3440.10 with Changes - Navy Medicine - U.S. Navy

DEPARTMENT OF THE NAVY 

BUREAU OF MEDIONE AND SURGERY 

2300 E STREET NW 

WASHINGTON DC 20372-5300 IN REPlY REFER TO 

BUMEDINST 3440.10 CH-I 

BUMED-M3/5 

12 Dec 2011 

BUMED INSTRUCTION 3440.10 CHANGE TRANSMITTAL I 

From: Chief, Bureau of Medicine and Surgery 

Subj: NAVY MEDICINE FORCE HEALTH PROTECTION EMERGENCY MANAGEMENT 

PROGRAM 

Ref: (a) BUMEDINST 3440.10 

Encl: (1) Revised pages 7 through II (Tables 2 through 4) of original enclosure (1) to 

reference (a) 

(2) Revised pages 19 through 23 of original enclosure (1) to reference (a) 

1. Purpose. To issue an updated list of Bureau of Medicine and Surgery (BUMED) approved 

and issued Emergency Management Program (EMP) equipment and a revised listing of Navy 

medical treatment facilities (MTFs) with EMP tier designations. Enclosure (1) is an updated 

listing of MTFs by EMP tier designation and regional alignment, and enclosure (2) is the current 

list of approved EMP equipment. 

2. Scope and Applicability. Reference (a) is the Navy Medicine Force Health Protection (FHP) 

EMP manual, which established the BUMED capability for all-hazards preparedness. It applies 

to all BUMED activities, with the exception of mobile, expeditionary, afloat, or deployed 

medical forces. This change transmittal updates the basic instruction and carries the same scope 

and applicability. 

3. Action. Replace pages 7 through 11 (Tables 2 through 4) of enclosure (1) to reference (a) 

with enclosure (1) of this change transmittal. Replace pages 19 through 23 of enclosure (1) to 

reference (a) with enclosure (2) of this change transmittal. 

4. Retain. For record purposes, keep this change transmittal in front of the basic instruction. 

M. L. NATHAN 

Distribution is electronic only via the Navy Medicine Web site at: 

hI tps:llwww.mcd .navy.miI/Pagcs/Def au It .aspx

3. Scope and Applicability 

BUMEDINST 3440.10 

20 Nov 2008 

a. Scope. This instruction defines responsibilities and authority of Chief, BUMED and 

responsibilities of subordinate commands in implementing and sustaining a comprehensive FHP 

EMP per references (a) and (b) and in coordination with reference (c). It also establishes 

capabilities for all-hazards preparedness, mitigation, prevention, response, and recovery to 

sustain mission readiness, save lives, reduce human suffering, and protect property. This 

instruction serves as the HSS companion to references (c) and (d). 

(1) All BUMED activities shall follow Federal Regulatory Code for worker safety in this 

program as designated in references (e) through (g). 

(2) In accordance with reference (a), BUMED-M3/5 shall develop a CBRNE readiness 

assessment and reporting process. 

(3) Navy Medicine collaborates closely with Commander, Naval Installations Command 

(CNIC) and Headquarters Marine Corps (HQMC) in aligning goals and objectives through 

common FHP EMP standards and policy. 

(4) This instruction establishes a Navy Medicine FHP EMP and unifies the HSS 

component of these programs to promote efficiency and eliminate duplication. 

b. Applicability. Applies to all BUMED activities. This instruction does not apply to 

mobile, expeditionary, afloat, or other deployable medical forces or personnel when in a 

deployed status. 

4. Definitions 

a. Medical Treatment Facility (MTF). A single health care (Naval Medical Center, Naval 

Hospital, Branch Medical Clinic, or Naval Dental Clinic) or multiple medical and dental 

facilities under a single commanding officer (CO) or officer in charge (OIC). 

b. Emergency Management. A risk-based, comprehensive, and continual process to prepare 

for, mitigate, prevent, respond to, and recover from an incident that threatens life, property, 

operations, or the environment. 

5. Background. The Department of Defense (DoD) and its components are key participants in 

the national strategy of deterrence, protection, prevention, and defense against any and all threats 

to DoD assets and the homeland, and response to and recovery from the consequences of events 

caused by those threats. 

a. The terrorist attacks on the United States in the fall of 2001 resulted in an historic 

restructuring of the Federal Government’s strategies on homeland defense and civil support, with 

rapidly evolving concepts of defense against all forms of disasters and a unified approach to 

incident management. These principles are incorporated in references (h) through (j), which 

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20 Nov 2008 

stress coordination, cooperation, and interoperability across all Federal, State, tribal, and local 

jurisdictions, and implementation of an incident management system. DoD installations 

represent local, Federal level jurisdictions, and are vital to overall military operational success. 

The protection of installation resources and personnel is paramount to military readiness. The 

effectiveness of emergency management planning will directly impact the success of operations 

of all supported installation personnel and commands. 

b. Reference (c) is the principal issuance within the Navy for implementing ashore FHP 

EMPs directed by references (a) and (k) under an “all-hazards” approach. Reference (c) replaces 

the disaster preparedness construct previously employed by the Navy. The intent of the Navy 

Medicine FHP EMP is to provide seamless HSS to both the Navy and Marine Corps 

installations. 

c. Substantial overlap of capabilities exists within the HSS area of programs that address 

EM, ATFP, CIP, and CBRNE Installation Protection Programs (IPPs). This policy coordinates 

and streamlines capability development across these programs. 

6. Policy. BUMED policy is to ensure that all-hazard emergencies will not be a decisive factor 

in degrading mission readiness or effectiveness. BUMED fully supports references (c) and (d), 

and other programs designed to protect installations, active duty personnel, their dependents, and 

tenant civilians at those installations, while further assisting installation commanders in responding 

to, and recovering from, the consequences of such events. 

a. The Navy Medicine FHP EMP shall serve as the principal guidance within BUMED and 

BUMED activities for implementing all-hazards EM as directed by references (a) and (b). 

b. BUMED activities shall develop a local, all-hazards EM plan that supports the installation 

EM plans and is aligned with Navy and/or Marine Corps regional plans as required by 

references (a) through (d). 

c. Within the United States, its territories, and possessions, commanders of BUMED 

activities shall be prepared to assist civil authorities under local immediate response or through 

Civil Authority (CA) as outlined in reference (l) and Defense Support in reference (i). 

d. MTFs shall implement the Hospital Incident Command System (HICS) as the official 

type of Incident Command System (ICS), which meets requirements of references (h) and (m) 

and is delineated in reference (n), which can be located at www.emsa.ca.gov/hics/hics.asp. 

7. Responsibilities 

a. Director, Navy Medicine Office of Operations, Plans, Force Protection/Force Health 

Protection (BUMED-M3/5), is designated the Program Manager, Navy Medicine FHP EMP and 

is responsible for the overall program planning, coordination, oversight, and management. 

BUMED-M3/5 serves as the BUMED principal coordinator of expertise in addressing HSS for 

EM, MTF ATFP, certain health sector aspects of the DoD CIP, CIV-MIL operations, and FHP 

EMP issues. Specific responsibilities include: 

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20 Nov 2008 

(1) Developing and maintaining an overarching and unifying policy for FHP EMP HSS. 

(2) Establishing a framework for support and oversight of BUMED commands and 

activities covered under this instruction. Such oversight and support shall include, but not be 

limited to: 

(a) Analysis of vulnerabilities of BUMED activities from all-hazards incidents. 

(b) Definition of program standards and requirements. 

(c) Response capability analysis for readiness and preparedness. 

(d) Risk-based prioritization of program capabilities. 

(e) EM plans development. 

(f) Resource identification and procurement. 

(g) Exercise development and evaluation. 

(h) Incorporation of lessons learned from the Navy Medicine Lessons Learned 

(NMLL) Data Base. 

(i) Centralized HSS FHP EMP sustainment. 

(3) Determining expected competencies for personnel supporting installation HSS 

programs. 

(4) Identifying education and training requirements for BUMED activity personnel to 

support these competencies. 

(5) Determining materiel requirements and standards in support of the FHP EMP. 

(6) Maintaining appropriate liaison with and collaborating with appropriate Service and 

DoD offices, and other Federal agencies to further standards development, coordination, 

integration, interoperability, and information sharing related to EM. 

b. The Deputy Chief of Staff, Current and Future Medical Operations (BUMED-M3/M5) 

shall ensure full coordination and collaboration across BUMED activities for the FHP EMP. 

Direct supervision provided by the Assistant Deputy Chief of Staff, Operations (BUMED-M3B). 

c. The Staff Judge Advocate (BUMED-M00J) shall provide legal consultation, as needed, 

throughout Navy Medicine to successfully implement the program. 

4


20 Nov 2008 

d. The Deputy Chief of Staff, Manpower Personnel (BUMED-M1) shall ensure integration 

of Navy Medicine personnel into overall program objectives and shall leverage, where possible, 

Reserve capabilities to promote and facilitate effective installation level FHP HSS. 

e. The Deputy Chief of Staff, Installations and Logistics (BUMED-M4) shall assist in the 

management of medical logistics and health care and support facilities requirements. Provides 

safety and occupational and health, including industrial hygiene, policy support FHP EMP. 

f. Deputy Chief of Staff, Resource Management/Comptroller (BUMED-M8) shall assist 

through facilitation of programs, plans, and budget initiatives in support of this program. 

g. Navy Medicine Manpower, Personnel, Training and Education Command (NAVMED 

MPT&E) shall allocate sufficient resources to establish and improve FHP HSS EM education 

and training dealing specifically with CBRNE/all-hazards prevention and mitigation, 

preparedness, response, and recovery measures for all medical personnel. 

h. CO, Navy and Marine Corps Public Health Center (NMCPHC) shall: 

(1) Provide technical and scientific subject matter expertise (SME) reach-back support, 

as appropriate. 

(2) Provide occupational medicine and industrial hygiene support to include the 

Respiratory Protection Program. 

(3) Serve as the disease and syndromic surveillance hub for the Navy and Marine Corps. 

i. Naval Operational Medicine Institute (NOMI) shall serve as the archival site (NMLL 

System) for after action reports (AAR) and lessons learned from exercise assessments conducted 

involving MTFs in support of the FHP EMP, per reference (o). 

j. NAVMED Regional (NAVMEDREG) commanders shall support BUMED activities 

within their respective areas of responsibility (AOR) in training, implementation, inventory 

management, sustainment issues, and evaluation as directed. 

(1) Appoint a full-time command emergency management officer (EMO) in accordance 

with enclosure (1), section 5. 

(2) Ensure hazard vulnerability assessments (HVAs) are conducted at MTFs at least 

every 3 years, with results addressed and coordinated with BUMED-M3/5. This program shall 

be coordinated with the Chief of Naval Operations (CNO) Installation Vulnerability Assessments 

(IVA), Marine Corps IVA programs, and Joint Staff Installation Vulnerability Assessments 

(JSIVA). 

k. Navy Medicine Inspector General (BUMED-M00IG) shall include inspection and 

organizational assessments of command FHP EMP; including currency of the command EM 

Plan and compliance with the Navy Medicine FHP EMP program objectives. 

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20 Nov 2008 

(1) Review HVAs conducted at MTFs annually and ensure results are addressed and 

incorporated into the command EM Plan, used to drive training exercise objectives, and 

coordinated with BUMED-M3/5. 

(2) Inspect for adherence to FHP EMP program objectives, such as proper accounting of 

command response capabilities for readiness; proper storage and maintenance of equipment and 

pharmaceuticals; currency of training and exercises; execution of the Respiratory Protection 

Program (RPP); and use of standard information management tools in program management. 

l. MTF Commanders shall: 

(1) Implement an HSS FHP EMP consistent with this instruction and supporting 

publications. 

(a) Commands providing support through proximate subordinate clinics shall develop 

programs that support installation requirements and leverage all available resources in preparedness, 

prevention, mitigation, response, and recovery operations. 

(b) Satellite MTFs so remote from parent commands that timely response support 

would not be feasible through those parent commands may, subject to CO’s discretion, develop 

activity EM plans that are separate from parent command programs (referred to as “independent 

programs”). MTFs with independent programs shall be subject to all requirements established 

by this and subordinate instructions from parent MTFs. 

