicine</strong> FHP EMP establishes minimum training standards as required by<br />
references (a), (e), and (o) of this section. Training standards are based on existing DoD,<br />
Occupational Safety and Health Administration (OSHA), National Fire Protection Agency<br />
(NFPA), and military standards and guidelines as referenced in (l) and (o) of this section. These<br />
training standards focus on the requirements for Category 1 personnel to maintain critical<br />
operations, for Category 2-4 personnel to gain hazard awareness and understanding of warning<br />
and response procedures, and for Category 5 personnel to conduct safe and effective operations<br />
at their level of training.<br />
2. NAVMEDREG and MTF EMOs shall meet the minimum training standards established by<br />
this instruction <strong>with</strong> the ability to tailor each program based upon specific mission requirements<br />
and incorporate their regional/installations capabilities and resources. All personnel will receive<br />
required training through identified military, government civilian, local/State agencies, and<br />
contractors unless otherwise noted. Training will include realistic exercises (see Standard 10)<br />
demonstrating the level of proficiency required for training and evaluation purposes.<br />
3. A comprehensive training continuum utilizing established standards and addressing the<br />
requirements for initial and recurring training will be developed by BUMED for the following<br />
areas:<br />
a. Category 1 specific.<br />
b. Category 2-4 specific.<br />
c. Category 5 specific.<br />
d. All enterprise personnel.<br />
(1) Public awareness level training does not have to result in certification. Public<br />
awareness level training must include general EM and CBRNE hazard information as well as<br />
region and/or installation specific EM guidance per reference (a) of this section.<br />
(2) All baseline didactic CBRNE training requirements will be met by the <strong>Navy</strong><br />
Knowledge On-line (NKO)-based CBRNE EMPRC. The EMPRC, available at:<br />
http://www.dmrti.army.mil, is a multi-module, web-based, interactive training product. Each of<br />
the modules is made up of multiple topics that have opportunities throughout to test knowledge<br />
retained up to that point.<br />
4. The EMPRC is tailored to the target audience and offered in four versions:<br />
a. Basic Course. Non-essential civilian employees and contractors (non-medical/nonsecurity).<br />
16 Enclosure (1)
BUMEDINST <strong>3440.10</strong><br />
20 Nov 2008<br />
b. Operator/Responder Course. First responders/receivers (e.g., general corpsmen, nonclinicians,<br />
MTF security personnel, MTF based Basic EMS).<br />
c. Clinician Course. First responder/receiver clinicians, physicians, dentists, veterinarians,<br />
nurses, physician assistants, independent duty corpsmen, and MTF based Advanced EMS.<br />
d. Executive/Commander Course. MTF commanding officers and Executive Steering<br />
Committee (ESC) members.<br />
5. The EMPRC is hosted on the following sites:<br />
a. <strong>Navy</strong> Active and Reserve: http://www.nko.navy.mil.<br />
b. <strong>Navy</strong>-affiliated civilian and contractors: http://www.swankhealth.com.<br />
6. Required specialty training (e.g., MTF EOC Operations, PHEO, etc.) will be identified by<br />
BUMED-M3/5 in coordination <strong>with</strong> NAVMEDREG and MTF commanders and conducted<br />
following reference (b) of this section.<br />
FHP EMP Standard 9: Equipment<br />
1. The <strong>Navy</strong> <strong>Medicine</strong> FHP EMP establishes standardized equipment requirements, designated<br />
as the FoS, for all BUMED facilities as required by references (a) and (b) of this section.<br />
Equipment standards focus on the requirements for Category 5 personnel to conduct safe and<br />
effective first receiver operations. Equipment shall be provided <strong>with</strong> the appropriate<br />
maintenance, operation, and employment training.<br />
2. Reference (p) of this section addresses the following receiver functions: command and<br />
control (C2), mass warning and notification, communications, detection, survey, identification,<br />
personal protection, personal immediate decontamination, casualty (secondary) decontamination,<br />
medical surveillance, and CBRN Pharmaceutical Countermeasures (CPCs). These standards<br />
address requisite storage, maintenance, inventory, training, repair, and life-cycle cost estimate<br />
(LCCE). These standards shall be solely utilized to proper procurement and sustainment of all<br />
EM-related equipment.<br />
3. Equipment standards shall examine both Government-off-the-shelf (GOTS) and<br />
Commercial-off-the-shelf (COTS) for initial FoS development as well as for spiral insertion.<br />
a. GOTS equipment utilized to protect against the effects of, detect the presence of, or<br />
remove/reduce the hazard of CBRNE agents shall be procured, maintained, employed, and<br />
inventoried in accordance <strong>with</strong> applicable Joint Chemical Biological Defense Program<br />
(J-CBDP), J-8/Joint Requirements Office (JRO), JPEO-CBD, U.S. <strong>Navy</strong>, and USMC guidance.<br />
b. COTS equipment utilized <strong>with</strong>in the scope of the FHP EMP, including CBRNE events,<br />
shall meet applicable OSHA, National Institute of Occupational Safety and Health (NIOSH), and<br />
NFPA standards, guidelines, and criteria as well as all applicable Federal and military standards<br />
and guidelines.<br />
17 Enclosure (1)
BUMEDINST <strong>3440.10</strong><br />
20 Nov 2008<br />
4. BUMED shall be responsible for ensuring that the approved FoS and BoA are updated and<br />
maintained for all <strong>Navy</strong> <strong>Medicine</strong> facilities. <strong>Changes</strong> to the FoS and BoA will be issued via<br />
Defense Message Traffic. GOTS CBRNE equipment shall be BUMED centrally coordinated<br />
<strong>with</strong> CNIC, NAVSEA, and NAVFACHQ. The Interagency Board’s (IAB) Selected Equipment<br />
List (SEL) shall serve as a basis for the selection of CBRNE-related COTS equipment by<br />
BUMED.<br />
5. BUMED must include procurement, life-cycle cost (LCC), and sustainment cost of assigned<br />
equipment in appropriate budget and Program Objective Memorandum (POM) submissions.<br />
6. Naval Medical Logistics Command (NAVMEDLOGCOM), <strong>Navy</strong> <strong>Medicine</strong> Support<br />
Command (NAVMEDSUPCOM), and MTF Material Managers shall ensure all equipment<br />
is reflected in Defense Medical Logistics Standard Support (DMLSS) available at:<br />
http://www.tricare.mil/dmlss/ for accountability purposes.<br />
7. NAVMEDSUPCOM shall work <strong>with</strong> NAVMEDLOGCOM in the standardization of<br />
procurement and distribution of MTF-required equipment. BUMED will provide MTF<br />
equipment requirements and program funding to ensure compliance <strong>with</strong> tier requirements.<br />
NAVMEDLOGCOM will provide detailed, itemized quarterly reports to BUMED-M3/5<br />
regarding procurement status.<br />
8. Basis of Allocation. The following information contains equipment designated for use<br />
by MTFs/personnel in the event of a CBRNE incident. All MTF personnel should note that<br />
procurement for items used in CBRNE and emergency response must be approved by<br />
BUMED-M3/5.<br />
a. Personal Protective Equipment (PPE)<br />
Level C Suits (OSHA)/Class 3 NFPA Suits. All CBRN protective ensembles fielded for<br />
use will be in compliance <strong>with</strong> OSHA Level C/NFPA 1994 (2007) Class 3 CBRN Protective<br />
Ensemble standards. Annual review of standards and CBRN protective ensemble selection will be<br />
performed and any required updates or modifications will be disseminated to MTFs accordingly by<br />
BUMED.<br />
OSHA Level C Ensemble Components OSHA Level C Guidelines for Use<br />
▪ Full-face or half-mask, air-purifying respirators<br />
(NIOSH approved)<br />
▪ Hooded chemical-resistant clothing (overalls; two-piece<br />
chemical-splash suit; disposable chemical-resistant<br />
overalls)*<br />
▪ Coveralls*<br />
▪ Gloves, outer, chemical-resistant.<br />
▪ Gloves, inner, chemical-resistant.<br />
▪ Boots (outer), chemical-resistant steel toe and shank*<br />
▪ Boot-covers, outer, chemical-resistant (disposable)*<br />
▪ Hard hat*<br />
▪ Escape mask*<br />
▪ Face shield*<br />
*Optional, as applicable.<br />
1. The atmospheric contaminants, liquid<br />
splashes, or other direct contact will not<br />
adversely affect or be absorbed through any<br />
exposed skin;<br />
2. The types of air contaminants have been<br />
identified, concentrations measured, and an<br />
air-purifying respirator is available that can<br />
remove the contaminants, and;<br />
3. All criteria for the use of air-purifying<br />
respirators are met.<br />
18 Enclosure (1)
BUMEDINST <strong>3440.10</strong> CH-l<br />
12 Dec 2011<br />
From NFPA 1994 (2007 Edition). 3.3.9.2 Class 3 CBRN Protective Ensemble and<br />
Ensemble Elements: A chemicallbiological terrorism incident protective ensemble designed to<br />
protect emergency responder personnel at terrorism incidents involving low levels of vapor or<br />
liquid chemical hazards where the concentrations are below Immediately Dangerous to Life and<br />
Health, permitting the use of Chemical (Chern), Biological (Bio), Radiological (Rad), and<br />
Nuclear (CBRN) Positive Air-Purifying Respirator (P APR).<br />
Chemical Protective Ensemble(s)<br />
