Governor Chris Christie Lt. Governor Kim Guadagnoorder for it to carry out its public health emergency response mission. The framework described in this document will be used by the

Governor Chris ChristieLt. Governor Kim Guadagno

Responding to Public Health Emergencies

Executive Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

Introduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

Guiding Principles . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

Network-Centric Health Emergency Response (NCHER). . . . . . . . . . . . 9Cooperative Engagement Health Response System . . . . . . . . 10Command and Control Network . . . . . . . . . . . . . . . . . . . . . . . . 12Situational Awareness Network Software (Hippocrates) . . . . . 15Regionalized Emergency Response Assets. . . . . . . . . . . . . . . . 16

Regional Health Infrastructure Program. . . . . . . . . . . . . 17Regional Coordination of Public Health Agencies. . . . . . 19

Operational Categories . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21Surveillance and investigation . . . . . . . . . . . . . . . . . . . . . . . . 22Medical Surge . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23Mental Health . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25Mass Prophylaxis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27Isolation / Quarantine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29Emergency Medical Systems . . . . . . . . . . . . . . . . . . . . . . . . . . 30Laboratory . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33Animal Disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35Food Safety . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37Environmental Hazards . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39Public Health Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41

Overarching Capabilities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43Communications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44Volunteer Management . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49At Risk Populations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50Exercises . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52

Glossary. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 54

Table of Contents

2 Responding to Public Health Emergencies

Executive Summary

The public health role inemergency preparedness andresponse is diverse and

critical. An effective public healtheffort can prevent or diminish theeffect of any event that mightresult in human morbidity andmortality.

v The responsibilities and actionsof public health agencies andhealthcare organizations aredefined in a series ofinterrelated documents.

v There are three primary sourcesof authority in New Jerseywhich permit the State toaddress public healthemergencies by implementing awide panoply of controlmeasures, all of which aresubject to the constraints of dueprocess. These are the DisasterControl Act, the Emergency

Health Powers Act, and theauthority granted to theCommissioner under thestatutes to declare an epidemicand to issue administrativeorders. Local boards of healthhave concurrent jurisdictionunder these statutes. However,upon declaration of a publichealth emergency under theEmergency Health Powers Act,the Commissioner assumesprimary jurisdiction.

v This Strategy document forhealth emergency preparednessand response describes theDepartment’s capabilities andactivities to carry out the tasksdefined in the ESF-8 in order toenhance New Jersey’s ability tomanage a terrorist threat,infectious disease outbreak, andall other events that affect thehealth of the State’s inhabitantsand visitors. These actionsemphasize preparedness andprevention in order to minimizeor negate the need for aresponse. However, should aresponse be necessary, DHSSpossesses significant capabilityto monitor, coordinate or direct,and support health emergencyoperations.

v This Strategy for New Jersey’sresponse to any public healthemergency is based on asystems approach thatincorporates the capabilities ofindividual health entities into a

Guiding Documentsl Emergency Health Powers

Actl New Jersey Emergency

Response Planl Emergency Support

Function 8 (ESF-8)l DHSS Health Emergency

Preparedness andResponse Strategy andMaster Plan

l Standard OperatingProcedures (SOP)

3Responding to Public Health Emergencies

coordinated State healthresponse. This ensures that theweight of an escalated healthburden is distributed amongcapable and availableorganizations.

v Network-Centric HealthEmergency Response (NCHER)is the central concept aroundwhich DHSS has organized thisStrategy. NCHER focuses onlinking health emergencypreparedness and responsepersonnel, platforms, andsystems into highly integratedlocal and wide-area electronicand social networks. DHSSbelieves that NCHER willdramatically improve publichealth and healthcare deliveryresponse capability andefficiency.

v NCHER will be implementedthrough the Network-CentricHealth Response System(NCHRS), which is comprised offour key core components:l Cooperative Engagement

Health Response System(CEHRS)

l Command and ControlNetwork

l Situational AwarenessNetwork Software(Hippocrates)

l Regionalized EmergencyResponse Assets

v This document describes each ofthe core components of theNCHRS. It also describes thespecific strategies adopted by theDHSS in each of the operationalareas that correspond to theparticular functions that must beperformed in emergencysituations, as well as theoverarching capabilities requiredto support all of these programsin completing their respectivemissions.

v The purpose of this document isto communicate to allstakeholders the principles andorganizational structure that havebeen developed by the DHSS inorder for it to carry out its publichealth emergency responsemission. The frameworkdescribed in this document willbe used by the DHSS as the basisfor development of a Master Planfor health emergencypreparedness and response in thecoming months. The Master Planwill define the specific actions tobe undertaken in order tooperationalize, maintain andcontinuously improve thepreparedness and responseprograms. Upon adoption of theMaster Plan, each of theseprograms will develop StandardOperating Procedures (SOPs)describing the detailed sequenceof actions to be taken inemergency situations.


Introduction

The public health role inemergency preparednessand response is diverse and

critical. An effective publichealth effort can prevent ordiminish the effect of any eventthat might result in humanmorbidity and mortality.

Health emergency preparednessis a part of the overallresponsibility health systemshave for the well-being of thecommunity. Public health mustprovide for the preparedness andresponse to natural disasters,emerging disease, and otherpublic health emergenciesincluding planning and

preparedness for the health-related consequences of any act ofterrorism. Only through attentionto the entire environment ofhealth threats are we able toensure a comprehensive responsethat will reduce the morbidity andmortality of any healthemergency.

Public health capabilities includesurveillance, detection, diagnosisand response. The responsibilitiesand actions of public healthagencies and health careorganizations are defined in aseries of interrelated guidancedocuments.

“A robust system for public healthpreparedness and response is vital to

the nation’s security.”

WORLD AT RISK: The Report of the Commission on the Prevention ofWMD Proliferation and Terrorism; December 2008.

Guiding Documents

v Emergency Health Powers Act - N.J.S.A. 26:13-1 et seq.

v State of New Jersey Emergency Response Plan

v Emergency Support Function 8 (ESF-8) – Public Health and MedicalServices Annex

v DHSS Health Emergency Preparedness and Response Strategy

v DHSS Health Emergency Preparedness and Response Master Plan

v Standard Operating Procedures (SOP) for each health emergencypreparedness and response program


There are three primary sourcesof authority in New Jersey whichpermit the State to address publichealth emergencies byimplementing a wide panoply ofcontrol measures, all of which aresubject to the constraints of dueprocess. First, the Governor hasbroad authority under theDisaster Control Act to declare anemergency and to issue necessaryorders. Next, the Commissionerof Health and Senior Services hasauthority under the EmergencyHealth Powers Act to implementcontrol measures after theGovernor has declared a publichealth emergency. TheCommissioner also has authorityto take certain steps prior to thedeclaration of a public healthemergency. Finally, theCommissioner, under the statutespre-dating the Emergency HealthPowers Act, has authority todeclare an epidemic and to issueadministrative orders. Localboards of health have concurrentjurisdiction under these statutes.However, upon declaration of apublic health emergency underthe Emergency Health PowersAct, the Commissioner assumesprimary jurisdiction. The Actprovides the legal structurefundamental to enabling a rapidand effective response to threatsto the public health.

The planning and actions of theDHSS are based on a systems

approach by which the principlesof preparedness, prevention andresponse are employed as thetools of public health against thethreat of a public healthemergency. By adhering to theseprinciples, the Departmentprovides a standardized andcoordinated approach whenpreparing for or responding toany threat that might causetrauma, illness, or death tohumans.

Acknowledging that interagencyinteraction for planning as well ascooperative partnerships forresponse are key elements of asuccessful approach, all of DHSS’planning documents aredeveloped to be consistent withState, regional and cityEmergency Operations Plans(EOPs), coordinated withappropriate entities, andconsistent with the UnifiedCommand and EmergencyOperations Center concepts, aswell as the legal authorityprovided by the EmergencyHealth Powers Act. The DHSS’strategy is also consistent withthe recommendations of theWorld at Risk report of theCommission on the Commissionon the Prevention of WMDProliferation and Terrorism, inthat it includes measuresdesigned to prevent bioterrorismand to enhance New Jersey’scapabilities for a rapid response to


Introduction

prevent biological attacks frominflicting mass casualties.

DHSS is the lead agency forEmergency Support Function 8(ESF-8) – Public Health andMedical Services Annex of theNew Jersey State EmergencyResponse Plan. The State Planlists ninety-eight (98) tasksdelegated to DHSS in support ofstatewide health emergencyresponse.

This Strategy for healthemergency preparedness andresponse describes theDepartment’s capabilities andactivities to carry out the tasksdefined in the ESF-8 in order to

enhance New Jersey’s ability tomanage a terrorist threat,infectious disease outbreak, andall other events that affect thehealth of the State’s inhabitantsand visitors. These actionsemphasize preparedness andprevention in order to minimizeor negate the need for a response.However, should a response benecessary, DHSS possessessignificant capability to monitor,coordinate or direct, and supporthealth emergency operations.

