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BY THE ORDER OF THE SECRETARY
OF THE AIR FORCE
AIR FORCE INSTRUCTION 10-2603
13 OCTOBER 2010
Operations
EMERGENCY HEALTH POWERS
ON AIR FORCE INSTALLATIONS
COMPLIANCE WITH THIS PUBLICATION IS MANDATORY
ACCESSIBILITY: Publications and forms are available on the e-Publishing website at
www.e-Publishing.af.mil for downloading or ordering.
RELEASABILITY: There are no releasability restrictions on this publication.
OPR: AF/A5XPC
Supersedes: AFI10-2603,
7 December 2005
Certified by: AF/A5X
(Maj Gen Kip L. Self)
Pages: 49
Air Force Instruction (AFI) 10-2603, Emergency Health Powers on Air Force Installations,
provides guidance to protect Air Force installations, facilities, and personnel in the event of a
public health emergency. This Instruction implements provisions contained in Department of
Defense Instruction (DoDI) 6200.03, Public Health Emergency Management, and Air Force
Policy Directive (AFPD) 10-26, Counter-Chemical, Biological, Radiological, and Nuclear
Operations.
This Instruction applies to all installations and activities under Air Force command (hereafter
referred to collectively as ―installations‖), to the Air Reserve Component (ARC), and to
geographically separated units (GSU), except where otherwise noted. Air National Guard
(ANG) units will follow the guidelines outlined in Chapter 6 when performing Federal service.
The term ―commanders,‖ as used in this Instruction, refers to commanders at the installation and
wing (for ARC) level unless specifically stated otherwise.
Air Force units in Joint Basing situations, whether in the supporting (i.e., host) or supported (i.e.,
tenant) role, must continue to comply with Air Force guidance. In accordance with (IAW) Joint
Basing Implementation Guidance (JBIG), tenants and/or host units should implement
Memorandums of Agreement (MOA) to establish standards of support. The JBIG also
establishes procedures for adjudicating differences and establishing Common Output Level
Standards. Units that cannot meet Air Force requirements by exhausting the JBIG adjudication
process must coordinate with their Major Command (MAJCOM) to alleviate discrepancies.
MAJCOMs that cannot resolve discrepancies will coordinate with the appropriate Headquarters
Air Force (HAF) office to determine a solution.
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This Instruction also applies to military personnel and those civilian personnel, dependents of
military or civilian personnel, and contractors present on an Air Force installation (collectively
referred to as ―non-military personnel‖); Air Force facilities; Air Force-owned, leased, or
managed infrastructure and assets critical to mission accomplishment; and other Air Force-
owned, leased, or managed mission essential assets overseas and in the U.S., its territories, and
possessions. In areas outside the continental United States (OCONUS), this Instruction applies
to the extent consistent with local conditions and applicable treaty requirements, agreements, and
other arrangements with foreign governments and Allied Forces.
This Instruction complements AFI 10-2604, Disease Containment Planning Guidance, and does
not: (1) take precedence over actions covered by AFPD 10-8, Homeland Defense and Civil
Support, AFI 10-801, Assistance to Civilian Law Enforcement Agencies, and AFI 10-802,
Military Support to Civil Authorities; (2) apply to foreign disasters covered by AFPD 10-25,
Emergency Management, AFI 10-2501, Air Force Emergency Management (EM) Program
Planning and Operations, and Air Force Manual (AFMAN) 10-2502, Air Force Incident
Management System (AFIMS) Standards and Procedures; or (3) integrate contingency war
planning as a supplement to Air Force Installation response.
Ensure that all records created as a result of processes prescribed in this publication are
maintained in accordance with AFMAN 33-363, Management of Records, and disposed of IAW
the Air Force Records Disposition Schedule located at
https://www.my.af.mil/afrims/afrims/afrims/rims.cfm. To recommend changes or
suggestions to this publication, use Air Force Form 847 and route it through the publishing
channels to AF/A5XP for consideration. Accomplish collections and After Action Reports
(AAR) for major operations, contingencies, key exercises and experiments, and other significant
events and topics identified by leadership IAW AFI 90-1601, Air Force Lessons Learned
Program. Post approved AARs to the Air Force Joint Lessons Learned Information System,
either directly or by forwarding to AF/A9L.
