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Indian Health Service The Federal Health Program for American Indians and Alaska Natives

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     Indian Health Manual

Part 1 - General

Chapter 10 -
Emergency Operations of DIH Field Activities

Title Section
Purpose 1-10.1
Policy 1-10.2
Planning Assumptions 1-10.3
    Internal Facility Emergencies 1-10.3A
    Local Emergencies not Requiring Facility Protection 1-10.3B
    Local Area Emergencies Requiring Facility Protection 1-10.3C
    National Emergency 1-10.3D
Planning Requirements 1-10.4
    Plans Development 1-10.4A
    Local Coordination 1-10.4B
    Organization for Self Protection 1-10.4C
    Emergency Assignments 1-10.4D
Special Requirements 1-10.5
    Headquarters Personnel 1-10.5A
    Area Offices 1-10.5B
    Medical Facilities 1-10.5C
Plans Issuance 1-10.6
Information and Assistance 1-10.7
Plans Testing and Revision 1-10.8
Responsibility of Officer in Charge 1-10.9
Report of Activities 1-10.10

1-10.1  PURPOSE.

This chapter provides general policy, guidance, and requirements for the development of emergency operation plans by Division of Indian Health field facilities in local or national disasters.  It supplements HEW Emergency Manual Chapter 8-20-40 and PHS Chapter 8-20-40.

The possibility of wide spread disaster and human suffering either through natural catastrophe or thermo-nuclear war, and to a lesser degree through local disasters, requires extensive planning at all Division levels for the provision of emergency health services.  There are several situation assumptions of disasters that must be considered in planning so that any emergency can be met successfully.  The DHEW Emergency Operations Manual sets out in great detail the Departmental policies and should be consulted in preparation of plans.  The primary mission of DIH field facilities will be to provide life saving services and support to disaster areas and any plan must be flexible enough to adjust to circumstances as they arise.

1-10.2  POLICY.

  1. Emergency Operations Plan.  Each PHS field facility shall have a written emergency operations plan in accordance with the HEW Emergency Manual, Part 8, PHS Chapter 8-20-44.  For the purposes of this Chapter the following are considered field facilities (Emergency Manual Circular PHS-1, dated May 28, 1963):

    Indian and Alaska Native Health Area Offices
    Indian and Alaska Native Hospitals
    Indian and Alaskan Native Health Centers (with full time medical officer)
    Indian and Alaskan Native School Health Centers (with full time medical officer)

  2. Facilities occupying space in buildings maintained by General Services Administration are responsible for coordinating their plans with GSA.  (Reference - Disaster Control and Civil Defense in Federal Buildings, - GSA Handbook - PBS P 2460.1A, October 4, 1965).
  3. Each Division facility shall have an "Organization for Self-Protection" plan in accordance with Part 10 of the HEW Emergency Manual.  This may be combined with the Emergency Operations Plan.
  4. Plans of facilities employing ten or more persons are subject to approval of the Regional Health Director, Director, Division of Indian Health, and the Director, Division of Health Mobilization.  (Emergency Manual PHS Chapter 8-20-42.)


Certain general assumptions are applicable to all DIH field facilities.  In addition, and most pertinent to facility preparedness, the geographic location of each facility determines the risk and hazards to which it may be subjected.  Each plan must be structured to prepare the facility for the most probable local situation.  Planning assumptions below must be considered.  The plan should describe the type of hazards and threats to which the facility is susceptible and the types of emergency services that would be provided under any circumstances.  These assumptions are:

  1. Internal Facility Emergencies.  Describe the facility's vulnerability to emergencies which may occur in the facility, including (1) minor fire or explosion within the building and (2) fire or explosion requiring evacuation of the building.
  2. Local Emergencies Not Requiring Facility Protection.  Describe the susceptibility of the area to local disasters which could-occur and require more than normal service by the facility.  Included would be (1) train, airplane or other wreck, (2) fire or explosion in vicinity, (3) epidemic, or (4) mass food poisoning.
  3. Local Area Emergencies Requiring Facility Protection.  Describe the susceptibility of the area to natural disasters which would require more than normal service by the facility, but which would also require protective measures and might hamper the facility in accepting the additional load.  Included would be (1) hurricane, tornado, blizzard, tidal wave or flood, (2) earthquake, or (3) volcanic eruption.
  4. National Emergency.  Describe the facility's vulnerability in event of nuclear attack.  Consideration must be given to each of the contingencies set forth in Emergency Manual PHS Chapter 8-20-43.  These contingences are:  (1) no fallout or damage in the area but destruction to surrounding areas: (2) fallout only in the area, lasting as long as two weeks; (3) damage only in the area; (4) fallout and damage in the area.


The following general requirements are applicable to all DIH field facilities and shall be considered in developing emergency plans.

  1. Plans Development.  Each facility officer in charge shall develop an emergency operations plan.  Plans may be combined with facility natural disaster plans and/or organization for self protection plans.  (1-10.3 Planning Assumptions).  Plans shall be in Division of Indian Health Manual format.  Health Mobilization Regional and State Program Representatives are available to facility officers in charge for assistance and consultation.
  2. Local Coordination.  Facility emergency plans shall be as consistent as possible with local community plans (if existent) and shall be developed through consultation with local civil defense and health officials.  Plans should be reviewed and endorsed (for cognizance only) by appropriate local and state health authorities before submission for Regional Office and Headquarters approval.
  3. Organization For Self Protection.  The first responsibility of each facility officer in charge is to take all possible precautions to assure survival of patients in medical facilities, personnel and usability of the facility.  See HEW Emergency Manual Part.10 for detailed guidance.
  4. Emergency Assignments.  Plans shall provide for definite assignments of specific emergency responsibility to personnel.  At least one alternate should be assigned for each key position.  An order of succession to the position of facility officer in charge shall be established.  Designation should be made by position title and not by names.