Level C Suit<br />
Item provided to Military Treatment Facilities (MTFs): Geomet DTAP (Disposable<br />
Toxicological Agent Protective) Level Cl coverall, NFPA 1992 (sizes available: S, M, L, XL,<br />
2XL,3XL). The Geomet DTAPS suit will provide sufficient protection to those expected to work<br />
directly in the Warm Zone when Level C is authorized. This suit will provide adequate dermal<br />
protection for all individuals who are not expected to be exposed to high levels of contamination<br />
and/or those who perform an outdoor task as a first receiver (e.g., decontamination, patient<br />
transport, etc.).<br />
Item provided to MTFs: The Tychem SL-121B Level B/C suit is issued for use in<br />
training, to prevent training incurred damage to the more costly Geomet DTAP suits, which are<br />
reserved for use during actual contingency events. The Tychem suit consists of a coverall, elastic<br />
wrists, front zipper closure, storm flap over zipper, and attached socks. Suits are available in<br />
sizes S to 3XL.<br />
Overboots<br />
Gloves<br />
Item provided to MTFs: EZ Fit HAZMAX (sizes available: S, M, L, XL).<br />
Item provided to MTFs: North Viton (sizes available: 9, 10, and 11).<br />
Inner Gloves<br />
PAPR<br />
Item provided to MTFs: North Silver Shield (sizes available: 8,9, and 10).<br />
Item provided to MTFs: The 3MTM RBE-NMIO Loose-Fitting PAPR is a belt-mounted,<br />
turbo-blower/filtration unit that includes the butyl rubber hood (BE-l OBR), cartridge/canister<br />
(RBE-57), nickel metal-hydride battery pack (BP-15), breathing tube assembly (RBE-BTH),<br />
decon belt (RBE-BLT), airflow indicator, smart battery charger (BC-21 0) and the carrying bag.<br />
The P APR is intended to provide respiratory protection against chemical and biological agents as<br />
19 Enclosure (2)
BUMEDINST <strong>3440.10</strong> CH-l<br />
12 Dec 2011<br />
well as certain particulates, organic vapors, and acid gases, and other inorganic gases. The MTF<br />
allocation includes all the above mentioned items. Additionally, one third of the P APR inventory<br />
is issued <strong>with</strong> the Con Space voice amplifier and radio interface.<br />
PPE Bag<br />
Item Provided to MTFs: 30 X 16 X 15 (MDDSD).<br />
Tiered MTF PPE Allotment. See Table 5 below:<br />
Table 5 - Tiered MTF PPE Allotment<br />
Facility MTF First Receiver PPE<br />
142 Level C Suits<br />
130PAPRS<br />
Tier 1 142 Boots<br />
284 Gloves (1 outer, 1 inner)<br />
79 Level C Suits<br />
72 PAPRS<br />
Tier 2<br />
79 Boots<br />
159 Gloves (1 outer, 1 inner)<br />
40 Level C Suits<br />
37PAPRS<br />
Tier 3 40 Boots<br />
80 Gloves (1 outer, 1 inner)<br />
Tier 4 No PPE or equipment fielded<br />
b. Radiation Identification Detection Capability<br />
Item provided to MTFs: ANIPDQ-l Multi-function Survey Meter (OA-9449IPDQ).<br />
Multi-function instrument used to locate and measure low and high intensity radioactivity in the<br />
form of gamma rays, or used <strong>with</strong> external probes to locate and measure beta and gamma<br />
radiation. This meter is designed for both large area surveying, to find the extent and intensity of<br />
radioactive contamination, as well as for area and personnel monitoring, to determine the<br />
presence and intensity of residual radiation.<br />
Item provided to MTFs: Exploranium GR-135HD (<strong>with</strong> software, serial cable, and<br />
docking station). The GR-135 radioisotope identification device detects radioactive materials and<br />
identifies the specific radioisotopes.<br />
c. Chemical Detection Capability<br />
Item provided to MTFs: Joint Chemical Agent Detector (JCAD). The JeAD is a handheld,<br />
pocket-sized detector designed to detect, identify, quantify, and warn ofthe presence of<br />
chemical agents (nerve, blister, blood agents), using both audible and visual alarms.<br />
20 Enclosure (2)
d. Biological Detection Capability<br />
BUMEDINST <strong>3440.10</strong> CH-l<br />
12 Dec 2011<br />
Item provided to MTFs: Operational Hand-Held Assay (HHA) Panel. HHAs are<br />
simple, antibody-based assays used to provide rapid presumptive identification.<br />
Item provided to MTFs: DoD Biological Sampling Kit (BSK). The DoD BSK is a<br />
prepackaged sampler/collection kit used for field screening and presumptive identification. The<br />
kit is able to simultaneously identify up to eight different biological agents. The DoD BSK<br />
includes the following in a sealed foil packet: operational HHA panel (8 HHAs encased in a<br />
plastic panel), 4 mL phosphate buffered solution (PBS), 2 Dacron-tipped swabs, and a laminated<br />
instructional card.<br />
Table 6 - Tiered Radiological, Chemical, and Biological Detection Equipment Allotment:<br />
RAD<br />
CHEM<br />
Detect ion (Dc, ices) Ticr I Tier 2 Tier J Ticr .t<br />
ANIPDQ-l 2 2 2 0<br />
GR-135 HD 1 1 1 0<br />
JeAD<br />
I 2 2 2 0<br />
HHAs 10 10 10 0<br />
BfO Training HHAs 10 10 10 0<br />
DoDBSK 10 10 10 0<br />
e. Decontamination and Patient Triage Capability<br />
Item provided to MTFs: TVI 3-Line Decontamination System. The shelter system is a<br />
self-supporting, quick-erect shelter. It provides either three ambulatory lines, or two ambulatory,<br />
and one non-ambulatory (litter) line. The TVI 3-Line Decontamination System contains privacy<br />
curtains, an integral water shower system <strong>with</strong> flash heater, and provides a litter conveyor<br />
system. The water used for decontamination can be pre-heated and the discharge water can be<br />
captured in a bladder if required. Items shipped include the shelter, flash heater, SOO-gallon<br />
water bladder and Personal Care IDecon kits.<br />
Item provided to MTFs: Reactive Skin Decontamination Lotion (RSDL). RSDL is a<br />
bio-degradable, non-flammable lotion formulated for the decontamination of intact skin only.<br />
Additional uses include the decontamination of sensitive equipment and spot decontamination of<br />
military equipment. The indications for the lotion's use include both prophylactic administration<br />
and administration after exposure to a chemical warfare agent. It is intended for external use<br />
only.<br />
21 Enclosure (2)
Table 7 - Tiered Decontamination and Treatment Equipment Allotment:<br />
BUMEDINST <strong>3440.10</strong> CH-l<br />
12 Dec 2011<br />
Capability Tier 1 Tier 2 Tier 3 Tier 4<br />
3 Line Casualty Decon<br />
Shelter<br />
1 1 1 0<br />
500 Gallon Bladder 2 2 2 0<br />
Decontamination Personal Care IDecon Kits 200 200 200 0<br />
RSDL Joint Service<br />
Personnel Skin Detection<br />
System (JSPDS)<br />
180 120 60 0<br />
RSDL (JSPDS)<br />
Triage/Treatment<br />
Triage Tags<br />
60<br />
500<br />
60<br />
300<br />
60<br />
200<br />
0<br />
0<br />
f. Patient Mobility Capability<br />
Item provided to MTFs: Raven Model 90C. The Raven Model 90C is identical to the<br />
Talon II® Model90C, <strong>with</strong> the exception of the bi-fold configuration. It is United States Air<br />
Force Safe-to-Fly Certified, exceeds military 3X decontamination requirements, meets civilian<br />
and military fire safety codes, and is compatible <strong>with</strong> North Atlantic Treaty Organization Patient<br />
Evacuation Platforms, including Utility Helicopter (UH-60) Carousel.<br />
E ui ment Tier 1 Tier 2 Tier 3 Tier 4<br />
Raven Model 90C 15 15 15 o<br />
g. Medical Surveillance Capability<br />
Item provided to MTFs: Electronic Surveillance System for the Early Notification of<br />
Community-Based Epidemics (ESSENCE). ESSENCE uses both syndromic and non-traditional<br />
health information to provide very early warning of abnormal health conditions. It is the only<br />
known system to combine both military and civilian health care information for daily outbreak<br />
surveillance, integrating clinical and non-clinical human behavior indicators as a means of<br />
identifying the abnormality as close to the time of onset of symptoms as possible.<br />
h. CBRN Pharmaceutical Countermeasures CCPCs)<br />
Items provided to MTFs: Ciprofioxacin, Doxycycline, Antidote Treatment-Nerve<br />
Agent Auto-injector (ATNAA), Convulsant Antidote for Nerve Agent (CANA), and Potassium<br />
Iodide (KI).<br />
22 Enclosure (2)
Table 8 Tiered CPC Allotment:<br />
Pharmaceutical<br />
Countermeasures<br />
Tier 1 Tier 2 Tier 3<br />
Ciprofloxacin (500 mg, tab) 330 250 200<br />
Doxycycline<br />
(100 mg cap)<br />
2,920 2,250 1,800<br />
ATNAA(ea) 975 750 600<br />
CANA(ea) 325 250 200<br />
KI (130 mg tab, 14 per pg) 325 250 200<br />
FHP EMP Standard 10: Exercise and Evaluation<br />
Tier 4<br />
150<br />
1,350<br />
450<br />
150<br />
150<br />
BUMEDINST <strong>3440.10</strong> CH-l<br />
12 Dec 2011<br />
Comments<br />
- 10% ofBIO Allotment (90/10 Doxy/<br />
Cipro Split)<br />
- number of 5-day courses (500 mg,<br />
twice daily (BID), X 5 days = 10 Tabs<br />
per responder per course)<br />
- 90% of BIO Allotment (9011 0 Doxy/<br />
Cipro Split)<br />
- number of 5-day courses (100 mg<br />
BID X 5 days = 10 Tabs per responder<br />
per course)<br />
- three injectors per first responder/<br />
receiver<br />
- one injector per first responder/<br />
receiver<br />
- all first responders/receivers will be<br />
18 years old (or older)<br />
1. To meet the requirements of references (a), (b), (e), (0), (q), and (r) of this section, MTFs and<br />
other designated Bureau of <strong>Medicine</strong> and Surgery activities must actively participate in <strong>Navy</strong><br />