SUMMARY OF CHANGES
This document has been substantially revised and must be completely reviewed. The changes in
this document align it with DoDI 6200.03 and deconflict guidance provided in AFI 10-2604.
This revision incorporates specialized Public Health Emergency Officer training requirements,
superseding HQ USAF/SG3 Memorandum dated 12 February 2010 SUBJECT: Public Health
Emergency Officer (PHEO) Appointment and Training Requirements. This Instruction provides
additional guidance on emergency health powers (Chapter 1), further delineates roles and
responsibilities (Chapter 2), clarifies authorities of installation commanders (Chapter 3),
includes directives for a Public Health Emergency Working Group (Chapter 4), outlines
available medical countermeasures and the appropriate process for acquisition/use of the
Strategic National Stockpile (Chapter 5), includes specific guidance for the Air National Guard
(Chapter 6), and concludes with prescribed and adopted forms (Chapter 7).
Chapter 1—EMERGENCY HEALTH POWERS ON MILITARY INSTALLATIONS 5
1.1. Purpose. .................................................................................................................. 5
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AFI10-2603 13 OCTOBER 2010 3
1.2. Chemical, Biological, and Radiological (CBR) Incidents. .................................... 5
1.3. Overseas Limitations. ............................................................................................ 6
1.4. ARC and GSU Limitations. ................................................................................... 6
1.5. Public Health Emergencies. ................................................................................... 7
1.6. Events of Public Health Concern. .......................................................................... 8
1.7. Situational Standards of Care. ................................................................................ 8
Chapter 2—ROLES AND RESPONSIBILITIES 9
2.1. Headquarters Air Force PHEO. ............................................................................. 9
2.2. MAJCOM Chief of Aerospace Medicine (SGP) or Other Appropriate Medical Officer. 9
2.3. Installation Commander. ........................................................................................ 9
2.4. Medical Treatment Facility Commander. .............................................................. 11
2.5. Public Health Emergency Officer. ......................................................................... 12
2.6. Other Medical Personnel. ....................................................................................... 14
Chapter 3—EMERGENCY HEALTH POWERS FOR INSTALLATION COMMANDERS 18
3.1. Public Health Emergency Declaration. .................................................................. 18
3.2. Legal Authorities. .................................................................................................. 18
3.3. Violation of Restriction of Movement: .................................................................. 20
3.4. Contesting Restriction of Movement: .................................................................... 20
Chapter 4—PUBLIC HEALTH EMERGENCY WORKING GROUP 21
4.1. Mission Statement. ................................................................................................. 21
4.2. PHEWG Membership: ........................................................................................... 21
4.3. PHEWG Responsibilities. ...................................................................................... 22
Chapter 5—STRATEGIC NATIONAL STOCKPILE AND MEDICAL COUNTERMEASURE
PLANNING REQUIREMENTS 24
5.1. Medical Countermeasure Sources. ......................................................................... 24
5.2. Strategic National Stockpile Planning Guidance. .................................................. 24
5.3. Mass Prophylaxis Point of Dispensing. ................................................................. 26
5.4. Receiving, Staging, and Storage Sites. .................................................................. 27
5.5. Overseas Installations. ........................................................................................... 27
Chapter 6—AIR NATIONAL GUARD 29
6.1. Purpose. .................................................................................................................. 29
6.2. Roles and Responsibilities ..................................................................................... 29
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6.3. Public Health Emergency Working Group. ........................................................... 31
Chapter 7—PRESCRIBED AND ADOPTED FORMS 32
7.1. AF Form 847, Recommendation for Change of Publication. ................................ 32
Attachment 1—GLOSSARY OF REFERENCES AND SUPPORTING INFORMATION 33
Attachment 2—PUBLIC HEALTH EMERGENCY OFFICER TRAINING REQUIREMENTS 41
Attachment 3—TEMPLATE: DECLARATION OF A PUBLIC HEALTH EMERGENCY 43
Attachment 4—TEMPLATE: NOTICE OF QUARANTINE 45
Attachment 5—TEMPLATE: NOTICE OF ISOLATION 47
Attachment 6—AIR FORCE REPORT FOR STRATEGIC NATIONAL STOCKPILE AND MASS
PROPHYLAXIS ACTIONS 49
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Chapter 1
EMERGENCY HEALTH POWERS ON MILITARY INSTALLATIONS
1.1. Purpose. This AFI specifies the authority of Installation Commanders and assigns
responsibilities for declaring, reporting, and managing a public health emergency. It also
identifies the responsibilities and tasks of the Medical Treatment Facility (MTF) Commander,
the Public Health Emergency Officer (PHEO), and other key personnel.
