July 29 – August 4, 2019

The Northwest Region Healthcare Coalition’s next meeting is the Cardinal Resolve Table Top Exercise on August 15th. The Table Top Exercise is the first of two joint exercises by VDH and VHHA. Please see the flyer below for more information.


1. Save the Dates

Upcoming exercises: We will be participating in a Joint VHHA and VDH Table Top Exercise August 15th in-place of our regional coalition meeting. This exercise is a lead-up to the Joint Full Scale Exercise October 23rd. Questions regarding the upcoming exercises, please contact our Exercise and Training Coordinator, Matt Cronin. Please see the Cardinal Resolve TTX Flyer for more details.

Upcoming regional training: The Coalition will host the MGT – 349 Pediatric Disaster Response and Emergency Preparedness course November 18 – 19, 2019 in Harrisonburg, VA. Questions regarding upcoming training, please contact our Exercise and Training Coordinator, Matt Cronin. Please see the link for more details.

2. Clinical Advisor

As part of expanding the regional coalition collaboration, the Northwest Region Healthcare Coalition will seek to hire a part-time physician to serve as a clinical advisor. The clinical advisor will be asked to:

  • Provide clinical leadership to the coalition and serve as a liaison between the coalition and medical directors/medical leadership at health care facilities, supporting entities (e.g., blood banks), and EMS agencies.
  • Review and provide input on coalition plans, exercises, and educational activities to assure clinical accuracy and relevance.
  • Act as an advocate and resource for other clinical staff to encourage their involvement and participation in coalition activities.
  • Assure that the coalition mass casualty/surge plans provide for appropriate distribution (and re-distribution) of trauma patients to avoid overloading single centers whenever possible and work with health care facilities to understand their capabilities and capacity.
  • Assure that subject matter experts are available, and a process exists to support secondary transfer prioritization in specialty surge (e.g., burn, pediatric) mass casualty situations (i.e., identify which patients are a priority to transfer to specialty care centers when adequate transportation or inpatient resources are unavailable).
  • Engage health care delivery system clinical leaders to provide input, acknowledgement, and understanding of their facility and regional strategic and operational roles in acute medical surge planning to include CBRNE, trauma, burn, and pediatric readiness and response.


3. Memorandum of Understanding

We are pleased to announce that the Northwest Region Healthcare Coalition continues to receive requests to sign a Memorandum of Understanding (MOU) between the coalition and non-hospital facilities. The MOU is designed for healthcare facilities that are not classified as an Acute Care or Critical Access hospital, and it is good for five (5) years before it will need to be renewed. If your organization resides within the Northwest Region and you have not signed the MOU, you can contact either the Regional Coordinator or the Medically Vulnerable Populations Coordinator to find out more details.

We are expanding our outreach to healthcare agencies within the region as a way of offering assistance to you and your organization. We ask for everyone’s help to spread the word by talking with your colleagues about the Northwest Region Healthcare Coalition. You can contact us by clicking the Contact Us tab on our website.


Click here to access our website. Don’t forget to visit the Events calendar for upcoming training and exercise events.


We have developed a one page understanding of the regional coalition that can be shared between coalition partners. Please click here to view the regional “one-pager”.

Virginia Hospital & Healthcare Association Credit:

Virginia Department of Health

UPDATE: Virginia Department of Health is Investigating an Increase in Intestinal Illness Associated with Cyclospora

The Virginia Department of Health (VDH) is providing more information about the ongoing investigation of reports of intestinal illness associated with Cyclospora. The goal of public health investigations is to protect the public’s health. An increase in cases was first identified in Northern Virginia in mid-June 2019. Our investigation has found an additional outbreak in Central Virginia. A food or water source of these outbreaks has not yet been identified.

Since May 1, 2019 there have been 39 confirmed cases of Cyclosporiasis in Virginia (Central Region–4, Eastern Region–2, Northern Region–27, Northwest Region–4, Southwest Region–2). The five-year average for the same time frame from 2014 to 2018 was 9 cases. To read more on this story, please click here.

