Running Head: HEART DISEASE PLAN FOR CARE 1 Heart Disease Plan for Care Ralph Marrero South University 05/02/2020 Introduction Chronic illnesses are those diseases that last for at least three months and include arthritis, cancer, cardiovascular diseases, among others. Chronic disease usually affects multiple parts of the body and only partly responds to treatment. Patients suffering from such conditions have a period where the disease temporarily goes away and then reappears (Andreadis, 2016). Chronic diseases, therefore, need well-planned care that address the patients’ needs and how they need to be addressed. The development of a treatment schedule is challenging and requires consideration of the various aspects of the disease. From healthy people, 2020 topics on chronic disease, the paper will discuss heart disease as a chronic illness and give reasons for the choice. The paper will also develop a questionnaire for patients to help prepare a plan of care and include healthy people 2020 goals for heart diseases. Nice overview! Identification of the chronic illness listed under Health People 2020 goals. Heart diseases refer to heart conditions that affect the flow of blood to the heart. The most common heart disease is coronary artery disease and resulted in deaths of 365,914 people in the year 2017("Heart disease and stroke | Healthy people 2020," n.d.). Plaque builds up in the blood arteries of a heart disease patient, narrowing the path of blood to the heart. In other instances, the plaque may rupture, forming a blood clot in the arteries that completely blocks the flow of blood. Insufficient flow of blood results in heart attacks and deaths that are hard to be prevented if not early predicted. The paper chooses to address this chronic illness since it is the leading cause of deaths from all ethnic groups in the United States. From statistics in the United States, in every four deaths, one results from heart disease, and approximately 647,000 Americans die from it annually("Heart disease and stroke | Healthy people 2020," n.d.). However, the cases of deaths can be managed by better treatment and preventing deterioration of heart diseases before they reach acute levels. Quality of life for patients living with these diseases can be improved by proper care if well scheduled and thereby increasing their lifespan. Developing a questionnaire for patients Heart diseases are determined by several medical conditions that need to be resolved. These factors that put patients under a high risk of a heart attack need to be considered in developing a plan of care. They include diabetes, obesity, high blood pressure, physical inactivity, and excessive alcohol consumption (University of Colorado Denver, n.d.). Questionnaire related to blood pressure 1. When was the last you had your blood pressure checked · Less than 12 months ago · More than 12 months ago · Never tested .

1. Running Head: HEART DISEASE PLAN FOR CARE
1
Heart Disease Plan for Care
Ralph Marrero
South University
05/02/2020
Introduction
Chronic illnesses are those diseases that last for at least three
months and include arthritis, cancer, cardiovascular diseases,
among others. Chronic disease usually affects multiple parts of
the body and only partly responds to treatment. Patients
suffering from such conditions have a period where the disease
temporarily goes away and then reappears (Andreadis, 2016).
Chronic diseases, therefore, need well-planned care that address
the patients’ needs and how they need to be addressed. The
development of a treatment schedule is challenging and requires
consideration of the various aspects of the disease. From
healthy people, 2020 topics on chronic disease, the paper will
discuss heart disease as a chronic illness and give reasons for

2. the choice. The paper will also develop a questionnaire for
patients to help prepare a plan of care and include healthy
people 2020 goals for heart diseases. Nice overview!
Identification of the chronic illness listed under Health People
2020 goals.
Heart diseases refer to heart conditions that affect the flow of
blood to the heart. The most common heart disease is coronary
artery disease and resulted in deaths of 365,914 people in the
year 2017("Heart disease and stroke | Healthy people 2020,"
n.d.). Plaque builds up in the blood arteries of a heart disease
patient, narrowing the path of blood to the heart. In other
instances, the plaque may rupture, forming a blood clot in the
arteries that completely blocks the flow of blood. Insufficient
flow of blood results in heart attacks and deaths that are hard to
be prevented if not early predicted. The paper chooses to
address this chronic illness since it is the leading cause of
deaths from all ethnic groups in the United States. From
statistics in the United States, in every four deaths, one results
from heart disease, and approximately 647,000 Americans die
from it annually("Heart disease and stroke | Healthy people
2020," n.d.). However, the cases of deaths can be managed by
better treatment and preventing deterioration of heart diseases
before they reach acute levels. Quality of life for patients living
with these diseases can be improved by proper care if well
scheduled and thereby increasing their lifespan.
Developing a questionnaire for patients
Heart diseases are determined by several medical conditions
that need to be resolved. These factors that put patients under a
high risk of a heart attack need to be considered in developing a
plan of care. They include diabetes, obesity, high blood
pressure, physical inactivity, and excessive alcohol
consumption (University of Colorado Denver, n.d.).
Questionnaire related to blood pressure
1. When was the last you had your blood pressure checked
· Less than 12 months ago
· More than 12 months ago

3. · Never tested
2. What was the state of your blood pressure?
· Normal
· High
· Not sure
3. If high, do you currently take medicines to manage it?
· Yes
· No
4. Any healthy eating that you have adopted? Tick where
appropriate
· Cutting down on salt intake to manage blood pressure ie don’t
consume it anymore or reduced intake.
· Reducing alcohol consumption
· Engaging in physical activity like exercising.
· All of the above
· None of the above
Blood cholesterol management.
5. Have you ever had your blood cholesterol checked?
· Yes
· No
· Unsure
6. When was the last time you had it checked?
· More than five years ago
· More than 2 years ago
· Within the last 2 years
· Not sure
7. What was the status of you blood cholesterol level?
· Normal
· High
· Not sure
8. Have you ever consulted a health professional on why your
blood cholesterol is high?
· Yes
· No
· Not sure
9. If yes, explain in a few words why the doctor said it was high