The purpose of this document isto communicate to allstakeholders the principles andorganizational structure that havebeen developed by the DHSS inorder for it to carry out its publichealth emergency responsemission. The frameworkdescribed in this document will beused by the DHSS as the basis fordevelopment of a Master Plan forhealth emergency preparednessand response in the comingmonths. The Master Plan willdefine the specific actions to beundertaken in order tooperationalize, maintain andcontinuously improve thepreparedness and responseprograms. Upon adoption of theMaster Plan, each of theseprograms will develop StandardOperating Procedures (SOPs)describing the detailed sequenceof actions to be taken inemergency situations.


l Provide the State of New Jersey with preparedness,prevention and response capabilities for addressing all publichealth incidents and emergencies, with a focus on thereduction of morbidity and mortality rates.

l Create social and technology network-centric systems toenable continuance of the integrity of the public health andhealth care system during periods of stress, surge andoverload.

l Facilitate interdependency of healthcare delivery, publichealth and emergency management in order to effect anintegrated approach to preparedness and response.

l Promote integration of grassroots resources (including theprivate sector, government and community-based) throughpartnerships in order to provide consistency and ensureintegration of State and national plans.

Guiding Principles



The foundation for NewJersey’s response to anypublic health emergency is

a systems approach thatincorporates the capabilities ofindividual health entities into acoordinated State healthresponse. This ensures that theweight of a health burden thatexceeds the capabilities of asingle facility or group isdistributed among capable andavailable organizations.

The central concept around whichDHSS has organized this Strategyis the Network-Centric HealthEmergency Response (NCHER).NCHER focuses on usingcomputers, high speed data links,networking software andprocesses to link healthemergency preparedness andresponse personnel, platforms,and systems into highlyintegrated local and wide-areaelectronic and social networks.Within these networks, personnelwill share large amounts ofcritical information on a rapid andcontinuous basis. DHSS believesthat NCHER will dramaticallyimprove public health andhealthcare delivery responsecapability and efficiency.

NCHER is operationalizedthrough the Network-CentricHealth Response System

Network-Centric Health Emergency Response

(NCHRS). NCHRS is comprisedof four key core components:

v Cooperative EngagementHealth Response System(CEHRS)

v Command and ControlNetwork

v Situational AwarenessNetwork Software(Hippocrates)

v Regionalized EmergencyResponse Assets.


Network-Centric Health Emergency Response (NCHER)

Cooperative Engagement Health Response System

New Jersey is operating under theconcept of a CooperativeEngagement Health ResponseSystem (CEHRS), defined as theintegration of public health andhealth care delivery organizationsable to provide the necessarypharmaceutical, medical andmental health response to apublic health emergency througha process of measured,coordinated and escalatingcooperation. CEHRS relies on thecooperation and interaction ofpublic, private and not-for-profitorganizations.

CEHRS is based on the principlethat during emergencies of largemagnitude, individual facilitieswill eventually reach aculmination point – a point whereresources or will of the facility canno longer provide the necessaryresponse. In order to address thissituation and enable sustainedadequate response, a designatedcommand structure coordinatesand maintains the activities of theindividual CEHRS entities belowindividual culmination points,while through combined andcoordinated efforts providing asystem response equal to orexceeding what is required for anemergency.

The goal of CEHRS is to reducethe need for individual facilitiesto expend resources and stockpilelarge quantities of rarely usedequipment, instead relying on

sharing or handoff of responsibili-ties during an emergency toCHERS partners before any reachtheir culmination point.

CEHRS provides the frameworkfor coordination of the publichealth community, healthcaredelivery entities, EmergencyMedical Services (EMS),laboratories, and State health andmental health assets during apublic health emergency. Itincludes the development of planswhich describe the responsibili-ties of these organizations, therelationships to each other andthe command and controlumbrella for statewide healthcoordination during anemergency. It provides astandardized, coordinated,efficacious all-hazardspreparedness and responsecapability for New Jersey throughintegration of the public health,healthcare delivery andemergency management systems- the “Health Emergency Triad”(Figure 1). It also integrates thecomponents of New Jersey’shealth system into the State’semergency management systemand provides capabilities forintegration into federal response.


Cooperative Engagement Health Response System

Components of the NJ CEHRSinclude:

v The DHSS, including theHealth Command Center,Medical Coordination Centersystem, emergency medicationand medical supply caches,Laboratory, CommunicableDisease and EmergencyResponse;

v New Jersey’s Acute CareHospital System, includingLevel 1 Trauma Centers,Level 2 Trauma Centers, and aburn center; and specialtyhospitals such asrehabilitation, psychiatric andlong term acute care hospitals

v Federally Qualified HealthCare Centers (FQHCs);

v Nursing homes and assistedliving facilities;

v Home health and hospiceagencies;

v Local health departments,including LINCS public healthagencies;

v Emergency Medical Services:EMS Task Forces, Dispatch,Basic Life Support (BLS) andAdvanced Life Support (ALS)systems;

v Partner Health Associations(NJ Hospital Association, NJPrimary Care Association,Health Care Association of NJ,NJ Association of Homes andServices for the Aging, and theHome Care Association of NJ);

v New Jersey Medical ReserveCorps; and

v Offices of EmergencyManagement at the State,county and local levels.

Figure 1. Health Emergency Triad

Rec

overMitiga

tePre

par

e Respond

Public Health

Healthcare Delivery

System

Emergency

Management



Command and Control Network

DHSS Emergency Structure

In order to expand organizationalcapacity commensurate with themagnitude of its responsibility, andco-locate functionally and mission-similar units to build efficienciesand synergies, DHSS created theDivision of Health InfrastructurePreparedness and Response(HIPER). HIPER provides a centralcoordination and oversightstructure for public healthemergency preparedness andresponse. The mission of theDivision is to provide leadership,coordination, and support in allprevention, preparedness, detection,response, and recovery activitiesrelated to the health consequencesof any emergency event.

HIPER, under the leadership ofthe Senior AssistantCommissioner, consists ofprograms responsible forPreparedness and EmergencyResponse Policy, EmergencyPlanning and Operations,Emergency PreparednessInitiative Development, andHealth InfrastructurePreparedness. This lastorganizational unit covers HealthCare System Preparedness,Emergency Medical Services, andPublic Health Infrastructure.HIPER coordinates its activitieswith other organizational units ofthe DHSS that have responsibili-ties related to emergencypreparedness and response,including the CommunicableDisease Service, the Consumerand Environmental HealthService, the Public Health andEnvironmental Laboratories,Senior Services and HealthSystems, and the Office ofCommunications.

Health Command Center

In order to provide command, realtime information, communicationand coordination for New Jersey’spublic health and healthcarecontinuum during health relatedemergencies, the DHSS operatesthe Health Command Center(HCC). The HCC supports theState Emergency OperationsCenter (SEOC), is an integralcomponent of the Incident


Command and Control Network

Command System (ICS), and isthe sole authority for dispensingof DHSS resources. The principalrole of the DHSS HCC is toprovide real-time intelligence/information, communication andcoordination for theCommissioner of Health andSenior Services and/or designee,the New Jersey public health andhealthcare continuum and theSEOC during emergency events.The HCC is connected to thecommand and control nodes oflocal, county, State, and federaldepartments and agencies. Thisconnection is through telephone,fax, e-mail, satellite and radiosystems.

The Health Command Centerspecific responsibilities include:

v Coordination of DHSS healthemergency managementoperations.

v Collection, analysis anddissemination of daily healthsystem statistics, using DHSSinformation technology, toappropriateauthorities/agencies within thehealthcare continuum.

v Providing accurate andconcise information to DHSSleadership during times ofpublic health emergencies andother events affecting orpotentially affecting theState’s public health andhealthcare continuum.

v Monitor responsibilities of,and information from, theregional Medical CoordinationCenters (MCCs), individualhospitals, FQHCs, LINCSagencies, local healthdepartments and EMS duringa health emergency.

v Monitor and disseminateinformation from the NewJersey Office of EmergencyManagement (OEM) and/or theRegional OperationsIntelligence Center (ROIC).

v Monitor and disseminateinformation to and frompartner New Jersey Stateagencies, federal agencies andothers as necessary regardingthe State’s public health andhealthcare issues.

v Maintaining communicationavenues with DHSS personnelassigned to the SEOC throughwhich information and/or datais transmitted and received.

Emergency Communication CallCenters

Emergency communication callcenters are a key component ofDHSS’s communications strategy,providing enhanced capabilities todisseminate public healthinformation during events withheightened public andprofessional interest and concern(e.g. H1N1 outbreak). DHSS



maintains two call centers asresources for New Jersey’sresidents and visitors that wouldlike specific informationregarding an ongoing event. Theinquiries received by the callcenters are reviewed by DHSSmanagement in order to identifymessaging or other responseactivities that requiremodification and/oraugmentation.

1. DHSS Hotline: The DHSSHotline is activated by theCommissioner to respond toinquiries from the generalpublic related to a specific

event. Using a toll-free phonenumber, the public are able tospeak directly with trainedoperators that will providespecific event relatedinformation. The operatorswork from detailed scriptsdeveloped by DHSS’s healtheducators, answeringquestions and providinginformation on availableresources. The primary site ofthe DHSS Hotline is theCentral West MCC with otherMCCs providing expansion/backup capabilities.

2. Emergency CommunicationsCenter (ECC): The EmergencyCommunications Center(ECC), staffed by DHSSpersonnel, responds toinquiries from New Jersey’spublic health and healthcareprofessionals. Thisinformation includes, but isnot limited to: emergencyresponse activities, treatmentrecommendations forphysicians, diseasesurveillance activities andguidance on educationalinformation for patients.