regional and installation level EM related training, to include regional and/or local table top<br />
exercise, command post exercise/functional exercise, and functional training exercise/full scale<br />
exercise. Additionally, MTFs shall also participate in appropriate local community EM related<br />
exercises, in close coordination <strong>with</strong> their respective <strong>Navy</strong> <strong>Medicine</strong> regional commander.<br />
23 Enclosure (2)
BUMEDINST <strong>3440.10</strong><br />
20 Nov 2008<br />
2. MTFs shall participate in the exercise planning process <strong>with</strong> the region, installation, and<br />
civilian community to provide medically relevant exercise play that will contribute to enhanced<br />
EM interoperability, communications, and overall readiness.<br />
3. MTFs shall generate written AARs to capture lessons learned for future use. AARs shall be<br />
maintained for a minimum of 2 years or until the next Joint Commission/Medical Inspector<br />
General visit (whichever is longer). A copy of the AAR shall be forwarded to the respective<br />
NAVMEDREG. The region will then forward the AAR to BUMED-M3/5 which is responsible<br />
for coordination <strong>with</strong> NOMI.<br />
4. Exercise scenarios should consider the full spectrum of possible hazards and meet requirements<br />
set forth by reference (m) of this section.<br />
5. When an MTF has responded to an actual event of appropriate magnitude, the respective<br />
NAVMEDREG may exempt the MTF from participation in exercises for a period of 6-12<br />
months.<br />
FHP EMP Standard 11: Mitigation and Prevention<br />
1. The <strong>Navy</strong> <strong>Medicine</strong> FHP EMP establishes mitigation and prevention standards and tools for<br />
use by MTF commanders in support of both MTF and installation operations.<br />
2. MTFs shall assist in the processes through which mitigation efforts may diminish the effects<br />
of identified natural and man-made hazards. Such assistance will include providing initial site<br />
survey as well as risk assessment assistance following an incident, as well as granting approval<br />
for re-entry and making recommendations for proper and effective respiratory/personnel<br />
protection for first responders/receivers.<br />
3. Where the capability exists, MTFs shall assist in the identification and confirmation of<br />
disease agents, and the prevention and/or mitigation of morbidity and mortality related to any<br />
all-hazards event. MTFs shall maintain a system and process for collecting, analyzing, and<br />
reporting installation population health that is sensitive to significant fluctuations in normal<br />
disease rates, and is coordinated <strong>with</strong> regional and local civilian public health surveillance<br />
systems. Those epidemiological investigative services will include and interact <strong>with</strong> clinical,<br />
environmental health, criminal/forensic services, as well as the surveillance of animal health,<br />
potable water and food, and air quality. In addition, MTFs shall maintain the capability to<br />
investigate and establish whether an infectious disease outbreak is occurring, and develop a case<br />
definition for victims of the outbreak.<br />
4. In the event of an actual disease outbreak or CBRNE event, MTFs shall utilize their cache of<br />
CPCs and Medical Emergency Response Pharmaceuticals (MERP) to support designated<br />
Category 1 and 5 personnel as well as the general installation population. Furthermore, MTFs<br />
shall provide dispensing and/or immunizing teams to screen and educate patients, dispense<br />
pharmaceuticals, and provide post-exposure immunizations. In addition, MTFs shall be prepared<br />
24 Enclosure (1)
BUMEDINST <strong>3440.10</strong><br />
20 Nov 2008<br />
to develop and provide sound and effective medical recommendations for the isolation, quarantine,<br />
restriction of movement, and evacuation of installation personnel. Finally, to assist in the<br />
mitigation and recovery efforts, MTFs shall provide targeted and effective public health risk<br />
communications for use by the region and installation command elements as well as to all<br />
personnel visiting the MTF.<br />
5. The responsibilities outlined in this standard should be carried out in a coordinated manner in<br />
conjunction <strong>with</strong> the NMCPHC and/or the PHEO as appropriate.<br />
FHP EMP Standard 12: Response<br />
1. The <strong>Navy</strong> <strong>Medicine</strong> FHP EMP establishes common response standards for all Category 5<br />
personnel as required by references (e), (h), (m), (o), (s), and (t) of this section.<br />
2. All response standards must be consistent <strong>with</strong> existing OSHA, NIOSH, NFPA standards,<br />
guidelines, and criteria. Response standards shall focus on the first 72 hours post-event, while<br />
acknowledging possible longer response periods during specific events (earthquake, building<br />
collapse, CBRNE, etc.).<br />
3. While preservation of evidence is highly desirable in many cases, actions to recover and/or<br />
preserve evidence shall not compromise the safety of any personnel.<br />
4. The common command and control construct identified in reference (u) of this section shall<br />
be used for all EM events covered by this instruction, <strong>with</strong> the possible exception of bioterrorism<br />
events. This construct shall utilize the HICS and Unified Command System (UCS) as specified<br />
<strong>with</strong>in references (t) and (v) of this section.<br />
5. Base Operating Support (BOS) Category 1 and 5 personnel will respond in accordance <strong>with</strong><br />
reference (b) of this section.<br />
6. MTFs shall use HICS and provide the adequate first receiver functions to include, but not<br />
limited to:<br />
a. Medical and syndromic surveillance.<br />
b. Thorough mass casualty decontamination.<br />
c. Triage and Treatment.<br />
d. Transport.<br />
e. Shelter, shelter-in-place, quarantine, and restriction of movement.<br />
25 Enclosure (1)
f. MTF security and zone management.<br />
g. Psychological care.<br />
h. Medical Examiner.<br />
BUMEDINST <strong>3440.10</strong><br />
20 Nov 2008<br />
7. SOH and IH personnel, where available, shall advise the MTF commander on respiratory<br />
protection and heat stress management. SOH and IH personnel may assist HAZMAT team<br />
personnel, when trained and equipped to do so.<br />
8. Response efforts may quickly exhaust MTF EM capabilities and require the capabilities of<br />
regional, installation, Federal, State, local, other Service, and/or private (or HN) EM-related<br />
agencies and departments. Prior coordination <strong>with</strong> these agencies and departments will<br />
significantly enhance the overall EM capabilities that may be brought to bear in a significant event.<br />
The implementation of appropriate Memorandum of Understanding (MOU) or Memoranda of<br />
Agreement (MOA) in advance of actual emergency situations is encouraged. Special attention and<br />
planning must be focused on the fiscal and logistical impact of response efforts.<br />
FHP EMP Standard 13: Recovery<br />
1. The <strong>Navy</strong> <strong>Medicine</strong> FHP EMP establishes common recovery standards for Category 5<br />
personnel as required by references (e), (l), (m), (o), (q), (w), (x), and (y) of this section.<br />
2. All recovery standards must be consistent <strong>with</strong> existing OSHA guidelines and NFPA<br />
standards. <strong>Navy</strong> Environmental and Natural Resources Program representatives shall ensure that<br />
all recovery efforts are in compliance <strong>with</strong> reference (z) of this section and applicable EPA<br />
guidelines.<br />
3. Recovery efforts may quickly exhaust MTF EM capabilities and require the capabilities of<br />
regional, installation, Federal, State, local, other Service, and/or private (or HN) EM-related<br />
agencies and departments. Prior coordination <strong>with</strong> these agencies and departments will<br />
significantly enhance the overall EM capabilities that may be brought to bear in a significant<br />
event. Special attention and planning must be focused on the fiscal and logistical impact of<br />
recovery efforts.<br />
FHP EMP Standard 14: Sustainment<br />
1. BUMED will establish the programming, budgeting, and resourcing necessary to develop<br />
and sustain FHP EMP requirement per references (e) and (o) of this section. The MTF FHP<br />
EMP, via the NAVMEDREG, shall provide BUMED <strong>with</strong> any unique MTF EM mission<br />
requirements, deficiencies, or new start programs. BUMED will validate these requests in close<br />
coordination <strong>with</strong> the respective NAVMEDREG.<br />
26 Enclosure (1)
BUMEDINST <strong>3440.10</strong><br />
20 Nov 2008<br />
SECTION 2<br />
NATIONAL INCIDENT MANAGEMENT SYSTEM (NIMS) COMPLIANCE<br />
Ref: (a) Homeland Security Presidential Directive/HSPD-5<br />
(b) National Incident Management System (NIMS)<br />
(c) National Response Plan<br />
(d) Implementation of the National Response Plan and the National Incident<br />
Management System, DEPSECDEF memo of 29 Nov 2005<br />
1. Purpose. To provide guidance to MTF commanders on issues of compliance <strong>with</strong> the NIMS<br />
to ensure efficient and effective use of NIMS in its emergency management planning,<br />
preparedness, response, recovery, and mitigation activities.<br />
2. Background<br />