1.2. Chemical, Biological, and Radiological (CBR) Incidents. Public health emergencies can
arise from chemical, biological, or radiological incidents. These events can lead to widespread
health, social, and economic consequences. Commanders must be prepared to make timely
decisions for actions that will protect the lives and well being of personnel and enable Air Force
units to continue operations. Although many of the legal authorities described in Paragraph 3.2
of this document are applicable to specific incidents involving biological agents, the more
general emergency health powers can be used as necessary within the context of response to
chemical and/or radiological incidents.
1.2.1. Biological Incidents. Biological agents include both infectious pathogens
(e.g., smallpox) and non-infectious agents (e.g., biological toxins). Early recognition of
exposure, knowledge of the pathogen, and where needed, application of appropriate infection
control measures are critical in controlling outbreaks and mitigating the effects of infectious
disease spread. Therefore, rapid collection and assessment of pertinent data is necessary in
responding to disease outbreaks. Commanders should expect a level of uncertainty during
the decision-making process, especially during the early stages of a biological incident, prior
to identification and attribution of a specific agent. Communication and coordination
between the military leadership and the local community are critical to a coordinated
response effort.
1.2.2. Chemical Incidents. Chemical events, to include releases of Toxic Industrial
Chemicals, pose a significant hazard to personnel exposed at the time of release, as well as
subsequent hazard from reaerosolization or agent transfer. Detection, identification, and
early warning and reporting are critical to an effective response. Pre-planning actions
promote a favorable contamination avoidance posture for personnel, equipment, vehicles,
and other resources, as well as development and/or deployment of a detection capability to
determine the existence/extent of contamination in the event of a chemical attack. Following
a chemical attack or event, commanders will use available risk management tools to reduce
the protective posture as quickly as possible with acceptable risk. Appropriate pre-, trans-,
and post-attack/event actions reduce chemical exposure and contamination and increase
operational capability.
1.2.3. Radiological Incidents. Radiological incidents range in size and magnitude depending
on the type of event. Upon recognizing an event has occurred, immediate implementation of
exposure control measures is warranted and is critical to personnel survivability. The effects
of exposure to radiation can range from non-life-threatening burns to acute radiation sickness
as a result of a high dose, whole body exposure. Situational awareness sets the stage for
minimizing inadvertent exposures and making case-by-case determinations in regards to
applicable protective action and mission sustainment options. In many cases, the residual
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hazard from a radiological event will not be sufficient to force the cessation of critical
mission operations. Therefore, it is imperative to identify, characterize, and quantify the
threat.
1.2.4. Additional guidance for responding to CBR incidents can be found in AFI 10-2604;
Air Force Tactics, Techniques, and Procedures (AFTTP) 3-2.33, Multiservice Tactics,
Techniques, and Procedures for Installation CBRN Defense; AFTTP 3-2.37, Multiservice
Tactics, Techniques, and Procedures for Chemical, Biological, Radiological, and Nuclear
Consequence Management Operations; and AFMAN 10-2503, Chemical, Biological,
Radiological, Nuclear, and High-Yield Explosives (CBRNE) Operations.
1.3. Overseas Limitations. Host nation agreements, governmental oversight, and control of
overseas installations may prevent commanders from unilaterally implementing many of the
provisions of this Instruction. Ultimately, U.S. prerogatives and control at overseas locations are
subject to the sovereignty of the host nation, except as otherwise defined in applicable
international agreements, such as status of forces agreements, defense cooperation agreements,
and base rights agreements.
1.3.1. A U.S. military commander’s authority overseas extends generally only to U.S.
service members, civilian employees of U.S. forces, U.S. Department of Defense (DoD)
contractor employees (when specified by agreements), and the dependents of these categories
of personnel.
1.3.2. A commander’s authority may be limited in scope as it pertains to host nation
personnel. Overseas installations will review their respective host nation agreements and
incorporate guidance into existing installation emergency preparedness and response plans
(e.g., Disease Containment Plan (DCP), Medical Contingency Response Plan (MCRP), and
Comprehensive Emergency Management Plan (CEMP) 10-2) and agreements.