4. ---------------------------------------------------------------------------
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------------------------------
Well done!
Engagement in physical activity
Physical activities may be considered as either light, moderate,
or vigorous. Light activity includes strolling, light house chore,
where an individual can do while talking or singing. Moderate
exercises make your heart beat faster than normal, and someone
doing it can talk but not sing. Include swimming, aerobics, fast
walking, or lifting weights. The third class of physical activities
involves vigorous exercises like running, basketball, jogging, or
hiking steep hills.
10. How many days per week do you engage in moderate
exercise for at least 40 minutes?
___________________days (enter 0 if none)
11. How many days per week do you engage in vigorous
activities for at least 20 minutes?
_________________days (enter 0 if none)
12. Do you have a plan to get more physically active per week?
· Yes within the next one month
· Yes within the next six months
· No, maybe after 6 months
Symptoms of heart attack
13. Do you think the following are signs of a heart attack (you
may say yes, no or not sure)
· Feeling weak, faint and lightheaded ____________
· Swelling of the legs and feet____________
· Sudden trouble in sight_______________
· Chest, jaw or neck pains and discomfort __________
· Shortness of breath ______________
Morbidity and comorbidity of the disease.
Patients suffering from heart diseases are at high risk for
comorbidity. These cardiovascular diseases are interlinked and

5. the possibility of one risks the occurrence of another. Heart
failures result from three common comorbidities; obesity,
diabetes, and hypertension. Hypertension rarely occurs in
isolation, but it is instead developed when two disorders, such
as diabetes and heart diseases, share risk factors. A disorder
such as obesity could likely cause diabetes and cyclic cause of
heart disease (Healthy people 2020 Midcourse review, 2016).
Impact of chronic illnesses on the overall health of nation.
The United States of America has invested heavily in the
management of heart disease. Every 37 seconds, one person dies
from cardiovascular disease, and among ten deaths, two are
from the productive age group ("Heart disease and stroke |
Healthy people 2020," n.d.). This implies that the overall health
of the nation does not only lose in treatment services but also
its productivity. The comorbidity of the disease makes it more
complicated for a health professional to monitor and manage it.
As such, the government has invested in coming up with ways
such as kits for self-management of the disease. More
government interventions on educational material to
individuals, programs of healthy eating and physical activities,
and free diagnosis of related to comorbidities of the disease
increase the expenditure by the government. The US is said to
be spending at least $219 billion each year on heart diseases.
Generally, the condition is a burden to the government,
healthcare providers, and every individual.
Conclusion with the integration of Healthy People 2020 goals
for heart disease.
Healthy People 2020 main goal is to improve the cardiovascular
health of all individuals. To achieve this, the goal has been
subdivided into specific goals, which include detection,
prevention, and treatment of associated risk factors. Prevention
revolves around educating people on healthy lifestyle and
nutrition while detection provides early identification of heart
disease occurrence. Treatment serves to improve the quality of
life of heart disease patients and prolong their lives (Healthy
people 2020 Midcourse review, 2016). The three specific goals,

6. when properly implemented, will reduce the re-occurrence of
cardiovascular disease and reduce the high rate of mortality.
References Start references on a new page.
Andreadis, E. A. (2016). Hypertension and cardiovascular
disease. Springer.
Healthy people 2020 Midcourse review. (2016).
Heart disease and stroke | Healthy people 2020. (n.d.). Healthy
People 2020 |. Retrieved from
https://www.healthypeople.gov/2020/topics-
objectives/topic/heart-disease-and-stroke
(n.d.). University of Colorado Denver | | Accredited Degrees,
Research and Health Care | Denver, Colorado | University of
Colorado Denver. Retrieved from
https://www.ucdenver.edu/academics/colleges/PublicHealth/rese
arch/centers/CAIANH/ceed/Documents/General%20Population
%20--%20Pre-Test%20--%2010-12-09Clean.pdf
HLSC 500
Discussion Board Forum Instructions
There will be 8 Discussion Board Forums throughout this
course. You are required to provide a thread in response to the
provided topic for each forum. Each thread is to be at least 250
words, cite at least 2 sources, and demonstrate course-related
knowledge. In addition to the thread, you are required to reply
to 2 other classmates’ threads. Each reply must be at least 100
words. Acceptable sources include the textbook, peer-reviewed
journal articles, government sources, professional association
websites, etc. Each original discussion will also require a
biblical reference/quote (which is not a part of the original
source count).
Responding to a classmate’s thread requires both the addition of
new ideas and analysis. A particular point made by the
classmate must be addressed and built upon by your analysis in

7. order to move the conversation forward. Thus, the reply is a
rigorous assignment that requires you to build upon the thread
to develop deeper and more thorough discussion of the ideas
introduced. As such, replies that merely affirm, restate or
unprofessionally quarrel with the previous thread(s) and fail to
make a valuable, substantive contribution to the discussion will
receive appropriate point deductions.
This course utilizes the Post-First feature in all Discussion
Board Forums. This means you will only be able to read and
interact with your classmates’ threads after you have submitted
your thread in response to the provided prompt. For additional
information on Post-First, click here for a tutorial.
The threads are due by 11:59 p.m. (ET) on Thursday of the
assigned modules/weeks, and the replies are due by 11:59 p.m.
(ET) on Sunday of the same modules/weeks, except for
Module/Week 8.
For Module/Week 8, the thread is due by 11:59 p.m. (ET) on
Wednesday, and the replies are due by 11:59 p.m. (ET) on
Friday.
National Response Framework
i
t

8. N
ational Response
Fra
mework
Fourth Edition
October 28, 2019
National Response Framework
ii
E x e c u t i v e S u m m a r y
The National Response Framework (NRF) provides foundational
emergency management doctrine for