Hippocrates is a web-basedapplication developed by the DHSSto enhance situational awareness,assisting with the preparation for,response to, and recovery fromnatural and man-made healththreats and emergencies.Hippocrates is a unique softwarepackage able to integrate static anddynamic data, geospatially displaythis data, provide analysis capabilityand support emergency commandand control. This integration ofstatic and real time data on NewJersey’s health system in a one-stopportal allowing users to makeinformed decisions during anemergency. Hippocrates is alsoused to monitor New Jersey’s dailyhealth system status, to informplanners and to conduct exercises.

Hippocrates is an umbrellaapplication with modules thatcollect and analyze health systemdata.

v The Command Center Console(CCC) provides real-timetracking and management toolsfor events, incidents, andcommand centers throughoutthe State.

v The Healthcare SystemResources (HSR) modulemaintains the capability toobtain information, bed status,and contact information for NewJersey’s healthcare facilities.

v Hippocrates data is synthesizedin the GIS-based InteractiveMapping module, pulling data

Hippocrates: Health Information Technology System

from the CCC and HSR as well asother sources, including theEmergency PreparednessInventory System providingstockpile inventory; theEmergency Medical Servicestatus system (called JEMSTAT)tracking hospital diversions,weather and traffic, and the NJMedical Reserve Corps registry ofvolunteers.

v The Communications Channelmodule provides users with thecapability to exchangeinformation in real time.

Current Hippocrates usersinclude:v DHSS v Health Command Center

(HCC)v Regional Medical

Coordination Centers (MCCs)v Healthcare Associations v Acute care facilities &

corporate healthcare systemsv Local Information Network

and Communication System(LINCS) agencies

v Local health departmentsv NJ State Police (State

Emergency OperationsCenter; Regional OperationsIntelligence Center)

v Federal agencies (USDHHSRegion II, FBI)

v External partners

The Hippocrates program supportsexpansion to include additionalState, Federal and private sectorpartners.



Regionalized Emergency Response Assets

In order to minimize any gapsbetween State, county and local

response to public healthemergencies, and to

more effectivelydeploy DHSS

assets, the

DHSS has designated five publichealth regions covering the 21counties of New Jersey. Theseregions are:

v Northeast – Bergen, Essex andHudson counties

v Northwest –Morris, Passaic,Sussex and Warren counties

v Central East - Middlesex,Monmouth, Ocean and Unioncounties

v Central West – Hunterdon,Mercer and Somerset counties

v South – Atlantic, Burlington,Camden, Cape May,Cumberland, Gloucester, andSalem counties.



Regional Health Infrastructure ProgramThe Regional HealthInfrastructure Program (RHIP) isdesigned to enhance the capabilityand maintain the integrity of NewJersey’s public healthcare systemin order to minimize morbidity andmortality during public healthemergencies. RHIP willaccomplish this mission throughregional planning for thecoordination and management ofmedical and medically relatedactivities and resources that will beintegrated and synchronized withpublic health and emergencymanagement systems.

RHIP major responsibilitiesv Assessmentv Regional Planningv Grant Administrationv Relationship Buildingv Exercise Strategy &

Implementationv Responsev Training Coordinationv Support of State effortsv Identification of regional gaps

In support of the RHIP, the DHSShas supported the development ofnine Medical Coordination Centers(MCCs). The MCCs provide anoperational tool for implementingthis mission through use oftechnology, community resourcesand regional command, control andcommunication capabilities. Thepurposes of the MCCs are tocoordinate information andeffectively communicateemergency information, to assist

with the coordination of patienttransportation, and to monitorpublic health activities to enhancethe statewide capability to maintainthe integrity of New Jersey’shealthcare systems. Theintegration of these systemsinclude, but is not limited to suchagencies as acute care hospitals,home care, primary care, long termcare, federally qualified health carecenters (FQHCs), emergencymedical services andoutpatient/ambulatory care centers.

One MCC has been established ineach of the five regions. Inaddition, four specialized MCCshave been established as resourcesfor the coordination of eventsinvolving New York City, theNewark Liberty InternationalAirport and Port Newark / PortElizabeth area, the Shore area, andlarge numbers of burn victims.

The day-to-day responsibilities ofthe RHIP are to assist in thedevelopment of regional healthplanning, training, and exercisingthroughout the public healthregions. The MCC will assist ingathering information/communication within themunicipal, county and State publichealth, healthcare and emergencymanagement systems.Implementation of this structureallows for statewide standardizationas well as specialization within thefive public health/healthcare regionsaround the State.



During an event, the MCCs, incoordination with the State HCC,provide accurate, real timesituational awareness to theleadership responsible forresponding to public healthemergencies. The MCCs willgather, communicate and shareinformation to maximize themedical surge capacity andcapability to effectively respond toan incident. To assist with surgecapacity information and tomaximize surge capacity and

capability in a real event, each MCChas the ability to obtain real timeinformation on hospital diversionstatus, healthcare facility bedstatus, pharmaceutical stockpileavailability, medicalepidemiological information, aswell as, EMS systems statusthrough the Hippocrates datasystem. This real time access todata enables the MCCs and thehealthcare facilities and entitieswithin the specific publichealth/healthcare region, todetermine, direct and transportpatients as needed to maximizesurge capability and capacity in theevent of a disaster. Surge capacityinformation is collaborativelyshared with other MCCs, theHealth Command Center (HCC),and the State EmergencyOperations Center (SEOC).

As each public health/healthcareregion is unique in population anddemographics, a Regional AdvisoryCouncil has been established ineach region. Those represented onthese Councils include EMS,hospitals, long term care, homecare, primary care, emergencymanagement, FQHCs, ambulatorycare, local public healthdepartments, LINCS agencies, lawenforcement, fire service, MedicalReserve Corps, and additionalsubject matter experts, asappropriate.



Regional Coordination of Public Health AgenciesNew Jersey is likely to face publichealth emergencies that expand beyondthe single municipality reaching thecounty level and beyond, however, theimpact of these emergencies will be feltlocally and any response will includelocal involvement.

Local health departments (LHDs) arethe base of the public health system inNew Jersey and are relied on for theinitial response to any public healthemergency. Public health is amunicipal responsibility by State law,Municipalities may meet thisresponsibility by creating a municipalhealth department, making anagreement with another municipalityfor coverage by its health department,joining a Regional HealthCommission, or coming under thejurisdiction of a county healthdepartment (as counties are alsopermitted to assume public healthresponsibilities). This mix ofarrangements has resulted in anetwork of 111 LHDs covering NewJersey’s 566 municipalities.

Pursuant to New Jersey law, the localhealth department, operating underthe authority of a local Board of Healthor the local governing body, and underthe direction of a licensed HealthOfficer, has the primary responsibilityand authority at the local level forinvestigating reports of communicablediseases and responding to a publichealth emergency. The EmergencyHealth Powers Act grants theCommissioner of Health and SeniorServices the authority to use thesesame powers during a declared

statewide public health emergency.But absent such a declaration, thelocal boards of health shareconcurrent jurisdiction with theCommissioner, but the primaryresponsibility will rest on the localHealth Officer.

Recognizing that public healthemergencies may be regional inscope, and that many smallermunicipal health departments lackthe resources and specializedexpertise to respond to large scalepublic health threats, DHSS hasdesigned systems to provide for theregional planning and coordinationof a public health response.

DHSS has developed the LocalInformation Network andCommunication System (LINCS) asa concept for specialized regionalpublic health services. Currently, 21strategically positioned local healthdepartments are designated asLINCS agencies to serve as theState’s regional public healthpartners in coordination of diseasesurveillance, communications,data/information exchange, andpublic health emergency planningand response. The LINCS agenciescarry out these functions incooperation with other local healthdepartments, hospitals, physicians,emergency responders, and avariety of community organizationsin their jurisdictions. There areLINCS agencies covering eachcounty (one agency covers twocounties) and the City of Newarkhas its own LINCS agency.



The LINCS agencies have beenprovided federal and State grantfunding to build infrastructure andexpertise for disease surveillance andresponse coordination. These LINCSagencies are actively involved, incooperation with the DHSS, in thedevelopment and implementation ofcountywide or multi-countywidecoordinated planning, surveillance,specimen/sample collection andhandling, and education forbioterrorism, West Nile virus, andinfluenza. Activities include: theformation of public health planningtaskforces, serving as a resource foressential data and information,coordinating response to unusualoccurrences of emerging infections,providing technical assistance tolocal/county agencies andorganizations, coordinating passiveand active infectious diseasesurveillance, using GIS and databasetechnologies to analyze data andidentify disease trends, determiningappropriate levels of local response tocontrol diseases and hazards,establishing relationships withphysicians, hospitals, and otherhealthcare providers to facilitateaccurate and timely disease reporting,providing quality assurance forspecimen/sample collection andsubmission, coordinating regionalpublic and professional education,disseminating information andeducational materials, developinginformational websites, and ensuring24/7 public health emergencyresponse services. Each LINCSagency also supports and manages aMedical Reserve Corps Unit.

LINCS agencies have beeninstrumental in developing thestatewide Health Alert Network(HAN) that provides frequent publichealth information, updates,advisories, and alerts to local healthdepartments, physicians, hospitals,emergency responders, and othersin community, health care, andpublic health sectors. Routineactivity and summary reports suchas weekly Influenza SurveillanceReports are distributed to the targetaudiences. LINCS agencies areresponsible for the expansion andmaintenance of their respectiveCommunity Health Alert andInformation Networks (CHAIN) andserve as the communication “hub”in the dissemination and responseto priority public health information.