1.3.3. Many of the authorities cited in this publication are non-applicable or unable to be
implemented in an overseas environment without the cooperation of host nation authorities,
except to the extent specified by governing international agreements.
1.3.4. Should it be necessary to enter into international agreements to adequately address the
requirements of this Instruction, OCONUS MAJCOMs and Commanders of Air Force forces
will consult AFI 51-701, Negotiating, Concluding, Reporting, and Maintaining International
Agreements, and applicable combatant command regulations to determine whether authority
exists, or must be requested, to negotiate and conclude such agreements.
1.4. ARC and GSU Limitations. ARC units and GSUs may not have the resident capability or
personnel to prepare for or respond to a public health emergency. This will ultimately limit a
commander’s ability to implement some of the provisions of this Instruction, to include
designating a PHEO. As a result, these organizations must rely heavily on civilian agencies/local
authorities for emergency response.
1.4.1. Commanders of GSUs will review their respective emergency response plans and
incorporate measures from this AFI that are reasonable and appropriate given their GSU’s
situation. At a minimum, such measures will include coordination of emergency response
procedures and plans with applicable local and/or State authorities.
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1.4.2. The appointed State ANG PHEO-Liaison Officer (PHEO-LNO) will advise ANG
Wing Commanders on potential public health emergency situations.
1.4.3. Commanders of ANG units not collocated on active duty military installations are
encouraged to communicate identified health threats to the DoD installation PHEO in their
catchment area.
1.4.4. The Traditional Reserve PHEO point of contact for Air Force Reserve Command
installations will be familiar with civilian agencies/local authorities for emergency response
for that state.
1.5. Public Health Emergencies.
1.5.1. DoDI 6200.03 defines a public health emergency as an occurrence or imminent threat
of an illness or health condition that:
1.5.1.1. May be caused by any of the following: biological incident, either manmade or
naturally-occurring; the appearance of a novel, previously controlled, or eradicated
infectious agent or biological toxin; naturally-occurring pandemic or epidemic; zoonotic
disease; natural disaster; chemical attack or accidental release; radiological or nuclear
attack or accident; or high-yield explosives.
1.5.1.2. Poses a high probability of: a significant number of deaths in the affected
population considering the severity and probability of the event; a significant number of
serious or long-term disabilities in the affected population considering the severity and
probability of the event; widespread exposure to an infectious or toxic agent, including
those of zoonotic origin, that poses a significant risk of substantial public harm to a large
number of people in the affected population; and/or healthcare needs that exceed
available resources.
1.5.1.3. Requires World Health Organization notification as a Public Health Emergency
of International Concern IAW the International Health Regulations.
1.5.2. Specifically, the following diseases and public health conditions would cause a
commander to declare a Public Health Emergency:
1.5.2.1. One or more human cases of any of the following diseases that is unusual or
unexpected and may have serious public health impact: smallpox, anthrax, pneumonic
plague, poliomyelitis due to wild-type poliovirus, human influenza caused by a new
subtype, severe acute respiratory syndrome (SARS), and viral hemorrhagic fevers (e.g.,
Ebola, Lassa, Marburg).
1.5.2.2. Any other disease of special military, national, or regional concern (e.g., Dengue
fever, Yellow fever, West Nile fever, Rift Valley fever, meningococcal disease, cholera)
that may have a serious impact on public health, is unusual or unexpected, or has a
significant risk of spread and/or affecting the mission.
1.5.2.3. The occurrence of any item listed in Paragraph 1.5.1 that overwhelms the local
capabilities to respond to the situation, to include requesting assets from the Strategic
National Stockpile (SNS). See Chapter 5 for SNS planning requirements. Note: SNS
assets will not be relied upon as part of an installation’s initial response capability to a
public health emergency.
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1.5.2.4. One or more cases of any disease which requires the use of quarantine to control.
Orders for quarantine or for the apprehension, detention, or conditional release of
personnel exposed to a contagious disease but without confirmed illness may not be
issued by the PHEO unless the Installation Commander has declared a public health
emergency. A Notice of Quarantine template is provided in Attachment 4.
1.5.3. The Installation Commander is the only authority who can declare a public health
emergency on an Air Force installation. The Secretary of Health and Human Services (HHS)
has the authority to declare a national public health emergency within U.S. borders, and some
states and local governments can declare public health emergencies covering their
jurisdictions. Commanders on ANG installations will coordinate with their Joint Forces
Headquarters - State (JFHQ-State) and the National Guard Bureau (NGB) prior to declaring a
public health emergency. Attachment 3 provides a template for declaring a public health
emergency.