9. how the Nation responds to all types of incidents. The NRF is
built on scalable, flexible, and adaptable
concepts identified in the National Incident Management
System (NIMS) to align key roles and
responsibilities across the Nation. The structures, roles, and
responsibilities described in this
Framework can be partially or fully implemented in the context
of a threat or hazard, in anticipation of
a significant event, or in response to an incident.
Implementation of the structures and procedures
described herein allows for a scaled response, delivery of
specific resources and capabilities, and a
level of coordination appropriate to each incident.
Responding to disasters and emergencies requires the
cooperation of a variety of organizations; the
larger or more complex the incident, the greater the number and
variety of organizations that must
respond. Think of a residential fire: Firefighters are leading the
charge; public works may be on scene
providing traffic control; police are providing security;
emergency medical services personnel are
triaging, transporting, and redistributing injured to local
hospitals; and a local nonprofit or voluntary
organization (e.g., American Red Cross and Salvation Army)
may be on hand to assist displaced
residents. For large disasters, such as major hurricanes or
earthquakes, the incident complexity is
increased as others—such as states or tribes and, ultimately, the
Federal Government—become
involved. Businesses, voluntary organizations, and other
elements of the private sector are also key
stakeholders, providing the essential services that must be
restored following an incident. The NRF
provides the foundation for how these organizations coordinate,
integrate, and unify their response.

10. The unprecedented scale of recent disasters has spurred
continued innovation in response operations
and highlighted the need for further progress to build resilient
capabilities to respond to disasters of
increasing frequency and magnitude. This fourth edition of the
NRF embraces lessons-learned from
those disasters and shares emerging best practices.
Since publication of the third edition of the NRF in 2016,
disaster response operations have
underscored the paramount importance of sustaining essential
community lifelines. The Framework
defines community lifelines as those services that enable the
continuous operation of critical
government and business functions and are essential to human
health and safety or economic security.
If disrupted, rapid stabilization of community lifelines is
essential to restoring a sense of normalcy.
Recent disasters have illuminated two underlying features of
community lifelines that highlight
opportunities to strengthen response planning and operations.
First, community lifelines are interdependent and vulnerable to
cascading failures. For example,
communications and electric power systems rely on each other
to function; severe damage to one will
disrupt the other. Most lifelines also rely on complex supply
chains. Water and wastewater service
depend on the resupply of a broad array of chemicals and—if
power goes out—fuel for emergency
generators. However, in a severe natural or human-caused
incident, those supply chains themselves
may be broken.
Second, community lifeline stabilization relies on businesses

11. and infrastructure owners and operators
who have the expertise and primary responsibility for managing
their systems in emergencies.
Accordingly, new doctrine and coordination mechanisms are
needed to enable the private sector to
play a larger, more comprehensive role in preparedness and
response activities.
The NRF is structured to help jurisdictions, citizens,
nongovernmental organizations (NGO), and
businesses develop whole community plans, integrate continuity
plans, and build capabilities to
respond to cascading failures among businesses, supply chains,
and infrastructure sectors, as well as
collaborate with the private sector and NGOs to stabilize
community lifelines and enable restoration
National Response Framework
iii
of services in severe incidents. Critical infrastructure sector
leadership (sector-specific agencies,
government coordinating councils, and sector coordinating
councils) create an established network to
collaborate with their respective private sector partners and
support cross-sector1 response operations.
Often, Emergency Support Functions (ESF) work with sector
leadership to bolster preparedness for
cross-sector collaboration. This fourth edition of the NRF
describes new initiatives that leverage
existing networks and better integrate business interests and
infrastructure owners and operators into
the heart of emergency management.

12. The NRF describes ways to improve coordination and response
structures to build preparedness for
catastrophic incidents. Stabilizing community lifelines in
catastrophic incidents is vital and
extraordinarily difficult. Communities cannot meet these
challenges solely by scaling up existing plans
and capabilities. Rather, new mechanisms are needed to
supplement and integrate those already in
place and facilitate cross-sector coordination, while respecting
the roles of private sector partners and
authorities of agencies at all levels of government.
A new ESF #14 – Cross-Sector Business and Infrastructure is
introduced to focus on engaging private
sector interests and infrastructure owners and operators—
particularly those in sectors not currently
aligned to other ESFs—and conducting cross-sector analysis to
help inform decision making. ESF #14
relies on other ESFs aligned with a critical infrastructure sector
to continue coordination with their
corresponding sector during response efforts. ESF #14 helps
coordinate multi-sector response
operations between (or across) the government and private
sector for natural or human-caused
catastrophic incidents that jeopardize national public health and
safety, the economy, and national
security.
This edition of the Framework also builds on the response
approach in previous editions to address
national security emergencies. The National Security Strategy
of the United States of America notes
that potential adversaries are developing advanced weapons and
capabilities that could threaten U.S.
critical infrastructure.2 Adversaries may also strategically

13. target attacks to exploit interdependencies
between infrastructure sectors and magnify cascading failures
between them, posing incident response
challenges above and beyond those created by earthquakes or
other catastrophic natural hazards. The
initiatives in this Framework address the resulting challenges
for consequence management in ways
that supplement and support other government, private sector,
and NGO plans and coordinating
structures.
1 Cross-sector operations are those actions taken by public and
private sector organizations from one or more of the
16 critical infrastructure sectors to help entities or facilities
associated with other sectors respond to an incident, being
focused on preventing or mitigating cascading failures between
sectors and restoring critical supply chains.
2 For more information on the National Security Strategy of the
United States of America, see
https://www.whitehouse.gov/wp-content/uploads/2017/12/NSS-
Final-12-18-2017-0905.pdf.
https://www.whitehouse.gov/wp-content/uploads/2017/12/NSS-
Final-12-18-2017-0905.pdf
National Response Framework
iv
T a b l e o f C o n t e n t s
Introduction