(2) Appoint a Command or Activity EMO: 

(a) Commanders of Tier 1, 2, and 3 facilities, as delineated in enclosure (1), section 

1, shall designate EMOs in writing. EMOs at Tier 1 and 2 facilities shall be full-time in that 

position while EMOs at a Tier 3 activity may fulfill their role as a single collateral duty, as 

delineated in enclosure (1), section 1. They will be responsible for overall command 

implementation and management of the HSS FHP EMP. 

(b) MTF commanders shall designate a representative to the Installation Emergency 

Management Working Group (EMWG) per reference (c). 

(c) Commanders of parent MTFs shall designate a representative to the Regional 

EMWG per reference (c). 

(d) OICs of Tier 4 clinics that participate in parent MTF integrated FHP EMPs shall 

designate an activity EMO responsible for clinic EM implementation and management. The 

EMO shall also serve as principle liaison with local (community medical) EM committees, and 

parent command EM committees. 

(3) Establish a multi-disciplinary MTF EMWG comprised of command, subordinate 

activity, tenant commands, and ad hoc outside representatives to provide planning and 

coordination of EM activities through the EMO. The EMWG shall replace any existing activity 

Disaster Preparedness Committee. 

6

NAVY MEDICINE 

FORCE HEALTH PROTECTION 

EMERGENCY MANAGEMENT PROGRAM MANUAL 

TABLE OF CONTENTS 

BUMEDINST 3440.10 CH-2 

25 Apr 2012 

SECTION 1 - EMERGENCY MANAGEMENT PROGRAM STANDARDS ....................... 2 

Standard 1 - Program Management .......................................................................................... 3 

Standard 2 - Personnel Categorization ...................................................................................... 3 

Standard 3 Tiered Implementation ......................................................................................... 4 

Table 1. MTF Tiered Personnel Requirements .................................................................. 6 

Table 2. NA VMEDREG East MTF Tier Designations ...................................................... 7 

Table 3. NA VMEDREG West MTF Tier Designations ..................................................... 9 

Table 4. NA VMEDREG NCA MTF Tier Designations .................................................. 11 

Standard 4 - Assessments ........................................................................................................ 12 

Standard 5 - Interoperability ................................................................................................... 13 

Standard 6 - Preparedness ....................................................................................................... 13 

Standard 7 Planning .............................................................................................................. 15 

Standard 8 - Training .............................................................................................................. 16 

Standard 9 Equipment .......................................................................................................... 17 

Standard 10 - Exercise and Evaluation ................................................................................... 23 

Standard 11 - Mitigation and Prevention ................................................................................ 24 

Standard 12 Response ........................................................................................................... 25 

Standard 13 - Recovery ........................................................................................................... 26 

Standard 14 - Sustainment ...................................................................................................... 26 

SECTION 2 - NATIONAL INCIDENT MANAGEMENT SYSTEM (NIMS) 

COMPLIANCE ................................................................................................ 27 

SECTION 3 - COMMAND AND CONTROL ....................................................................... 33 

SECTION 4 - REQUIRED EM PLAN ANNEXES ............................................................... 35 

SECTION 5 - NAVY MEDICINE EMP EMO COMPETENCIES AND 

STANDARDIZED CIVILIAN CLASSIFICATION ..................................... 37 

SECTION 6 - PROCEDURES FOR REQUESTING WAIVERS OR EXCEPTIONS ..... .41 

Enclosure (1)

SECTION 1 

EMERGENCY MANAGEMENT PROGRAM STANDARDS 


20 Nov 2008 

Ref: (a) OPNAVINST 3440.17 

(b) CNICINST 3440.17 

(c) U.S. Marine Corps CBRNE Installation Preparedness Campaign Plan 

(d) DoDINST 1400.32 of 24 Apr 1995 

(e) DoDINST 2000.18 of 4 Dec 2002 

(f) (U) CJCSI 3110.03C, Joint Strategic Capability Plan (JSCP) - Logistics 

(g) (U) Installation Prioritization for J8 JRO CBRND JSAP (J-8A 00052-06) 

(h) (U) Program Decision Memorandum, Installation Prioritization Study of 12 Dec 2002 

(i) DoD Strategy for Homeland Defense and Civil Support 

(j) Chief, BUMED ltr Ser 04UM3M42067 of 20 Oct 2004 

(k) BUMEDINST 7050.1A 

(l) National Incident Management System (NIMS) of 1 Mar 2004 

(m) DoDDIR 6200.3 of 12 May 2003 

(n) BUMEDINST 6200.17 

(o) SECNAVINST 3400.4 

(p) JPEO-CBD USN Approved Family of Systems (FoS) of 21 Aug 2006 

(q) Joint Commission Comprehensive Accreditation Manual for Hospitals (EC1.4) 

(r) DoDINST 2000.16 of 2 Oct 2006 

(s) National Response Framework of Jan 2008 

(t) HICS Guidebook, Aug 2006 

(u) DoDDIR 3025.15 of 18 Feb 1997 

(v) OPNAVINST 3440.16C 

(w) DoDINST 6055 series 

(x) OPNAVINST 5100.23G 

(y) National Response Plan Catastrophic Incident Supplement (NRP-CIS) 

(z) OPNAVINST 5090.1C 

1. Purpose. To define Navy Medicine FHP EMP standards aligned with those issued by 

references (a) through (c) of this section. 

2. Background 

a. Program standards for the Navy FHP EMP are issued in reference (a) of this section. 

b. Close alignment of program standards and integration of Navy Medicine into installation 

and regional plans will facilitate interoperability in an all-hazards environment and across the 

EM spectrum. 

3. Responsibility. BUMED-M3/5 shall establish and maintain FHP EMP standards as 

delineated in this manual. NAVMEDREG commanders and MTF commanders shall adopt and 

maintain these standards. 

2 Enclosure (1)

FHP EMP Standard 1: Program Management 


20 Nov 2008 

1. The Navy Medicine FHP EMP establishes management guidelines that delineate operational 

and administrative command responsibilities. BUMED, regional, and MTF EMOs shall be 

responsible for preparing for, preventing, mitigating effects of, responding to, and recovering 

from all-hazards emergencies. The FHP EMP will be measured against existing standards. A 

process for continuous quality improvement will be instituted and monitored through exercise, 

assessment, lessons learned, and analysis. 

2. All tiered facilities shall designate an EMO as described in this instruction and per reference 

(j) of this enclosure. The commander shall also designate the appropriate number of personnel to 

properly support and manage the FHP EMP, as well as provide HSS to the installation FHP 

EMP. The facility/MTF EMO shall coordinate and work closely with the NAVMEDREG 

EMOs, regional and installation emergency managers, and CNIC regional CBRNE coordinators. 

3. Tenant MTFs shall coordinate with the host installation’s FHP EMP as outlined in host-tenant 

agreements or support agreement (SA). Coordination shall include active participation in EM 

preparedness, prevention, training, mitigation, response, and recovery efforts, as required by 

CNIC or USMC regional and/or installation FHP EMPs. 

FHP EMP Standard 2: Personnel Categorization 

1. The Navy Medicine FHP EMP categorizes personnel in accordance with reference (a) of this 

section. 

2. The Navy Medicine FHP EMP focuses on the preparedness and prevention, mitigation, 

response, and recovery capabilities of Category 5 personnel to ensure the protection of Category 

1-4 personnel, while providing continuity of operations (COOP). 

3. The following definitions are provided for the five categories of personnel: 

a. Category 1: Emergency-essential U.S. military personnel, DoD civilians, and DoD 

contractor (or subcontractor) personnel who perform mission-essential services. 

b. Category 2: Other U.S. personnel, including: 

(1) U.S. military family members living on or off a military installation. 

(2) Non-emergency essential U.S. military personnel, Navy civilian employees, and other 

persons covered by reference (d) of this section. 

(3) Navy contractor (and subcontractor) employees other than those performing 

emergency-essential Navy services. 

(4) Employees of other U.S. Government agencies. 

(5) Other U.S. Government contractor (and subcontractor) employees. 

3 Enclosure (1)

c. Category 3: Other personnel supporting U.S. military operations, including: 


20 Nov 2008 

(1) Personnel (non-U.S. citizens) who are employees of the Navy or a Navy contractor 

(or subcontractor), and who are not included in Categories 1 or 2. 

(2) Foreign military personnel employed by the host-nation government or by contractors 

of the host-nation government. 

d. Category 4: Allied/coalition nation personnel, including host-nation personnel and third 

country nationals that the U.S. may assist pursuant to an international agreement approved by the 

Department of State (DoS) or as directed by the Secretary of Defense (SECDEF), such as 

allied/coalition military forces, government officials, and emergency response personnel. 

e. Category 5: Emergency first responders/receivers who are U.S. military personnel, DoD 

civilians and/or contractor personnel, including, but not limited to: 

(1) EM personnel, Fire and Emergency Services personnel, hazardous material 

(HAZMAT) teams, Naval Security Forces (NSF), emergency medical service (EMS) personnel, 

explosive ordnance disposal (EOD) teams, MTF providers, Public Health Emergency Officers 

(PHEO), 911 dispatch center personnel, regional operations center (ROC) and emergency 

operations center (EOC) personnel, emergency response teams (ERT) and mass care, mass 

fatality, and mortuary affairs personnel. 

(2) Personnel designated to perform response/recovery tasks including safety and 

occupational health (SOH), industrial hygiene (IH), public works, public affairs, supply/logistics, 

and any others designated to perform response or recovery tasks in support of the FHP EMP. 

4. The Navy Medicine FHP EMP shall provide HSS to ensure the ability of Category 1 

personnel to continue mission-essential functions for at least 12 hours at either their primary or 

alternate site. The Navy Medicine FHP EMP shall protect Category 1 through 4 personnel 

primarily through the utilization of evacuation or shelter-in-place procedures coupled with the 

proper operational employment of organized, trained, equipped, exercised, evaluated, and 

sustained Category 5 personnel. 

EMP Standard 3: Tiered Implementation 

1. The Navy Medicine FHP EMP establishes a tiered approach to support a comprehensive EM 

Plan. To date, the tiering effort has been focused on Navy Medicine assets that provide patient 

care. The intent of the tiering is to ensure appropriate resource allocations to support mission 

requirements and overall FHP. 

2. Reference (e) of this section establishes guidance for CBRNE preparedness and response 

capabilities on military installations involving weapons of mass destruction. 

Reference (f) of this section establishes HSS capability requirements as “unit type codes” 

(UTCs) in support of FHP. 

4 Enclosure (1)


20 Nov 2008 

3. BUMED-M3/5, in coordination with each NAVMEDREG commander and major parent 

command, assigned tier designations for all fixed MTFs. BUMED M3/5 will conduct periodic 

reviews of MTF tier designations to ensure applicability to the current Navy and Marine Corps 

missions, to include such factors as Medical Readiness Review, Base Realignment and Closure 

(BRAC) Commission, and Force Reshaping. 

4. Reference (a) of this section establishes tiered response as a program standard for the “allhazards” 

EM approach. This tiered response prioritizes resource allocation, financial 

management, and capability requirements. Each tier equates to a defined capability level that 

will provide the basis for organizing, training, and equipping resources. 

5. MTFs are divided into four tiers representing (1) high, (2) medium, (3) low, and (4) minimal 

response capabilities. MTF tiering is based on the following elements: 

a. Installation prioritization per reference (g) of this section. 

b. Support to power projection or strategic assets, per references (g) and (h) of this section. 

c. Human capital. 

d. Scope of response per reference (i) of this section. 

e. Geographic (or potential) isolation from additional support capabilities (e.g., distance and 

vulnerable transportation infrastructure such as bridges and tunnels). 

6. The tier designation determines the type and number of MTF response elements required to 

support the FHP EMP. Each specific element will be standardized across all Navy Medicine. 

For example, a decontamination element at a Tier 3 MTF will be organized, trained, and 

equipped to the same FHP EMP objectives as a decontamination element at a Tier 1 MTF. 