In addition, the DHSS hasencouraged the formation of aGovernmental Public HealthPartnerships (GPHP) in each countywhich has more than one LHD. TheGPHPs are designed to facilitate thedevelopment of countywidecollaboration among the LHDs.Currently, there are GPHPs in tencounties, and a regional GPHPamong the eight LHDs in the seven-county southern region. While theGPHPs focus on all aspects of publichealth, the some GPHPS haveinitiated activities related to publichealth emergency preparedness,including joint planning, exercises,and mutual aid agreements amongtheir member LHDs.


The specific strategiesadopted by the DHSSto prepare for and

respond to public healthemergencies are categorizedinto operational areas thatcorrespond to the particularfunctions that must beperformed in emergencysituations. In some casesthese functions correspondwith specific programs inthe DHSS organizationalstructure. In other cases,these functions areaccomplished through thecooperative efforts ofmultiple DHSS programs.The following sectiondescribes the guidingstrategy for eachoperational area.

Many of these operationalcategories correspond with thenational Target Capabilities Listdeveloped by the U.S. Departmentof Homeland Security. Togetherwith the National PreparednessGuidelines, the TargetCapabilities List establishes an allhazards framework for thenational preparedness system.The Target Capabilities providethe means to accomplish amission and to achieve desiredoutcomes by performing criticaltasks, under specified conditions,to target levels of performance.

Operational Categories



Surveillance and Investigation

The DHSS Communicable DiseaseService (CDS) is responsible forsurveillance and investigation ofreportable communicable diseases(including foodborne, vectorborne,and zoonotic diseases) and emerginginfectious disease issues (includingantimicrobial resistance and avianinfluenzae). In addition, CDSdevelops plans that specificallyaddress diseases of particularconcern.

CDS has developed procedures tosystematically examine data fromseveral surveillance systems. Theprimary surveillance system is theCommunicable Disease Reportingand Surveillance System (CDRSS), a web-based database for notifiablecommunicable diseases. Over 900local public health and healthcarepartners (including hospital andlaboratory staff) statewide useCDRSS for electronic reports ofnotifiable communicable conditions.CDS staff and regional epidemiolo-gists at each of the LINCS agenciesroutinely monitor reportablecommunicable diseases. Follow-upactivities on disease reports includecase and contact interviews, charac-terization of outbreaks, andimplementation of infection controlmeasures as indicated (e.g., post-exposure prophylaxis recommen-dations, appropriate isolation forcases, quarantine of exposed andpotentially infected asymptomaticcontacts) in collaboration with thestaff of local health departments.CDS epidemiologists evaluate allCDRSS reports for appropriate

public health management andcompleteness. The New JerseyImmunization Information System(NJIIS) is also designed to trackvaccination coverage rates, includinginfluenza

Additionally, CDS epidemiologistsmonitor BioSense data from LabCorpand federal sources, including theVeterans Administration and theDepartment of Defense. Theepidemiologists examine these datafor illnesses (e.g. fever illness, rash,lymphadentitis) and syndromes (e.g.gastroenteral, respiratory, neurologic)of public health concern. CDSepidemiologists also monitor dailyhospital emergency visit andadmission volume to detect unusualhospital emergency/admissionactivity. CDS and regionalepidemiologists in seven countiesmonitor the Epicenter surveillancesystem which provides real-timetracking and analysis of emergencydepartment visits. CDS routinelyprovides summaries of reportabledisease findings to local health andhealthcare partners.

DHSS collaborates with the NewJersey Department of Agriculture(NJDA) in surveillance of animaldiseases that potentially threatenhuman health. Enhancements toNJDA’s Agriculture’s ReportableAnimal Disease Database System(RADDS) may enable sharing ofanimal disease reports fromveterinarians and animal healthcarefacilities between RADDS andCDRSS.


DHSS has addressed the uniquecharacteristics of New Jersey’shealthcare system to enhancemedical surge by developing acommand, control, coordination,and communications networkacross the health system,increasing stockpiles of medicalsurge equipment at the State,regional, local and individualhealthcare facilities levels, andimplementing training programsfor the healthcare system.

All acute care facilities in New Jersey have EmergencyOperations Plans that outline howa facility would respond during anevent. Facilities have stockpiledequipment and supplies thatwould be needed to supportspecialized patient care or a surgein patient volume during aterrorism event, a natural disaster,or a naturally occurring diseaseoutbreak. Additionally, DHSSmaintains a State stockpile ofequipment and supplies that willbe deployed to healthcarefacilities to augment the surgecapacity.

Acute care facilities were alsorequired to develop pandemicinfluenza plans and prophylaxisplans for facility staff and for thefamily members of staff. In order

Medical Surge

to provide for theirpersonnel, manyhealthcare facilitieshave stockpiledsupplies ofantibiotics for useby first receiversand householdmembers.

Healthcarefacilities, includingacute care, long-term care, homecare and primarycare, have formaland informalmutual aidagreements,especially facilitieswithin onehealthcare systemor one geographiclocation. Theseagreements providefor the sharing ofstaff andequipment andincludearrangements forpatient transfers.In addition, someagreements existbetween acute care facilities toshare responsibility for alternatecare sites.



DHSS and the LINCS agencieshave worked with medicalfacilities to identify alternate caresites. Long-term care facilitiesand Federally Qualified HealthCenters (FQHCs) are being usedas alternate care sites in the eventof a mass casualty event. FQHCshave been asked to serve asscreening, triage and treatmentsites to relieve the burden onacute care hospitals andemergency rooms during aninfluenza pandemic.

DHSS has directed its State levelefforts on the development ofmobile medical facilities andassets. DHSS acquired a mobilemedical facility, the WesternShelter Gatekeeper System,which can provide care for up to100 individuals. The facility willbe maintained and mobilized bythe New Jersey EMS Task Force.The facility can be deployed formedical surge anywhere in theState as an ad-hoc medicalevaluation/ quarantine facility.Medical Reserve Corps (MRC)volunteers will support the staffstructure for the facility alongwith the EMS Task Force.Specialized teams of health careprofessionals and support staffselected from the NJMRCprogram will be created to meetthe staffing needs for the MobileCare Facility. In addition, DHSShas developed arrangements tocoordinate use of this facility withother medical surge assets in theState, including the UASI regionMobile Emergency Departmentinitiative and HackensackUniversity Medical Center’smobile medical assets.


The DHSS collaborates with theNew Jersey Department ofHuman Services (NJDHS) toassure that the mental healthneeds of emergency responders,care providers and the generalpublic are included in theplanning for and response topublic health emergencies.

The Division of Mental HealthServices (DMHS) within theNJDHS is home to a specializedmental health Disaster andTerrorism Branch (DTB) locatedwithin the Office of Planning,Evaluation and Technology. TheDirector of the Disaster andTerrorism Branch is responsiblefor activating the State's mentalhealth disaster response planduring a declared disaster, incoordination with the NJDHSEmergency Social ServicesCoordinator and the New JerseyOffice of EmergencyManagement.

Each New Jersey countymaintains a county-specific allhazards mental health disasterplan which can be activated bythe County Mental HealthAdministrator in coordinationwith the county Office ofEmergency Management and incollaboration with the Statepartners. The services availablethrough the Disaster andTerrorism Branch include:individual crisis counseling;psychological first aid; written or

Mental Health

verbal psycho-educationalinformation on disaster stressmanagement; group crisiscounseling; consultation andtraining; information and referralservices; and toll free help lineservices.

The Disaster and TerrorismBranch developed a RapidAssessment, Deployment andResponse (RADAR) Team toprovide a coordinated response tothe mental health needs of allaffected populationsin the wake of adisaster or terroristevent. The RADARTeam serves as aforward responsegroup comprised ofrepresentativesfrom the mentalhealth and firstrespondercommunities. Uponnotification, theRADAR teamresponds as soon aspossible toEmergencyOperations Centers(EOCs) to providetechnical assistanceto decision-makersin assessing theneed for disastermental healthservices and incoordinating thedeployment of crisiscounselors, peer-support



personnel and other specializeddisaster mental health resources.

In response to declared disasters,DMHS in its role as the Statemental health authority applies toFEMA for crisis counseling grantprograms. The grants fundcommunity-based outreachprograms to assist individualsaffected by disasters. Anyindividuals offering mental healthor crisis counseling servicesshould be credentialed by theDTB. Crisiscounselors areregistered throughthe credentialingprocess whichincludes: anapplication,background check,interview,reference checks,and completion ofrequired training,at which time, thecounselor isassigned to aspecific level ofcompetence toaccommodate arange of skills.

The Disaster andTerrorism Branchmaintains adisaster mentalhealth websitewww.disastermen-talhealthnj.com to

share relevant information withthe public and with mental healthprofessionals, and publishes the e-newsletter, the New Jersey CrisisCounselor, in order to provideclose collaboration withrepresentatives from publichealth, law enforcement,emergency management, andother professionals at the local,State and federal level tocoordinate mitigation, planning,response and recovery efforts.


In the event of a public healthemergency, DHSS is the leadagency responsible forpharmaceutical distribution. TheDHSS Strategic NationalStockpile and PharmaceuticalDistribution Plan provides thespecifications for request, receipt,and distribution of vaccinesand/or pharmaceuticals in order torapidly dispense medications withthe most efficient utilization ofavailable workforce.When fullyimplemented, the planis capable of providingpharmaceutics to theapproximately 8.5million residents ofNew Jersey. The planalso provides partialactivation planning toquickly administerprophylaxis in theevent of a morelocalized incident.