14. ...............................................................................................
.................... 1
Evolution of the Framework
...............................................................................................
....1
Framework Purpose and Organization
.................................................................................2
Scope......................................................................................
....................................................3
Intended Audience
...............................................................................................
....................5
Guiding Principles
...............................................................................................
....................5
Foundational Components
........................................................................................... 8
Prioritized Stabilization of Community Lifelines
.................................................................8
National Incident Management System
...............................................................................11
Core Capabilities
...............................................................................................
.....................12
Operational Coordination
...........................................................................................
15
Private Sector Engagement
...............................................................................................
....15
Locally Executed Response
...............................................................................................
....16
State, Tribal, Territorial, and Insular Area Managed Response

15. ......................................18
Federally Supported Response
.............................................................................................1
9
Roles and Responsibilities for Response
................................................................. 25
Communities
...............................................................................................
............................26
Local Government
...............................................................................................
..................29
State, Tribal, Territorial, and Insular Area Government
..................................................30
Federal Government
...............................................................................................
...............34
Federal Authorities
...............................................................................................
....... 42
Federal Response and Assistance Under the Robert T. Stafford
Disaster Relief and
Emergency Assistance Act
...............................................................................................
.....43
Federal Departments and Agencies Acting Under Their Own
Authorities .....................44
Federal-to-Federal Support
.............................................................................................. .
...46
International Support
...............................................................................................
.............46
Federal Response and Assistance Available Without a Stafford

16. Act Declaration...........47
National Response Framework
v
Operational Planning
...............................................................................................
... 47
Federal Planning
...............................................................................................
.....................48
Application for Planning
...............................................................................................
........49
Continuity Considerations
...............................................................................................
.....50
Supporting Resources
...............................................................................................
. 50
Maintenance
...............................................................................................
............................50
Conclusion
...............................................................................................
.................... 51

17. National Response Framework
1
I n t r o d u c t i o n
The National Preparedness System outlines an organized
process for the whole community3 to move
forward with its preparedness activities and achieve the
National Preparedness Goal. The National
Response Framework (NRF) sets the strategy and doctrine for
how the whole community builds,
sustains, and delivers the response core capabilities identified
in the National Preparedness Goal in an
integrated manner with the other mission areas. The fourth
edition of the NRF emphasizes enhancing
the unity of effort between the government and the private
sector through better coordination and
collaboration.
E v o l u t i o n o f t h e F r a m e w o r k
The NRF builds on over 25 years of federal response guidance,
beginning with the Federal Response
Plan, published in 1992, and the National Response Plan,
published in 2004. This fourth edition of the
NRF reorganizes and streamlines the previous version of the
NRF, expands principles and
concepts to better integrate government and private sector
response efforts, and introduces the
community lifelines concept and terminology.
This document supersedes the National Response Framework,
Third Edition that was
issued in June 2016 and becomes effective 60 days after
publication.

18. Community lifelines are those services that enable the
continuous operation of critical government and
business functions and are essential to human health and safety
or economic security. In serious but
purely local incidents, interruptions of water service, electric
power, and other community lifeline
components are typically brief and easy to mitigate. However,
severe and widespread incidents can
halt lifeline services for many weeks or months. Such
disruptions are especially extensive in
catastrophic incidents and may result in mass casualties and
other cascading consequences.
Making community lifelines a core focus of incident response
within the NRF offers unique benefits
for incidents ranging from small-scale to catastrophic disasters.
By building capabilities to stabilize4
and accelerate the restoration of community lifeline services, it
will be possible to save countless lives,
limit damage to the economy, help maintain essential services
for critical national security installations,
reduce the initial impacts of disasters, and facilitate recovery
operations. While the primary focus of
incident response remains on stabilizing community lifelines,
other secondary considerations regarding
the natural and cultural environment and economic factors are
equally as important.
3 Whole community includes individuals and communities,
businesses, private and public sector owners and operators
of critical infrastructure, faith-based organizations, nonprofit
organizations, and all levels of government (local,
regional/metropolitan, state, tribal, territorial, insular area, and
federal). Whole community is defined in the National

19. Preparedness Goal as “a focus on enabling the participation in
national preparedness activities of a wider range of
players from the private sector, including nongovernmental
organizations and the general public, in conjunction with
the participation of all levels of governmental in order to foster
better coordination and working relationships.”
4 Stabilization occurs when immediate threats to life and
property are anticipated, resourced, and managed and basic
community lifeline services are provided to survivors.
https://www.fema.gov/national-preparedness-system
https://www.fema.gov/national-preparedness-goal
National Response Framework
2
Community lifelines provide a valuable decision-making
construct to integrate cross-sector5 response
operations and reporting. Each lifeline depends on multiple
infrastructure sectors, businesses, and
supply chains to function. Focusing on community lifelines
allows emergency managers and their
partners to account for these complex interdependencies and
prioritize response operations to achieve
high-impact, multi-sector benefits. The Framework describes
how the resources and capabilities of the
Federal Government support such operations, while the new
Emergency Support Function (ESF) #14
– Cross-Sector Business and Infrastructure Annex describes
how it facilitates coordination and
collaboration with business and infrastructure owners and