However, the Tier 3 MTF will have a smaller decontamination element footprint than the Tier 1 

MTF. See Table 1 for the minimum tiered MTF personnel requirements. 

a. Personnel. Personnel will be task-organized into unit identification code (UIC)-based 

capabilities areas (see Table 1). Designated active duty and civilian personnel located at an 

MTF, independent of expeditionary wartime military augmentation platforms, must participate. 

b. Training. All baseline didactic CBRNE training requirements will be met by the Navy 

Knowledge Online-based CBRNE Emergency Medical Preparedness and Response Course 

(EMPRC) as directed in reference (j) of this section. Additional practical application, 

equipment, and training exercises (e.g., tabletop (TTX), command post exercises (CPX)/field 

exercises (FE), and field training exercises (FTX)/full-scale exercises (FSE)) will contribute to 

the training qualification standards. 

5 Enclosure (1)


20 Nov 2008 

c. Equipment. Equipment to support the FHP EMP will be standardized across Navy 

Medicine and listed in the BUMED-M3/5 FoS. Based on the MTF tier, a Basis of Allocation 

(BoA) will serve as the template to be developed into Authorized Medical Allowance Lists 

(AMAL) managed by Navy Medical Logistics Command and Marine Corps Logistics 

Command. BUMED-M3/5 will coordinate closely with CNIC, Naval Sea Systems Command 

(NAVSEA), Naval Facilities Engineering Command Headquarters (NAVFACHQ), and the Joint 

Program Executive Office for Chemical and Biological Defense (JPEO-CBD) in maintaining the 

FoS and BoA. See FHP EMP Standard 9 (equipment) for more detail. 

Table 1. MTF Tiered Personnel Requirements 

The following table outlines MTF response capabilities by tier. Total number shown indicates 

the minimum number of personnel needed to perform the designated capability/function in the 

event of a CBRNE/all-hazards incident. 

CAPABILITY AREA TIER 1 TEAM(S) TIER 2 TEAM(S) TIER 3 TEAM(S) 

Decontamination 

MTF Zone Management 

Detection 

Transport 

Triage/Treatment 

Patient Administration 

TOTAL 

4 (12 members each) 

Total = 48 


Total = 16 


Total = 4 


Total = 24 


Total = 20 


Total = 6 

118 


Total = 24 


Total = 8 


Total = 4 


Total = 16 


Total = 10 


Total = 4 

66 

1 (12 members) 

Total = 12 

1 (4 members) 

Total = 4 


Total = 2 


Total = 8 


Total = 5 


Total = 2 

6 Enclosure (1) 

33

Table 2. NA VMEDREG East MTF Tier Designations 

7 

BUMEDINST 3440.10 CH-l 

12 Dec 2011 

Enclosure (1)

Table 3. NA VMEDREG West MTF Tier Designations 

9 


12 Dec 2011 

Enclosure (1 )

Table 4. NA VMEDREG NCA MTF Tier Designations 

11 


12 Dec 2011 

Enclosure (1)

FHP EMP Standard 4: Assessments 


20 Nov 2008 

1. The Navy Medicine FHP EMP identifies minimum MTF assessment standards and methods 

in support of the risk management process. 

2. Risk management is a continuous process of evaluating evolving threats, vulnerabilities, and 

capabilities to maintain the desired level of readiness. This process includes the use of threat 

assessments, vulnerability assessments, and EM capability assessments. These assessments 

should incorporate information and recommendations from a variety of sources including, but 

not limited to, HVA, JSIVA CNO IVA, CIP planning and assessments, and COOP planning. 

These assessments will assist in resource allocation and prioritization. 

a. Threat Assessments. MTF commanders, in conjunction with regional and installation 

commanders, shall utilize existing threat and vulnerability assessment methods to analyze the 

threats potentially impacting their commands at least annually. 

(1) Focus on the command’s overarching EM and ATFP programs. 

(2) Utilize appropriate SMEs for the areas being assessed. 

(3) Consider the range of identified and projected response capabilities needed for a 

natural or man-made hazard, including a terrorist or criminal act against the installation, its 

personnel, facilities, and other critical assets. 

(4) Identify responses to threats and vulnerabilities and solutions for enhanced protection 

of personnel and resources. 

(5) Provide threat and vulnerability-based analysis of the command’s FHP EMP. 

(6) Report, prioritize, and track assessments in time to support and coordinate the budget 

process at BUMED-M3/5. 

(7) Classify assessments in accordance with the appropriate security classification 

guidance. 

b. Ensure that EM personnel are trained to maximize the use of threat assessments and 

intelligence derived from civil and military law enforcement and public safety agencies and 

departments as well as EM, meteorological, environmental, and public health processes and 

procedures. 

c. EM Capability Assessments and Status. The Navy Medicine FHP EMP will utilize a 

comprehensive capabilities assessment and status process to determine the status of an MTF’s 

required EM capabilities with respect to readiness and preparedness. The process will examine: 

12 Enclosure (1)


20 Nov 2008 

(1) MTF capability to utilize threat assessments along with installation and MTF HVAs 

to determine risk posed by all hazards. 

EMP. 

(2) MTF capability to reduce the assessed risk through the implementation of the FHP 

(3) The availability of resources to support plans as written. 

(4) The frequency and extent to which plans have been reviewed, trained, and exercised. 

(5) The proper utilization of exercise assessments and AARs in the improvement of the 

FHP EMP. 

(6) Written agreements (e.g., SA) with supporting/supported organizations per reference 

(k) of this section. 

(7) Use of operational risk management. 

FHP EMP Standard 5: Interoperability 

1. The Navy Medicine FHP EMP requires interoperability standards and methods as set forth in 

reference (a) of this section, and in support of references (b), (c), and (l) of this section. 

2. Interoperability must include the standardization of systems, procedures, and terms to the 

maximum extent possible. The goal is compatibility of tactics, techniques, and procedures 

(TTP), especially command, control, and communications (C3) among regional and installation 

EM assets and applicable Federal, State, tribal, local, and/or private (or host nation (HN)) EM 

agencies and departments. 

3. MTF commanders or their representatives shall participate in regional and installation EM 

planning, training, and exercises and encourage reciprocal participation by these entities in their 

EM planning, training, and exercises. 

FHP EMP Standard 6: Preparedness 

1. The Navy Medicine FHP EMP establishes minimum preparedness standards as required by 

references (a) and (m) of this section, and in support of reference (b) of this section. These 

standards include the proper organization, manning, C3 with Federal, State, tribal, local, and/or 

private (or HN) agencies and departments, and functional area relationships. 

2. The preparedness tasks of planning, training, FoS selection and BoA, exercise, training, 

evaluation, and assessments are covered within other standards outlined in this instruction. 

a. Public Health Emergency Officers (PHEO). MTF commanders shall assist operational 

commanders who request nomination of a PHEO for designation by that commander, in 

accordance with reference (m) of this section. The PHEO shall serve as a member of the 

13 Enclosure (1)


20 Nov 2008 

installation or Navy region Military Biological Advisory Committee (MBAC) in support of 

reference (b) of this section, and is the principal advisor determining the existence of and the 

actions required to respond to a public health emergency (PHE) either onboard or potentially 

affecting installation(s) assigned to the specific Navy or USMC installation, region, or activity. 

b. EM Working Group (EMWG). MTF commanders shall establish and maintain an 

EMWG to assist the MTF emergency manager in the development, execution, exercise, and 

assessment of the MTF FHP EMP. The EMWG will actively participate in Navy or Marine 

Corps region and installation EM activities and planning programs. 

c. Mass Warning and Notification. MTF commanders shall develop capabilities to rapidly 

warn and notify personnel as necessary. Per reference (a) of this section, Category 2 through 4 

personnel must receive warning and notification within 15 minutes of an event and Category 1 

and 5 personnel must receive warning and notification within 5 minutes of an event. Outside the 

U.S., its territories, and possessions, this task shall include warning and notification of sponsored 

family members living off base. These capabilities should integrate with the mass warning and 

notification system(s) employed by the local community (or HN) to the extent possible. Mass 

warning and notification systems shall be constructed in accordance with Unified Facilities 

Criteria (UFC) 4-021-01 (Design, Operations, and Maintenance: Mass Notification Systems). 

d. Regional Operations Center (ROC). MTF commanders shall designate, in writing, 

trained and qualified personnel capable of assisting, advising, and/or serving as liaison to the 

ROC in the event of activation. 

e. Emergency Operations Centers (EOC). MTF commanders shall designate and assign in 

writing, trained and qualified personnel capable of assisting, advising, and/or serving as liaison 

to the installation EOC in the event of activation. 

f. Communications. MTF commanders shall develop operable communications across the 

Category 5 functional areas. Interoperable communications are highly recommended (see EM 

Standard 5). Commanders should pursue procedure-based solutions to interoperability 

challenges, including the use of liaison officers at the ROC, EOC, and Incident Command Post 

(ICP) levels, whenever appropriate. 

g. Written Agreements (WAs). MTF commanders shall coordinate with regional, installation, 

and local EM resources in the development of WAs as necessary per reference (k) of this 

section. These WAs should outline cooperative measures where MTF Category 5 personnel may 

assist the civilian community and vice versa in response to and recovery from all-hazards natural 

and man-made emergencies, including CBRNE events. 

h. Civil-Military (CIV-MIL) Operations. MTF commanders shall coordinate with regional 

and installation commanders in the development of relationships with the appropriate Federal, 

State, tribal, local, and/or private (or HN) EM-related agencies and departments to identify and 

update responsible points of contact, emergency protocols, and expectations in the event of an 

emergency onboard or affecting a Navy Medicine MTF or installation. This task 

14 Enclosure (1)


20 Nov 2008 

should also include MTF EM coordination with nearby military installations of other Services 

including the U.S. Coast Guard, and local medical community organizational planning such as 

through local emergency planning committees. 

i. Joint Information Center (JIC). MTF commanders shall coordinate with region and 

installation EM staffs to identify and update points of contact for public affairs, risk communication, 

emergency protocols, and media expectations. 

FHP EMP Standard 7: Planning 

1. The Navy Medicine FHP EMP establishes minimum planning standards as required by 

reference (a) of this section. Planning is critical to preparedness, prevention, mitigation, 

response, and recovery from an emergency. The MTF EM Plan must be coordinated with the 

installation plan, if the MTF is a tenant command, or with the regional plan, if the MTF is a 

stand-alone installation. 

2. All Navy Medicine MTF EM Plans shall be reviewed at least annually and provided to the 

immediate superior in command (ISIC). Elements of the MTF EM Plan must be coordinated 

with the applicable Navy and USMC region, and installation-specific EM Plans and exercises. 

The MTF EM Plan should also be coordinated with Federal, State, tribal, local, other-Service, or 

HN, and/or private response and/or recovery partners. 

3. Evacuation planning, shelter-in-place planning, and shelter development procedures should 

be based upon applicable DoD, Department of Homeland Security (DHS), and American Red 

Cross (ARC) guidelines. Evacuation, rather than procurement and employment of protective 

equipment, is the primary means of addressing hazards faced by Category 2 personnel. In 

overseas locations, evacuations will follow established U.S. DoS evacuation procedures. 

4. Per reference (b) of this section, Navy region and installation commanders shall develop 

plans and procedures to direct Category 2 through 4 personnel to safe locations, shelters, or to a 

shelter-in-place should evacuation not be an option. When shelter-in-place is utilized, the goal 

will be to protect at least 90 percent of personnel within 15 minutes. MTF commanders and 

EMOs shall communicate regularly and coordinate closely with region or installation EM 

planning processes. 

5. Additional aspects of planning that must be incorporated are: 

a. Assistance to requesting commanders in identifying a PHEO per reference (n) of this 

section. 

b. Participation in the MBAC per reference (c) of this section. 

c. Liaison with the installation EOC and ROC. 

15 Enclosure (1)

FHP EMP Standard 8: Training 


20 Nov 2008 

1. The Navy Medicine FHP EMP establishes minimum training standards as required by 

references (a), (e), and (o) of this section. Training standards are based on existing DoD, 

Occupational Safety and Health Administration (OSHA), National Fire Protection Agency 

(NFPA), and military standards and guidelines as referenced in (l) and (o) of this section. These 

training standards focus on the requirements for Category 1 personnel to maintain critical 

operations, for Category 2-4 personnel to gain hazard awareness and understanding of warning 

and response procedures, and for Category 5 personnel to conduct safe and effective operations 

at their level of training. 