1.6. Events of Public Health Concern.
1.6.1. An event of public health concern is defined as an occurrence of an illness or health
condition caused by an epidemic, or a serious and potentially fatal infectious agent that poses
a substantial risk of human infection, but that does not constitute a public health emergency.
Examples of events of a public health concern include a single case of infectious (active)
tuberculosis, or an adenovirus epidemic that is contained before leading to a significant
number of deaths or long-term disabilities and that can be addressed using available
healthcare resources.
1.6.2. Many of the directives issued in this Instruction apply to responding to an event of
public health concern. The PHEO will provide recommendations to the Installation
Commander and/or the MTF commander on the actions necessary to respond, mitigate, and
control the public health event.
1.6.3. Orders regarding isolation and restriction of movement (ROM) of individuals with a
confirmed illness may be issued during events of public health concern or during a public
health emergency. A Notice of Isolation template is provided in Attachment 5.
1.7. Situational Standards of Care. Public health emergencies may result in surge
requirements that overwhelm the response capacity, capability, and resources of medical
facilities and health care providers, resulting in an inability to meet normal standards of care.
Under these conditions, it may be necessary to provide situational standards of care. Such
situational standards will be directed IAW Enclosure 4 of DoDI 6200.03.
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Chapter 2
ROLES AND RESPONSIBILITIES
2.1. Headquarters Air Force PHEO. The Assistant Surgeon General for Health Care
Operations (AF/SG3) will appoint a PHEO to act as the Air Force Medical Service (AFMS)
focal point for issues pertaining to public health emergencies. Specific responsibilities include:
2.1.1. Serve as AFMS representative to ASD(HA) and MAJCOMs for developing public
health emergency policy.
2.1.2. Act as the Air Force stakeholder to ensure Joint training for PHEOs is developed and
maintained appropriately.
2.1.3. Provide reachback capability to MAJCOM PHEO consultants for support not
routinely provided regionally.
2.1.4. Develop standardized Public Health and Disease Outbreak Emergency Response
Training for use by installation PHEOs in meeting the senior leader training described in
Paragraph 4.3.6.
2.2. MAJCOM Chief of Aerospace Medicine (SGP) or Other Appropriate Medical
Officer. Will serve as the PHEO Consultant for their respective commands and have the
following roles and responsibilities:
2.2.1. Complete all PHEO training requirements listed in Attachment 2.
2.2.2. Provide expertise and guidance to installation PHEOs conducting emergency response
actions as needed.
2.2.3. Maintain a listing of name and contact information for all PHEOs and alternate
PHEOs within their command. This listing will be sent semi-annually and, as requested, to
the HAF PHEO residing in AFMSA/SG3P.
2.2.4. Monitor adequacy of training and support for MAJCOM and installation PHEOs.
2.2.5. Provide MAJCOM-specific guidance on public health emergency planning activities
to supplement guidance from higher headquarters as necessary.
2.2.6. During public health emergencies, coordinate information and requirements to higher
headquarters and between MAJCOMs, as appropriate.
2.3. Installation Commander. The Installation Commander will:
2.3.1. Ensure that all units/tenants comply with requirements for preventing and controlling
diseases, injuries, and other reportable conditions IAW current Air Force guidance and
installation PHEO recommendations. In addition, the Installation Commander will ensure
that public health emergency management is integrated into existing installation emergency
preparedness and response plans (e.g., DCP, MCRP, and CEMP 10-2) and agreements.
2.3.2. Designate, in writing, an installation PHEO and an alternate PHEO to provide medical
and/or public health recommendations in response to public health emergencies.
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2.3.2.1. For installations with associated GSUs, direct reporting agencies, or forward
operating areas, the Installation Commander may designate additional PHEOs as
appropriate.
2.3.2.2. Installations with small MTFs (i.e., <75 personnel assigned) do not require the
designation of a PHEO if the supporting MTF’s PHEO performs the duty for the
supported MTF.
2.3.2.3. The Installation Commander will ensure that the PHEO and alternate PHEO
have adequate support and resources to accomplish their mission.