a. Reference (a) of this section requires all Federal Departments and Agencies to adopt<br />
NIMS for domestic incident management. References (b) and (c) of this section establish an alldiscipline,<br />
all-hazards approach to the management of domestic incidents. Reference (d) of this<br />
section provides direction on DoD implementation of NIMS and the NRP. Paragraph 5 of this<br />
section provides NIMS guidance and implementation activities for hospitals and health care<br />
systems. Paragraph 6 of this section provides specific minimum training guidance for <strong>Navy</strong><br />
<strong>Medicine</strong> personnel.<br />
b. <strong>Navy</strong> <strong>Medicine</strong> provides support to civil authorities for domestic incidents as directed by<br />
the President or Secretary of Defense, consistent <strong>with</strong> military readiness and when appropriate<br />
under the circumstances and the law. <strong>Navy</strong> <strong>Medicine</strong> will also receive support from civil<br />
authorities in response to domestic incidents, which can be essential to sustaining or restoring<br />
<strong>Navy</strong> <strong>Medicine</strong> capabilities that are critical to operations and the execution of the National<br />
Military Strategy. Any such mutually beneficial, cooperative relationship is most effective when<br />
based upon a shared understanding <strong>with</strong> a common language and structure for coordination.<br />
NIMS and NRP were issued by the U.S. DHS to provide that comprehensive and consistent<br />
national framework to all-hazard incident management at all jurisdictional levels and across<br />
functional disciplines.<br />
c. The NIMS Integration Center (NIC), in collaboration <strong>with</strong> the HHS, developed the NIMS<br />
implementation activities for hospitals and health care systems to assist them <strong>with</strong> NIMS<br />
implementation and integration, further enhancing their efficiency and effectiveness in response<br />
and recovery. This guidance provides direction that will advance individual hospital and health<br />
care emergency management and preparedness.<br />
3. Responsibility. BUMED-M3/5 has established minimum training requirements for<br />
designated <strong>Navy</strong> <strong>Medicine</strong> personnel <strong>with</strong> a reasonable likelihood of involvement in incident<br />
management/response; all designated <strong>Navy</strong> <strong>Medicine</strong> personnel shall meet the requirements of<br />
paragraph 6 of this section. Personnel currently serving in the positions identified in paragraph 6<br />
27 Enclosure (1)
BUMEDINST <strong>3440.10</strong><br />
20 Nov 2008<br />
of this section must complete requirements <strong>with</strong>in 90 days. Those personnel newly assigned to<br />
the positions identified in paragraph 6 of this section must complete requirements <strong>with</strong>in 90 days<br />
of reporting aboard. The MTF commander shall:<br />
a. Ensure that NIMS is an integral part of the MTF’s EM Plan.<br />
b. Ensure the MTF has taken steps to meet all the NIMS implementation activities for<br />
hospitals and health care systems per paragraph 5 of this section.<br />
c. Ensure training completion is tracked in local training records.<br />
4. Procedures. All BUMED MTFs shall meet the requirements for NIMS implementation<br />
activities. Additional specific guidance for elements <strong>with</strong>in the NIMS implementation activities:<br />
a. Incident Command System (ICS). In accordance <strong>with</strong> the accompanying instruction, all<br />
BUMED MTFs will adopt the HICS.<br />
b. Multi-agency Coordination System. MTF commanders shall coordinate <strong>with</strong> regional<br />
and installation commanders in the development of relationships <strong>with</strong> the appropriate Federal,<br />
State, local, and tribal EM-related agencies and departments to identify and update responsible<br />
points of contact, emergency protocols, and expectations in the event of an incident. This task<br />
should also include local medical community organizational planning via local emergency<br />
planning committees.<br />
c. Support Agreements (SA). MTF commanders shall coordinate <strong>with</strong> regional and<br />
installation EM personnel, BUMED-M3/5, and local emergency responders/receivers in the<br />
development of SAs.<br />
d. Training. DHS/Federal Emergency Management Agency (FEMA) provides free<br />
online training via the Emergency Management Institute Independent Study Program<br />
(http://www.training.fema.gov/EMIWeb/IS/), for personnel involved in emergency response.<br />
All required independent study courses may be found at this link.<br />
5. National Incident Management System (NIMS). Compliance Activities for Health Care<br />
Organizations (public and private) 1 .<br />
1 Draft developed for discussion by the HICS National Working Group and consideration by the NIMS Integration Center to address the question<br />
of “what types of activities should health care organizations engage in to ensure NIMS compliance?” The draft was developed from the NIMS<br />
National Standard Curriculum Training Development Guidance. Adaptations of the language for each element for health care organizations<br />
follows legislative format, <strong>with</strong> underlined items (additions) and strikethroughs (deletions). Examples of compliance were added to provide<br />
additional specificity to a health care organization.<br />
a. Organizational Adoption<br />
(1) Element 1. Adopt NIMS at the organizational level for all departments and business<br />
units, as well as promote and encourage NIMS adoption by associations, utilities, partners, and<br />
suppliers.<br />
28 Enclosure (1)
BUMEDINST <strong>3440.10</strong><br />
20 Nov 2008<br />
Example of compliance: The seventeen elements included in this document are<br />
addressed in the organization’s emergency management program documentation.<br />
b. Command and Management<br />
(2) Element 2. Incident Command System (ICS). Manage all emergency incidents<br />
and preplanned (recurring/special events) in accordance <strong>with</strong> ICS organizational structures,<br />
doctrine, and procedures, as defined in NIMS. ICS implementation must include consistent<br />
application of Incident Action Planning and Common Communications Plans.<br />
Example of compliance: The organization’s Emergency Operations Plan explains the<br />
use of ICS, particularly incident action planning and a common communications plan.<br />
(3) Element 3. Multi-agency Coordination System. Coordinate and support<br />
emergency incident and event management through the development and use of integrated multiagency<br />
coordination systems. That is, develop and coordinate connectivity capability <strong>with</strong><br />
hospital Emergency Operations Center (EOC) and local incident command posts (ICPs), local<br />
911 centers, local EOCs, and the State EOC as applicable.<br />
Example of compliance: The organization’s Emergency Operations Plan explains the<br />
management and coordination linkage between the organization’s EOC and other, similar,<br />
external centers (multi-agency coordination system entities).<br />
(4) Element 4. Public Information System (PIS). Implement processes and/or plans to<br />
communicate timely, accurate information including through a Joint Information System and<br />
Joint Information Center.<br />
Example of compliance: The organization’s Emergency Operations Plan explains the<br />
management and coordination of public information <strong>with</strong> health care partners and jurisdictional<br />
authorities, such as local public health, emergency management, and so on.<br />
c. Preparedness Planning<br />
(5) Element 5. Health care organizations will track NIMS implementation on a yearly<br />
basis as part of the organization’s emergency management program.<br />
Example of compliance: NIMS organizational adoption, command and management,<br />
preparedness/planning, preparedness/training, preparedness/exercises, resource management,<br />
and communication and information management activities will be tracked from year-to-year<br />
<strong>with</strong> a goal of improving overall emergency management capability.<br />
(6) Element 6. Develop and implement a system to coordinate appropriate hospital<br />
preparedness funding to employ NIMS across the organization.<br />
Example of compliance: The organization’s emergency management program<br />
documentation includes information on local, State, and Federal preparedness grants that have<br />
been received and work progress.<br />
29 Enclosure (1)
BUMEDINST <strong>3440.10</strong><br />
20 Nov 2008<br />
(7) Element 7. Revise and update plans and standard operating procedures (SOPs) to<br />
incorporate NIMS components, principles, and policies, to include planning, training, response,<br />
exercises, equipment, evaluation, and corrective action.<br />
Example of compliance: The organization’s emergency management program work<br />
plan reflects status of any revisions to the Emergency Operations Plan, training materials,<br />
response procedures, exercise procedures, equipment changes and/or purchases, evaluation, and<br />
corrective action processes.<br />
(8) Element 8. Participate in and promote interagency mutual aid agreements, to include<br />
agreements <strong>with</strong> the public and private sector and non-governmental organizations.<br />
