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ESF8 - Public Health and Medical Services

The National Response Framework is a guide to how the Nation responds to all types of disasters and emergencies. It is built on scalable, flexible, and adaptable concepts identified in the National Incident Management System to align key roles and responsibilities across the Nation. This Framework describes specific authorities and best practices for managing incidents that range from the serious but purely local to large-scale terrorist attacks or catastrophic natural disasters. The National Response Framework describes the principles, roles and responsibilities, and coordinating structures for delivering the core capabilities required to respond to an incident and further describes how response efforts integrate with those of the other mission areas.

National Incident Management System 3rd Ed (October 2017)

National Response Framework 3rd Ed (June 2016)

Community Lifelines

Community Lifelines are a new construct developed by the Federal Emergency Management Agency (FEMA) to better organize essential services. A lifeline provides indispensable service that enables the continuous operation of critical business and government functions, and is critical to human health and safety, or economic security.

Decision-makers must rapidly determine the scope, complexity, and interdependent impacts of a disaster. Applying the lifelines construct allows decision-makers to:

  • Prioritize, sequence, and focus response efforts towards maintaining or restoring the most critical services and infrastructure
  • Utilize a common lexicon to facilitate unity of purpose across all stakeholders
  • Promote a response that facilitates unity of purpose and better communication amongst the whole community (Federal, state, tribal, territorial, and local governments, and private sector and non-governmental entities)
  • Clarify which components of the disaster are complex (multifaceted) and/or complicated (difficult), requiring cross-sector coordination

The Community Lifelines consist of the following lifelines:

  • Safety and Security
  • Food, Water, Sheltering
  • Health and Medical
  • Energy
  • Communications
  • Transportation
  • Hazardous Materials

Health and Medical Community Lifeline

Health and Medical consist of the 5 following areas and components:

Medical Care

  • Status of acute medical care facilities
  • Status of chronic medical care facilities
  • Status of primary care and behavioral facilities
  • Status of home health agencies
  • Status of VA health system resource in the affected area

Patient Movement

  • Status of state and local EMS systems
  • Active patient evacuations
  • Future patient evacuations

Public Health

  • Status of state and local health departments
  • Public health advisories

Fatality Management

  • Availability of mortuary and post-mortuary services
  • Availability of transportation, storage and disposal resources
  • Status of body recovery and processing
  • Descendant's family assistance

Healthcare Supply Chain

  • Status of pharmaceutical supply chain

The community lifeline concept is expected to be incorporated into the 4th edition of the National Response Framework.

Emergency Support Functions (ESF)

Emergency Support Functions (ESFs) is the grouping of governmental and certain private sector capabilities into an organizational structure to provide support, resources, program implementation, and services that are most likely needed to save lives, protect property and the environment, restore essential services and critical infrastructure, and help victims and communities return to normal following domestic incidents.

Emergency Support Functions

  • ESF1     Transportation
  • ESF2     Communications
  • ESF3     Public Works and Engineering
  • ESF4     Firefighting
  • ESF5     Emergency Management
  • ESF6     Mass Care, Housing, and Human Services
  • ESF7     Resources Support
  • ESF8     Public Health and Medical Services
  • ESF9     Urban Search and Rescue
  • ESF10   Oil and Hazardous Materials Response
  • ESF11   Agriculture and Natural Resources
  • ESF12   Energy
  • ESF13   Public Safety and Security
  • ESF14   Long-term Community Recovery and Mitigation
  • ESF15   External Affairs

EFS-8 Public Health and Medical Services

ESF-8 is responsible for the following core functional areas:

  • Assessment of public health/medical needs
  • Health surveillance
  • Medical care personnel
  • Health/medical/veterinary equipment and supplies
  • Patient evacuation
  • Patient care
  • Safety and security of drugs, biologics, and medical devices
  • Blood and blood products
  • Food safety and security
  • Agriculture safety and security
  • All-hazard public health and medical consultation, technical assistance, and support
  • Behavioral health care
  • Public health and medical information
  • Vector control
  • Potable water/wastewater and solid waste disposal
  • Mass fatality management, victim identification, and decontaminating remains
  • Veterinary medical support

Local, State, and Federal Primary ESF-8 Agency

At each level of jurisdiction, the Primary ESF-8 Coordinating Agency falls to the following:

Jurisdiction Agency
Local Local Public Health Department
State Inidana State Department of Health
Federal US Health and Human Services




Each jurisdiction works with emergency management to provide input to the jurisdiction's Comprehensive Emergency Management Plan's (CEMP) ESF-8 Annex that details the roles and responsibilities of ESF-8, as well as the roles and responsibility of ESF-8 supporting partners.

National ESF-8 Public Health and Medical Services Annex (June 2016)

In each jurisdiction, the Primary ESF-8 Coordinating Agency is often responsible for staffing the ESF-8 seat in the jurisdictions Emergency Operations Center during emergencies and disasters. In the Emergency Operations Center, all ESFs and Emergency Management coordinate the response.