These capabilitiessupport massprophylaxis to beconducted with Stateresources and, whennecessary, federalresources provided bythe CDC. DHSSmaintains a StrategicState Stockpile (SSS)including antibiotics,antivirals, personalprotective equipmentas well as assets fromCDC’s CHEMPACK

Mass Prophylaxis

Program. When this cache cannotmeet the public health needs ofthe response, DHSS will notifythe Governor’s Office to requestStrategic National Stockpile(SNS) assets through CDC.

DHSS has developed athree–tiered approach to addressthe goal of providing medicationsto the State’s population within 48hours: a First Responder Plan,



Fixed Facility Plan and fivealternate points of dispensing(POD) modalities. The FirstResponder Plan providesmedications to the firstresponders and their familymembers. This is necessary toensure that these individuals areavailable to assist in thedistribution efforts for the generalpublic. The Fixed Facility Planincorporates planning efforts forthose identified facilities such asprivate industry, colleges anduniversities, defined communities

(seniorcitizenscomplexes),correctionalfacilities, andhospitals.DHSS hasalso exploredalternatemodalities toaddressdispensingmedicationsquickly totheremaining

public, including special needspopulations, which are notcovered under the other twoapproaches. DHSS has developedplanning templates for localhealth departments providingthem with a model that describesalternative methods to providemedications to the entirepopulation.

Each LINCS Agency, incoordination with OEM and localhealth departments whereapplicable, has developed a massprophylaxis plan meeting the goalof providing medications to theirjurisdictions within 48 hours. Inthe event that prophylaxis isneeded for a smaller number ofindividuals standardized points ofdistribution (POD) operationswould be used. The POD manualdeveloped by the DHSS would beused as an operational guide.Each LINCS Agency willcoordinate POD activation in itsjurisdiction in consultation withDHSS and other local healthofficers where applicable.

Numerous entities anddepartments, including State andlocal agencies and the MedicalReserve Corps work incoordination to move materialsthroughout the State, and toensure the public has theappropriate standard of care. Aweb-based EmergencyPreparedness Inventory Systemtracks medications and suppliesfrom the point of receipt to thepoint of distribution.


Local Health Officers and theDHSS have the authority toimpose isolation/quarantine. Thisauthority is established by theNew Jersey Administrative Code,which states that:

“ A health officer or the Department,upon receiving a report of acommunicable disease, shall, bywritten order, establish such isolationor other restrictive measures requiredby statute or rule to prevent orcontrol disease. If, in the judgmentof the health officer or theDepartment, it is necessary toprovide adequate isolation, a healthofficer or the Department shallpromptly remove, or cause to beremoved, a person who is ill with acommunicable disease to a hospital.Such order shall remain in force untilterminated by the health officer orthe Department.”

N.J.A.C. 8:57 –1.9.

The Emergency Health Powers Act(N.J.S.A. 26:13-1 et seq.) reinforcesthe DHSS’ authority to implementisolation and quarantineprocedures. The Act formallyclarifies and organizes powersenumerated in previous pieces oflegislation. Upon the Governor'sdeclaration of a public healthemergency, the Commissioner ofHealth and Senior Services isempowered to take a number ofactions to protect the health of thepublic, including ordering theisolation and/or quarantine ofpersons as required.

Isolation / Quarantine

Themechanism toactivateisolation/quarantinehas beenestablishedand has beenutilized forseveral real-life events inNew Jersey.The localhealthdepartments are responsible formonitoring those individuals inisolation/quarantine outside of ahealthcare facility. Enforcementof isolation/quarantine orders isthe responsibility of theDepartment of Law and PublicSafety, the Office of the AttorneyGeneral, the State Office ofEmergency Management, CountyProsecutors, and county/localOffices of EmergencyManagement.

The authority and responsibilityto screen international travelersand implement travel restrictionsrests with the federal government,and has been assigned to the CDCGlobal Migration and Quarantine(DGMQ). DHSS and other Stateand local agencies have beenworking closely with DGMQ tounderstand existing federal plansand to support DGMQ asnecessary.



Emergency Medical Services

The Office of Emergency MedicalServices (OEMS) is the StateEmergency Medical Services(EMS) coordinator and the leadcoordinating agency for all EMSassets during times of need asdirected by ESF# 8. Duringactivation, OEMS staff report tothe State Emergency OperationsCenter (SEOC). OEMS has takenan active approach to fulfilling itsrole and works closely with theCounty Office of EmergencyManagement EMS Coordinators.During times of activation, an

OEMSrepresentative alsostaffs the HCC toserve as the EMSexpert and liaison.

OEMS staff areavailable for fieldresponse shouldthe need arise.OEMS has acquireda MobileCommunicationPlatform vehiclethat will allow fornot only interoper-ability in the field,but also providesthe ability to sendstreaming videofrom an incident toan internet web siteand to the HCC.The platform is alsoequipped with VHF,UHF, 800 MHz, andHAM radios in

addition to cellular and landlinecapabilities.

During activation, OEMScontinues in-house operations bymanning the office phones andproviding technical support toindividuals. In the past, providershave inundated the office withcalls requesting informationincluding treatment protocols andpersonal protection guidelines onthe ongoing incident.

A statewide New Jersey TriageTag has been adopted and OEMSsupplies the EMS agenciesstatewide with standardized triagetags at no cost. To date, in excessof 500,000 tags have beendistributed.

OEMS, in conjunction with NJPEOSH, has implemented aRespiratory Protection Programto all of the EMS agenciesthroughout the State. OEMS hadcreated a training poster titledPersonal Protective Equipmentfor EMS Agencies that was issuedto every agency in October 2007.This poster is part of educationalposter series for EMS providers,which also includes: New JerseyDisaster Triage Tag, HomelandSecurity Threat Assessment forEMS, and CBRNE for EMSAgencies.

OEMS maintains and continues toorient agencies to the JEMSTATHospital Diversion website.


Emergency Medical Services

JEMSTAT provides real timeinformation to the EMScommunity about which hospitalsare on diversion status andidentifies why the hospital needsto be on diversion. JEMSTAT isbeing incorporated intoHippocrates.

By statute, DHSS is responsiblefor ensuring a statewide poisoncontrol center. Through OEMS,the Department has ensured thiscapability through recognition ofthe New Jersey PoisonInformation and EducationSystem (NJPIES) located at theUniversity of Medicine andDentistry of NewJersey. NJPIESoperates a 24/7/365poisoning hotline(as part of anational network)that providesassistance to thepublic and healthcare professionalsand tracks the callsit receives todetermine patternsand trends inincidents ofpoisoning. Thesecapabilities enableNJPIES to act as anearly warningsystem to detectincidents ofintentional spreadof toxins and toassist those affected

with immediate countermeasuresand linking to the EMS system.

The New Jersey EmergencyMedical Services Task Force(NJEMSTF) was established toprovide a coordinated emergencyresponse to major emergenciesand catastrophic disasters. TheNJEMSTF is a DHSS-ledstatewide initiative that isorganized into three regions(North, Central and South). Itsmission is to provide an organizedresponse during any majorincident. The NJEMSTF providesa specialized force that combinesthe best of New Jersey’s various



EMS resources, including careerand volunteer Basic Life Support(BLS) services, hospital-basedAdvanced Life Support (ALS)services, commercial ambulanceproviders and EMScommunications centers.

The NJEMSTF provides themechanism for a coordinatedresponse and is intended tosupplement existing emergencymanagement plans. Its mission isto provide incident planning,specialized assets and incidentsupport. The NJEMSTF isactivated at the request of localEMS agencies through theirrespective County OEM-EMSCoordinator. All deployments ofstaff and equipment areauthorized and coordinated byDHSS.

Staging and accountability is atthe foundation of any successful

large scaleresponse. TheNJEMSTF, inconjunctionwith the NewJersey StateAssociation ofCounty OEM-EMSCoordinators,has developeda StatewideStaging AreaManagementPlan which

provides for a common approachto staging, accountability andtasking. There are fourstrategically located RegionalStaging Areas as well asnumerous County Staging Areas.Air Medical assets are managedand staged via a StatewideHelibase Management Plan.

Major NJEMSTF assets includeMass Care Response Vehicles andMass Care Trailers, incidentsupport vehicles, Staging andAccountability Trailers, towvehicles, patient movingequipment, radio caches andcommunications vehicles. Each ofthese specialized assets is staffedby trained volunteers.

The NJEMSTF also provides theability to provide inter-stateresponse capability through theFederal Emergency ManagementAgency (FEMA) EmergencyManagement Assistance Compact(EMAC) Program. It is alsoavailable for deployment to NewYork City through activation of aMutual Aid Agreement betweenthe City of New York and theState of New Jersey.


The Division of Public Health andEnvironmental Laboratories(PHEL) is responsible forprovision and coordination oflaboratory services to detectand/or confirm disease organismsand chemical agents. Laboratoryservices related to emergencypreparedness and response areprovided through four units: theBioThreat Response Laboratory(BTRL) and the VirologyLaboratory within the PublicHealth Laboratory Services(PHLS), the Environmental andChemical Laboratory Services(ECLS), and the LaboratoryOutreach Program (LOP) withinthe Office of Policy Planning andRegulatory Compliance (OPPRC).