Example of compliance: The organization’s emergency management program<br />
documentation includes information on mutual aid agreements.<br />
d. Preparedness Training<br />
(9) Element 9. Complete IS-700: NIMS: An Introduction.<br />
Example of compliance: The organization’s emergency management program<br />
training records track completion of IS-700 (or equivalent as approved by BUMED-M3/5) by<br />
personnel <strong>with</strong> a direct role in emergency preparedness, incident management, or response.<br />
(See NIMS Health Care Training Guidance.)<br />
(10) Element 10. Complete IS-800: NRP: An Introduction.<br />
Example of compliance: The organization’s emergency preparedness program<br />
training records track completion of IS-800 or equivalent by personnel whose primary<br />
responsibility is emergency management. (See NIMS Health Care Training Guidance.)<br />
(11) Element 11. Complete ICS-100 and ICS-200 training.<br />
Examples of compliance:<br />
• The organization’s emergency preparedness program training records track<br />
completion of ICS-100 or equivalent by personnel at the entry level, first-line supervisor level,<br />
middle management level, and command and general staff level of emergency management<br />
operations. (See NIMS Health Care Training Guidance.)<br />
• The organization’s emergency management program training records track<br />
completion of ICS-200 or equivalent by personnel at the first-line supervisor level, middle<br />
management level, and command and general staff level of emergency management operations.<br />
(See NIMS Health Care Training Guidance.)<br />
30 Enclosure (1)
e. Preparedness Exercises<br />
BUMEDINST <strong>3440.10</strong><br />
20 Nov 2008<br />
(12) Element 12. Incorporate NIMS/ICS into internal and external, local, and regional<br />
emergency management training and exercises.<br />
Example of compliance: The organization’s emergency management program<br />
training and exercise documentation reflects use of NIMS/ICS.<br />
(13) Element 13. Participate in an all-hazard exercise program based on NIMS that<br />
involves responders from multiple disciplines, multiple agencies, and organizations.<br />
Example of compliance: The organization’s emergency management program<br />
training and exercise documentation reflects the organization’s participation in exercises <strong>with</strong><br />
various external entities.<br />
(14) Element 14. Incorporate corrective actions into preparedness and response plans<br />
and procedures.<br />
Example of compliance: The organization’s emergency management program<br />
documentation reflects a corrective action process.<br />
f. Resource Management<br />
(15) Element 15. Maintain an inventory of organizational response assets.<br />
Example of compliance: The organization’s emergency management program<br />
documentation includes a resource inventory (e.g., medical/surgical supplies, pharmaceuticals,<br />
personal protective equipment, staffing, etc.).<br />
(16) Element 16. To the extent permissible by law, ensure that relevant national<br />
standards and guidance to achieve equipment, communication, and data interoperability are<br />
incorporated into acquisition programs.<br />
Example of compliance: The organization’s emergency management program<br />
documentation includes emphasis on the interoperability of response equipment,<br />
communications, and data systems <strong>with</strong> external entities.<br />
g. Communications and Information Management<br />
(17) Element 17. Apply standardized and consistent terminology, including the<br />
establishment of plain English communications standards across the public safety sector.<br />
Example of compliance: The organization’s emergency management program<br />
documentation reflects an emphasis on the use of plain English by staff during emergencies.<br />
31 Enclosure (1)
6. <strong>Navy</strong> <strong>Medicine</strong> NIMS Compliance Matrix<br />
FEMA EMI<br />
Independent Courses<br />
IS-1<br />
Emergency Manager: An Orientation to the Position<br />
IS-100/IS-100.HC<br />
Introduction to Incident Command System<br />
IS-200/IS-200.HC<br />
ICS for Single Resource and Initial Action Incidents<br />
IS-275<br />
The EOC's Role in Community Preparedness, Response,<br />
and Recovery Activities<br />
IS-300<br />
Intermediate ICS Course (12 months)<br />
IS-400<br />
Advanced ICS Course (12 months)<br />
IS-700<br />
National Incident Management System (NIMS), An<br />
Introduction<br />
IS-701<br />
Multi-agency Coordination System (MACS)<br />
IS-800-F<br />
National Response Framework (NRF), An Introduction<br />
IS-1900<br />
National Disaster Medical System (NDMS) Federal<br />
Coordination Center Operations Course<br />
All<br />
Personnel<br />
X<br />
EMOs<br />
X<br />
X<br />
X<br />
X<br />
X<br />
BUMEDINST <strong>3440.10</strong><br />
20 Nov 2008<br />
Management and<br />
Personnel <strong>with</strong><br />
EM Roles**<br />
** Personnel that have a:<br />
(1) Leadership role in emergency or incident management and/or;<br />
(2) Emergency first responder/receiver functions during an incident (i.e., DECON, Treatment/Triage, etc.).<br />
X<br />
X<br />
X<br />
X<br />
X<br />
X<br />
X<br />
X<br />
X<br />
PHEOs<br />
32 Enclosure (1)<br />
X<br />
X<br />
X<br />
X
SECTION 3<br />
COMMAND AND CONTROL<br />
Ref: (a) National Incident Management System (NIMS)<br />
(b) Hospital Incident Command System (HICS) Guidebook<br />
BUMEDINST <strong>3440.10</strong><br />
20 Nov 2008<br />
1. Purpose. To provide guidance to MTF commanders on issues of Command and Control (C2)<br />
<strong>with</strong>in the framework of EM operations.<br />
2. Background<br />
a. The MTF command structure is an excellent model for daily business operations, and, in<br />
many cases, increased operational tempo events. However, in the face of an emergency or large-<br />
scale event requiring concise and smooth interoperability <strong>with</strong> other DoD commands or agencies,<br />
other Federal agencies, or State and local responders, the normal command structure and position<br />
titles are not the most efficient means to conduct EM operations.<br />
b. The Secretary of Defense and all other cabinet level officers are signatories to the NIMS,<br />
reference (a) of this section. A key item required by this document is that the ICS will be utilized<br />
any time two or more Federal agencies respond to an emergency. Further, the document requires<br />
Federal agencies to encourage partner State and local agencies to utilize the system. This ensures<br />
use of common terminology and contributes towards development of a common operating picture<br />
between responding agencies.<br />
c. Reference (b) of this section, the HICS Guidebook, meets NIMS requirements and has<br />
been developed <strong>with</strong> the support of the DHS NIMS Integration Center, Health and Human<br />
Services (HHS), American Hospital Association, and the Joint Commission.<br />
3. Responsibility. The MTF commander shall:<br />
a. Ensure that HICS is utilized as directed herein.<br />
b. Maintain full responsibility for the actions of his or her command and subordinate<br />
commanders when incident command authority is delegated.<br />
4. Procedures<br />
a. HICS shall serve as the command and control tool during all EM events.<br />
b. BUMED MTFs shall utilize HICS as documented in the HICS Guidebook, reference (b)<br />
of this section, whenever the installation or supported community implements ICS for an<br />
incident that will include MTF participation. This will assure commonality of terminology and<br />
functions when operating <strong>with</strong> local, State, tribal, and Federal responders/receivers, other<br />
hospitals, or local/regional emergency operations centers.<br />
33 Enclosure (1)
BUMEDINST <strong>3440.10</strong><br />
20 Nov 2008<br />
(1) MTFs should consider utilization of HICS for any large-scale events that have the<br />
potential to cause disruptions in normal activities.<br />
(2) Personnel functioning under HICS and serving in positions at the command staff or<br />
section chief level should be aware of the relationship to the military staff structure. This will<br />
ease transition <strong>with</strong> participating military agencies that may not have implemented ICS. Further,<br />
understanding the relationship will assist in fostering a better understanding of ICS/HICS and the<br />
staff structure.<br />
c. BUMED MTFs will utilize the crosswalk chart provided in the HICS Guidebook to<br />
determine the most appropriate personnel to fill each relevant position. It is suggested that MTFs<br />
examine different scenarios, including the DHS 15 national planning scenarios, to determine and<br />
develop crosswalk charts for each of these scenarios, as different personnel may be appropriate in<br />
different positions depending on the event.<br />
34 Enclosure (1)
BUMEDINST <strong>3440.10</strong><br />
20 Nov 2008<br />
SECTION 4<br />
REQUIRED EMERGENCY MANAGEMENT (EM) PLAN ANNEXES<br />
1. Purpose. To provide guidance to MTF commanders on the content of MTF EM Plans.<br />
2. Background. <strong>Navy</strong> <strong>Medicine</strong> will standardize EM planning to the maximum extent possible.<br />
While EM Plans will vary between MTFs, the format and content should be standardized across<br />
BUMED MTFs. Maintaining standard formats and content supports capabilities-based planning,<br />
