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HPP MY / EOY
1. Cover
OMB Control No: 0990Expiration Date :

U.S. Department of Health and Human Services
Hospital Preparedness Program (HPP)
HPP EOY Progress Report
Grantee Name

Grantee/Awardee

POC Name
Award Fiscal Year:

Report Type
Capability

Amount Proposed

HPP Award Amount

$0

Amount Obligated-Not
Liquidated

Amount Unobligated

Amount
Obligated-Liquidated

Administrative Information

$0

$0

$0

$0

Overarching Requirements

$0

$0

$0

$0

Level One Sub Capabilities

$0

$0

$0

$0

Level Two Sub Capabilities

$0

$0

$0

$0

Additional Considerations

$0

$0

$0

$0

Other HPP Areas

$0

$0

$0

$0

Total

$0

$0

$0

$0

Certification: I certify to the best of my knowledge and belief that this report is correct and complete for performance of activities for the purposes set forth in the
award documents.
Typed or Printed Name and Title of Authorized Certifying Official

Signature of Authorized Certifying Official

Telephone (area code, number and extension)
Email Address
Date Report Submitted (Month, Day, Year)

According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a valid OMB control
number. The valid OMB control number for this information collection is 0990- . The time required to complete this information collection is estimated to
average (25hours) per response, including the time to review instructions, search existing data resources, gather the data needed, and complete and review
the information collection. If you have comments concerning the accuracy of the time estimate(s) or suggestions for improving this form, please write to: U.
S. Department of Health & Human Services, OS/OCIO/PRA, 200 Independence Ave., S.W., Suite 336-E, Washington D.C. 20201, Attention: PRA Reports
Clearance Officer

2. Preparedness Element: Facilities
Facilities

Hospitals
All
VA
DoD
IHS
Children's

Trauma Centers
All
Level I
Level II

Other Health Provider Organizations
Community Health Centers
Mental Health Centers
Nursing Homes

Long Term Care Facilities (excluding nursing homes)

State (#)

Participating (#)

3. Administrative Information
Category
No. 1
Total

Activity Description

Progress Description

Amount
Proposed

Amount
Unobligated

Amount
Amount
Obligated-Not
Obligated-Liquidated
Liquidated

$0

$0

$0

$0

$0

$0

$0

$0

4. Overarching Requirements
Category
No. 1
Totals:

Activity Description

Progress Description

Amount
Proposed

Amount
Unobligated

Amount
Amount
Obligated-Not
Obligated-Liquidated
Liquidated

$0

$0

$0

$0

$0

$0

$0

$0

5. Level I Sub Capabilities
Category
No. 1
Totals:

Activity Description

Progress Description

Amount
Proposed

Amount
Unobligated

Amount
Amount
Obligated-Not
Obligated-Liquidated
Liquidated

$0

$0

$0

$0

$0

$0

$0

$0

6. Level II Sub Capabilities
Category
No. 1
Total

Activity Description

Progress Description

Amount
Proposed

Amount
Unobligated

Amount
Amount
Obligated-Not
Obligated-Liquidated
Liquidated

$0

$0

$0

$0

$0

$0

$0

$0

7. Additional Considerations
Category
No. 1
Total

Activity Description

Progress Description

Amount
Proposed

Amount
Unobligated

Amount
Amount
Obligated-Not
Obligated-Liquidated
Liquidated

$0

$0

$0

$0

$0

$0

$0

$0

8. Other HPP Areas of Interest
Category
No. 1
Totals:

Activity Description

Progress Description

Amount
Proposed

Amount
Unobligated

Amount
Amount
Obligated-Not
Obligated-Liquidated
Liquidated

$0

$0

$0

$0

$0

$0

$0

$0

9. HPP Best Practices
HPP is interested in learning about successes in the implementation of the mission and
requirements of the program. Provide a brief summary of the State's demonstrated best
practices for at least two of the categories (1.1 through 1.5) described below and 1.6.
The State may provide more responses should the State have additional successes to
share.
Stories and scenarios related to
(category):
1.1 Integrating of medical
capabilities with public health
services
1.2 Increasing preparedness and
response capabilities
1.3 Addressing at-risk public
health and medical needs
1.4 Reducing duplication and
ensuring coordination
1.5 Maintaining of vital public
health and medical services
1.6 Documenting unplanned
response events and/or new
capabilities changing policy

Please describe the activity, action,
policy, incident or event that best
reflects the category description

Please describe the intended goal and how the goal
of the activity described is reflective of the goals
described in the application and the FOA

Please describe the planned and/or unplanned
impact, results, success, and lessons learned as
a result of the activity described