 Assistant Secretary for Preparedness and Response


Assistant Secretary for Preparedness and Response Technical Resource,                                                                                                                             Assistance Center, and Information Exchange

Hospital Preparedness Program




1. Accountable Care Organizations, and Medical Surge During Disasters

Accountable care organizations (ACOs) are groups of healthcare providers and care settings that come together to deliver high-quality care to an assigned patient population. The Centers for Medicare & Medicaid Services (CMS) supports the development of ACOs through the Medicare Shared Savings Program and Innovation Center Models (e.g., the Next Generation ACO Model). Medicaid and commercial insurers have also established various ACO models for their beneficiary populations. ACOs provide incentives for groups of healthcare entities to coordinate care for their assigned patients with the goal of efficiently providing high quality care as measured by reduced inefficiencies and overall healthcare delivery costs. As a relatively new healthcare delivery and payment model, little is known about the role of Medicare ACOs and their participants in the medical surge response to emergencies and disasters.

To read more about how these types of organizations can assist in preparing for a medical surge, please click here.

2. HHS Health Sector Cybersecurity Coordination Center Threat Briefing on Healthcare Malware Threat Update 2019

The HHS Health Sector Cybersecurity Coordination Center has released this report on Healthcare Malware Threat Update 2019.” The white paper is labeled TLP: white. 

For questions on the report, contact HC3@hhs.govMore information on the Traffic Light Protocol (TLP) designations is available via the US-CERT website

3. The Express

We know our stakeholders stay busy during the dog days of summer; ASPR TRACIE is here to help! Due to the heat wave that recently gripped much of the nation, we want to remind you to check out the Lessons Learned: Extreme Heat and Plans, Tools, and Templates: Excessive Heat sections in our Natural Disasters Topic Collection. You also can find related resources in our Utility Failures Topic Collection.

We’ve been busy creating new and updating existing resources that can help with your disaster medicine, healthcare system preparedness, and public health emergency preparedness efforts. We sincerely appreciate your support and encourage you to reach out to us if you have a resource to share or need technical assistance.

In this issue of The Express, we highlight new publications, upcoming events, and updates from our three domains.


New: Mass Casualty Trauma Triage, Paradigms and Pitfalls

This paper incorporates lessons learned from recent bombing and mass shooting incidents to provide a triage framework for emergency medical providers that accounts for the differences between conventional  mass casualty incidents and mass violence incidents.


New: ASPR TRACIE Healthcare Coalition Surge Estimator Tool

In a mass casualty incident, healthcare coalitions (HCCs) need to understand their capacity to accommodate the incident from both the conventional (usual) and contingency or crisis (surge) capacity perspectives. The aggregate of this data can provide critical information about the capacities of the HCC’s acute care hospitals and allow prediction about whether a given incident will overwhelm the local beds available and how much outside support may be required. The Healthcare Coalition Surge Estimator Tool (and accompanying Data Collection Form; both available in Excel) concentrate on key measures that represent conventional and contingency capacity, with the understanding that crisis standards of care may be required when these are insufficient. The information is submitted by each hospital to their HCC for aggregation for use in local, state, and federal planning. Individual hospital data is not submitted to ASPR.

We also encourage you to check out the Healthcare Coalition Pediatric Surge Annex Template which includes general headers and descriptions HCCs can incorporate while developing their own plans. This annex is complemented by our recent comprehensive refresh of the Pediatric Topic Collection.


New: Engaging Healthcare System Partners in Medical Surge

This ASPR TRACIE webpage includes links to recent reports on healthcare providers perceived levels of medical surge preparedness. These partners represent a variety of settings (e.g., accountable care organizations, clinics, home health and hospice, primary care, and urgent care centers).


