Just when I think I’m getting this whole disaster thing, someone throws a new acronym at me. My personal theory is that the higher you go in government, the more acronyms  you find. I’ve spent the last week deciphering acronyms and agencies. Except for those who plan to bug out and live completely on their own after a disaster, it’s not a bad idea to have a basic idea of who does what, and why. Believe me, it’s not all FEMA! On the other hand, if your eyes glaze over and your brain turns off while reading this, I won’t blame you. In fact, it happened to me so many times while writing, it has taken me 4 days to complete this!FEMA

When I dabbled in local preparedness, everything seemed easy to understand. There was County and City Emergency Management, County Public Health, Citizen Corps, Red Cross, and Map Your Neighborhood. The few acronyms made sense, like CERT (Community Emergency Response Teams), MRC (Medical Reserve Corps), ICS (Incident Command System), EOC (Emergency Operations Center) and even FEMA (Federal Emergency Management Agency). In retrospect, it’s interesting that acronyms started creeping in with federally based programs!

My acronym anxiety notched up when attending monthly HPP meetings – a regional group of hospitals, first responders, public health, and emergency managers. Does HPP mean Hospital Preparedness Program or Healthcare Preparedness Program? Even today, I found myself checking once more to make sure I remembered correctly. The answer is Healthcare, although the agenda often focuses on hospitals. In HPP meetings, they throw acronyms around like HAN (Health Alert Network), HOSCAP (Hospital Capacity), and AAR (After-Action Reports). Once you learn them, at least these acronyms usually make sense.

Then last week, I found myself suddenly inundated with acronyms during the Public Health Summit in Atlanta (now forever labeled in my mind as alphabet city). Since I’m not a  government employee, much was new to me.  It seems the federal government has a limited supply of words for divisions, plans, and laws about federal emergency response – they just mix them up in different combinations and assign an acronym.  If you don’t believe me, check out the 78 page reference called FAAT (FEMA Acronyms, Abbreviations & Terms). Not only are there too many acronyms, but agency names often sound the same. You can’t even count on a name sticking around. Each presidential administration issues new directives, leading to reorganization and renaming. People always complain about medical language, but at least doctors use a single word for a single thing, and it rarely changes.

DHSLet’s start with DHS – the well-known Department of Homeland Security. (At a state level, DHS often means Department of Human Services –completely different and quite confusing.) The U.S. DHS is our guru for America’s overall security, preparedness, and response, including coordinating with anyone who owns a piece of the emergency response pie. U.S. DHS responsibilities include things like immigration and border control, TSA (Transportation Security Administration – your favorite airport pat-down artists), the Coast Guard, and the Secret Service.  FEMA (Federal Emergency Management Agency) is the DHS department for actual emergency management, including preparedness, mitigation (advance actions to decrease disaster damage), response, recovery, individual disaster assistance, and local government support (a bit of everything – probably FEMA is the one agency we’ve all heard of).

U.S. DHS created a slew of written plans, which I find difficult to tell apart. Here are some official descriptors – see if you share my confusion:

  • National Preparedness System (no acronym – the National Park Service already claimed NPS): “an organized process for everyone in the community to move forward with preparedness activities and achieve the National Preparedness Goal”, which in turn is defined as “a secure and resilient nation with the capabilities required across the whole community to prevent, protect against, mitigate, respond to, and recover from the threats and hazards that pose the greatest risk.”
  • NRF (National Response Framework): “a guide to how the Nation conducts all-hazards response – from the smallest incident to the largest catastrophe”.
  • NIMS (National Incident Management System): “a comprehensive, national approach to incident management that is applicable at all jurisdictional levels and across functional disciplines”.
  • ESF (Emergency Support Functions): “the structure for coordinating Federal inter-agency support for a Federal response to an incident and mechanisms for grouping functions most frequently used to provide Federal support.”

My best interpretation for you (I confess, I didn’t read the documents in whole – over 450 pages for these 4 areas alone!):ESF-8

  • National Preparedness Goal – a bunch of fancy words describing what a prepared country would look like
  • National Preparedness System focuses on community level preparedness
  • NRF describes the grand scheme of agencies, roles, and responsibilities for emergency response
  • NIMS defines procedures and language to help agencies work together
  • ESF breaks down disaster response into key areas, such as safety, transportation, communications, and energy, and defines which agencies are responsible for each area.

As a doctor, ESF 8 (Public Health and Medical Services) is the area I should understand. The lead agency is HHS (Department of Health and Human Services) – an annoyingly similar acronym to DHS but with completely different words and meaning. HHS also controls a bunch of non-disaster stuff like Medicare, Medicaid, the FDA (Food and Drug Administration), and the NIH (National Institutes of Health). The HHS division for disasters is called ASPR (Office of the Assistant Secretary for Preparedness and Response – previously known as the Office of Public Health Emergency Preparedness, just to keep you on  your toes). ASPR’s mission is to ‘lead the nation in preventing, preparing for, and responding to the adverse health effects of public health emergencies and disasters” – in other words, they focus on medical and health consequences of disasters.ASPR

Among other things, ASPR runs the NDMS (National Disaster Medical System), which includes DMATs (Disaster Medical Assistance Teams), DMORTs (Disaster Mortuary Operational Response Teams), and NVRTs (National Veterinary Response Teams). DMATs consist of trained medical professional teams ready to drop what they are doing and rush to disasters around the country. Triage, emergency care, shelters, hospitals, or primary care – DMATs step in wherever needed (the model I am using to develop our local MRC). DMORT teams handle bodies, including the unpleasant duty of identifying remains, or parts of remains. For pet lovers, NVRTs assess veterinary needs in disaster areas, help with pet care or evacuation, and watch for public health problems associated with pets.