20. operators to provide assistance and integrate
the private sector's support during response, particularly for
those sectors not currently aligned to other
ESFs. Additional detail on the community lifelines can be found
in the Prioritized Stabilization of
Community Lifelines section.
Finally, the Framework’s focus on community lifelines
necessitates deeper collaboration with the
private sector and nongovernmental organizations (NGO).
During the disasters of 2017 and 2018,
individual businesses and infrastructure owners and operators
(including public and private sectors)
forged innovative, collaborative relationships with government
agencies to help prioritize and
accelerate the stabilization of community lifeline services. The
fourth edition of the NRF and ESF #14
– Cross-Sector Business and Infrastructure Annex
institutionalize their progress and build upon it in
ways that respect the authorities, responsibilities, and roles of
all public, private, and NGO partners
essential to incident response.
F r a m e w o r k P u r p o s e a n d O r g a n i z a t i o n
The NRF is a guide to how the Nation responds to all types of
disasters and emergencies. The NRF is
built on scalable, flexible, and adaptable concepts identified in
the National Incident Management
System (NIMS) to align key roles and responsibilities across the
Nation. The NRF describes specific
authorities and best practices for managing incidents that range
from the serious but purely local to
those that are catastrophic and national in scope.
Within the NRF, the term “response” includes actions to save
lives, protect property and the

21. environment, stabilize the incident, and meet basic human needs
following an incident. Response also
includes the execution of emergency plans and actions to enable
recovery. The NRF describes doctrine
for managing all types of disasters or emergencies, regardless of
scale, scope, and complexity. The
goals and objectives herein explain common response
disciplines and processes that have been
developed at all levels of government (local, state, tribal,
territorial, insular area,6 and federal) and have
matured over time.
To achieve the National Preparedness Goal, the objectives of
the NRF are to do the following:
coordinating structures, as well as key roles and
responsibilities for integrating
capabilities across the whole community, to support the efforts
of governments, the private sector,
and NGOs in responding to actual and potential incidents;
how unity of effort among public and private
sectors, as well as NGOs, supports the
stabilization of community lifelines and prioritized restoration
of infrastructure during an incident
5 Cross-sector operations are those actions taken by public and
private sector organizations from one or more of the
16 critical infrastructure sectors to help entities or facilities
associated with other sectors respond to an incident,
focused on preventing or mitigating cascading failures between
sectors and restoring critical supply chains. These
operations include measures taken by infrastructure owners and
operators, businesses, and their government partners
to account for cross-sector interdependencies in incident

22. response operations.
6 Per the Stafford Act, insular areas include Guam, the
Commonwealth of the Northern Mariana Islands, American
Samoa,
and the U.S. Virgin Islands. Other statutes or departments and
agencies may define the term “insular area” differently.
http://www.fema.gov/national-incident-management-system
http://www.fema.gov/national-incident-management-system
National Response Framework
3
and enables recovery, including the elements that support
economic security, such as restoration
of business operations and other commercial activities;
response core capabilities, including
capabilities brought through businesses and infrastructure
owners and operators in an incident;
actions; and
foundation for continued improvement of the
Response Federal Interagency Operational Plan (FIOP), its
incident annexes, as well as
department and agency plans that implement the FIOP.
The NRF also advances progress under the National Security
Strategy of the United States of America.

23. The Framework helps achieve the strategy’s first pillar: to
“protect the American people, the homeland,
and the American way of life.” To accomplish this goal, the
strategy calls for initiatives to strengthen
the Nation’s ability to withstand and recover rapidly from
attacks and natural disasters. The NRF is
structured to help achieve these goals by establishing a new
federal ESF coordinating structure to help
mitigate the impact of catastrophic incidents on community
lifelines and account for the risk that
adversaries will seek to complicate and disrupt U.S. response
operations.
The NRF is composed of a base document, ESF annexes, and
support annexes. The annexes provide
detailed information to assist with the implementation of the
NRF.
group resources and capabilities into
functional areas most frequently needed in a national response.
is organized among private sector,
NGO, and federal partners. The support annexes describe the
essential supporting processes and
considerations common to most incidents. Content found within
the support annexes is superseded
by changes and updates to legislation. The support annexes
include the following:
− Financial management
− International coordination
− Public affairs
− Tribal relations
− Volunteer and donations management

24. − Worker safety and health
The Critical Infrastructure and Key Resources Support Annex
and Private Sector Coordination Support
Annex, which supplemented previous versions of the NRF, have
been superseded in this fourth edition
of the NRF by ESF #14 – Cross-Sector Business and
Infrastructure Annex, which has been added as
part of this updated framework. All references to these support
annexes within the ESF or support
annexes should be read as referring to the ESF #14 – Cross-
Sector Business and Infrastructure.
S c o p e
The NRF is a framework for all types of threats and hazards,
ranging from accidents, technological
hazards, natural disasters, and human-caused incidents. This
Framework is utilized to implement
NIMS and describes whole community coordinating structures
and response activities; in particular,
the Framework outlines government, private sector, and
nongovernmental roles to reinforce
https://www.whitehouse.gov/wp-content/uploads/2017/12/NSS-
Final-12-18-2017-0905.pdf
https://www.fema.gov/national-preparedness-resource-library
National Response Framework
4
collaborative incident response.7 The NRF also describes the
structure and mechanisms for national-