New: Federal Recovery Programs for Healthcare Organizations

As disasters continue to have direct effects on healthcare facilities, organizational financial and administrative preparedness capabilities are gaining more attention. This tip sheet provides an overview of eligibility factors, program/grant requirements, and pre- and post-disaster federal financial opportunities (e.g., direct reimbursement and disaster-related loans) for healthcare facilities. 


Evacuating a Region: New Behind the Response Article

Floodwaters from Hurricane Harvey inundated 23 out of 25 southeast Texas counties covered by the Southeast Texas Regional Advisory Council’s (SETRAC) Regional Healthcare Preparedness Coalition (RHPC). Many hospitals and nursing homes were evacuated while others closed their submarine doors, sheltered in place, and received critical supplies via helicopter and high-water vehicles. ASPR TRACIE interviewed Lori Upton (RN, BSN, MS, CEM), Director of Regional Preparedness and Operations for SETRAC, to learn more about healthcare facility evacuation from a regional perspective.


Register Today for the ASPR TRACIE Resource Review Webinar!  

Join us on August 27, from 1:30-2:45 PM ET, as we walk participants through an overview of new and updated resources and webpages across a variety of topics, and share what’s on the horizon for ASPR TRACIE. Register today space is limited.


Additional Upcoming Events

August 18-20, 2019

The 2019 Community Health Institute & EXPO (held in Chicago) allows health centers to learn more about new disciplines, collaboration, workforce development, technology and pursuing innovative models of care that target both the social determinants of health and address the emerging public health issues and challenges of our day. We invite you to visit ASPR TRACIE’s poster presentation on August 18, from 5:00-6:30 PM.  

September 23-24, 2019

The Public Health & Disasters Conference (held in West Jordan, UT) is an annual, multidisciplinary national conference that brings together professionals from public health, health care, emergency management and other disciplines involved in preparing for, responding to, and recovering from public health emergencies.   

October 9-11, 2019

The 11th Annual Healthcare Preparedness Symposium (held in Galveston, TX) provides an opportunity for national collaboration and information sharing while promoting resiliency in the healthcare community.  

October 13-15, 2019

The 2019 Home Care and Hospice Conference and Expo provides home care and hospice professionals the opportunity to network, learn from colleagues and discuss exciting new trends in home care and hospice delivery. ASPR TRACIE will be speaking on the connection between home health and hospice providers and medical surge capabilities.  

November 4-6, 2019

The AHEPP Annual Conference (held in Orlando, FL) provides attendees the opportunity to learn more about research and best practices, network, and collaborate on ways to move healthcare preparedness forward.  

December 2-5, 2019

This year’s National Healthcare Coalition Preparedness Conference is being held in Houston and will focus on how coalitions can contribute to community resilience.

Credit: Centers for Disease Control and Prevention

1. CDC Yellow Book 2020 Highlights

Interested in the latest travel health recommendations? View the CDC Yellow Book, Health Information for International Travel, to answer your patients’, employees’, or your own travel health questions.  

What is the Yellow Book?

The Yellow Book provides current U.S. government travel health guidelines, including pre-travel vaccine recommendations, destination-specific health advice, and easy-to-reference maps, tables, and charts.

Written by CDC’s travel health experts, the Yellow Book is a reference for health care providers, including doctors, nurses, and pharmacists. 

The Yellow Book contains numerous resources to assist health care professionals in making appropriate recommendations to their patients, before, during, and after international travel.


Pre-travel resources include—

  • How to conduct a pre-travel consultation
  • Travel-related disease information: Causes, global distribution, prevention measures
  • Vaccines: Updated vaccine requirements and recommendations
  • Clinical guidance: An in-depth look at the specific travel health needs of infants and children, pregnant travelers, and those with chronic medical conditions or weakened immune systems
  • Overviews of popular tourist destinations and itineraries
  • Recommendations for expatriates, travelers visiting friends and relatives overseas or participating in study abroad, travel for work, adventure travel.