standard readiness metrics, streamlined training of personnel, and allows for economies of scale<br />
in logistical support and sustainment of the FHP EMP.<br />
3. Responsibility. The MTF commander shall:<br />
a. Develop an EM Plan that meets all the requirements of this instruction.<br />
b. Assure all annexes listed as required are included in the MTF EM Plan. Additional<br />
annexes applicable to local risked-based hazards should be developed and included.<br />
4. Procedures<br />
a. Review required annexes and develop them to support each MTF mission.<br />
b. Develop the list of required and risked-based annexes to assure standardization across<br />
<strong>Navy</strong> <strong>Medicine</strong>.<br />
5. Required Annexes for all MTF EM Plans<br />
a. Command and Control.<br />
b. Continuity of Operations Plan.<br />
c. Personnel Recall.<br />
d. Hazard and Vulnerability Analysis (HVA).<br />
e. Communications<br />
(1) Reporting Requirements.<br />
(2) Format.<br />
f. Acronyms and Definitions.<br />
35 Enclosure (1)
g. Hazard Specific Annexes<br />
(1) Chemical.<br />
(2) Biological.<br />
(3) Radiological.<br />
(4) Nuclear.<br />
(5) Explosive.<br />
i. Functional Annexes<br />
(1) Surge Capacity.<br />
(2) Shelter-in-Place.<br />
(3) Evacuation.<br />
(4) Mass Care.<br />
(5) Physical Security.<br />
(6) Mass Fatality.<br />
j. NDMS/FCC Operations Annex (<strong>Navy</strong> FCCs only).<br />
k. Hazard Mitigation and Recovery Operations.<br />
BUMEDINST <strong>3440.10</strong><br />
20 Nov 2008<br />
6. Situation Dependant Annexes. These annexes are to be adopted and included when indicated<br />
by the annual HVA.<br />
a. Extreme Weather.<br />
b. NDMS Patient Reception Area Plan.<br />
c. Wildfire.<br />
d. Seismic event.<br />
e. External flooding.<br />
36 Enclosure (1)
SECTION 5<br />
NAVY MEDICINE EMP EMO COMPETENCIES AND<br />
STANDARDIZED CIVILIAN CLASSIFICATION<br />
Ref: (a) MTF Interim Emergency Manager Competencies Memo of 12 Nov 2004<br />
BUMEDINST <strong>3440.10</strong><br />
20 Nov 2008<br />
1. Purpose. To provide guidance regarding the qualifications and competencies required of all<br />
EMOs in <strong>Navy</strong> <strong>Medicine</strong> as well as identifying standardized position classifications for civilian<br />
EMOs across BUMED activities.<br />
2. Background. EM is an evolving and developing profession which has been growing in scope<br />
and regulation since the creation of the U.S. DHS. Accordingly, <strong>Navy</strong> <strong>Medicine</strong> must detail<br />
and/or employ well-qualified individuals to these positions to assure proper execution of an FHP<br />
EMP and successful integration <strong>with</strong> other Federal, State, local, and tribal communities.<br />
3. Scope. The guidance and requirements set forth in this section applies to all current and<br />
future <strong>Navy</strong> <strong>Medicine</strong> personnel who encumber EM positions, even if not titled EMO<br />
specifically.<br />
4. Action<br />
a. BUMED, NAVMEDREG East, NAVMEDREG West, NAVMEDREG NCA, and all<br />
Tier 1 and 2 facilities shall have a qualified commissioned officer or civil service EMO as<br />
defined in paragraph 4d below.<br />
b. NAVMEDSUPCOM and all Tier 3 and 4 facilities shall have a qualified EMO as defined<br />
by reference (a) of this section.<br />
c. NAVMEDREG East, NAVMEDREG West, NAVMEDREG NCA, and all Tier 1<br />
through Tier 4 facilities shall utilize the approved position description located on the following<br />
page for hiring or converting personnel to perform EM functions <strong>with</strong>in <strong>Navy</strong> <strong>Medicine</strong> as<br />
civilian employees.<br />
d. Minimum EMO Qualifications for Echelon 2 and 3, Commands as well as Tier 1 and 2<br />
commands:<br />
Qualification/Training Required NLT<br />
International Association of Emergency Managers,<br />
Certified Emergency Manager ®<br />
End FY-10<br />
Minimum 3 years experience in EM Prior to employment/assignment<br />
Strong working knowledge of ICS and HICS Prior to employment/assignment<br />
Familiarity <strong>with</strong> USNORTHCOM JRMPO program 90 days after employment/assignment<br />
Reference (a) 90 days after employment/assignment<br />
37 Enclosure (1)
BUMEDINST <strong>3440.10</strong><br />
20 Nov 2008<br />
38 Enclosure (1)
BUMEDINST <strong>3440.10</strong><br />
20 Nov 2008<br />
39 Enclosure (1)
BUMEDINST <strong>3440.10</strong><br />
20 Nov 2008<br />
40 Enclosure (1)
SECTION 6<br />
PROCEDURES FOR REQUESTING WAIVERS AND<br />
EXCEPTIONS TO POLICY<br />
BUMEDINST <strong>3440.10</strong> CH-2<br />
25 Apr 2012<br />
Ref: (a) NTTP 3-07.2.3, Law Enforcement and Physical Security for <strong>Navy</strong> Installations<br />
1. Purpose. To provide guidance regarding the procedures for requesting waivers and<br />
exceptions to policy for the requirements established in the BUMED <strong>Navy</strong> <strong>Medicine</strong> FHP EMP<br />
Manual, BUMEDINST <strong>3440.10</strong>.<br />
2. Background. This section governs the procedures for requesting and approving waivers or<br />
exceptions to policy for BUMEDINST <strong>3440.10</strong>, <strong>Navy</strong> <strong>Medicine</strong> FHP EMP Manual. It mirrors<br />
the procedures contained in reference (a) used to request similar waivers or exceptions for<br />
established security requirements on <strong>Navy</strong> installations. Commanders at all levels must weigh<br />
the risks involved in complying <strong>with</strong> the requirements and standards contained in numerous<br />
instructions. The inability to meet minimum standards and requirements may result in an<br />
increased risk to the MTF. Whenever the mandatory requirements ofBUMEDINST <strong>3440.10</strong><br />
cannot be met by a BUMED commanded activity subject to this instruction, the activity must<br />
request a waiver or exception in accordance <strong>with</strong> this section. Waivers and exceptions to policy<br />
will be evaluated based on merit only and must include compensatory measures.<br />
a. Waiver. A waiver is written temporary relief, normally for a period of 1 year or less,<br />
from specific requirements established by this instruction. A waiver will be requested whenever<br />
a requirement prescribed in this instruction is not currently achieved, but the condition is<br />
correctable <strong>with</strong>in 1 year.<br />
b. Exception. An exception is written long-term (for a period greater than 12 months) or<br />
permanent relief, from specific requirements established by this instruction. An exception will<br />
be requested whenever a requirement prescribed in this instruction cannot be achieved, or when<br />
attainment of the requirement requires more than one year. Exceptions shall also be submitted<br />
when corrective actions would be cost-prohibitive.<br />
3. Scope. The guidance and requirements set forth in this section apply to all requirements<br />
established by this instruction.<br />
4. Action. All <strong>Navy</strong> <strong>Medicine</strong> region and MTF commanders, commanding officers, and<br />
officers in charge shall:<br />
a. Submit a request for waiver or exception whenever the mandatory requirements of<br />
BUMEDINST 3440.1 0 are not achieved and attainment is not expected <strong>with</strong>in 30 days.<br />
Requests for waivers and exceptions will be submitted in the format outlined in this section.<br />
Blanket waivers and exceptions are not authorized. Waivers and long-term exceptions are selfcanceling<br />
on the expiration dates stated in the approval letters unless the original approval<br />
authority approves an extension. Cancellations do not require BUMED approval.<br />
41 Enclosure (1)
BUMEDINST <strong>3440.10</strong> CH-2<br />
25 Apr 2012<br />
b. Requests for waivers or exceptions will be submitted via the chain of command from the<br />
MTF to the <strong>Navy</strong> <strong>Medicine</strong> region commander to BUMED. The request for waiver must include<br />
a complete description of the problem and alternative procedures, as appropriate. It is important<br />
to note that the inability to completely meet a requirement is not justification to waive the<br />
requirement entirely. For example, manning shortfalls that prevent an MTF from fully staffing a<br />
medical decontamination team are justification to field a partially staffed decontamination team<br />
and request a waiver for the partial staffing; they are not justification to ignore the requirement<br />
entirely and request it be waived. Waiver approvals will normally be for a period of 12 months<br />
and long-term exception approvals will normally be for a period of 36 months. Extensions of the<br />
waiver or exception (normally for 12 months) must be requested via the chain of command and<br />
approved by BUMED. Waiver and exception extension requests will refer to previous<br />
correspondence approving initial and previous extensions, as appropriate.<br />
c. Requests shall be in letter format in accordance <strong>with</strong> the <strong>Navy</strong> Correspondence Manual,<br />
and all elements of the applicable table below will be specifically addressed. Non-applicable<br />
elements will be noted as NI A.<br />
Table 6.1<br />
Required Elements for Waivers Request<br />
Element 1 Full name and UIC of the requesting MTF<br />
Element 2 Statement of the waiver requirement and references to the standard<br />
and pagel paragraph in this instruction that cite the standard that<br />
cannot be met<br />