25. level policy and operational direction for incident management
to ensure timely and effective federal
support to local, state, tribal, territorial, and insular area
governmental activities and survivors. The
NRF is applicable to all federal, local, state, tribal, territorial,
and insular area departments and agencies
that participate in operations requiring a coordinated federal
response.
NRF elements can be implemented at any time for any hazard,
including the employment of ESF
mechanisms. The structures, roles, and responsibilities
described herein can be partially or fully
implemented in the context of a threat or hazard, in anticipation
of a significant event, or in response
to an incident. Implementation of NRF structures and
procedures allows for a scaled response, delivery
of the specific resources and capabilities, and a level of
coordination appropriate to each incident.
The response mission area includes the capabilities necessary to
stabilize an incident, save lives, protect
property and the environment, meet basic human needs, restore
community lifeline services and other
basic community functionality, and establish a safe and secure
environment to facilitate the integration
of recovery activities.
In this fourth edition of the NRF, the thresholds for catastrophic
incident response may vary depending
on one’s perspective. A localized flood can be catastrophic to
an individual family who lost their home
and possessions, a severe tornado can be catastrophic to a town
or city, and a hurricane can be
catastrophic to a state or territory. At the national level, a
catastrophic incident8 is one of such extreme

26. and remarkable severity or magnitude that the Nation’s
collective capability to manage all response
requirements would be overwhelmed, thereby posing potential
threats to national security, national
economic security, and/or the public health and safety of the
Nation. A national catastrophic incident
implies that the necessary resources are not available within
expected timeframes for incident response.
During a national catastrophic incident, decision makers would
be forced to consider the landscape of
requirements and prioritize resources to manage shortfalls
rather than to address all needs at once. Such
a situation would also require the extraordinary means of
mobilizing and prioritizing national resources
to alleviate human suffering; protect lives and property; reduce
damage to natural, cultural, and historic
resources; stabilize the Nation’s economy; and ensure national
security.
In this Framework, the term “incident” includes any occurrence,
natural or manmade, that necessitates
a response to protect life or property and includes planned
events, as well as emergencies or disasters
of all kinds and sizes. The NRF’s structures and procedures
address how federal departments and
agencies coordinate support for local, state, tribal, territorial,
and insular area governments and how
government at all levels works in unity with private sector and
NGOs.
Nothing in the NRF is intended to alter or impede the ability of
a local, state, tribal, territorial, or insular
area government or Federal Government department or agency
to carry out its authorities or meet its
responsibilities under applicable laws, Executive orders, and
directives.

27. 7 The NRF must be consistent with all pertinent statutes and
policies, particularly those involving privacy and civil
and human rights, such as the Americans with Disabilities Act
of 1990, the Rehabilitation Act of 1973, and the Civil
Rights Act of 1964.
8 The Post-Katrina Emergency Management Reform Act of 2006
defines the term “catastrophic incident” as “any
natural disaster, act of terrorism, or other man-made disaster
that results in extraordinary levels of casualties or damage
or disruption severely affecting the population (including mass
evacuations), infrastructure, environment, economy,
national morale, or government functions in an area.”
National Response Framework
5
I n t e n d e d A u d i e n c e
The NRF is intended to be used by communities; the private
sector; NGOs; local, state, tribal,
territorial, and insular area governments; and the Federal
Government, as well as other entities involved
in response. The private sector includes for-profit and nonprofit
organizations, formal and informal
structures, commerce, and industries that comprise the national
economy and are not part of a
government structure. NGOs are a distinct category of
organizations within the private sector that can
include voluntary, ethnic, faith-based, veteran-based,

28. disability,9 relief agency, and animal welfare
organizations, among others, and are referenced separately. This
all-inclusive whole community
approach focuses efforts and enables a full range of
stakeholders to participate in national preparedness
activities and to be full partners in incident response, including
emergency management practitioners,
first responders, and community leaders.
Infrastructure owners and operators (in private and public
sectors), and other elements of the private
sector, are especially important partners for incident response
and a key audience for the Framework.
These partners are vital for strengthening the coordination
between industry and government that is
necessary to stabilize community lifelines after major incidents
or events. They are also crucial partners
for creating the plans and doctrine to support essential functions
for cross-sector response operations,
especially where their ability to volunteer capabilities and
expertise provides vital (and in some cases
irreplaceable) contributions to protecting public health and
safety. Moreover, because catastrophic
incidents …
SME: Hello. Welcome back to Module Three. Homeland
Security 500 - Foundations of Homeland Security.
Understanding Mitigation and Preparedness. Remember how I
said on phases on modules one and two, we talked about there's
four phases of Emergency Management, Mitigation and
Preparedness, Response and Recovery. In this module, we're
going to talk about the first two, Mitigation and Preparedness.
But I do want to say this is cyclical. It never ends and, there’s
no clear line between one end and one begins. Let's go ahead
and get started, I hope you're having a great week. I hope you're

29. enjoying the course and let's get going.
Okay. First, let's look at risk management framework. The
National Infrastructure Protection Plan, NIPP, describes
processes to set goals and objectives. Identify assets, systems,
and networks. Assess risk; consequences, vulnerabilities, and
threats. Prioritize. Implement protective programs and
resiliency strategies a.k.a. mitigation. And then measure
effectiveness. I think visuals help. There's really three areas
we're going to look at. One will be physical, one cyber and one
human.
We're going to set goals to objectives for our risk management.
We're going to identify assets, systems and networks. We're
going to assess risk, the consequences, vulnerabilities, and
threats and we're going to prioritize. And from the program,
we're going to measure effectiveness and we're going to
continue to do this. How often do you do it? Well, you do it
initially then you want to keep reviewing it. Something new
kicks in, there's new threats on the horizon I would suggest you
do it. At least yearly, we want to go back and look at our risk
assessment. Worst thing you can do is to do a risk assessment,
see you have vulnerabilities and then do nothing about it.
That's bad in so many ways, morale wise people will see that
you don't care. Liability wise, you've increased your liability.
It's just not a good business practice to do it and then do
nothing about it. Okay, risk analysis and management. What is
risk? Risk is the likelihood of a threat or hazard occurring to an
object, a person, place or thing that is to be protected.
Remember in the last module we talked about all the different
risk that are out there. And threats and hazards are either man-
made or natural. And both can occur, both can hurt you, kill
you, hamper your productivity, set you back.
So, we must look at both man-made and natural. Man-made can
be purposeful or accidental. We have threats and we have
hazards. Protection is keeping something or someone safe from
harm or outside influence. Now, notice earlier we talked about
persons, places or things. Persons can be groups like events or