2. NAVMEDREG and MTF EMOs shall meet the minimum training standards established by 

this instruction with the ability to tailor each program based upon specific mission requirements 

and incorporate their regional/installations capabilities and resources. All personnel will receive 

required training through identified military, government civilian, local/State agencies, and 

contractors unless otherwise noted. Training will include realistic exercises (see Standard 10) 

demonstrating the level of proficiency required for training and evaluation purposes. 

3. A comprehensive training continuum utilizing established standards and addressing the 

requirements for initial and recurring training will be developed by BUMED for the following 

areas: 

a. Category 1 specific. 

b. Category 2-4 specific. 

c. Category 5 specific. 

d. All enterprise personnel. 

(1) Public awareness level training does not have to result in certification. Public 

awareness level training must include general EM and CBRNE hazard information as well as 

region and/or installation specific EM guidance per reference (a) of this section. 

(2) All baseline didactic CBRNE training requirements will be met by the Navy 

Knowledge On-line (NKO)-based CBRNE EMPRC. The EMPRC, available at: 

http://www.dmrti.army.mil, is a multi-module, web-based, interactive training product. Each of 

the modules is made up of multiple topics that have opportunities throughout to test knowledge 

retained up to that point. 

4. The EMPRC is tailored to the target audience and offered in four versions: 

a. Basic Course. Non-essential civilian employees and contractors (non-medical/nonsecurity). 

16 Enclosure (1)


20 Nov 2008 

b. Operator/Responder Course. First responders/receivers (e.g., general corpsmen, nonclinicians, 

MTF security personnel, MTF based Basic EMS). 

c. Clinician Course. First responder/receiver clinicians, physicians, dentists, veterinarians, 

nurses, physician assistants, independent duty corpsmen, and MTF based Advanced EMS. 

d. Executive/Commander Course. MTF commanding officers and Executive Steering 

Committee (ESC) members. 

5. The EMPRC is hosted on the following sites: 

a. Navy Active and Reserve: http://www.nko.navy.mil. 

b. Navy-affiliated civilian and contractors: http://www.swankhealth.com. 

6. Required specialty training (e.g., MTF EOC Operations, PHEO, etc.) will be identified by 

BUMED-M3/5 in coordination with NAVMEDREG and MTF commanders and conducted 

following reference (b) of this section. 

FHP EMP Standard 9: Equipment 

1. The Navy Medicine FHP EMP establishes standardized equipment requirements, designated 

as the FoS, for all BUMED facilities as required by references (a) and (b) of this section. 

Equipment standards focus on the requirements for Category 5 personnel to conduct safe and 

effective first receiver operations. Equipment shall be provided with the appropriate 

maintenance, operation, and employment training. 

2. Reference (p) of this section addresses the following receiver functions: command and 

control (C2), mass warning and notification, communications, detection, survey, identification, 

personal protection, personal immediate decontamination, casualty (secondary) decontamination, 

medical surveillance, and CBRN Pharmaceutical Countermeasures (CPCs). These standards 

address requisite storage, maintenance, inventory, training, repair, and life-cycle cost estimate 

(LCCE). These standards shall be solely utilized to proper procurement and sustainment of all 

EM-related equipment. 

3. Equipment standards shall examine both Government-off-the-shelf (GOTS) and 

Commercial-off-the-shelf (COTS) for initial FoS development as well as for spiral insertion. 

a. GOTS equipment utilized to protect against the effects of, detect the presence of, or 

remove/reduce the hazard of CBRNE agents shall be procured, maintained, employed, and 

inventoried in accordance with applicable Joint Chemical Biological Defense Program 

(J-CBDP), J-8/Joint Requirements Office (JRO), JPEO-CBD, U.S. Navy, and USMC guidance. 

b. COTS equipment utilized within the scope of the FHP EMP, including CBRNE events, 

shall meet applicable OSHA, National Institute of Occupational Safety and Health (NIOSH), and 

NFPA standards, guidelines, and criteria as well as all applicable Federal and military standards 

and guidelines. 

17 Enclosure (1)


20 Nov 2008 

4. BUMED shall be responsible for ensuring that the approved FoS and BoA are updated and 

maintained for all Navy Medicine facilities. Changes to the FoS and BoA will be issued via 

Defense Message Traffic. GOTS CBRNE equipment shall be BUMED centrally coordinated 

with CNIC, NAVSEA, and NAVFACHQ. The Interagency Board’s (IAB) Selected Equipment 

List (SEL) shall serve as a basis for the selection of CBRNE-related COTS equipment by 

BUMED. 

5. BUMED must include procurement, life-cycle cost (LCC), and sustainment cost of assigned 

equipment in appropriate budget and Program Objective Memorandum (POM) submissions. 

6. Naval Medical Logistics Command (NAVMEDLOGCOM), Navy Medicine Support 

Command (NAVMEDSUPCOM), and MTF Material Managers shall ensure all equipment 

is reflected in Defense Medical Logistics Standard Support (DMLSS) available at: 

http://www.tricare.mil/dmlss/ for accountability purposes. 

7. NAVMEDSUPCOM shall work with NAVMEDLOGCOM in the standardization of 

procurement and distribution of MTF-required equipment. BUMED will provide MTF 

equipment requirements and program funding to ensure compliance with tier requirements. 

NAVMEDLOGCOM will provide detailed, itemized quarterly reports to BUMED-M3/5 

regarding procurement status. 

8. Basis of Allocation. The following information contains equipment designated for use 

by MTFs/personnel in the event of a CBRNE incident. All MTF personnel should note that 

procurement for items used in CBRNE and emergency response must be approved by 

BUMED-M3/5. 

a. Personal Protective Equipment (PPE) 

Level C Suits (OSHA)/Class 3 NFPA Suits. All CBRN protective ensembles fielded for 

use will be in compliance with OSHA Level C/NFPA 1994 (2007) Class 3 CBRN Protective 

Ensemble standards. Annual review of standards and CBRN protective ensemble selection will be 

performed and any required updates or modifications will be disseminated to MTFs accordingly by 

BUMED. 

OSHA Level C Ensemble Components OSHA Level C Guidelines for Use 

▪ Full-face or half-mask, air-purifying respirators 

(NIOSH approved) 

▪ Hooded chemical-resistant clothing (overalls; two-piece 

chemical-splash suit; disposable chemical-resistant 

overalls)* 

▪ Coveralls* 

▪ Gloves, outer, chemical-resistant. 

▪ Gloves, inner, chemical-resistant. 

▪ Boots (outer), chemical-resistant steel toe and shank* 

▪ Boot-covers, outer, chemical-resistant (disposable)* 

▪ Hard hat* 

▪ Escape mask* 

▪ Face shield* 

*Optional, as applicable. 

1. The atmospheric contaminants, liquid 

splashes, or other direct contact will not 

adversely affect or be absorbed through any 

exposed skin; 

2. The types of air contaminants have been 

identified, concentrations measured, and an 

air-purifying respirator is available that can 

remove the contaminants, and; 

3. All criteria for the use of air-purifying 

respirators are met. 

18 Enclosure (1)


12 Dec 2011 

From NFPA 1994 (2007 Edition). 3.3.9.2 Class 3 CBRN Protective Ensemble and 

Ensemble Elements: A chemicallbiological terrorism incident protective ensemble designed to 

protect emergency responder personnel at terrorism incidents involving low levels of vapor or 

liquid chemical hazards where the concentrations are below Immediately Dangerous to Life and 

Health, permitting the use of Chemical (Chern), Biological (Bio), Radiological (Rad), and 

Nuclear (CBRN) Positive Air-Purifying Respirator (P APR). 

Chemical Protective Ensemble(s) 

Level C Suit 

Item provided to Military Treatment Facilities (MTFs): Geomet DTAP (Disposable 

Toxicological Agent Protective) Level Cl coverall, NFPA 1992 (sizes available: S, M, L, XL, 

2XL,3XL). The Geomet DTAPS suit will provide sufficient protection to those expected to work 

directly in the Warm Zone when Level C is authorized. This suit will provide adequate dermal 

protection for all individuals who are not expected to be exposed to high levels of contamination 

and/or those who perform an outdoor task as a first receiver (e.g., decontamination, patient 

transport, etc.). 

Item provided to MTFs: The Tychem SL-121B Level B/C suit is issued for use in 

training, to prevent training incurred damage to the more costly Geomet DTAP suits, which are 

reserved for use during actual contingency events. The Tychem suit consists of a coverall, elastic 

wrists, front zipper closure, storm flap over zipper, and attached socks. Suits are available in 

sizes S to 3XL. 

Overboots 

Gloves 

Item provided to MTFs: EZ Fit HAZMAX (sizes available: S, M, L, XL). 

Item provided to MTFs: North Viton (sizes available: 9, 10, and 11). 

Inner Gloves 

PAPR 

Item provided to MTFs: North Silver Shield (sizes available: 8,9, and 10). 

Item provided to MTFs: The 3MTM RBE-NMIO Loose-Fitting PAPR is a belt-mounted, 

turbo-blower/filtration unit that includes the butyl rubber hood (BE-l OBR), cartridge/canister 

(RBE-57), nickel metal-hydride battery pack (BP-15), breathing tube assembly (RBE-BTH), 

decon belt (RBE-BLT), airflow indicator, smart battery charger (BC-21 0) and the carrying bag. 

The P APR is intended to provide respiratory protection against chemical and biological agents as 

19 Enclosure (2)


12 Dec 2011 

well as certain particulates, organic vapors, and acid gases, and other inorganic gases. The MTF 

allocation includes all the above mentioned items. Additionally, one third of the P APR inventory 

is issued with the Con Space voice amplifier and radio interface. 

PPE Bag 

Item Provided to MTFs: 30 X 16 X 15 (MDDSD). 

Tiered MTF PPE Allotment. See Table 5 below: 

Table 5 - Tiered MTF PPE Allotment 

Facility MTF First Receiver PPE 

142 Level C Suits 

130PAPRS 

Tier 1 142 Boots 

284 Gloves (1 outer, 1 inner) 


72 PAPRS 

Tier 2 

79 Boots 



37PAPRS 

Tier 3 40 Boots 


Tier 4 No PPE or equipment fielded 

b. Radiation Identification Detection Capability 

Item provided to MTFs: ANIPDQ-l Multi-function Survey Meter (OA-9449IPDQ). 

Multi-function instrument used to locate and measure low and high intensity radioactivity in the 

form of gamma rays, or used with external probes to locate and measure beta and gamma 

radiation. This meter is designed for both large area surveying, to find the extent and intensity of 

radioactive contamination, as well as for area and personnel monitoring, to determine the 

presence and intensity of residual radiation. 

Item provided to MTFs: Exploranium GR-135HD (with software, serial cable, and 

docking station). The GR-135 radioisotope identification device detects radioactive materials and 

identifies the specific radioisotopes. 

c. Chemical Detection Capability 

Item provided to MTFs: Joint Chemical Agent Detector (JCAD). The JeAD is a handheld, 

pocket-sized detector designed to detect, identify, quantify, and warn ofthe presence of 

chemical agents (nerve, blister, blood agents), using both audible and visual alarms. 

20 Enclosure (2)

d. Biological Detection Capability 


12 Dec 2011 

Item provided to MTFs: Operational Hand-Held Assay (HHA) Panel. HHAs are 

simple, antibody-based assays used to provide rapid presumptive identification. 

Item provided to MTFs: DoD Biological Sampling Kit (BSK). The DoD BSK is a 

prepackaged sampler/collection kit used for field screening and presumptive identification. The 

kit is able to simultaneously identify up to eight different biological agents. The DoD BSK 

includes the following in a sealed foil packet: operational HHA panel (8 HHAs encased in a 

plastic panel), 4 mL phosphate buffered solution (PBS), 2 Dacron-tipped swabs, and a laminated 

instructional card. 