10. Preparedness Element: Beds
State Total of Staffed
Beds (Number)

Bed Type

State Total 24-Hour
Surge Bed Availability
(Number)

State Total 24-Hour
Surge Bed Capacity

All Hospital
Adult Intensive Care Unit (ICU)
Medical/Surgical (Med/Surg)
Burn
Pediatric ICU
Pediatric
Psychiatric (Psych)
Negative Pressure Isolation
Operating Room

Can the State EOC report available beds for at least 75% of participating hospitals, according to HAvBED definitions, to the HHS SOC within 4 hours or less of a
request, during an incident or exercise at least once during the current project period?
Can the State report available beds, according to HAvBED definitions to the HHS SOC or other Federal Partners within 4 hours of request
during and exercise or event? (Y/N)
How many participating hospitals are included in the State's report to the HHS SOC or other Federal Partner? (Number)
Report in number of hours, the amount of time required to report available beds according to HAvBED definitions to the HHS
SOC (Number)
Report the number of participating hospitals that can report available beds, according to HAvBED definitions, to the State EOC within
60 minutes or less of a State request at least once during the current project period (Number)
Did participating hospitals report available beds, according to HAvBED definitions, to the State EOC within 60 minutes or less of a State request at least once
during the current project period? (Y/N)
Collection Method
Survey or Interview Tool
Electronic Data System
Phone or Fax
Other

Table Top

Drill

Functional Exercise

Full Scale Exercise

Real Event

11. Preparedness Element: NIMS
Identify the number of participating hospitals that report completion of the following NIMS implementation activities
NIMS Concepts and Principles

Number of Participating Hospitals

1. Adoption 1: Adopt NIMS throughout the healthcare organization
2. Adoption 2: Awards support NIMS implementation
3. Preparedness: Planning: Revise EOPs, SOPs, SOGs, NRF
4. Preparedness: Planning: Mutual aid and/or assistance agreements
5. Preparedness: Training: IS 100, IS 200, and IS 700
6.
Preparedness:
Training:
IS
800/800B
7.
Preparedness:
Training:
Promote
NIMS
8. Communication and Information Management: Equipment, communications, and data interoperability
9. Communication and Information Management: Common and consistent terminology
10. Communication and Information Management: Collection and distribution of consistent and accurate information
11. Command and Management: ICS Organizational Structure
12.
Command
and
Management:
Incident
Action
Plan
(IAP)
13. Command and Management: Joint Information Center (JIC) and Joint Information System (JIS)
14. Command and Management: Public Information Systems

List all healthcare facilities participating in NIMS implementation activities. Use the drop down boxes to indicate the status of each activity. The choices are: X =
Achieved,IP = In Progress,UNK = No report or status known.
Participating Healthcare Facilities
No. 1

ProviderID

1

2

3

4

5

6

7

8

9

10

11

12

13

14

12. Preparedness Element: Exercises
Preparedness Element: Exercises
Report the total number of table top exercises conducted during current budget period that included hospital personnel, equipment or facilities
(Number)
Report the total number of drills conducted during current budget period that included hospital personnel, equipment or facilities (Number)
Report the total number of functional exercises conducted during current budget period that included hospital personnel, equipment or facilities
(Number)
Report the total number of full scale exercises conducted during current budget period that included hospital personnel, equipment or facilities
(Number)
Report the number of participating hospitals that have participated in at least one statewide exercise, regional exercise, and/ or incident during the
current reporting period (Number)
Report

the

number

of

hospitals

that

have

developed

improvements

plans

based

on

after

action

reports

(Number)

Report the number of statewide and regional exercises conducted that incorporate NIMS concepts and principles during the current project
period
Did the State/Territories conduct statewide and regional exercises that incorporate NIMS concepts and principles and included hospitals during the
current project period? (Y/N)
Report the number of statewide and regional exercises conducted that incorporate NIMS concepts and principles and included hospitals during the
current project period (Number)
How
Report

many
the

Cities
number

of

Readiness
exercises

Initiatives
that

(CRI)
included

Cities
regions

does
which

the
State
encompass
CRI

have?
cities

(Number)
(Number)

As required in the Funding Opportunity Announcement (FOA), States were expected to test the following capabilities during each of the required
exercises. Please report the number of statewide and/or regional exercises conducted that tested each of the following capabilities. (Number)
Capabilities

Table Top

Drill

Functional Exercise

Full Scale Exercise

Real Event or Incident

Interoperable Communications
ESAR-VHP
Interoperable Communications and
ESAR-VHP
Fatality Management
Medical Evacuation
Bed Tracking Availability
Memorandum Of Understandings
between Partnerships