During-travel resources include—

  • Conditions: Including travelers’ diarrhea, altitude illness, jet lag, motion sickness, and respiratory infections.

Post-travel resources include—

  • How to conduct a post-travel evaluation
  • Post-travel evaluation and management: Fever in the returned traveler, sexually transmitted infections, skin and soft tissue infections, persistent diarrhea, screening newly arrived immigrants and refugees. 

What’s New for 2020? 

The 2020 edition offers a variety of new sections and information, including—

  • Henipaviruses
  • Recommendations for practicing travel health remotely, via telemedicine 
  • Updated vaccine recommendations
  • Updated road and traffic-safety advice 
  • Emerging travel-related illnesses, including Zika, Ebola, and sarcocystosis
  • New FDA-approved drugs
  • Rapid diagnostic tests for tropical infectious diseases
  • Recommendations for travelers with severe allergies
  • Use of the One Health approach to manage zoonotic diseases
  • Treating infectious diseases in the face of increasing antimicrobial resistance 
  • Legal issues facing clinicians who provide travel health care 

The entire book is also available online at the CDC website.

2. Updated Interim Infection Prevention and Control Recommendations for Measles in Healthcare Settings

  • Ensuring healthcare personnel (HCP) have presumptive evidence of immunity to measles
  • Rapidly identifying and isolating patients with known or suspected measles
  • Adhering to Standard and Airborne Precautions for patients with known or suspected measles
  • Routinely promoting and facilitating respiratory hygiene and cough etiquette
  • Appropriately managing exposed and ill HCP
CDC’s interim guidance should be implemented as part of a comprehensive infection prevention program to prevent the spread of germs among patients, healthcare providers, and visitors.

Credit: U.S. Food & Drug


Credit: Centers for Medicare and Medicaid Services


         U.S. Department of Homeland Security 

Federal Emergency Management Agency

Course of the Week

Flyer for the Hazardous Materials Awareness / Hazardous Materials Basic Responder for Mass Casualty Incidents courses can be found here. These courses are run consecutively and provide responders from all backgrounds with knowledge and practical experience in essential hazardous materials competencies. Some of the large metropolitan areas are sending their law enforcement officers who work with the homeless personnel within their communities; others are sending their public works personnel for general awareness as they perform their general duties day to day. Regardless of who attends, everyone gains knowledge and strengthens the response capacity of their agency and community.

Hazardous Materials Awareness https://cdp.dhs.gov/find-training/course/AWR-358

Hazardous Materials Basic Responder for Mass Casualty Incidents https://cdp.dhs.gov/find-training/course/PER-338

Virginia Department of Emergency Management

Course Offerings

2019 Mass Care Symposium August 8, 2019. The day will focus on efforts to provide Mass Care services during Hurricanes Matthew and Florence, as well as best practices and pitfalls within Inclusive Planning.

CVEMA 2019 Mass Care Symposium

ICS 400 Advanced Incident Command Systems course is scheduled for August 28-29, 2019. Please see flyer for additional details.

Course Announcement ICS 400 Madison

ICS 300 Intermediate ICS for Expanding Incidents course is scheduled for September 14-15, 2019. Please see flyer for additional details.

Course Announcement ICS 300 Shenandoah

MGT-418 Readiness: Training Identification and Preparedness Planning (RTIPP) course is rescheduled for September 23-24, 2019. Please see the flyer for additional details.     

MGT418 Course Announcement – Spotsylvania VA

PER-335 Complex Coordinated Attacks (CCA) course is scheduled for October 15-16, 2019. Please see the flyer for additional details.

PER335 Course Announcement – Fredericksburg, VA

Central Region Healthcare Coordination Center Manager Job Opening

The Central Region is seeking candidates to fill a job opening as their Regional Healthcare Coordination Center Manager. All of the information can be found in this attachment. The closing date is August 15, 2019.