Table 6 - Tiered Radiological, Chemical, and Biological Detection Equipment Allotment: 

RAD 

CHEM 

Detect ion (Dc, ices) Ticr I Tier 2 Tier J Ticr .t 

ANIPDQ-l 2 2 2 0 

GR-135 HD 1 1 1 0 

JeAD 

I 2 2 2 0 

HHAs 10 10 10 0 

BfO Training HHAs 10 10 10 0 

DoDBSK 10 10 10 0 

e. Decontamination and Patient Triage Capability 

Item provided to MTFs: TVI 3-Line Decontamination System. The shelter system is a 

self-supporting, quick-erect shelter. It provides either three ambulatory lines, or two ambulatory, 

and one non-ambulatory (litter) line. The TVI 3-Line Decontamination System contains privacy 

curtains, an integral water shower system with flash heater, and provides a litter conveyor 

system. The water used for decontamination can be pre-heated and the discharge water can be 

captured in a bladder if required. Items shipped include the shelter, flash heater, SOO-gallon 

water bladder and Personal Care IDecon kits. 

Item provided to MTFs: Reactive Skin Decontamination Lotion (RSDL). RSDL is a 

bio-degradable, non-flammable lotion formulated for the decontamination of intact skin only. 

Additional uses include the decontamination of sensitive equipment and spot decontamination of 

military equipment. The indications for the lotion's use include both prophylactic administration 

and administration after exposure to a chemical warfare agent. It is intended for external use 

only. 

21 Enclosure (2)

Table 7 - Tiered Decontamination and Treatment Equipment Allotment: 


12 Dec 2011 

Capability Tier 1 Tier 2 Tier 3 Tier 4 

3 Line Casualty Decon 

Shelter 

1 1 1 0 

500 Gallon Bladder 2 2 2 0 

Decontamination Personal Care IDecon Kits 200 200 200 0 

RSDL Joint Service 

Personnel Skin Detection 

System (JSPDS) 

180 120 60 0 

RSDL (JSPDS) 

Triage/Treatment 

Triage Tags 

60 

500 

60 

300 

60 

200 

0 

0 

f. Patient Mobility Capability 

Item provided to MTFs: Raven Model 90C. The Raven Model 90C is identical to the 

Talon II® Model90C, with the exception of the bi-fold configuration. It is United States Air 

Force Safe-to-Fly Certified, exceeds military 3X decontamination requirements, meets civilian 

and military fire safety codes, and is compatible with North Atlantic Treaty Organization Patient 

Evacuation Platforms, including Utility Helicopter (UH-60) Carousel. 

E ui ment Tier 1 Tier 2 Tier 3 Tier 4 

Raven Model 90C 15 15 15 o 

g. Medical Surveillance Capability 

Item provided to MTFs: Electronic Surveillance System for the Early Notification of 

Community-Based Epidemics (ESSENCE). ESSENCE uses both syndromic and non-traditional 

health information to provide very early warning of abnormal health conditions. It is the only 

known system to combine both military and civilian health care information for daily outbreak 

surveillance, integrating clinical and non-clinical human behavior indicators as a means of 

identifying the abnormality as close to the time of onset of symptoms as possible. 

h. CBRN Pharmaceutical Countermeasures CCPCs) 

Items provided to MTFs: Ciprofioxacin, Doxycycline, Antidote Treatment-Nerve 

Agent Auto-injector (ATNAA), Convulsant Antidote for Nerve Agent (CANA), and Potassium 

Iodide (KI). 

22 Enclosure (2)

Table 8 Tiered CPC Allotment: 

Pharmaceutical 

Countermeasures 

Tier 1 Tier 2 Tier 3 

Ciprofloxacin (500 mg, tab) 330 250 200 

Doxycycline 

(100 mg cap) 

2,920 2,250 1,800 

ATNAA(ea) 975 750 600 

CANA(ea) 325 250 200 

KI (130 mg tab, 14 per pg) 325 250 200 

FHP EMP Standard 10: Exercise and Evaluation 

Tier 4 

150 

1,350 

450 

150 

150 


12 Dec 2011 

Comments 

- 10% ofBIO Allotment (90/10 Doxy/ 

Cipro Split) 

- number of 5-day courses (500 mg, 

twice daily (BID), X 5 days = 10 Tabs 

per responder per course) 

- 90% of BIO Allotment (9011 0 Doxy/ 

Cipro Split) 

- number of 5-day courses (100 mg 

BID X 5 days = 10 Tabs per responder 

per course) 

- three injectors per first responder/ 

receiver 

- one injector per first responder/ 

receiver 

- all first responders/receivers will be 

18 years old (or older) 

1. To meet the requirements of references (a), (b), (e), (0), (q), and (r) of this section, MTFs and 

other designated Bureau of Medicine and Surgery activities must actively participate in Navy 

regional and installation level EM related training, to include regional and/or local table top 

exercise, command post exercise/functional exercise, and functional training exercise/full scale 

exercise. Additionally, MTFs shall also participate in appropriate local community EM related 

exercises, in close coordination with their respective Navy Medicine regional commander. 

23 Enclosure (2)


20 Nov 2008 

2. MTFs shall participate in the exercise planning process with the region, installation, and 

civilian community to provide medically relevant exercise play that will contribute to enhanced 

EM interoperability, communications, and overall readiness. 

3. MTFs shall generate written AARs to capture lessons learned for future use. AARs shall be 

maintained for a minimum of 2 years or until the next Joint Commission/Medical Inspector 

General visit (whichever is longer). A copy of the AAR shall be forwarded to the respective 

NAVMEDREG. The region will then forward the AAR to BUMED-M3/5 which is responsible 

for coordination with NOMI. 

4. Exercise scenarios should consider the full spectrum of possible hazards and meet requirements 

set forth by reference (m) of this section. 

5. When an MTF has responded to an actual event of appropriate magnitude, the respective 

NAVMEDREG may exempt the MTF from participation in exercises for a period of 6-12 

months. 

FHP EMP Standard 11: Mitigation and Prevention 

1. The Navy Medicine FHP EMP establishes mitigation and prevention standards and tools for 

use by MTF commanders in support of both MTF and installation operations. 

2. MTFs shall assist in the processes through which mitigation efforts may diminish the effects 

of identified natural and man-made hazards. Such assistance will include providing initial site 

survey as well as risk assessment assistance following an incident, as well as granting approval 

for re-entry and making recommendations for proper and effective respiratory/personnel 

protection for first responders/receivers. 

3. Where the capability exists, MTFs shall assist in the identification and confirmation of 

disease agents, and the prevention and/or mitigation of morbidity and mortality related to any 

all-hazards event. MTFs shall maintain a system and process for collecting, analyzing, and 

reporting installation population health that is sensitive to significant fluctuations in normal 

disease rates, and is coordinated with regional and local civilian public health surveillance 

systems. Those epidemiological investigative services will include and interact with clinical, 

environmental health, criminal/forensic services, as well as the surveillance of animal health, 

potable water and food, and air quality. In addition, MTFs shall maintain the capability to 

investigate and establish whether an infectious disease outbreak is occurring, and develop a case 

definition for victims of the outbreak. 

4. In the event of an actual disease outbreak or CBRNE event, MTFs shall utilize their cache of 

CPCs and Medical Emergency Response Pharmaceuticals (MERP) to support designated 

Category 1 and 5 personnel as well as the general installation population. Furthermore, MTFs 

shall provide dispensing and/or immunizing teams to screen and educate patients, dispense 

pharmaceuticals, and provide post-exposure immunizations. In addition, MTFs shall be prepared 

24 Enclosure (1)


20 Nov 2008 

to develop and provide sound and effective medical recommendations for the isolation, quarantine, 

restriction of movement, and evacuation of installation personnel. Finally, to assist in the 

mitigation and recovery efforts, MTFs shall provide targeted and effective public health risk 

communications for use by the region and installation command elements as well as to all 

personnel visiting the MTF. 

5. The responsibilities outlined in this standard should be carried out in a coordinated manner in 

conjunction with the NMCPHC and/or the PHEO as appropriate. 

FHP EMP Standard 12: Response 

1. The Navy Medicine FHP EMP establishes common response standards for all Category 5 

personnel as required by references (e), (h), (m), (o), (s), and (t) of this section. 

2. All response standards must be consistent with existing OSHA, NIOSH, NFPA standards, 

guidelines, and criteria. Response standards shall focus on the first 72 hours post-event, while 

acknowledging possible longer response periods during specific events (earthquake, building 

collapse, CBRNE, etc.). 

3. While preservation of evidence is highly desirable in many cases, actions to recover and/or 

preserve evidence shall not compromise the safety of any personnel. 

4. The common command and control construct identified in reference (u) of this section shall 

be used for all EM events covered by this instruction, with the possible exception of bioterrorism 

events. This construct shall utilize the HICS and Unified Command System (UCS) as specified 

within references (t) and (v) of this section. 

5. Base Operating Support (BOS) Category 1 and 5 personnel will respond in accordance with 

reference (b) of this section. 

6. MTFs shall use HICS and provide the adequate first receiver functions to include, but not 

limited to: 

a. Medical and syndromic surveillance. 

b. Thorough mass casualty decontamination. 

c. Triage and Treatment. 

d. Transport. 

e. Shelter, shelter-in-place, quarantine, and restriction of movement. 

25 Enclosure (1)

f. MTF security and zone management. 

g. Psychological care. 

h. Medical Examiner. 


20 Nov 2008 

7. SOH and IH personnel, where available, shall advise the MTF commander on respiratory 

protection and heat stress management. SOH and IH personnel may assist HAZMAT team 

personnel, when trained and equipped to do so. 

8. Response efforts may quickly exhaust MTF EM capabilities and require the capabilities of 

regional, installation, Federal, State, local, other Service, and/or private (or HN) EM-related 

agencies and departments. Prior coordination with these agencies and departments will 

significantly enhance the overall EM capabilities that may be brought to bear in a significant event. 

The implementation of appropriate Memorandum of Understanding (MOU) or Memoranda of 

Agreement (MOA) in advance of actual emergency situations is encouraged. Special attention and 

planning must be focused on the fiscal and logistical impact of response efforts. 

FHP EMP Standard 13: Recovery 

1. The Navy Medicine FHP EMP establishes common recovery standards for Category 5 

personnel as required by references (e), (l), (m), (o), (q), (w), (x), and (y) of this section. 

2. All recovery standards must be consistent with existing OSHA guidelines and NFPA 

standards. Navy Environmental and Natural Resources Program representatives shall ensure that 

all recovery efforts are in compliance with reference (z) of this section and applicable EPA 

guidelines. 

3. Recovery efforts may quickly exhaust MTF EM capabilities and require the capabilities of 

regional, installation, Federal, State, local, other Service, and/or private (or HN) EM-related 

agencies and departments. Prior coordination with these agencies and departments will 

significantly enhance the overall EM capabilities that may be brought to bear in a significant 

event. Special attention and planning must be focused on the fiscal and logistical impact of 

recovery efforts. 

FHP EMP Standard 14: Sustainment 

1. BUMED will establish the programming, budgeting, and resourcing necessary to develop 

and sustain FHP EMP requirement per references (e) and (o) of this section. The MTF FHP 

EMP, via the NAVMEDREG, shall provide BUMED with any unique MTF EM mission 

requirements, deficiencies, or new start programs. BUMED will validate these requests in close 

coordination with the respective NAVMEDREG. 

26 Enclosure (1)


20 Nov 2008 

SECTION 2 

NATIONAL INCIDENT MANAGEMENT SYSTEM (NIMS) COMPLIANCE 

Ref: (a) Homeland Security Presidential Directive/HSPD-5 

(b) National Incident Management System (NIMS) 

(c) National Response Plan 

(d) Implementation of the National Response Plan and the National Incident 

Management System, DEPSECDEF memo of 29 Nov 2005 

1. Purpose. To provide guidance to MTF commanders on issues of compliance with the NIMS 

to ensure efficient and effective use of NIMS in its emergency management planning, 

preparedness, response, recovery, and mitigation activities. 