Element 3 Specific description of conditi6n(s) that caused the need for the<br />
waiver and reason(s) why applicable standards in this manual<br />
cannot be met<br />
Element 4 Identify interim mandatory compensatory measures in effect or<br />
planned<br />
Element 5 Describe the impact on mission and any problems that will<br />
interfere <strong>with</strong> safety or<br />
operating requirements if the waiver is not approved<br />
Element 6 Identify resources, including estimated cost from which budgeting<br />
decisions can be<br />
made, to eliminate the waiver<br />
Element 7 Identify actions initiated or planned (local capability or other) to<br />
eliminate the waiver and estimated time to complete<br />
Element 8 Provide point of contact to include name, rank/grade, DSN, and<br />
commercial phone<br />
numbers<br />
42 Enclosure (1 )
Element 1<br />
Element 2<br />
Element 3<br />
Element 4<br />
Element 5<br />
Element 6<br />
Element 7<br />
Element 8<br />
Element 1<br />
Element 2<br />
Element 3<br />
Element 4<br />
Element 5<br />
Element 6<br />
Table 6.2<br />
Required Elements for Long-Term Exceptions Requests<br />
BVMEDINST <strong>3440.10</strong> CH-2<br />
25 Apr 2012<br />
Full name and VIC ofthe requesting MTF<br />
Statement of the long-term exception requirement and references to the<br />
standard and page/paragraph in this instruction that cite the standard<br />
that cannot be met<br />
Specific description of condition(s) that caused the need for the<br />
permanent exception and reason(s) why applicable standards in this<br />
manual cannot be met<br />
Identify interim mandatory compensatory measures in effect or planned<br />
Describe the impact on mission and any problems that will interfere<br />
<strong>with</strong> safety or<br />
operating requirements if the long-term exception is not approved<br />
Identify resources, including estimated cost from which budgeting<br />
decisions can be<br />
made, to eliminate the long-term exception<br />
Identify actions initiated or planned (local capability or other) to<br />
eliminate the long-term exception and estimated time to complete<br />
Provide point of contact to include name, rank/grade, DSN, and<br />
commercial phone numbers<br />
Table 6.3<br />
Format for Requests for Permanent Exceptions<br />
Full name and VIC of the requesting MTF<br />
Statement of the permanent exception requirement and reference to the<br />
standard and page/paragraph in this instruction that cite the standard<br />
that cannot be met<br />
Specific description of condition(s) that caused the need for the<br />
permanent exception and reason(s) why applicable standards in this<br />
manual cannot be met<br />
Identify, in detail, compensatory security measures that are being<br />
applied<br />
Describe the impact on mission and any problems that will interfere<br />
<strong>with</strong> safety or<br />
operating requirements if the permanent exception is not approved<br />
Provide point of contact to include name, rank/grade, DSN, and<br />
commercial phone<br />
numbers<br />
43 Enclosure (1)
From:<br />
To:<br />
Via:<br />
SAMPLE WAIVER REQUEST<br />
BUMEDINST <strong>3440.10</strong> CH-2<br />
25 Apr 2012<br />
3440<br />
Serial<br />
Date<br />
Officer in Charge, Naval Branch Health Clinic, Naval Air Station Jacksonville, FL<br />
Chief, Bureau of <strong>Medicine</strong> and Surgery (M3)<br />
(1) Commanding Officer, Naval Hospital Jacksonville, FL<br />
(2) Commander, <strong>Navy</strong> <strong>Medicine</strong> East<br />
Subj: REQUEST FOR WAIVER TO NAVY MEDICINE FORCE HEALTH PROTECTION<br />
EMERGENCY MANAGEMENT PROGRAM<br />
Ref: (a) BUMEDINST <strong>3440.10</strong><br />
Encl: (1) Waiver Request in case of Naval Branch Health Clinic, Naval Air Station<br />
Jacksonville<br />
1. In accordance <strong>with</strong> reference (a), enclosure (1) is submitted for consideration.<br />
J. A. SAILOR<br />
44 Enclosure (1 )
Waiver Request in case of Naval Branch Health Clinic,<br />
Naval Air Station Jacksonville<br />
BUMEDINST <strong>3440.10</strong> CH-2<br />
25 Apr 2012<br />
Element 1. Naval Branch Health Clinic (NBHC), Naval Air Station Jacksonville, FL, UIC<br />
34566<br />
Element 2. Request a waiver for the total size of medical response teams as specified in standard<br />
3, pages 6 and 7, Tables 1 and 2, of enclosure (1), BUMED <strong>Navy</strong> <strong>Medicine</strong> FHP EMP Manual,<br />
BUMEDINST <strong>3440.10</strong>.<br />
Element 3. NBHC Jacksonville NAS is a Tier 3 MTF per Table 2 of the subject instruction and<br />
requires a minimum of33 personnel to fully staff the six medical response teams required in<br />
accordance <strong>with</strong> Table 1 of the instruction. Due to continuing individual augmentee<br />
deployments and an ongoing shortfall in hospital corpsmen manning at the E-5 and E-6 levels,<br />
the average daily staffing at the facility for the previous six months has been 28 full-time<br />
personnel, or just under 80 percent of our full allowance. The ongoing shortfall in staffing<br />
precludes fielding a minimum of33 personnel across the six medical response teams.<br />
Element 4. Due to the temporary reduction in manning at the clinic, medical response team<br />
personnel have been shifted to fully staff the decontamination, zone management, detection and<br />
patient administration teams, and the transport and triage/treatment teams have been partially<br />
staffed.<br />
Element 5. All medical response teams are considered fully mission capable and there is no<br />
impact on mission, or any problems that will interfere <strong>with</strong> safety or operating requirements if<br />
the waiver is not approved.<br />
Element 6. Once the clinic is able to return to full staffing, the waiver can be eliminated. There<br />
are no additional resources or funding required, beyond the already approved manning levels for<br />
the clinic.<br />
Element 7. As an interim measure, the clinic is working to identify personnel from other tenant<br />
commands that can be assigned to the medical response teams as a collateral duty. We are<br />
working to scrub an initial list of candidates and estimate it will take an additional 30 days to<br />
fully vet the list, select, and train candidates. However, this augmentation is still considered an<br />
interim solution and a waiver will be required until the clinic's full-time staffing is restored to the<br />
90 percent or greater level.<br />
Element 8. Point of Contact: LCDR John Jones, DSN 123-4567, Commercial (904) 123-4567.<br />
45 Enclosure (1)
From:<br />
To:<br />
Via:<br />
SAMPLE LONG-TERM EXCEPTION REQUEST<br />
BUMEDINST <strong>3440.10</strong> CH-2<br />
25 Apr 2012<br />
3440<br />
Serial<br />
Date<br />
Officer in Charge, Naval Branch Health Clinic, Naval Air Station Jacksonville, FL<br />
Chief, Bureau of <strong>Medicine</strong> and Surgery (M3)<br />
(1) Commanding Officer, Naval Hospital Jacksonville, FL<br />
(2) Commander, <strong>Navy</strong> <strong>Medicine</strong> East<br />
Subj: REQUEST FOR LONG-TERM EXCEPTION TO NAVY MEDICINE FORCE<br />
HEALTH PROTECTION EMERGENCY MANAGEMENT PROGRAM<br />
Ref: (a) BUMEDINST <strong>3440.10</strong><br />
Encl: (1) Long-Term Exception Request in case of Naval Branch Health Clinic, Naval Air<br />
Station Jacksonville<br />
1. In accordance <strong>with</strong> reference (a), enclosure (1) is submitted for consideration.<br />
J. A. SAILOR<br />
46 Enclosure (1)
BUMEDINST <strong>3440.10</strong> CH-2<br />
25 Apr2012<br />
Long-Term Exception Request in case of Naval Branch Health Clinic,<br />
Naval Air Station Jacksonville<br />
Element 1. Naval Branch Health Clinic, Naval Air Station Jacksonville, FL, UIC 34566.<br />
Element 2. A long-term exception is required for the total size of the medical response teams as<br />
specified in standard 3, pages 6 and 7, Tables 1 and 2, of enclosure (1) of BUMEDINST<br />
<strong>3440.10</strong>.<br />
Element 3. NBHC Jacksonville NAS is a Tier 3 MTF per Table 2 of the subject instruction and<br />
requires a minimum of 33 personnel to fully staff the six medical response teams required per<br />
Table 1 ofthe instruction. Due to a recent reduction in the clinic's Basic Allowance (BA) for<br />
HM manning at the E-5 and E-6Ievels, the maximum staffing at the facility under the revised<br />
allowance will be 22 full-time personnel, or just under 65 percent of our previous allowance.<br />
The decrease in staffing precludes fielding a minimum of33 personnel across the six medical<br />
response teams.<br />
Element 4. Due to the long-term reduction in manning at the clinic, medical response team<br />
personnel have been shifted to fully staff the decontamination, zone management, detection and<br />
patient administration teams, and the transport and triage/treatment teams have been partially<br />
staffed.<br />
Element 5. All medical response teams are considered fully mission capable and there is no<br />
impact on mission, or any problems that will interfere <strong>with</strong> safety or operating requirements if<br />
the long-term exception is not approved.<br />
Element 6. If the clinic's HM manning is restored to previous allowance levels, the long-term<br />
exception can be eliminated. There are no additional resources or funding required, beyond the<br />
restoration of the former HM manning levels for the clinic.<br />
Element 7. As a possible solution, the clinic is working to identify personnel from other tenant<br />