ASPR also deploys FMS (federal medical stations). With equipment, beds, supplies, and pharmaceuticals for up to 250 patients (but not personnel), FMS set up in any available large building such as a gymnasium or hotel. It takes about 60 hours from the time of request until ready to accept their first patient. FMS typically provide hospital overflow care for stable patients, medically fragile shelter care, or even quarantine centers.

Did you know the United States has an active uniformed division called the PHSCC (Public Health Service Commissioned Corps), with ranks and everything? They’re an unarmed force with a public health focus. They fall under the command of the OSG (Office of the Surgeon General – now I understand the military title of general!), which is apparently also my federal home for the MRC. The OSG in turn belongs to another HHS division called ASH (Office of the Assistant Secretary for Health). ASPR provides FMS stuff, but ASH actually provides the staff – go figure! The PHSCC can quickly field RDFs (Rapid Deployment Forces) – 105 member medical teams to staff FMS, or to provide mass care, medication distribution, triage, or primary care – whatever is needed. The PHSCC also provides APHTs (Applied Public Health Teams) “public health in a box” groups who look at environmental health, infrastructure, food safety, epidemiology, and surveillance, and  MHTs (Mental Health Teams) who assess and treat stress and suicide risks within the affected population, as well as helping manage responder stress.NDMS copy

HHS is also the parent agency for the CDC (Centers for Disease Control and Prevention) – “and Prevention” was added in 1992 but luckily didn’t change the acronym.  CDC provides “the expertise, information, and tools that people and communities need to protect their health – through health promotion, prevention of disease, injury and disability, and preparedness for new health threats.”  Traditionally, CDC focused on infectious disease, but gradually expanded to chronic disease, disabilities, injury control, workplace hazards, and environmental health. With the addition of the OPHPR (Office of Public Health Preparedness and Response), CDC now emphasizes “all-hazards preparedness” for Public Health, including disasters, pandemics, and terrorism. Unfortunately, much of the healthcare community still considers CDC a “disease” organization, not a disaster organization, so they miss out on incredible training and information available through the CDC’s COCA (Clinician Outreach Communication Activity).

CDCIn a disaster or public health emergency, not only can CDC help on the scene, but they set up a  CDC EOC (Emergency Operations Center –basic acronym from paragraph one) and convene experts to help decide the best health response. If a serious pandemic or CBRN (chemical, biological, radiation, or nuclear) terrorism event occurs, the CDC will be our go-to group for determining a plan to save as many lives as possible. Obviously, it makes sense that the CDC also maintains and distributes the SNS (Strategic National Stockpile) assets, including mass antibiotics and antidotes.

That’s it for today, or I will go bonkers. Despite the painful process, I believe I now understand who does what in federal disaster response from a health care perspective (at least until someone hands me another acronym). Hopefully others found this of value (if only to appreciate our unbelievably convoluted federal government), and hopefully easier to understand than the official sites.  If I’ve got something wrong, or if someone has a favorite acronym or governmental agency that I’ve neglected, please comment!

Stay Safe,

Sheila Sund, M.D.

P.S. If I counted correctly, I only used acronyms 82 times in the above post – a failure on my part. I was aiming for 100!

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Comments
  1. Judith Scarborough says:

    Thank you for a good laugh (and review!) this morning, Sheila. I find it hilarious that those of us who get involved in disaster response (I am a Medical Reserve Corps unit coordinator) are required almost at the onset to take NIMS training which specifically states – SPEAK IN PLAIN ENGLISH & DO NOT USE ACRONYMS. And then when we get into the business and in the field and at conferences, that is all you hear. Congratulations on surviving your first PHP Summit.

    • disasterdoc says:

      I’m glad you enjoyed it. My amusement with the whole federal language thing started when taking NIMS. They talk about plain English, but their writing is horrible. Considering NIMS is required for so many people, you’d think they could make the language accessible. I’m sure I’ll soon be throwing around acronyms like the rest of you, but I hope I never forget how incomprehensible they can be. To my blog readers – if I ever start sounding like a government publication, feel free to chastise me!

  2. I feel confident that you already are using acronyms instinctually. QID, ASA, and CAT are common, and of course, you also have to fight through the context specific definitions, such as with PCP, which is either the primary care physician, or the reason you’re in the ER to begin with.

    Also painful is the world of abbreviations.

    • disasterdoc says:

      I hadn’t thought about it before, but maybe part of my sensitivity to acronyms comes from working in a Joint Commission accredited hospice for 13 years. Joint Commission determined that medical errors happen from misunderstood abbreviations, so agencies are required to have plans for controlling abbreviation use. In our agency, we eliminated almost all abbreviations and acronyms for anything that went outside the agency (including all medication orders and physician correspondence), and we had a list of “no-no” abbreviations even for internal use, including qid, bid, etc. So it’s been years since I used most medical abbreviations. Once I got used to avoiding them, I discovered I actually liked it, and communications were much clearer.

      In reality, I’d rather use acronyms than names for governmental departments – the names are too similar and confusing. I just wish the system made a bit more sense, and there was a better way of communicating what agencies actually do (I have the FAAT = FEMA Acronyms, Abbreviations, and Terms, but a 78 page long list just emphasizes the problem). But if it was all clear, then there would be no need for my blog attempting to translate things into everyday language!

  3. Junior says:

    The FAAT is critical to disaster speak! TIA (thanks in advance)

  4. Howard Richards says:

    And were we not taught during CERT to use every day common language and terms. Guess the Feds soon forgot, which brings me to the best acronym of all – SNAFU.

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