2. Background 

a. Reference (a) of this section requires all Federal Departments and Agencies to adopt 

NIMS for domestic incident management. References (b) and (c) of this section establish an alldiscipline, 

all-hazards approach to the management of domestic incidents. Reference (d) of this 

section provides direction on DoD implementation of NIMS and the NRP. Paragraph 5 of this 

section provides NIMS guidance and implementation activities for hospitals and health care 

systems. Paragraph 6 of this section provides specific minimum training guidance for Navy 

Medicine personnel. 

b. Navy Medicine provides support to civil authorities for domestic incidents as directed by 

the President or Secretary of Defense, consistent with military readiness and when appropriate 

under the circumstances and the law. Navy Medicine will also receive support from civil 

authorities in response to domestic incidents, which can be essential to sustaining or restoring 

Navy Medicine capabilities that are critical to operations and the execution of the National 

Military Strategy. Any such mutually beneficial, cooperative relationship is most effective when 

based upon a shared understanding with a common language and structure for coordination. 

NIMS and NRP were issued by the U.S. DHS to provide that comprehensive and consistent 

national framework to all-hazard incident management at all jurisdictional levels and across 

functional disciplines. 

c. The NIMS Integration Center (NIC), in collaboration with the HHS, developed the NIMS 

implementation activities for hospitals and health care systems to assist them with NIMS 

implementation and integration, further enhancing their efficiency and effectiveness in response 

and recovery. This guidance provides direction that will advance individual hospital and health 

care emergency management and preparedness. 

3. Responsibility. BUMED-M3/5 has established minimum training requirements for 

designated Navy Medicine personnel with a reasonable likelihood of involvement in incident 

management/response; all designated Navy Medicine personnel shall meet the requirements of 

paragraph 6 of this section. Personnel currently serving in the positions identified in paragraph 6 

27 Enclosure (1)


20 Nov 2008 

of this section must complete requirements within 90 days. Those personnel newly assigned to 

the positions identified in paragraph 6 of this section must complete requirements within 90 days 

of reporting aboard. The MTF commander shall: 

a. Ensure that NIMS is an integral part of the MTF’s EM Plan. 

b. Ensure the MTF has taken steps to meet all the NIMS implementation activities for 

hospitals and health care systems per paragraph 5 of this section. 

c. Ensure training completion is tracked in local training records. 

4. Procedures. All BUMED MTFs shall meet the requirements for NIMS implementation 

activities. Additional specific guidance for elements within the NIMS implementation activities: 

a. Incident Command System (ICS). In accordance with the accompanying instruction, all 

BUMED MTFs will adopt the HICS. 

b. Multi-agency Coordination System. MTF commanders shall coordinate with regional 

and installation commanders in the development of relationships with the appropriate Federal, 

State, local, and tribal EM-related agencies and departments to identify and update responsible 

points of contact, emergency protocols, and expectations in the event of an incident. This task 

should also include local medical community organizational planning via local emergency 

planning committees. 

c. Support Agreements (SA). MTF commanders shall coordinate with regional and 

installation EM personnel, BUMED-M3/5, and local emergency responders/receivers in the 

development of SAs. 

d. Training. DHS/Federal Emergency Management Agency (FEMA) provides free 

online training via the Emergency Management Institute Independent Study Program 

(http://www.training.fema.gov/EMIWeb/IS/), for personnel involved in emergency response. 

All required independent study courses may be found at this link. 

5. National Incident Management System (NIMS). Compliance Activities for Health Care 

Organizations (public and private) 1 . 

1 Draft developed for discussion by the HICS National Working Group and consideration by the NIMS Integration Center to address the question 

of “what types of activities should health care organizations engage in to ensure NIMS compliance?” The draft was developed from the NIMS 

National Standard Curriculum Training Development Guidance. Adaptations of the language for each element for health care organizations 

follows legislative format, with underlined items (additions) and strikethroughs (deletions). Examples of compliance were added to provide 

additional specificity to a health care organization. 

a. Organizational Adoption 

(1) Element 1. Adopt NIMS at the organizational level for all departments and business 

units, as well as promote and encourage NIMS adoption by associations, utilities, partners, and 

suppliers. 

28 Enclosure (1)


20 Nov 2008 

Example of compliance: The seventeen elements included in this document are 

addressed in the organization’s emergency management program documentation. 

b. Command and Management 

(2) Element 2. Incident Command System (ICS). Manage all emergency incidents 

and preplanned (recurring/special events) in accordance with ICS organizational structures, 

doctrine, and procedures, as defined in NIMS. ICS implementation must include consistent 

application of Incident Action Planning and Common Communications Plans. 

Example of compliance: The organization’s Emergency Operations Plan explains the 

use of ICS, particularly incident action planning and a common communications plan. 

(3) Element 3. Multi-agency Coordination System. Coordinate and support 

emergency incident and event management through the development and use of integrated multiagency 

coordination systems. That is, develop and coordinate connectivity capability with 

hospital Emergency Operations Center (EOC) and local incident command posts (ICPs), local 

911 centers, local EOCs, and the State EOC as applicable. 


management and coordination linkage between the organization’s EOC and other, similar, 

external centers (multi-agency coordination system entities). 

(4) Element 4. Public Information System (PIS). Implement processes and/or plans to 

communicate timely, accurate information including through a Joint Information System and 

Joint Information Center. 


management and coordination of public information with health care partners and jurisdictional 

authorities, such as local public health, emergency management, and so on. 

c. Preparedness Planning 

(5) Element 5. Health care organizations will track NIMS implementation on a yearly 

basis as part of the organization’s emergency management program. 

Example of compliance: NIMS organizational adoption, command and management, 

preparedness/planning, preparedness/training, preparedness/exercises, resource management, 

and communication and information management activities will be tracked from year-to-year 

with a goal of improving overall emergency management capability. 

(6) Element 6. Develop and implement a system to coordinate appropriate hospital 

preparedness funding to employ NIMS across the organization. 

Example of compliance: The organization’s emergency management program 

documentation includes information on local, State, and Federal preparedness grants that have 

been received and work progress. 

29 Enclosure (1)


20 Nov 2008 

(7) Element 7. Revise and update plans and standard operating procedures (SOPs) to 

incorporate NIMS components, principles, and policies, to include planning, training, response, 

exercises, equipment, evaluation, and corrective action. 

Example of compliance: The organization’s emergency management program work 

plan reflects status of any revisions to the Emergency Operations Plan, training materials, 

response procedures, exercise procedures, equipment changes and/or purchases, evaluation, and 

corrective action processes. 

(8) Element 8. Participate in and promote interagency mutual aid agreements, to include 

agreements with the public and private sector and non-governmental organizations. 


documentation includes information on mutual aid agreements. 

d. Preparedness Training 

(9) Element 9. Complete IS-700: NIMS: An Introduction. 


training records track completion of IS-700 (or equivalent as approved by BUMED-M3/5) by 

personnel with a direct role in emergency preparedness, incident management, or response. 

(See NIMS Health Care Training Guidance.) 

(10) Element 10. Complete IS-800: NRP: An Introduction. 

Example of compliance: The organization’s emergency preparedness program 

training records track completion of IS-800 or equivalent by personnel whose primary 

responsibility is emergency management. (See NIMS Health Care Training Guidance.) 

(11) Element 11. Complete ICS-100 and ICS-200 training. 

Examples of compliance: 

• The organization’s emergency preparedness program training records track 

completion of ICS-100 or equivalent by personnel at the entry level, first-line supervisor level, 

middle management level, and command and general staff level of emergency management 

operations. (See NIMS Health Care Training Guidance.) 

• The organization’s emergency management program training records track 

completion of ICS-200 or equivalent by personnel at the first-line supervisor level, middle 

management level, and command and general staff level of emergency management operations. 

(See NIMS Health Care Training Guidance.) 

30 Enclosure (1)

e. Preparedness Exercises 


20 Nov 2008 

(12) Element 12. Incorporate NIMS/ICS into internal and external, local, and regional 

emergency management training and exercises. 


training and exercise documentation reflects use of NIMS/ICS. 

(13) Element 13. Participate in an all-hazard exercise program based on NIMS that 

involves responders from multiple disciplines, multiple agencies, and organizations. 


training and exercise documentation reflects the organization’s participation in exercises with 

various external entities. 

(14) Element 14. Incorporate corrective actions into preparedness and response plans 

and procedures. 


documentation reflects a corrective action process. 

f. Resource Management 

(15) Element 15. Maintain an inventory of organizational response assets. 


documentation includes a resource inventory (e.g., medical/surgical supplies, pharmaceuticals, 

personal protective equipment, staffing, etc.). 

(16) Element 16. To the extent permissible by law, ensure that relevant national 

standards and guidance to achieve equipment, communication, and data interoperability are 

incorporated into acquisition programs. 


documentation includes emphasis on the interoperability of response equipment, 

communications, and data systems with external entities. 

g. Communications and Information Management 

(17) Element 17. Apply standardized and consistent terminology, including the 

establishment of plain English communications standards across the public safety sector. 


documentation reflects an emphasis on the use of plain English by staff during emergencies. 

31 Enclosure (1)

6. Navy Medicine NIMS Compliance Matrix 

FEMA EMI 

Independent Courses 

IS-1 

Emergency Manager: An Orientation to the Position 

IS-100/IS-100.HC 

Introduction to Incident Command System 

IS-200/IS-200.HC 

ICS for Single Resource and Initial Action Incidents 

IS-275 

The EOC's Role in Community Preparedness, Response, 

and Recovery Activities 

IS-300 

Intermediate ICS Course (12 months) 

IS-400 

Advanced ICS Course (12 months) 

IS-700 

National Incident Management System (NIMS), An 

Introduction 

IS-701 

Multi-agency Coordination System (MACS) 

IS-800-F 

National Response Framework (NRF), An Introduction 

IS-1900 

National Disaster Medical System (NDMS) Federal 

Coordination Center Operations Course 

All 

Personnel 

X 

EMOs 

X 

X 

X 

X 

X 


20 Nov 2008 

Management and 

Personnel with 

EM Roles** 

** Personnel that have a: 

(1) Leadership role in emergency or incident management and/or; 

(2) Emergency first responder/receiver functions during an incident (i.e., DECON, Treatment/Triage, etc.). 

X 

X 

X 

X 

X 

X 

X 

X 

X 

PHEOs 

32 Enclosure (1) 

X 

X 

X 

X

SECTION 3 

COMMAND AND CONTROL 

Ref: (a) National Incident Management System (NIMS) 

(b) Hospital Incident Command System (HICS) Guidebook 


20 Nov 2008 

1. Purpose. To provide guidance to MTF commanders on issues of Command and Control (C2) 

within the framework of EM operations. 

2. Background 

a. The MTF command structure is an excellent model for daily business operations, and, in 

many cases, increased operational tempo events. However, in the face of an emergency or large- 

scale event requiring concise and smooth interoperability with other DoD commands or agencies, 

other Federal agencies, or State and local responders, the normal command structure and position 

titles are not the most efficient means to conduct EM operations. 

b. The Secretary of Defense and all other cabinet level officers are signatories to the NIMS, 

reference (a) of this section. A key item required by this document is that the ICS will be utilized 

any time two or more Federal agencies respond to an emergency. Further, the document requires 

Federal agencies to encourage partner State and local agencies to utilize the system. This ensures 

use of common terminology and contributes towards development of a common operating picture 

between responding agencies. 

c. Reference (b) of this section, the HICS Guidebook, meets NIMS requirements and has 

been developed with the support of the DHS NIMS Integration Center, Health and Human 

Services (HHS), American Hospital Association, and the Joint Commission. 

3. Responsibility. The MTF commander shall: 

a. Ensure that HICS is utilized as directed herein. 

b. Maintain full responsibility for the actions of his or her command and subordinate 

commanders when incident command authority is delegated. 

4. Procedures 

a. HICS shall serve as the command and control tool during all EM events. 

b. BUMED MTFs shall utilize HICS as documented in the HICS Guidebook, reference (b) 

of this section, whenever the installation or supported community implements ICS for an 

incident that will include MTF participation. This will assure commonality of terminology and 

functions when operating with local, State, tribal, and Federal responders/receivers, other 

hospitals, or local/regional emergency operations centers. 

33 Enclosure (1)


20 Nov 2008 

(1) MTFs should consider utilization of HICS for any large-scale events that have the 

potential to cause disruptions in normal activities. 