The ECLS maintains a chemicaland radiological test capabilitythat may be used for the analysisof clinical specimens,environmental samples and foodsamples for chemical agents andcontaminants. ECLS has a fullservice water testing laboratory,which maintains the testingcapability to analyze drinkingwater and water pollution samplesfor bacteriological, inorganic,organic and radiologicalcontaminants. The laboratory hasexpanded its testing coverage toinclude toxins and poisons in foodproducts, as well as chemicalagent metabolites in clinicalspecimens. The laboratoryparticipates in the CDC’s

Laboratory

Laboratory Response Network –Chemical (LRN-C), the Food andDrug Administration’s (FDA) FoodEmergency Response Network(FERN) and the USEnvironmental ProtectionAgency’s (EPA) EmergencyLaboratory Response Network(eLRN). As a CDC LRN-Claboratory, the ECLS established aLevel 2 Laboratory testingcapability to analyze clinicalspecimens for toxic metals,cyanide, organophosphate nerve

agent acid metabolites andvolatile organic compounds.PHEL has establishedpartnerships with other LRNfacilities for surge support or inthe event of a catastrophic loss offacility.



The BioThreat ResponseLaboratory (BTRL), whichoperates in the BSL-3 ModularFacility, is able to providepresumptive (i.e., screening) andconfirmatory results for selectagents and other pathogens ofpublic health significance. TheBTRL, as the only LRN referencelaboratory in New Jersey, provides24/7/365 service to public healthdepartments, the FBI, State andlocal law enforcement, firedepartments, HAZMAT teams,hospitals, and healthcare

providers.Additionally, thelaboratory suppliesdiagnostic support tothe New JerseyBiowatch Program.

The Virology Programmaintains testingcapacity for theOrthopox family ofviruses. The Virologylaboratory possessesboth molecular andnon–molecularplatforms to performtesting for other rashillnesses, includingVaricella-Zoster virus(VZV), herpes simplexvirus (HSV),Enterovirus usingReal–time PCR, andculture in conjunction

with fluorescent antibody stainingto rule-out smallpox in low riskand medium risk patients and tosupport vaccination programs.The Virology laboratory is alsocapable of performing serologicaltesting for IgM antibody againstVZV. The Virology laboratory alsoparticipates in surveillanceinitiatives for influenza virus,West Nile virus and EasternEquine Encephalitis (EEE) virus.

The Laboratory OutreachProgram (LOP) focuses ondevelopment of partnerships with65 LRN sentinel and 91 clinicalchemistry laboratories in NewJersey. These partnerships aremaintained through meetings,training programs, an LRNwebpage, preparednessinspections, exercises, andmonitoring of sentinel laboratoryparticipation in the College ofAmerican Pathologists (CAP)Laboratory Preparedness Survey.Training for the State’s LRNsentinel and clinical chemistrylaboratories is provided by LOP incollaboration with the NationalLaboratory Training Network(NLTN), a jointly sponsoredprogram of the CDC and theAssociation of Public HealthLaboratories (APHL).


In New Jersey, three Statedepartments have jurisdictionalresponsibilities over animals.v The New Jersey Department of

Agriculture (NJDA) has theauthority to control andrespond to diseases infectiousto poultry, livestock,aquaculture, and animalsraised for fur.

v The New Jersey Department ofEnvironmental Protection(DEP) has the authority tocontrol and respond todiseases in wildlife, includingnative, exotic andendangered animals.

v The DHSS, through itsInfectious ZoonoticDisease Program(IZDP), has theauthority to control andrespond to diseases inpet stores, kennels, andanimal facilities anddiseases transmissibleto humans fromanimals.

The Departments performjoint surveillance andsampling activities. Forexample, as part of avianinfluenza surveillance, theDepartments arecollaborating on samplingthe bird populations in NewJersey. Each of the Departmentsis able to conduct animal healthepidemiological investigations,including follow-up to determinethe source of an animal disease

Animal Disease

outbreak and the potentiallyinfected animal populations, andcan verify the eventualelimination of the disease.

While all distinct in their respon-sibilities, the three Departmentsmust all collaborate andcommunicate because somediseases have the ability to infectand spread from one species toanother, including to humans,and/or impact the food supply.This is especially apparent in aforeign animal disease outbreak.

While NJDA will be involved withthe immediate response(detection, quarantine,eradication, etc.), DEP will beproviding the resources fordisposal and decontamination, in



addition to mitigating the possiblespread to/from wildlife, and DHSSwill be involved with themonitoring human health andmitigating the possible spread tohumans and pets.

These three Departments alsowork with their Federalcounterparts in an animal diseaseoutbreak: NJDA with the UnitedStates Department of Agriculture(USDA), DEP with the US Fishand Wildlife Service, and DHSSwith the CDC. Regular meetingsare held with federal partners in

order to share information, trendsand concerns regarding diseasesin animals.

The DHSS-IZDP works with localhealth departments, veterinarians,and facility owners on thediagnosis, treatment andprevention of communicablediseases in pet stores, kennels,shelters and pounds, and rabiesdisease in all animals. The IZDPand local health departments workclosely with Animal ControlOfficers (ACOs), managers ofanimal shelters, pounds, pet shopsand kennels, and veterinarians toinvestigate diseases that can betransmitted from animals topeople (zoonoses) and to institutecontrol measures to preventtransmission of diseases to otheranimals and people. During ananimal disease emergencyincident, DHSS veterinarians andstaff will work with ACOs andanimal facility managers tocoordinate the control of strayanimals, provide impounded straydomestic animals with housingand care and euthanize affectedanimals, if warranted.

The DHSS Public Health andEnvironmental Laboratories,while not an animal healthdiagnostic laboratory, conductsdiagnostic testing for zoonoticdiseases in humans and thus canserve as a rapid means to detectanimal diseases.


The DHSS Food and Drug SafetyProgram (FDSP) licenses andinspects over 2,500 wholesale foodmanufacturing and storagefacilities in New Jersey. Localhealth departments (LHDs) in theState have primary inspectionand licensing jurisdiction over55,000 retail food operations. TheFDSP has 26 field inspectorspositioned around the State toconduct inspections and assistLHDs upon request. The FDSP:

1. Promptly responds to singleevents involving imminenthealth hazards and providesguidance to help the licenseholder resume operation asquickly as possible;

2. Allows license holders toassess food safety within theirindividual establishmentduring a widespreademergency;

3. Communicates with theindustry during widespreademergencies through massmedia, hot lines, web sites,etc.;

4. Conducts surveillance duringa widespread emergency todetermine if license holdersare following the EmergencyAction Plan; and

5. Conducts enforcement activityas appropriate to protectpublic health.

The FDSP responds to anemergency by sending field staff

Food Safety

to conduct food,water andsanitationsurveillanceinspections ofaffected licensedwholesale foodestablishments.Inspectors detainadulterated foodsand/or witnessvoluntary fooddestructions anddistribute foodand wateremergencyinformationincluding foodestablishment



clean-up guidelines and re-opening procedures. The FDSPhas the ability to send “blast e-mail” messages containingemergency information and alertsto wholesale food operationsthroughout the State. Ifrequested by a LHD, FDSP fieldstaff assist with post-event food,water and sanitation surveillanceat retail food establishments aswell as other locations such asshelters, health care facilities andprivate residences. The FDSPwill also send out food disaster

and retail foodclean-up guidanceto LHDs duringan emergencyover the NJHealth AlertNetworkmessagingsystem.

FDSP’s FoodDefense Projectdeveloped a“Guidance forEmergency ActionPlanning forRetail FoodEstablishments”document. Thisdocument wasdesigned toprovide guidancein thedevelopment ofemergencyprocedures forretail food

establishments.Individualestablishmentscan use thesamples andresources inthis documentto developprocedures thatmeet the needsof their specificorganization.These guidelines were developedbased on similar models that areprovided by other State healthdepartments and were tailored tomeet the needs of New Jerseyretail food establishments. TheFDSP has distributed thisguidance document to LHDs forfurther distribution to the retailfood sector, New Jersey food tradeorganizations, and State inspectedretail food establishments. Thedocument has also been posted onthe FDSP web site.


DHSS worksclosely with theNew JerseyDepartment ofEnvironmentalProtection (DEP) toassess the healthand environmentalconsequences ofany event.Emergencyresponsecapabilities exist atDEP through theEmergencyManagementProgram and areintegrated with theState Office ofEmergencyManagement. Atthe county level,countyenvironmental health agencies,which in most counties are co-located with the LINCSagencies, have emergencyresponse capabilities and haveestablished a network foremergency response with othercounty and local hazardousmaterials response units withintheir county.

DEP administers a wide array ofenvironmental regulatoryprograms over water,wastewater, solid waste andhazardous waste facilities whichprovide extensive site-specificexpertise regarding these public

Environmental Hazards

facilities. Each has anestablished emergency responseplan which links to the State’sexisting network of emergencyresponse agencies. Thisoversight network makes theState very well situated torespond to any form of publichealth emergency situation andto maintain the provision ofbasic services.