Awardees must have tested the operational capability of the following medical surge components: 1. Interoperable communications and Emergency Systems
for Advance Registration of Volunteer Health Professionals (ESAR VHP); 2. A tabletop component to test the MOUs that are in place in partnerships/coalitions
within the areas selected (further information on what these MOUs should contain is described below in the Partnership/Coalition description below); and
3. Fatality Management, Medical Evacuation, Tracking of Bed Availability (at least 2 of these other Level-One capabilities).
Provide a brief overview of your state's exercise activities during this funding
Major Strengths (1)
Areas of Improvement/Corrective
period.
Action Plan Summaries (1)
(E.g. Provide healthcare system AAR summaries from regional exercises/
real-world events in accordance with the current Funding Opportunity
Announcement (FOA) CRI/Non-CRI exercise requirements). Attach here

No.

Exercise Name/Real-World Event

Major Strengths (2)

Areas of Improvement/Corrective
Action Plan Summaries (2)

Major Strengths (3)

Areas of Improvement/Corrective
Action Plan Summaries (3)

Types of Exercise

Capabilities Tested

No. 1

Based on these exercises/Real-World Event, what should future exercises
focus on?

What
capabilities
should
be
addressed?
National Incident Management System (NIMS)
Exercises Evaluation and Corrective Actions
Needs of At-Risk Populations
Interoperable Communications
Tracking of Bed Availability (HAvBED)
ESAR-VHP
Fatality Management
Medical Evacuation/Shelter-in-Place
Partnership/Coalition Development
Alternative Care Sites (ACS)
Moblile Medical Assets
Pharmaceutical Caches
Personal Protective Equipment
Decontamination
Medical Reserve Corps
Critical Infrastructure Protection (CIP)

13. Preparedness Element: Communications
Report the number of participating hospitals that demonstrate dedicated, redundant communications capability during an exercise or incident, as
evidenced by exercise evaluations or after action reports at least once during the current project period
Report the number of participating hospitals that indicate they have dedicated redundant communications capability (Number)
Report the number of participating hospitals that demonstrated dedicated, redundant communications capability, during an exercise or incident
using the following communications capabilities (Number)
UHF Radio (Number)
VHF Radio (Number)
700 MHz Radio (Number)
800 MHz Radio (Number)
POTS Telephone (Number)
Cellular Telephone (Number)
LAN (Number)
WAN (Number)
VoIP (Number)
Microwave (Number)
Other
type
of
communication
equipment
Are demonstrations of dedicated, redundant communications capabilities during an exercise or incident reflected in exercise evaluations and/or after
action reports? (Y/N)

Report the number of participating hospitals that demonstrate sustained two-way communications capability with the local EOC and Tier 2 partners during an
exercise or incident, as evidenced by exercise evaluations or after action reports at least once during the current project period (Number)
Report

the

number

of

participating

hospitals

that

indicate

they

have

two-way

communications

capability

Report the number of participating hospitals that demonstrated sustained two-way communications capabilities, during an exercise or incident using the following
communications capabilities (Number)

UHF Radio (Number)
VHF Radio (Number)
700 MHz Radio (Number)
800 MHz Radio (Number)
POTS Telephone (Number)
Cellular Telephone (Number)
LAN (Number)
WAN (Number)
VoIP (Number)
Microwave (Number)
Other

type

of

communication

equipment

List at least two Tier 2 partners with which the State was able to sustain two way
communications
Tier 2 partner 1
Tier 2 partner 2

Report the number of participating hospitals that tested sustained-two way communications capabilities with the local EOC or Tier 2 Partners for the
following time parameters:
Time Parameters
0-59 Minutes
1-2 hours
>2 hours
Are demonstrations of sustained two-way communications with local EOC or tier 2 partners during an exercise or incident reflected in exercise
evaluations and/or after action reports? (Y/N)

Number of Participating
Hospitals

14. Preparedness Element: Fatality Management
Preparedness Element: Fatality Management

Report

the

number

of

participating

hospitals

that

have

written

plans

to

address

Report the number of participating hospitals that have draft plans to address mass fatality management (Number)

mass

fatality

management

(Number)

15. Preparedness Element: Medical Evacuation/Shelter-In-Place
Preparedness Element: Medical Evacuation/Shelter-in-Place

Report

the

number

of

participating

hospitals

that

have

written

plans

to

address

medical

Report the number of participating hospitals that have draft plans to address medical evacuation/shelter-in-place (Number)

evacuation/shelter-in-place

(Number)