(2) Personnel functioning under HICS and serving in positions at the command staff or 

section chief level should be aware of the relationship to the military staff structure. This will 

ease transition with participating military agencies that may not have implemented ICS. Further, 

understanding the relationship will assist in fostering a better understanding of ICS/HICS and the 

staff structure. 

c. BUMED MTFs will utilize the crosswalk chart provided in the HICS Guidebook to 

determine the most appropriate personnel to fill each relevant position. It is suggested that MTFs 

examine different scenarios, including the DHS 15 national planning scenarios, to determine and 

develop crosswalk charts for each of these scenarios, as different personnel may be appropriate in 

different positions depending on the event. 

34 Enclosure (1)


20 Nov 2008 

SECTION 4 

REQUIRED EMERGENCY MANAGEMENT (EM) PLAN ANNEXES 

1. Purpose. To provide guidance to MTF commanders on the content of MTF EM Plans. 

2. Background. Navy Medicine will standardize EM planning to the maximum extent possible. 

While EM Plans will vary between MTFs, the format and content should be standardized across 

BUMED MTFs. Maintaining standard formats and content supports capabilities-based planning, 

standard readiness metrics, streamlined training of personnel, and allows for economies of scale 

in logistical support and sustainment of the FHP EMP. 

3. Responsibility. The MTF commander shall: 

a. Develop an EM Plan that meets all the requirements of this instruction. 

b. Assure all annexes listed as required are included in the MTF EM Plan. Additional 

annexes applicable to local risked-based hazards should be developed and included. 

4. Procedures 

a. Review required annexes and develop them to support each MTF mission. 

b. Develop the list of required and risked-based annexes to assure standardization across 

Navy Medicine. 

5. Required Annexes for all MTF EM Plans 

a. Command and Control. 

b. Continuity of Operations Plan. 

c. Personnel Recall. 

d. Hazard and Vulnerability Analysis (HVA). 

e. Communications 

(1) Reporting Requirements. 

(2) Format. 

f. Acronyms and Definitions. 

35 Enclosure (1)

g. Hazard Specific Annexes 

(1) Chemical. 

(2) Biological. 

(3) Radiological. 

(4) Nuclear. 

(5) Explosive. 

i. Functional Annexes 

(1) Surge Capacity. 

(2) Shelter-in-Place. 

(3) Evacuation. 

(4) Mass Care. 

(5) Physical Security. 

(6) Mass Fatality. 

j. NDMS/FCC Operations Annex (Navy FCCs only). 

k. Hazard Mitigation and Recovery Operations. 


20 Nov 2008 

6. Situation Dependant Annexes. These annexes are to be adopted and included when indicated 

by the annual HVA. 

a. Extreme Weather. 

b. NDMS Patient Reception Area Plan. 

c. Wildfire. 

d. Seismic event. 

e. External flooding. 

36 Enclosure (1)

SECTION 5 

NAVY MEDICINE EMP EMO COMPETENCIES AND 

STANDARDIZED CIVILIAN CLASSIFICATION 

Ref: (a) MTF Interim Emergency Manager Competencies Memo of 12 Nov 2004 


20 Nov 2008 

1. Purpose. To provide guidance regarding the qualifications and competencies required of all 

EMOs in Navy Medicine as well as identifying standardized position classifications for civilian 

EMOs across BUMED activities. 

2. Background. EM is an evolving and developing profession which has been growing in scope 

and regulation since the creation of the U.S. DHS. Accordingly, Navy Medicine must detail 

and/or employ well-qualified individuals to these positions to assure proper execution of an FHP 

EMP and successful integration with other Federal, State, local, and tribal communities. 

3. Scope. The guidance and requirements set forth in this section applies to all current and 

future Navy Medicine personnel who encumber EM positions, even if not titled EMO 

specifically. 

4. Action 

a. BUMED, NAVMEDREG East, NAVMEDREG West, NAVMEDREG NCA, and all 

Tier 1 and 2 facilities shall have a qualified commissioned officer or civil service EMO as 

defined in paragraph 4d below. 

b. NAVMEDSUPCOM and all Tier 3 and 4 facilities shall have a qualified EMO as defined 

by reference (a) of this section. 

c. NAVMEDREG East, NAVMEDREG West, NAVMEDREG NCA, and all Tier 1 

through Tier 4 facilities shall utilize the approved position description located on the following 

page for hiring or converting personnel to perform EM functions within Navy Medicine as 

civilian employees. 

d. Minimum EMO Qualifications for Echelon 2 and 3, Commands as well as Tier 1 and 2 

commands: 

Qualification/Training Required NLT 

International Association of Emergency Managers, 

Certified Emergency Manager ® 

End FY-10 

Minimum 3 years experience in EM Prior to employment/assignment 

Strong working knowledge of ICS and HICS Prior to employment/assignment 

Familiarity with USNORTHCOM JRMPO program 90 days after employment/assignment 

Reference (a) 90 days after employment/assignment 

37 Enclosure (1)


20 Nov 2008 

38 Enclosure (1)


20 Nov 2008 

39 Enclosure (1)


20 Nov 2008 

40 Enclosure (1)

SECTION 6 

PROCEDURES FOR REQUESTING WAIVERS AND 

EXCEPTIONS TO POLICY 


25 Apr 2012 

Ref: (a) NTTP 3-07.2.3, Law Enforcement and Physical Security for Navy Installations 

1. Purpose. To provide guidance regarding the procedures for requesting waivers and 

exceptions to policy for the requirements established in the BUMED Navy Medicine FHP EMP 

Manual, BUMEDINST 3440.10. 

2. Background. This section governs the procedures for requesting and approving waivers or 

exceptions to policy for BUMEDINST 3440.10, Navy Medicine FHP EMP Manual. It mirrors 

the procedures contained in reference (a) used to request similar waivers or exceptions for 

established security requirements on Navy installations. Commanders at all levels must weigh 

the risks involved in complying with the requirements and standards contained in numerous 

instructions. The inability to meet minimum standards and requirements may result in an 

increased risk to the MTF. Whenever the mandatory requirements ofBUMEDINST 3440.10 

cannot be met by a BUMED commanded activity subject to this instruction, the activity must 

request a waiver or exception in accordance with this section. Waivers and exceptions to policy 

will be evaluated based on merit only and must include compensatory measures. 

a. Waiver. A waiver is written temporary relief, normally for a period of 1 year or less, 

from specific requirements established by this instruction. A waiver will be requested whenever 

a requirement prescribed in this instruction is not currently achieved, but the condition is 

correctable within 1 year. 

b. Exception. An exception is written long-term (for a period greater than 12 months) or 

permanent relief, from specific requirements established by this instruction. An exception will 

be requested whenever a requirement prescribed in this instruction cannot be achieved, or when 

attainment of the requirement requires more than one year. Exceptions shall also be submitted 

when corrective actions would be cost-prohibitive. 

3. Scope. The guidance and requirements set forth in this section apply to all requirements 

established by this instruction. 

4. Action. All Navy Medicine region and MTF commanders, commanding officers, and 

officers in charge shall: 

a. Submit a request for waiver or exception whenever the mandatory requirements of 

BUMEDINST 3440.1 0 are not achieved and attainment is not expected within 30 days. 

Requests for waivers and exceptions will be submitted in the format outlined in this section. 

Blanket waivers and exceptions are not authorized. Waivers and long-term exceptions are selfcanceling 

on the expiration dates stated in the approval letters unless the original approval 

authority approves an extension. Cancellations do not require BUMED approval. 

41 Enclosure (1)


25 Apr 2012 

b. Requests for waivers or exceptions will be submitted via the chain of command from the 

MTF to the Navy Medicine region commander to BUMED. The request for waiver must include 

a complete description of the problem and alternative procedures, as appropriate. It is important 

to note that the inability to completely meet a requirement is not justification to waive the 

requirement entirely. For example, manning shortfalls that prevent an MTF from fully staffing a 

medical decontamination team are justification to field a partially staffed decontamination team 

and request a waiver for the partial staffing; they are not justification to ignore the requirement 

entirely and request it be waived. Waiver approvals will normally be for a period of 12 months 

and long-term exception approvals will normally be for a period of 36 months. Extensions of the 

waiver or exception (normally for 12 months) must be requested via the chain of command and 

approved by BUMED. Waiver and exception extension requests will refer to previous 

correspondence approving initial and previous extensions, as appropriate. 

c. Requests shall be in letter format in accordance with the Navy Correspondence Manual, 

and all elements of the applicable table below will be specifically addressed. Non-applicable 

elements will be noted as NI A. 

Table 6.1 

Required Elements for Waivers Request 

Element 1 Full name and UIC of the requesting MTF 

Element 2 Statement of the waiver requirement and references to the standard 

and pagel paragraph in this instruction that cite the standard that 

cannot be met 

Element 3 Specific description of conditi6n(s) that caused the need for the 

waiver and reason(s) why applicable standards in this manual 

cannot be met 

Element 4 Identify interim mandatory compensatory measures in effect or 

planned 

Element 5 Describe the impact on mission and any problems that will 

interfere with safety or 

operating requirements if the waiver is not approved 

Element 6 Identify resources, including estimated cost from which budgeting 

decisions can be 

made, to eliminate the waiver 

Element 7 Identify actions initiated or planned (local capability or other) to 

eliminate the waiver and estimated time to complete 

Element 8 Provide point of contact to include name, rank/grade, DSN, and 

commercial phone 

numbers 

42 Enclosure (1 )

Element 1 

Element 2 

Element 3 

Element 4 

Element 5 

Element 6 

Element 7 

Element 8 

Element 1 

Element 2 

Element 3 

Element 4 

Element 5 

Element 6 

Table 6.2 

Required Elements for Long-Term Exceptions Requests 

BVMEDINST 3440.10 CH-2 

25 Apr 2012 

Full name and VIC ofthe requesting MTF 

Statement of the long-term exception requirement and references to the 

standard and page/paragraph in this instruction that cite the standard 

that cannot be met 

Specific description of condition(s) that caused the need for the 

permanent exception and reason(s) why applicable standards in this 

manual cannot be met 

Identify interim mandatory compensatory measures in effect or planned 

Describe the impact on mission and any problems that will interfere 

with safety or 

operating requirements if the long-term exception is not approved 

Identify resources, including estimated cost from which budgeting 

decisions can be 

made, to eliminate the long-term exception 

Identify actions initiated or planned (local capability or other) to 

eliminate the long-term exception and estimated time to complete 

Provide point of contact to include name, rank/grade, DSN, and 

commercial phone numbers 

Table 6.3 

Format for Requests for Permanent Exceptions 

Full name and VIC of the requesting MTF 

Statement of the permanent exception requirement and reference to the 

standard and page/paragraph in this instruction that cite the standard 

that cannot be met 

Specific description of condition(s) that caused the need for the 

permanent exception and reason(s) why applicable standards in this 

manual cannot be met 

Identify, in detail, compensatory security measures that are being 

applied 

Describe the impact on mission and any problems that will interfere 

with safety or 

operating requirements if the permanent exception is not approved 

Provide point of contact to include name, rank/grade, DSN, and 

commercial phone 

numbers 

43 Enclosure (1)

From: 

To: 

Via: 

SAMPLE WAIVER REQUEST 


25 Apr 2012 

3440 

Serial 

Date 

Officer in Charge, Naval Branch Health Clinic, Naval Air Station Jacksonville, FL 

Chief, Bureau of Medicine and Surgery (M3) 

(1) Commanding Officer, Naval Hospital Jacksonville, FL 

(2) Commander, Navy Medicine East 

Subj: REQUEST FOR WAIVER TO NAVY MEDICINE FORCE HEALTH PROTECTION 

EMERGENCY MANAGEMENT PROGRAM 


Encl: (1) Waiver Request in case of Naval Branch Health Clinic, Naval Air Station 

Jacksonville 

1. In accordance with reference (a), enclosure (1) is submitted for consideration. 

J. A. SAILOR 

44 Enclosure (1 )

Waiver Request in case of Naval Branch Health Clinic, 

Naval Air Station Jacksonville 


25 Apr 2012 

Element 1. Naval Branch Health Clinic (NBHC), Naval Air Station Jacksonville, FL, UIC 

34566 

Element 2. Request a waiver for the total size of medical response teams as specified in standard 

3, pages 6 and 7, Tables 1 and 2, of enclosure (1), BUMED Navy Medicine FHP EMP Manual, 

BUMEDINST 3440.10. 