Response to environmentalhealth hazards requiresexpertise and competency inenvironmental modeling, fieldsurvey and laboratory sampleanalysis. The DEP and most



county agencieshave plumemodeling, grabsample and fieldanalyticalcapabilities tosupport this need.Geo-coded databases already existfor the coreenvironmentalhealthinfrastructure suchas water andwastewaterfacilities, solid and hazardouswaste facilities, hospitals andother healthcare facilities andassociated critical life-linefacilities, such as transportationnetworks and public utilities.The DEP, DHSS and Board of

Public Utilities (BPU) all haveassigned field staff capabilitiesto perform survey/assessmentwork as needed following anincident. DEP and DHSSprovide laboratory services andexpertise in sample analysis andinterpretation of data. DEP alsohas emergency responsecontractors who can be used tosupport the sampling missionfor hazardous material. Thesecontractors are available on a24/7 basis. Response toenvironmental hazards isintrinsically linked todecontamination and site clean-up so that both short-term andlong-term health effects can bemitigated.


To effectivelyrespond to allpublic healthemergencies,DHSS hasdeveloped arobust andcomprehensivecrisiscommunicationsplan thataddresses thecreation,development andassessment ofpublic healthinformation. Thisplan has beentested both inexercises andduring realevents.

The crisis communications plan iscomprised of: v communication protocols for

all levels of emergencies;v staffing information;v pre-approved messages

including fact sheets, pressrelease templates, frequentlyasked questions, pre-populated web pages, talkingpoints and public serviceannouncements; and

v contact lists for both internaland external partners.

Public Health Information

DHSS has developed a highlycoordinated network of healtheducators/risk communicators(HE/RCs) at the county and cityLINCS agencies throughout theState. DHSS Office ofCommunications/ RiskCommunications has developedcrisis communicationseducational and training modules,shared information and exercisedcommunication plans with theseprofessionals.



In addition to the specificfunctional capabilitiesperformed by the programs

included in the operationalcategories, there are overarchingcapabilities that must be presentin all of the programs in orderfor them to complete theirrespective missions. The mostimportant of these capabilitiesinclude:

v Communicationsv Volunteer recruitment and

managementv At Risk Populations awareness

and responsev Exercises

The DHSS maintains specializedcapabilities in each of theseoverarching areas to providesupport to its functionalprograms. These capabilities aredescribed in the following pages.

Overarching Capabilities



Communications

DHSS established the PublicHealth Emergency NotificationSystem (PHENS) to supportpublic health emergencypreparedness and response effortsstatewide through the use ofeffective, appropriate and

redundant informationtechnologies prior to, during andafter emergency events. PHENSconsists of a number of integratedcomponents, as illustrated in thediagram below.

PHENS

Hippocrates

800 mHz Radio

Network

Learning Management

Network

GETS System

NJLINCSHealth Alert

Network

MedicalReserve Corps

Web Site

Hand HeldTechnologies


Communications

The New Jersey LINCS HealthAlert Network (NJHAN) is astatewide information andcommunications system that linkstogether local, State and federalhealth agencies. Through theNJHAN, local health departmentsare linked to one another, to otheragencies critical to preparedness andresponse, to the DHSS and to federalagencies. NJHAN maintains asecure internet portal which enables24/7/365 redundant communicationsand emergency alerting capabilitiesamong and between DHSS and keypublic health and healthcarepartners. All web portal serviceshave been designed to be accessibleduring extreme emergencyconditions. NJHAN is part of theCDC’s nationwide Health AlertNetwork (HAN).

The NJHAN is able to provideredundant communicationsthrough a number of overlappingcomponents:

n Encrypted email system n Two-way digital cellular

communications and textmessaging

n Fax n Reverse 911 (Communicator)n Video conferencingn Document sharing (Share

Point)n Public health directories.

Through the partner network, theNJHAN messaging systemdistributes messages via email topublic health departments,

healthcare providers, emergencymedical services and othercommunity partners. Messagesare prioritized according toimportance, including publichealth information, public healthupdates, State and federal publichealth advisories, and publichealth alerts. The CommunityHealth Alert and InformationNetwork (C.H.A.I.N.) componentof the NJLINCS System iscurrently capable, through acascading arrangement with the22 LINCS agencies, of reaching33,000+ healthcare partners,including all acute care hospitalswithin the State.



NJLINCS HEALTH ALERT NETWORK

Text Messaging

EmergencyAlerting

DocumentSharing

Reverse 911

Public HealthDirectory

VideoConferencing

Public Health Messaging


The DHSS has also embarked ona statewide initiative to provideredundant communicationscapability for and between Tier 1healthcare organizations. Thegoal is to provide all members ofthe healthcare continuum (acutecare facilities, FQHCs, long-termcare, and home health agencies)the ability to communicate andrequest aid and assistance in anyall hazards emergency. Withfinancial assistance from DHSS,acute care facilities and FederallyQualified Health Centers (FQHCs)have invested in systems forredundant communicationincluding internet capability,satellite phones and 800 MHzradios to ensure the ability tocommunicate with public healthand other support providers.

The communications assets of theNew Jersey Emergency MedicalServices Task Force providestaging area communications andassist in resource management ofthe NJEMSTG units and otherEMS resources. These assetsinclude the following radiosystems: 800 MHZ conventionalrepeater or simplex operationssystem;

v Conventional repeater orsimplex operations systems;and

v VHF conventional repeater orsimplex operations systems.

Portable 800 MHz StatewideTrunked Radios were

programmed and distributed to all21 County Office of EmergencyManagement (OEM) EMSCoordinators, State Office ofEmergency Medical Services(OEMS) Coordinator, as well as toall NJEMSTF Leaders in order toprovide instantaneous statewidecommunications capability.

The New Jersey LearningManagement Network (NJLMN)is a web-based network designedto meet the professionaldevelopment and training needsof public health professionals inNew Jersey. Developed through apartnership of DHSS and RutgersUniversity, the NJLMN provides acatalog of DHSS-approvedcontinuing education courses forpublic health professionals, accessto a nationwide directory of on-



line emergencypreparedness courses,and a library ofinformation resourceson public health andemergencypreparedness. Theresources of theNJLMN are also beingused for the training ofMRC/ESAR-VHPvolunteers. In a publichealth emergency, theNJLMN has thecapability of providingreliable incidentspecific informationand training.

PHENS also includesaccess to theGovernmentEmergencyTelecommunicationsService (GETS), ameans for minimizingthe disruption oftelecommunicationsduring periods ofabnormally highvolume of telephone calls. GETSis an emergency phone serviceprovided by the federalDepartment of HomelandSecurity to support federal, State,local, and tribal government,industry, and non-governmentalorganization personnel inperforming their national securityand emergency preparednessmissions by providing emergencyaccess to and priority processing

in the local and long distancesegments of the Public SwitchedTelephone Network (PSTN). It isintended to be used in anemergency or crisis situationwhen the PSTN is congested andthe probability of completing acall over normal or other alternatetelecommunication means hassignificantly decreased.


In order to plan for and respondto medical surge capacity staffingneeds in the healthcare andpublic health sectors, DHSS hasdeveloped the New JerseyMedical Reserve Corps (NJMRC)Program, under the Citizen’sCorps umbrella, to support surgestaffing needs in the healthcareand public health system. TheNJMRC consists of both healthcare professionals and communityhealth volunteers. The healthcare professional component ofthe NJMRC Program serves asNew Jersey’s contribution to thefederal Emergency System for theAdvanced Registration ofVolunteer Health Professionals(ESAR-VHP). The registeredvolunteers will supplement andassist in meeting the surgecapacity needs in the event of apublic health emergency.

New Jersey’s MRC/ESAR-VHPProgram is a statewide county-based system with all 21 countieshaving units registered with thenational organization. Inaddition, New Jersey has severallocal units that were developedbefore the establishment of acounty-based system. Eachcounty MRC unit has aCoordinator. In addition, a StateCoordinator oversees the entireprogram and serves as the pointof contact with federal authorities.The NJMRC is overseen by anAdvisory Board that assists DHSSwith policy development.

Volunteer Management

New Jersey has a web-based MRCvolunteer registration system.Volunteers are asked to registerfor a county/local unit, and areasked if they are willing to bedeployed outside the countyand/or willing to participate infederally-coordinated emergencyresponse. In addition, applicantsare asked if they have volunteeredto serve with any otherorganizations duringemergencies. Each local MRCunit has access to its ownvolunteer database and canactivate individuals for localemergencies. The StateCoordinator has access to theentire volunteer database andwould assist with inter-county andinter-state responses, orresponding to any federalrequests for volunteer assistance.



At-Risk Populations

New Jersey is the most denselypopulated and one of the mostethnically diverse states in thenation. For the generalpopulation, these and othercharacteristics present emergencypreparedness planningchallenges. However, for certainAt-Risk Populations (ARP), thechallenges are even morecomplex. For example, over 30languages other than English arespoken in New Jersey. In 2006,24% of the population was under18 years, 13% was over 65 years

old, 9% were in poverty, and 12%of persons at least five years ofage reported a disability. Inaddition, 20% of the people livingin New Jersey were born outsideof the United States. Emergencyplanners face the additionalchallenge of identifying certainARP since many of them aredispersed among the generalpopulation. Consequently, theneeds of these ARP may not berecognized and planned for unlessthey self identify and state theirrequirements. Therefore, becausecertain ARP are at increased riskof harm, proactive on-goingattention to their public healthand special medical and otherpreparedness needs is requiredbefore, during and afteremergencies. These needs are notalways addressed and/orcoordinated. The DHSSestablished the Office ofPreparedness for At-RiskPopulations (OPARP) out ofrecognition that ARP awareness isan overarching capability thatmust be present in all HIPERoperational programs for theirmissions to be complete.