30. it can be individual like a president or governor or CEO or
somebody like that. Okay. Mitigation preparedness. Mitigation
is a type of long-term pre-disaster planning which involves
sustained expenditures are structural and non-structural efforts
to reduce or eliminate future risk. It's always going to be
structural or non-structural. I will talk about more as we go
along when it comes to mitigation.
Mitigation plans and activities are, in practice, usually medium
to long term and mitigation is the cornerstone of our emergency
management since it's a classic example of thinking ahead,
which pays off in the long run. A great example is Hurricane
Katrina. Actually, New Orleans would not have been hit nearly
as hard, had the levees been up to standards. The levees weren't
really designed for a category four or five hurricane. They were
barely designed for a category three.
If the levees had not failed, then New Orleans would not have
been hit nearly as hard. To the east of New Orleans, the coastal
area was destroyed, was wiped out. But the levees were what
was the problem. And mitigation could have fixed that problem
and that's a structural issue.
Mitigation is related to other concepts of long-term planning,
reconstruction and preparedness. Reconstruction means repair
or rebuilding but preparedness means getting ready or
practicing responding. Mitigation, it is short term too. You can
go for low-hanging fruit but we must look at the long term as
well. Reconstruction and preparedness. And then a lot of these
are a structural thing, we talked about preparing the levees,
building them up. A non-structural thing would be where you
can live, a policy or zoning change.
Mitigation means to lessen the effects or act toward the building
and putting together of certain structures and plans so that the
impact of any future disaster will be ameliorated or eliminated
if possible. If we want to reduce, we can't necessarily deal away
with a threat in some cases. We can't stop weather but we can
prepare for it. We can mitigate it through structural or non-
structural activities.

31. Amelioration means to change things for the better, and impact
can be understood as the consequences or the likelihood of
something happening in the first place if the latter is
theoretically possible. A lot of times you will see green spaces
if you go to a park. And there's a creek or river. At one point,
there may been a house there but at some point, maybe the
house is abandoned and it was destroyed. Instead of rebuilding
there, it was rezoned, maybe was purchased and it was turned
into a green space or a park. If a park floods, it's okay, the
water will recede and there's really no damage. But if there's
homes along the river then there's a problem with that.
That's just an example of actual structural and non-structural
mitigation strategy in use at the same time. Contingency
planning, the concept of contingency planning is technically
different than a concept of continuity planning. And we'll look
at this. A contingency plan is sometimes called a reversion plan
because it outlines what kinds of decisions and procedures are
the fall back procedures reverted to in case some crisis
unexpected circumstances arise. A basic contingency plan is
paper and pencil drills or backups. I'm old enough to know what
it was like before computers and cell phones. Maybe you are,
maybe you aren't.
Young people nowadays, they don't know what it's like not to
have a computer or a cell phone. They go to a store, and if that
scanner didn't work-- I've been to a store and stood at the cash
register where the scanner or computer is not working. And they
stand there and look at you. They don't know how to add up
change. They don't know how to add change up and give you
change back. They don't have a contingency plan for when that
happens. That's just as basic as it gets. We need to practice with
dispatchers. What happens if your CAD goes down? We need to
practice the old-fashioned way, with paper and pencil.
A contingency plan can also be redundancy or a hot site or
backup systems. Contingency plans always tend to refer to some
planned change for the organization while continuity plans
always tend to refer the services and assets that are already

32. operational. Emergency preparedness. Preparedness in the field
of emergency management can best be defined as the state of
readiness to respond to a disaster, crisis or other emergency
situation. And we're not going to get into a lot of this in more
detail.
If you take homeland security 510, we're going to get into a lot
more of this and more detail. And you'll get it in other classes
as well. This is an overview class covering all of these different
things. General or long-term preparedness encompasses the
marshaling of resources, the areas of prediction, forecasting,
and warning against disaster events. It also involves education
and training initiatives and planning to evacuate vulnerable
populations from threatened areas.
We look to education, that's awareness. Training, how do we
respond? What do we do? Years ago, in Virginia, like other
southern states along the coast. They put a counter-flow plan in
place. They spent a lot of money buying and building gates to
do a counter-flow but reverse the flow of traffic coming off
Interstate 64 coming away from the Tidewater, Virginia. We
needed to train with that, we needed to practice it. One
morning, one Sunday morning around three o'clock, we began to
implement that. And up and down the interstate, all the gates
were closed. It took about 500+ people from multiple agencies
to initiate this. We shut down the interstate and actually did a
counter-flow.
We didn't really put vehicles on the other side, we just kind of
had it there in case it happened. It went pretty well. There were
some little hiccups here and there but that was a valuable lesson
and it needed to be done. And we were opened back up by like
7:30 and it really didn't affect the traffic that bad. It often takes
place against a background of attempts to increase public and
political awareness of potential disasters and to garner support
for increased funding of mitigations efforts. And that's a
problem a lot of times because people don't want to spend
money, especially politicians, on something that hadn't
happened. It's a cliché but it's worth it to say an ounce of