16. Preparedness Element: Education and Preparedness Training
Report the number of participating hospitals that have identified appropriate hospital personnel for training and have verified their completion of
the following courses or their equivalent - IS 100, IS 200, IS 700, IS 800/800B
Report the number of participating hospitals that have identified appropriate personnel for training for the following courses or their equivalent - IS 100,
IS 200, IS 700, IS 800/800B (Number)
Report the number of participating hospitals that have verified completion of training by appropriate hospital personnel for the following courses or
their equivalent - IS 100, IS 200, IS 700, IS 800/800B (Number)
Number of Appropriate Hospital
Personnel Identified for Training

Training

Number of Appropriate Hospital
Personnel Identified That Completed
Training

IS 100
IS 200
IS 300
IS 400
IS 700
IS 800/800B

Preparedness Element: Education and Preparedness Training
Provider
Class
No.
1

Disaster Specific
Class

Incident Command
Specific

Specify Class Name (if 'other' is
selected)

Type of
Training

Overarching Requirement or Sub Capability
Addressed

# Personnel
Trained

17. Preparedness Element: Countermeasures
Preparedness Element: Countermeasures
How many doses of antibiotics are available statewide for the purpose of providing prophylaxis to hospital personnel, hospital based EMS, and their
family members in the first 72 hours of an event? (Number)
How many doses of antivirals are available statewide for the purposes of providing prophylaxis to hospital personnel, hospital based EMS, and their
family members in the first 72 hours of an event? (Number)
For planning purposes, what is the estimated number of hospital personnel, hospital based EMS, and their family members for whom the state will
provide antivirals for the purpose of providing prophylaxis in the first 72 hours of an event? (Number)
What is the number of dedicated state caches of pharmaceutical countermeasures available for treating hospital personnel, hospital-based
emergency first responder, and family members in the first 72 hours of an event? (Number)
What is the estimated number of hospital personnel and hospital based EMS personnel that may require prophylactic antibiotics from the state
cache in the first 72 hours of an event? (Number)
What is the estimated number of family members that may require prophylactic antibiotics from the state cache in the first 72 hours of an event?
(Number)
Estimate the current level of TOTAL state funds allocated to purchase the state caches dedicated for the treatment of hospital personnel, hospital
based emergency first responders and family members ($)

$0

Estimate the amount of HPP funds allocated to purchase the state caches dedicated for the treatment of hospital personnel, hospital based
emergency first responders and family members ($)

$0

18.

Preparedness

Element:

Isolation

Preparedness Element: Isolation
Report
the
number
of
regions
in
the
State
(Number)
Report the number of sub State regions that can maintain patients in negative pressure isolation in EDs (Number)
Report the number of sub State regions that can maintain patients in negative pressure isolation in non-ED settings
(Number)

19. Preparedness Element: Decontamination
How

many

ambulatory

patients

Preparedness Element: Decontamination
can
be
decontaminated
in

the

State

How many non-ambulatory patients can be decontaminated in the State within a 3-hour period? (Number)

within

a

3-hour

period?

(Number)

20. Preparedness Element: Labs
Preparedness Element: Labs
How many hospital-based lab personnel (medical and clinical laboratory technologists and technicians) are there in the State, territory, or
municipality? (Number)
How many hospital-based lab personnel (medical and clinical laboratory technologists and technicians) are trained in the protocols for referral of
clinical samples and associated information to public health labs? (Number)

21. Preparedness Element: Telecommunications Services Priority Programs (TSP)
Funding proposed for the State's TSP efforts ($)

$0

Describe the State?s biggest challenge for implementation of the TSP
TSP Funding Details Hospital Facilities Funded for
TSP
No.
1

Sub State
Region

Number of Lines
Funded

Activation
Charge

Monthly
Charge

$0

TSP Service
Provider/Carrier

$0

22. Preparedness Element: ESAR-VHP
Can the State/Territory demonstrate the ability to query their ESAR-VHP system during a drill, exercise, or actual event to generate a list of potential volunteer
health professionals, by discipline and credential level, within 2 hours or less of a request being issued by a requesting body or HHS SOC during the current
project period?
Can the State/Territory query the ESAR-VHP system to generate a list of potential volunteer health professionals to contact, by discipline and
credential level, within 2 hours of a request being issued by a requesting body or the HHS SOC? (Y/N)
Did the State/Territory test the ability to query their ESAR-VHP system to generate a list of potential volunteer health professionals to contact, by
discipline and credential level, within 2 hours of a request being issued by a requesting body or the HHS SOC? (Y/N)

If yes, how did the State/Territory test the ability to query their ESAR-VHP system to generate a list of potential volunteer health professionals to contact, by
discipline and credential level, within 2 hours of a request being issued by a requesting body or the HHS SOC?
Testing Method