Experience has demonstrated that there are substantial inadequacies in the "predictive approach" to disaster planning which results in plans lacking flexibility in meeting new and unusual situations.  A plans foundation must be flexible enough to compensate for a completely unforeseen mischance and be adaptable to unscheduled timing and the unstructured nature of a catastrophe.  If the plan does not meet these criteria it can fail in meeting the needs which arise in an unpredicted emergency situation.

The Division of Indian Health, because of its widespread existence and the variety of facilities within the organization, requires a variety of plans to meet local circumstances and has many special requirements.

  1. Headquarters Personnel.  In the event of a national emergency, headquarters personnel will be involved in the Department and Bureau of Health Services Emergency Plan and may not be available for support of field activities.  In local disasters, involving an Area or any of its subdivisions, the Director, Division of Indian Health and members of his headquarters staff will provide any and all assistance required, including personnel and resources.
  2. Area Offices.  The Indian Health Area Director, (1) in event of a national emergency, shall arrange with the respective Regional Health Directors to make the Area Office staff fully available for emergency relocation assignment to the Regional Emergency Health Service.  Staff not so assigned shall be given emergency assignment to the nearest Indian Health or other Federal civilian health facility in accordance with regional emergency plans.  Area Office operations as such shall be suspended during the national emergency.  (2) In event of a localized disaster within the Area, the Indian Health Area Director and staff will provide all necessary assistance in meeting the emergency needs.  (3) The Indian Health Area Director shall be prepared to send assistance to another Area including personnel, equipment and supplies, upon request of the Director, Division of Indian Health, or the Area Director in the affected Area.  (4) Alaskan facilities shall make their facilities and resources available to the Alaska Department of Health and Welfare.  Their plans shall conform to and be an integral part of the Alaska State Survival Plan.  (Chapter PHS: 8-20, Emergency Manual)
  3. Medical Facilities.
    1. In a national emergency in accordance with prearranged plans and agreements with State and local civil defense health authority, and until recalled to federal service, all medical care facilities shall be made fully available to help meet local emergency medical care needs.  Facilities shall concentrate on life saving services and shall provide emergency services without expectation of reimbursement and without regard to normal statutory entitlement or admission policies (Sec. 216, PHS Act as amended).  Officers in charge shall retain control of their facilities, material resources, and personnel.  They may maintain records of services rendered.  Federal officers and employees will retain their federal employee status during the emergency.
    2. In a local disaster the facility shall provide emergency services as required without regard to normal statutory entitlement or admission policies during the time of the emergency.


Upon receipt of the approved emergency plan, the complete plan shall be distributed to those personnel who are critical in the emergency operation of the facility.  A handbook or condensed version of the master plan should be prepared and distributed to current and new employees.  Simple rules posted at strategic points should complement the handbook and facilities emergency operations.


In preparing and improving plans, information and assistance can be obtained through consultation with Health Mobilization Regional State programs.  Inquiries or requests for information from Headquarters shall be addressed to the Chief, Office of Special Services.

Manual Issuances and Publications relating to Emergency and Disaster Planning which should be available in all Areas include:

  1. HEW Emergency Planning and Operation Manual, including PHS supplemental chapters.
  2. PHS Disaster Manual
  3. Health Mobilization Series
    1. A-1 Emergency Health Preparedness Publication Catalog
    2. A-2 Community Emergency Health Preparedness
    3. A-3 Emergency Health Service
    4. A-4 Health Material and Facilities Planning Guide for Emergency Management
    5. G-1 Hospital Planning for Nuclear Disaster
    6. G-2 Preparing the Hospital Plant for Emergencies
    7. I-1 Community Emergency Health Manpower Planning
  4. Field Facility Emergency Operations Guide
  5. FGE 13.7 November '64 and Change 1 January 1965 Emergency Welfare Services Manual
  6. Disaster Control and Civil Defense in Federal Buildings GSA Handbook October 1965
  7. The National Plan for Emergency Preparedness - Office of Emergency Planning, December 1964
  8. Building Organization for Self-Protection - GSA Handbook
  9. Readings in Disaster Planning for Hospitals.  American Hospital Association, 840 Lake Shore Drive, Chicago, Illinois 60611.  Catalog 2540, Revised Edition 1966.


Emergency plans shall be tested at least once each calendar year.  In addition, hospitals shall hold a second casualty drill to meet the recommendations of the Joint Commission on Accreditation of Hospitals, (Bulletin No. 28).  Advance copies of test exercise schedules and reports of the test drills shall be sent to the Indian Health Area Director and to the Chief, Office of Special Services, DIH.  The Area Offices will send copies to the appropriate Regional Health Director.  Based upon test and exercise experience and findings, plans shall be reviewed and if necessary, revised and reissued.  Readiness surveys of facilities will be made from time to time by Area and Headquarters consultants.


In the event of a disaster or emergency when it is not possible to establish communications with the Area Office, Headquarters or the Regional Office (in national emergencies) the Officer in Charge of a facility is authorized to carry out those responsibilities inherent in meeting the needs of the disaster or emergency.


By July 15 of each year, all facilities in each Area will submit to the Indian Health Area Director a report of emergency and disaster activities during the preceding fiscal year, including a resume of drills and any revisions of existing plans or assignments.  By July 30 the Indian Health Area Director shall submit a composite report of these activities to the Director, Division of Indian Health, Attention:  Chief, Office of Special Services.

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