Element 3. NBHC Jacksonville NAS is a Tier 3 MTF per Table 2 of the subject instruction and 

requires a minimum of33 personnel to fully staff the six medical response teams required in 

accordance with Table 1 of the instruction. Due to continuing individual augmentee 

deployments and an ongoing shortfall in hospital corpsmen manning at the E-5 and E-6 levels, 

the average daily staffing at the facility for the previous six months has been 28 full-time 

personnel, or just under 80 percent of our full allowance. The ongoing shortfall in staffing 

precludes fielding a minimum of33 personnel across the six medical response teams. 

Element 4. Due to the temporary reduction in manning at the clinic, medical response team 

personnel have been shifted to fully staff the decontamination, zone management, detection and 

patient administration teams, and the transport and triage/treatment teams have been partially 

staffed. 

Element 5. All medical response teams are considered fully mission capable and there is no 

impact on mission, or any problems that will interfere with safety or operating requirements if 

the waiver is not approved. 

Element 6. Once the clinic is able to return to full staffing, the waiver can be eliminated. There 

are no additional resources or funding required, beyond the already approved manning levels for 

the clinic. 

Element 7. As an interim measure, the clinic is working to identify personnel from other tenant 

commands that can be assigned to the medical response teams as a collateral duty. We are 

working to scrub an initial list of candidates and estimate it will take an additional 30 days to 

fully vet the list, select, and train candidates. However, this augmentation is still considered an 

interim solution and a waiver will be required until the clinic's full-time staffing is restored to the 

90 percent or greater level. 

Element 8. Point of Contact: LCDR John Jones, DSN 123-4567, Commercial (904) 123-4567. 

45 Enclosure (1)

From: 

To: 

Via: 

SAMPLE LONG-TERM EXCEPTION REQUEST 


25 Apr 2012 

3440 

Serial 

Date 





Subj: REQUEST FOR LONG-TERM EXCEPTION TO NAVY MEDICINE FORCE 

HEALTH PROTECTION EMERGENCY MANAGEMENT PROGRAM 


Encl: (1) Long-Term Exception Request in case of Naval Branch Health Clinic, Naval Air 

Station Jacksonville 


J. A. SAILOR 

46 Enclosure (1)


25 Apr2012 

Long-Term Exception Request in case of Naval Branch Health Clinic, 


Element 1. Naval Branch Health Clinic, Naval Air Station Jacksonville, FL, UIC 34566. 

Element 2. A long-term exception is required for the total size of the medical response teams as 

specified in standard 3, pages 6 and 7, Tables 1 and 2, of enclosure (1) of BUMEDINST 

3440.10. 

Element 3. NBHC Jacksonville NAS is a Tier 3 MTF per Table 2 of the subject instruction and 

requires a minimum of 33 personnel to fully staff the six medical response teams required per 

Table 1 ofthe instruction. Due to a recent reduction in the clinic's Basic Allowance (BA) for 

HM manning at the E-5 and E-6Ievels, the maximum staffing at the facility under the revised 

allowance will be 22 full-time personnel, or just under 65 percent of our previous allowance. 

The decrease in staffing precludes fielding a minimum of33 personnel across the six medical 

response teams. 

Element 4. Due to the long-term reduction in manning at the clinic, medical response team 

personnel have been shifted to fully staff the decontamination, zone management, detection and 

patient administration teams, and the transport and triage/treatment teams have been partially 

staffed. 

Element 5. All medical response teams are considered fully mission capable and there is no 

impact on mission, or any problems that will interfere with safety or operating requirements if 

the long-term exception is not approved. 

Element 6. If the clinic's HM manning is restored to previous allowance levels, the long-term 

exception can be eliminated. There are no additional resources or funding required, beyond the 

restoration of the former HM manning levels for the clinic. 

Element 7. As a possible solution, the clinic is working to identify personnel from other tenant 

commands that can be assigned to the medical response teams as a collateral duty. Establishing 

Memorandums of Agreement (MOAs) with tenant commands to provide this contingency 

augmentation is considered the best long-term solution to mitigate the decrease in HM manning 

allowances. A long-term exception will be required until the clinic's staffing is restored to the 

previous level, or MOAs are in place to provide the additional personnel to fully staff the 

medical response teams. 


47 Enclosure (1)

From: 

To: 

Via: 

SAMPLE PERMANENT EXCEPTION REQUEST 


25 Apr 2012 

3440 

Serial 

Date 





Subj: REQUEST FOR PERMANENT EXCEPTION TO NAVY MEDICINE FORCE 

HEALTH PROTECTION EMERGENCY MANAGEMENT PROGRAM 


Encl: (1) Permanent Exception Request in case of Naval Branch Health Clinic, Naval Air 

Station Jacksonville 


J. A. SAILOR 

48 Enclosure (1 )


25 Apr 2012 

Permanent Exception Request in case of Naval Branch Health Clinic, 


Element 1. Naval Branch Health Clinic, Naval Station Mayport, FL, UIC 34567. 

Element 2. A permanent exception is required for the total size of the medical response teams as 

specified in standard 3, pages 6 and 7, Tables 1 and 2, of enclosure (1) of BUMEDINST 

3440.10. 

Element 3. NBH C Mayport NS is current! y a Tier 3 MTF per Table 2 of the subj ect instruction 

and requires a minimum of 33 personnel to fully staff the six medical response teams required 

per Table 1 of the instruction. Due to the recent decision to consolidate military staffing for this 

clinic with the staff at NBHC Jacksonville NAS, and to transition the NBHC Mayport NS to a 

Tricare Outpatient Clinic (TOC), there will no longer be any military staff assigned to the 

facility. The elimination of military personnel will preclude fielding any medical response teams 

from Mayport NS. 

Element 4. Due to the permanent elimination of military manning at the Mayport NS clinic, the 

facility anticipates being changed to a Tier 4 MTF for emergency management response. 

Element 5. The change in status from a NBHC to a TOC will eliminate all organic medical 

response team capabilities at Mayport NS and the clinic will be completely unable to meet any 

medical response team mission or requirement if the permanent exception is not approved. 


49 Enclosure (l)

ACRONYMS LISTING 

BUMEDINST 3440.14 

20 Nov 2008 

AAR After Action Report 

ACADA Automatic Chemical Agent Detector Alarm 

ADP Automated Data Processing 

AMAL Authorized Medical Allowance Lists 

AOR Area of Responsibility 

APR Air-Purifying Respirator 

ARC American Red Cross 

ASF Auxiliary Security Force 

ATFP Antiterrorism Force Protection 

ATNAA Antidote Treatment-Nerve Agent Auto-injector 

BoA Basis of Allocation 

BOS Base Operating Support 

BRAC Base Realignment and Closure 

BSO Budget Submitting Office 

BUMED Bureau of Medicine and Surgery 

C2 Command and Control 

C3 Command, Control, and Communications 

CA Civil Authority 

CANA Convulsant Antidote for Nerve Agent 

CBRND Chemical, Biological, Radiological, and Nuclear Defense 

CBRNE Chemical, Biological, Radiological, Nuclear, and Explosives 

CEM Certified Emergency Manager 

CFFC Commander, Fleet Forces Command 

CIP Critical Infrastructure Program 

CIV-MIL Civil-Military 

CNIC Commander, Naval Installation Command 

CNO Chief of Naval Operations 

CO Commanding Officer 

COOP Continuity of Operations Plan 

COTS Commercial-Off-The-Shelf 

CPCs CBRN Pharmaceutical Countermeasures 

CPX Command Post 

DHS Department of Homeland Security 

DMLSS Defense Medical Logistics Standard Support 

DoD Department of Defense 

DON Department of Navy 

DoS Department of State 

EM Emergency Management 

EMO Emergency Management Officer 

EMP Emergency Management Program 

EMPRC Emergency Medical Preparedness and Response Course 

EMS Emergency Medical Service 

EMWG Emergency Management Working Group 

Enclosure (2)


20 Nov 2008 

EOC Emergency Operations Center 

EOD Explosive Ordnance Disposal 

ERT Emergency Response Team 

ESC Executive Steering Committee 

ESSENCE Electronic Surveillance System for Early Notification of 

Community-Based Epidemics 

FCC Federal Communications Commission 

FE Field Exercises 

FEMA Federal Emergency Management Agency 

FHP Force Health Protection 

FoS Family of Systems 

FSEs Full-Scale Exercises 

FTX Field Training Exercises 

GOTS Government-Off-The-Shelf 

HAZMAT Hazardous Material 

HD/CS Homeland Defense and Civil Support 

HHA Hand-Held Assay 

HHS Health and Human Services 

HICS Hospital Incident Command System 

HN Host Nation 

HQMC Headquarters, Marine Corps 

HSS Health Services Support 

HVA Hazard Vulnerability Assessment 

IAB Interagency Board 

IAEM International Association of Emergency Managers 

ICAM Improved Chemical Agent Monitor 

ICP Incident Command Post 

ICS Incident Command System 

IDLH Immediate Dangerous to Life and Health 

IH Industrial Hygiene 

IPP Installation Protection Program 

ISIC Immediate Superior In Command 

IVA Installation Vulnerability Assessments 

J-CBDP Joint Chemical Biological Defense Program 

JIC Joint Information Center 

JPEO-CBD Joint Program Executive Office for Chemical and Biological Defense 

JRO J-8/Joint Requirements Office 

JSCP Joint Strategic Capability Plan 

JSIVA Joint Staff Installation Vulnerability Assessments 

JSPDS Joint Service Personnel/Skin Decontamination System 

KI Potassium Iodide 

LAN Local Area Network 

LCC Life-Cycle Cost 

LCCE Life-Cycle Cost Estimate 

2 Enclosure (2)


20 Nov 2008 

MACS Multi-Agency Coordination System 

MBAC Military Biological Advisory Committee 

MERP Medical Emergency Response Pharmaceuticals 

MOA Memoranda of Agreement 

MOU Memorandum of Understanding 

MSCA Military Support to Civilian Authorities 

MTF Medical Treatment Facility 

NATO North Atlantic Treaty Organization 

NAVFACHQ Naval Facilities Engineering Command Headquarters 

NAVMED MPT&E Navy Medicine Manpower, Personnel, Training and Education 

Command 

NAVMEDLOGCOM Naval Medical Logistics Command 

NAVMEDREG Navy Medical Region 

NAVMEDSUPCOM Navy Medicine Support Command 

NAVSEA Naval Sea Systems Command 

NDMS National Disaster Medical System 

NFPA National Fire Protection Agency 

NIC NIMS Integration Center 

NIMS National Incident Management System 

NIOSH National Institute of Occupational Safety and Health 

NKO Navy Knowledge On-Line 

NMCPHC Navy and Marine Corps Public Health Center 

NMLL Navy Medicine Lessons Learned 

NOMI Naval Operational Medicine Institute 

NORTHCOM U.S. Northern Command 

NRF National Response Framework 

NRP-CIS National Response Plan Catastrophic Incident Supplement 

NSF National Security Forces 

OASD(HA) Office of the Assistant Secretary of Defense for Health Affairs 

OIC Officer in Charge 

OSHA Occupational Safety and Health Administration 

PAPR Positive Air-Purifying Respirator 

PHE Public Health Emergency 

PHEO Public Health Emergency Officer 

PIS Public Information System 

POC Point of Contact 

POM Program Objective Memorandum 

PPE Personal Protective Equipment 

ROC Regional Operations Center 

RPP Respiratory Protection Program 

RRPAS Rapid Response Powered Air System 

RSDL Reactive Skin Decontamination Lotion 

SA Support Agreement 

SECDEF Secretary of Defense 

3 Enclosure (2)

SEL Selected Equipment List 

SME Subject Matter Expert 

SOH Safety and Occupational Health 

SOP Standard Operating Procedure 

TTP Tactics, Techniques, and Procedures 

TTX Tabletop 

UCS Unified Command System 

UFC Unified Facilities Criteria 

UIC Unit Identification Code 

USMC United States Marine Corps 

UTC Unit Type Code 

WA Written Agreement 


20 Nov 2008 

4 Enclosure (2)

3440.10 with Changes - Navy Medicine - U.S. Navy

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