Y/N

Table Top
Drill
Functional Exercise
Full Scale Exercise
Real Event
Other
Report in hours/minutes the amount of time it took to query the ESAR-VHP system to generate a list of potential volunteer health professionals, by
discipline and credential level (Number)

0

Can the State/Territory compile an initial list of volunteer health professionals, by discipline and credential level, within 12 hours or less of a request
being issued by a requesting body or HHS SOC during the current project period? (Y/N)
Report in hours the amount of time it took to compile an initial list of willing volunteer health professionals, by discipline and credential level after a
request being issued (Number)
Can the State/Territory report a verified list of available volunteer health professionals, by discipline and credential level, within 24 hours or less of a
request being issued by a requesting body or HHS SOC during the current project period? (Y/N)
Report in hours how much time it took the State/Territory to report a verified list of available volunteer health professionals, by discipline and credential level
to a requesting body or HHS SOC during the current project period (Number)
Has the State/Territory developed an electronic registration system for recording and managing volunteer information based on the data definitions
presented in the ESAR-VHP Guidelines? (Y/N)
Is
the
ESAR-VHP
system
capable
of
assigning
volunteers
to
all
four
ESAR-VHP
credential
levels?
(Y/N)
Is the electronic system capable of recording ALL volunteer health professional/emergency preparedness affiliations of an individual, including local,
State, and Federal entities? (Y/N)
Is the electronic system capable of identifying volunteers willing to participate in a federally coordinated emergency response? (Y/N)
Is the State capable of updating volunteer information and re-verifying credentials every 6 months? (Y/N)

Upon receipt of a request for volunteers, is the State capable of completing the following requirements:
Timeframe
Within 2 hours query the electronic system to generate a list of potential volunteer health professionals to contact
Within 12 hours provide the requester an initial list of willing volunteer health professionals that includes the names, qualifications, credentials, and
credential levels of volunteers
Within 24 hours provide the requester with a verified list of available volunteer health professionals
Has the State developed and implemented a plan to recruit and retain volunteers? (Y/N)
Has the State developed a plan for coordinating with all volunteer health professional/emergency preparedness entities to ensure an efficient response to
an emergency, including but not limited to Medical Reserve Corps (MRC) units and the National Di
Has the State developed protocols for deploying and tracking volunteers during an emergency (Mobilization Protocols)? (Y/N)
Has the State developed a plan for regular testing of its ESAR-VHP system through drills and exercises? (Y/N)
Has
the
State
developed
a
plan
for
reporting
program
performance
and
capabilities?
(Y/N)
How
many
volunteer
health
professionals
are
currently
registered
in
the
ESAR-VHP
system?
(Number)
Of the total number of volunteer health professionals registered, how many are affiliated with the Medical Reserve Corps (MRC)? (Number)
Of the total number of volunteer health professionals registered, how many are affiliated with National Disaster Medical System (NDMS)?
(Number)

Y/N

23. Preparedness Element: ESAR-VHP Credentialing
Number of volunteer health professionals by discipline and credential level:
Level 1(Number)

Level 2(Number)

Level 3(Number)

Level 4(Number)

Level 1(Number)

Level 2(Number)

Level 3(Number)

Level 4(Number)

Health Profession
Allopathic Physicians (M.D.)
Osteopathic Physicians (D.O.)
Registered Nurses
Nurse Practitioners
Certified Nurse Anesthetists
Certified Nurse Midwives
Clinical Nurse Specialists
Licensed Practical Nurses and Licensed Vocational Nurses
Pharmacists
Psychologists
Clinical Social Workers
Mental Health Counselors
Radiological Technologists and Technicians
Respiratory Therapists
Medical
and
Clinical
Laboratory
Technologists
Medical and Clinical Laboratory Technicians (including Phlebotomists)
Physician Assistants
Dentists
Marriage and Family Therapists
Veterinarians
Cardiovascular Technologists and Technicians
Diagnostic Medical Sonographers
Emergency Medical Technicians and Paramedics
Medical Record and Health Information Technicians
Number of volunteer health professionals by
discipline and credential level:
Health Profession
Other Categories# 1

Other Categories
Description

24. Partnership/Coalition Status
Address the folowing Items:
a. The name of the partnership/coalition b. The location of the partnership/coalition c. The participant healthcare organizations and other partners d. Number
and type of MOUs that exist
Name of
Partnership/Coalition
No.
1

Area
Covered

Location

Names of the Participant Healthcare Organizations or
Partners

# of MOUs that
Exist

Types of MOUs that
Exist