33. prevention is worth a pound of cure. Okay. Emergency
preparedness. Short-term preparedness means to prepare for
certain disasters once they have begun to occur. If you work in
emergency management, you'll know when the ice storm or
snowstorm is coming. You'll have phone calls, you'll have
meetings, and will make sure everybody's prepared. Then have
an update after it starts every so many hours or every day. In
this latter sense, preparedness means to prepare as much as
possible for known disasters. The best preparations are always
about what we know best.
The best preparation is to get ready, plan, organize, set up,
practice some drill or test. These drills or tests can come in
various ways. They could be tabletops, they can be role-playing,
they can be paper pencil, or they can be full-blown.
Preparedness means proper planning, resource allocation,
training, and simulated disaster response exercises. Once
everything starts happening, you want to have your resources in
place. Staging is very important.
I've seen counties where rivers will flood and you can't get
across if you don't have the resources across the other side
already, not going to get them over there. Staging is an
important part of resource allocation. It is important to conduct
exercises to ensure the skills, equipment, and other resources
can be effectively coordinated when an emergency occurs. One
thing that happens is the area of impact will be inundated with
first responders.
Many years ago, I had an occasion to lead a team for a
jurisdiction with law enforcement in preparation for a sniper
attack, DC sniper. Actually, we worked all week long on
preparing for this and unfortunately, the sniper struck our area.
We were finishing our plan on a Friday and he struck in our
area on a Saturday. One thing we didn't want to happen, we did
with all of our resources, which was thousands of police
officers, to converge on the site of the shooting. We set up a
concentric circle, 50 miles out.
We shut down every single road. We didn't know where he

34. would strike but we knew we didn't want everybody going there.
We set up a staging area. We knew we would have staging
areas. That's exactly what we did. The plan worked very well.
We didn't catch him because we had faulty information. We
thought he was driving a white van and he was actually a dark
color sedan. He wasn’t very far away from where we were
standing and working.
Exercises also provide a good opportunity to identify
organizational and departmental shortcomings and to take
corrective action before an actual event takes place. Once you
do your planning, you want to exercise to the plan. Once you do
the exercise, you want to have a debriefing. On our lane
closure, our counter flow operation, I had 40 or 50 people in a
room. Probably a lot more. It was about 50+. We had about 40
or 50 people in the room about eight o'clock in the morning.
I held a debriefing and I asked each agency for the person to
raise your hand who was instant commander for that agency.
One particular agency, I won't embarrass them, I asked who the
commander was for their agency and about five people raised
their hands. That was a flaw. They didn't know who their
incident commander was. Everybody was there and everybody
saw that. It was a little embarrassing but it was a lesson to
learn.
Emergency management planning. Emergency management
planning is a broad term that encompasses many principles of
emergency, risk, disaster, and hazard mitigation or management,
as well as those aspects of civil defense and protection typical
of emergency preparedness. While the terms emergency,
disaster, and hazard might be synonymous, to some degree,
especially emergency and disaster, it is probably important to
be somewhat careful with definitions.
The fact of the matter is you're never going to get everybody to
agree what exactly a disaster is or a catastrophe or emergency.
It really is in the eye of the beholder. To begin with then, let us
ask what is an emergency? The definition of emergency is an
exceptional event that exceeds the capacity of normal resources

35. and organizations should cope. If you have a two-vehicle crash,
that's an emergency but is not an emergency in this phrase.
If you have 117 vehicles in one crash, that's an emergency.
That's a disaster. It took every resource we had and more to
handle that. All emergencies are by definition dangerous, which
means that the potential loss of life is involved. This is why
emergency and disaster are quasi-synonymous. Disaster is
defined by Black's Law Dictionary as a calamitous event
causing a great loss of life, damage or hardship.
But Perry, 2006, has a failure of a social system to deliver
reasonable conditions of life. It goes on, clearly, a disaster is
somewhat ambiguous and care must be taken to distinguish it
from other states of emergency. Your state or locality may have
definitions but more likely not. Many things can be taken from
messages just be careful the choice of words you use, especially
to communicate with the public. In this regard, Alexander says
there are four levels of emergency.
Routine dispatch problem, the most minor of emergencies of all
the first responders. Dealt with daily. Incident, any emergency a
jurisdiction can handle without needing to call in outside help.
Pretty close to the first one, right? Disaster, an incident or
catastrophe involving substantial destruction and mass casualty.
And then a national disaster or international, a substantial
magnitude of seriousness.
I think we can look at most of these things and say 9/11 was a
disaster, some people might say even an international disaster.
Katrina was a disaster, some people might say there's a
catastrophe. Those would both be okay. They weren't routine
dispatches and they weren't just incidents. But again, that
family, that lose a loved one, it's a disaster, it's a catastrophe.
We have to look at the context of the word. How is it used,
where is used, and so forth.
Emergency planning. The basic elements of an emergency plan
or context, legislative framework, participating organizations,
scenarios, hazard, vulnerability, risk, and impact. Emergency
needs such as search and rescue, medical care, triage, public

36. safety, food, shelter, damage prevention, and limitation.
Available resources such as structure, items, competencies and
personnel. Equipment, vehicles and buildings and facilities. The
resource utilization, application of resources to problems posed
by scenario, dissemination of plan, and testing, revising and use
of the plan.
We have to look at the context, scenarios, emergency needs.
Right now and in the future, there will be resources and
resource utilization. We're leaving with two more quotes.
Meno's Paradox, "How will you cope with a problem when you
don't know what the problem will be?" So, you have to be
prepared for everything, don't you? You have to plan for the
worst case.
Then Psalm 91:2 says, "I will say of the Lord. He is my refuge
and my fortress. In Him will I trust." Better words I haven't
heard. I hope you had a great week. I hope you have a great
next week. Let us know if you need anything. God bless. Take
care for now.
[00:17:53] [END OF AUDIO]
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