commands that can be assigned to the medical response teams as a collateral duty. Establishing<br />
Memorandums of Agreement (MOAs) <strong>with</strong> tenant commands to provide this contingency<br />
augmentation is considered the best long-term solution to mitigate the decrease in HM manning<br />
allowances. A long-term exception will be required until the clinic's staffing is restored to the<br />
previous level, or MOAs are in place to provide the additional personnel to fully staff the<br />
medical response teams.<br />
Element 8. Point of Contact: LCDR John Jones, DSN 123-4567, Commercial (904) 123-4567.<br />
47 Enclosure (1)
From:<br />
To:<br />
Via:<br />
SAMPLE PERMANENT EXCEPTION REQUEST<br />
BUMEDINST <strong>3440.10</strong> CH-2<br />
25 Apr 2012<br />
3440<br />
Serial<br />
Date<br />
Officer in Charge, Naval Branch Health Clinic, Naval Air Station Jacksonville, FL<br />
Chief, Bureau of <strong>Medicine</strong> and Surgery (M3)<br />
(1) Commanding Officer, Naval Hospital Jacksonville, FL<br />
(2) Commander, <strong>Navy</strong> <strong>Medicine</strong> East<br />
Subj: REQUEST FOR PERMANENT EXCEPTION TO NAVY MEDICINE FORCE<br />
HEALTH PROTECTION EMERGENCY MANAGEMENT PROGRAM<br />
Ref: (a) BUMEDINST <strong>3440.10</strong><br />
Encl: (1) Permanent Exception Request in case of Naval Branch Health Clinic, Naval Air<br />
Station Jacksonville<br />
1. In accordance <strong>with</strong> reference (a), enclosure (1) is submitted for consideration.<br />
J. A. SAILOR<br />
48 Enclosure (1 )
BUMEDINST <strong>3440.10</strong> CH-2<br />
25 Apr 2012<br />
Permanent Exception Request in case of Naval Branch Health Clinic,<br />
Naval Air Station Jacksonville<br />
Element 1. Naval Branch Health Clinic, Naval Station Mayport, FL, UIC 34567.<br />
Element 2. A permanent exception is required for the total size of the medical response teams as<br />
specified in standard 3, pages 6 and 7, Tables 1 and 2, of enclosure (1) of BUMEDINST<br />
<strong>3440.10</strong>.<br />
Element 3. NBH C Mayport NS is current! y a Tier 3 MTF per Table 2 of the subj ect instruction<br />
and requires a minimum of 33 personnel to fully staff the six medical response teams required<br />
per Table 1 of the instruction. Due to the recent decision to consolidate military staffing for this<br />
clinic <strong>with</strong> the staff at NBHC Jacksonville NAS, and to transition the NBHC Mayport NS to a<br />
Tricare Outpatient Clinic (TOC), there will no longer be any military staff assigned to the<br />
facility. The elimination of military personnel will preclude fielding any medical response teams<br />
from Mayport NS.<br />
Element 4. Due to the permanent elimination of military manning at the Mayport NS clinic, the<br />
facility anticipates being changed to a Tier 4 MTF for emergency management response.<br />
Element 5. The change in status from a NBHC to a TOC will eliminate all organic medical<br />
response team capabilities at Mayport NS and the clinic will be completely unable to meet any<br />
medical response team mission or requirement if the permanent exception is not approved.<br />
Element 6. Point of Contact: LCDR John Jones, DSN 123-4567, Commercial (904) 123-4567.<br />
49 Enclosure (l)
ACRONYMS LISTING<br />
BUMEDINST 3440.14<br />
20 Nov 2008<br />
AAR After Action Report<br />
ACADA Automatic Chemical Agent Detector Alarm<br />
ADP Automated Data Processing<br />
AMAL Authorized Medical Allowance Lists<br />
AOR Area of Responsibility<br />
APR Air-Purifying Respirator<br />
ARC American Red Cross<br />
ASF Auxiliary Security Force<br />
ATFP Antiterrorism Force Protection<br />
ATNAA Antidote Treatment-Nerve Agent Auto-injector<br />
BoA Basis of Allocation<br />
BOS Base Operating Support<br />
BRAC Base Realignment and Closure<br />
BSO Budget Submitting Office<br />
BUMED Bureau of <strong>Medicine</strong> and Surgery<br />
C2 Command and Control<br />
C3 Command, Control, and Communications<br />
CA Civil Authority<br />
CANA Convulsant Antidote for Nerve Agent<br />
CBRND Chemical, Biological, Radiological, and Nuclear Defense<br />
CBRNE Chemical, Biological, Radiological, Nuclear, and Explosives<br />
CEM Certified Emergency Manager<br />
CFFC Commander, Fleet Forces Command<br />
CIP Critical Infrastructure Program<br />
CIV-MIL Civil-Military<br />
CNIC Commander, Naval Installation Command<br />
CNO Chief of Naval Operations<br />
CO Commanding Officer<br />
COOP Continuity of Operations Plan<br />
COTS Commercial-Off-The-Shelf<br />
CPCs CBRN Pharmaceutical Countermeasures<br />
CPX Command Post<br />
DHS Department of Homeland Security<br />
DMLSS Defense Medical Logistics Standard Support<br />
DoD Department of Defense<br />
DON Department of <strong>Navy</strong><br />
DoS Department of State<br />
EM Emergency Management<br />
EMO Emergency Management Officer<br />
EMP Emergency Management Program<br />
EMPRC Emergency Medical Preparedness and Response Course<br />
EMS Emergency Medical Service<br />
EMWG Emergency Management Working Group<br />
Enclosure (2)
BUMEDINST <strong>3440.10</strong><br />
20 Nov 2008<br />
EOC Emergency Operations Center<br />
EOD Explosive Ordnance Disposal<br />
ERT Emergency Response Team<br />
ESC Executive Steering Committee<br />
ESSENCE Electronic Surveillance System for Early Notification of<br />
Community-Based Epidemics<br />
FCC Federal Communications Commission<br />
FE Field Exercises<br />
FEMA Federal Emergency Management Agency<br />
FHP Force Health Protection<br />
FoS Family of Systems<br />
FSEs Full-Scale Exercises<br />
FTX Field Training Exercises<br />
GOTS Government-Off-The-Shelf<br />
HAZMAT Hazardous Material<br />
HD/CS Homeland Defense and Civil Support<br />
HHA Hand-Held Assay<br />
HHS Health and Human Services<br />
HICS Hospital Incident Command System<br />
HN Host Nation<br />
HQMC Headquarters, Marine Corps<br />
HSS Health Services Support<br />
HVA Hazard Vulnerability Assessment<br />
IAB Interagency Board<br />
IAEM International Association of Emergency Managers<br />
ICAM Improved Chemical Agent Monitor<br />
ICP Incident Command Post<br />
ICS Incident Command System<br />
IDLH Immediate Dangerous to Life and Health<br />
IH Industrial Hygiene<br />
IPP Installation Protection Program<br />
ISIC Immediate Superior In Command<br />
IVA Installation Vulnerability Assessments<br />
J-CBDP Joint Chemical Biological Defense Program<br />
JIC Joint Information Center<br />
JPEO-CBD Joint Program Executive Office for Chemical and Biological Defense<br />
JRO J-8/Joint Requirements Office<br />
JSCP Joint Strategic Capability Plan<br />
JSIVA Joint Staff Installation Vulnerability Assessments<br />
JSPDS Joint Service Personnel/Skin Decontamination System<br />
KI Potassium Iodide<br />
LAN Local Area Network<br />
LCC Life-Cycle Cost<br />
LCCE Life-Cycle Cost Estimate<br />
2 Enclosure (2)
BUMEDINST <strong>3440.10</strong><br />
20 Nov 2008<br />
MACS Multi-Agency Coordination System<br />
MBAC Military Biological Advisory Committee<br />
MERP Medical Emergency Response Pharmaceuticals<br />
MOA Memoranda of Agreement<br />
MOU Memorandum of Understanding<br />
MSCA Military Support to Civilian Authorities<br />
MTF Medical Treatment Facility<br />
NATO North Atlantic Treaty Organization<br />
NAVFACHQ Naval Facilities Engineering Command Headquarters<br />
NAVMED MPT&E <strong>Navy</strong> <strong>Medicine</strong> Manpower, Personnel, Training and Education<br />
Command<br />
NAVMEDLOGCOM Naval Medical Logistics Command<br />
NAVMEDREG <strong>Navy</strong> Medical Region<br />
NAVMEDSUPCOM <strong>Navy</strong> <strong>Medicine</strong> Support Command<br />
NAVSEA Naval Sea Systems Command<br />
NDMS National Disaster Medical System<br />
NFPA National Fire Protection Agency<br />
NIC NIMS Integration Center<br />
NIMS National Incident Management System<br />
NIOSH National Institute of Occupational Safety and Health<br />
NKO <strong>Navy</strong> Knowledge On-Line<br />
NMCPHC <strong>Navy</strong> and Marine Corps Public Health Center<br />
NMLL <strong>Navy</strong> <strong>Medicine</strong> Lessons Learned<br />
NOMI Naval Operational <strong>Medicine</strong> Institute<br />
NORTHCOM U.S. Northern Command<br />
NRF National Response Framework<br />
NRP-CIS National Response Plan Catastrophic Incident Supplement<br />
NSF National Security Forces<br />
OASD(HA) Office of the Assistant Secretary of Defense for Health Affairs<br />
OIC Officer in Charge<br />
OSHA Occupational Safety and Health Administration<br />
PAPR Positive Air-Purifying Respirator<br />
PHE Public Health Emergency<br />
PHEO Public Health Emergency Officer<br />
PIS Public Information System<br />
POC Point of Contact<br />
POM Program Objective Memorandum<br />
PPE Personal Protective Equipment<br />
ROC Regional Operations Center<br />
RPP Respiratory Protection Program<br />
RRPAS Rapid Response Powered Air System<br />
RSDL Reactive Skin Decontamination Lotion<br />
SA Support Agreement<br />
SECDEF Secretary of Defense<br />
3 Enclosure (2)
SEL Selected Equipment List<br />
SME Subject Matter Expert<br />
SOH Safety and Occupational Health<br />
SOP Standard Operating Procedure<br />
TTP Tactics, Techniques, and Procedures<br />
TTX Tabletop<br />
UCS Unified Command System<br />
UFC Unified Facilities Criteria<br />
UIC Unit Identification Code<br />
USMC United States Marine Corps<br />
UTC Unit Type Code<br />
WA Written Agreement<br />
BUMEDINST <strong>3440.10</strong><br />
20 Nov 2008<br />
4 Enclosure (2)