The primary responsibility of theOPARP is to provide internal andexternal coordination and supportof statewide preparednessinitiatives specific to ARP. Itsmission is to ensure that all Stateand local emergencypreparedness plans address


At-Risk Populations

public health, special medical andother pre-and post-disaster needsspecific or unique to certain ARP.This is achieved through on-goingcollaboration with a wide range ofstakeholders across disciplines atthe federal, State and local levels.

Core activities of the Officeprimarily, but not exclusivelyfocus on: v Defining and redefining At-

Risk Populations;v Monitoring trends in both the

general population and ARPemergency preparednessenvironments;

v Serving as the principal DHSSadvisor on emergencypreparedness issues of ARP;

v Researching, collecting,analyzing and widelydisseminating ARP publicheath, special medical andother emergency preparednessresources;

v Identifying andrecommending policies andprocedures that seek toadvance ARP public health,special medical and otheremergency preparednessinitiatives in New Jersey;

v Implementing DHSS ARPemergency preparednesspriorities;

v Serving as the DHSS ARPemergency preparednessliaison at various internal andexternal forums;

v Supporting internal andexternal ARP emergencypreparedness activities byproviding subject matterexpertise and programmaticinformation;

v Coordinating ARP sections ofapplications, reports, and otherrelevant publications; and

v Building new andstrengthening existingstakeholder relationships.



Exercises

The exercise process an essentialpart of the DHSS’ on-going focuson improving and staying abreastof changing situations and newemerging threats. Exercises arecritical to test and demonstratethe effectiveness of eachoperational program’s responseprotocols, plans, policies andprocedures.

The mission of the DHSSExercise Support Team (EST) is toassist the public health andhealthcare sectors to identify,

plan, design, train, conduct andevaluate exercises related to allevents that have medical

consequences to the residents ofNew Jersey. The EST designs,conducts, evaluates and/orprovides assistance to partneragencies regarding exercises thatinclude but are not limited toWeapons of Mass Destruction(WMD), Chemical, Biological,Radiological, Nuclear andExplosive (CBRNE) agents, andinfectious diseases. Through along-range plan to addressemergent issues in carefullydesigned series of exercises, withreasonable and credible scenarios,

to include terrorist andnatural events, theTeam supports andguides these manyefforts.

In addition toaddressing the specificneeds of public healthand medicalprofessionals, the ESTcalls into the arena ofplay the totalcommunity so that theintegration andcollaboration necessaryfor a comprehensiveresponse to anemergency is notoverlooked. The ESTdirects the exerciseprogram to reflect thebuilding blocks ofcoordinated and

comprehensive response bybeginning with low stress andspecific exercises focusing on


Exercises

simple and singular incidents,and building to complex andmulti-agency responses using thefull spectrum of agencies andindividuals that may be needed ina catastrophic emergency. Thefive healthcare regions are usedas the venues for conductingDHSS exercises, thereby providea mechanism for many entities toparticipate.

The DHSS has developed anExercise Strategy to guide theexercise process. The foundationfor the exercises is the 15 NationalPlanning Scenarios. These serveas the basis for design andprovide much of the detail neededto depict the impact and results ofthe type of event selected. Toensure that the scope of theexercises is realistic andsupportive of the overarchingeffort at improving, the federalTarget Capabilities List will beused to pair roles and responsibil-ities to jurisdiction levels and theUniversal Task List will be usedto describe the “what”, “who” and“how”. The federal HomelandSecurity Exercise and EvaluationProgram (HSEEP) is the primaryprocess used to design, executeand evaluate all exercises.

The DHSS Exercise Strategyprovides a five phase progressivecycle of exercises that willadvance the participants in eachregion from training throughtabletop and functional exercises

all the way amajor full scaleexercise with afocus onmultiplejurisdictions,resources anddisciplines.Each round ofexercisesbuilds on theresults ofpreviousexercises andincorporatestheimprovementsrecommendedin the previousAfter ActionReports.

In addition toguidance inexercising, theTeam alsoprovides helpin training and document supportfor corrections that are needed toimprove a process or plan. TheEST also conducts follow-up tomonitor corrective action andimprovement plans and facilitatesthe examination of these changesthrough future exercises. Thisprocess helps to validate theimprovement cycle and adds tothe continued effort to alwaysmake improvements.


Glossary

Glossary

ARP - At-Risk PopulationsGroups of people with specialhealth and other preparednessneeds, and/or at increased risk ofharm in an emergency.

BioSense – A federal programdesigned to improve the nation’scapabilities for real-timebiosurveillance by providingaccess to data from hospitals andhealthcare systems in majormetropolitan areas.

CBRNE - Chemical, Biological,Radiological, Nuclear and ExplosiveTerm used to describe the fullspectrum of agents potentiallyinvolved in a terrorist attack oraccidental release incident.

CDC – U.S. Centers for DiseaseControl and Prevention

CDRSS – Communicable DiseaseReporting and Surveillance SystemDHSS information system that isused to enter, update and trackNew Jersey’s reportablecommunicable disease information.

CDS – Communicable Disease ServiceThe DHSS service unitresponsible for prevention andcontrol of communicable diseases.

DEP – New Jersey Department ofEnvironmental Protection

DHSS - New Jersey Department ofHealth and Senior Services

DMHS – Division of Mental HealthServicesThe division of the New JerseyDepartment of Human Servicesresponsible for State programspromoting mental health.

EMAC - Emergency ManagementAssistance CompactNational system to coordinatemutual aid among states foremergency response and recovery.

EMS – Emergency Medical Services

ESAR-VHP - Emergency System forthe Advanced Registration ofVolunteer Health ProfessionalsStandardized national program forregistration of health professionalsvolunteering to assist in health andmedical emergencies.

FEMA - Federal EmergencyManagement Agency

FQHC – Federally Qualified HealthCenterA facility located in a medicallyunderserved area that has beenapproved by the federalgovernment to provide low cost,preventive primary medical care toMedicare beneficiaries. FQHCsinclude community health centers,tribal health clinics, migrant healthservices, and health centers for thehomeless.


Glossary

GETS - Government EmergencyTelecommunications ServiceAn emergency phone serviceprovided by the federalDepartment of HomelandSecurity to support federal, State,local, and tribal government,industry, and non-governmentalorganization personnel inperforming their national securityand emergency preparednessmissions by providing emergencyaccess to and priority processingin the local and long distancesegments of the Public SwitchedTelephone Network.

HCC - Health Command CenterDHSS’ emergency operationscenter.

HIPER - Division of HealthInfrastructure Preparedness andResponseDivision of the DHSS whichfunctions as the centralcoordination and oversightstructure for public healthemergency preparedness andresponse.

HippocratesInformation system developed bythe DHSS to enhance situationalawareness, assisting with thepreparation for, response to, andrecovery from public healthemergencies.

ICS – Incident Command SystemStandardized command andcontrol organizational structuredesigned for response to any typeof emergency situation.

LINCS - Local Information Networkand Communications SystemNetwork of 22 strategicallylocated public health agencies inNJ responsible for planning,coordination, and delivery ofspecialized services related topublic health emergencies.

LRN – Laboratory Response Network

MCC – Medical Coordination CenterA regional facility whichcoordinates and communicatesemergency information regardingpatient care, public healthactivities and healthcare facilities.

MRC – Medical Reserve CorpsProfessional and lay volunteerswho have registered to provideassistance during a public healthemergency.

NJDA – New Jersey Department ofAgriculture

NJEMSTF - New Jersey EmergencyMedical Services Task ForceDHSS-led statewide initiative tocoordinate emergency medicalservices response to majoremergencies and catastrophicdisasters.


Glossary

NJHAN – NJ Health Alert NetworkStatewide information andcommunications system that linkstogether local, State and federalhealth agencies. NJHAN is partof the CDC’s nationwide HealthAlert Network (HAN).

OEM - Office of EmergencyManagementOffice within the NJ State Policethat plans, directs and coordinatesemergency operations. Eachcounty also has an OEM.

POD – Point of DispensingTerm used for a mass prophylaxisclinic.

RODS – Real-time Outbreak andDisease SurveillanceA national effort to monitor salesof over-the-counter healthcareproducts and analyze them foraberrations suggestive of adisease outbreak.

ROIC - Regional Operations andIntelligence CenterA division of the New Jersey StatePolice

SEOC - State Emergency OperationsCenterState Police command center thatcoordinates State of New Jerseyassets in response to anemergency incident

SNS – Strategic National StockpileAssets (medicine, medicalsupplies, equipment and vaccines)supplied to states by the federalgovernment to supplement andreplace stocks normally held byhealthcare facilities and tosupport expanded dispensingcapabilities in case of a large-scalepublic health emergency.

SSS – Strategic State StockpileMedication and medical supplyassets maintained by the DHSS.

UASI – Urban Area Security InitiativeA federal program that supportsregional preparedness in majormetropolitan areas. The NorthernNew Jersey UASI, whichencompasses Jersey City andNewark, and the seven counties ofBergen, Essex, Hudson,Middlesex, Passaic and Union, isone of the seven federally-designated Tier 1 urban regionsconsidered at greatest risk ofterrorist attack.

Governor Chris ChristieLt. Governor Kim Guadagno