2.3.3. Consult with the installation PHEO prior to declaring a public health emergency.
2.3.3.1. The Installation Commander will only exercise those emergency health powers
within his/her inherent authority necessary to respond to the public health emergency and
will coordinate all emergency health power actions with local and host nation officials.
The PHEO is the Installation Commander’s primary advisor during a public health
emergency regardless of local authority or host nation actions. Chapter 3 provides a
listing of emergency health powers available to an Installation Commander following the
declaration of a public health emergency.
2.3.3.2. Declaration of a public health emergency will be reported via an Operational
Event/Incident Report-3 (OPREP-3) Report IAW AFI10-206, Operational Reporting,
whenever national-level interest has been determined. The goal is to make initial voice
reports within 15 minutes of a declaration of public health emergency or disease
outbreak, with a message report submitted within one hour of the incident to the National
Military Command Center (NMCC). The NMCC will forward the OPREP-3 to the
Secretary of Defense. Reports must be timely, concise, and include sufficient
information to allow action addressees to fully understand the situation and provide
information to other levels, as required. All OPREP-3 for pandemic influenza incidents
will be reported to the NMCC with a courtesy copy provided to the NORAD-
USNORTHCOM Command Center or IAW applicable combatant command
requirements. All OPREP-3 reports containing medically-relevant information should be
coordinated with the PHEO.
2.3.3.3. Declarations will terminate automatically in 30 days, unless renewed and
rereported. Declarations may be terminated sooner by the commander who made the
declaration, any senior commander in the chain of command, the Secretary of the Air
Force, or the Secretary of Defense.
2.3.3.4. All public health emergencies will be managed IAW the Air Force Incident
Management System (AFIMS). See AFI 10-2501 for AFIMS guidance.
2.3.4. Establish a Public Health Emergency Working Group (PHEWG). The PHEWG is a
sub-group that reports to the installation Emergency Management Working Group (EMWG)
and is chaired by the PHEO. See Chapter 4 for PHEWG membership and responsibilities.
2.3.5. Cooperate with authorized law enforcement agencies investigating an actual or
potential terrorist act, or other relevant public health emergency.
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2.3.6. Approve and forward requests for delivery and transfer of SNS assets for sustainment
of a response to a public health emergency within the Continental United States (CONUS).
See Chapter 5.
2.3.7. Provide manpower and/or materiel support to local authorities in certain limited
circumstances when responding to a public health event (i.e., public health emergency or
event of public health concern).
2.3.7.1. The Installation Commander may execute such support unilaterally at the request
of local authorities when faced with imminently serious conditions resulting from any
civil emergency that requires immediate action to save lives, prevent human suffering, or
mitigate great property damage.
2.3.7.2. In accordance with AFI 41-209, Medical Logistics Support, Medical War
Reserve Materiel may be used to save life or prevent undue suffering.
2.3.7.3. In other circumstances, approval must be sought from higher headquarters prior
to providing support and may be limited by Federal laws and regulations (e.g., Posse
Comitatus Act). Generally, any support provided by the Air Force is enacted through
AFIMS and the National Response Framework (NRF).
2.3.8. Organize, train, equip, and exercise personnel to conduct and sustain emergency
management operations IAW AFI 10-2501.
2.3.9. Ensure that relevant communications are executed by Public Affairs in coordination
with all appropriate installation/command stakeholders.
2.4. Medical Treatment Facility Commander. The MTF/CC will:
2.4.1. Nominate a primary and alternate PHEO to the Installation Commander as specified in
Paragraph 2.3.2.
2.4.2. Authorize licensed but non-credentialed healthcare providers by granting temporary
privileges to provide care within their facilities when necessary to respond to emergency
requirements or as appropriate and IAW applicable laws and policies.
2.4.3. Direct medical personnel (i.e., healthcare providers or medical examiner) with respect
to any diagnosed illness or health condition; every pharmacist with respect to prescription
rates, types, or trends; and every laboratorian with respect to presumptive or confirmed
laboratory diagnostic results to promptly report circumstances suggesting a public health
emergency to the PHEO. Laboratory reports pertinent to public health emergencies are in
addition to otherwise applicable surveillance systems (e.g., the Electronic Surveillance
System for the Early Notification of Community-based Epidemics (ESSENCE)), including
non-DoD systems and reportable events to Public Health IAW the Tri-Service Reportable
Events prepared by the Armed Forces Health Surveillance Center.
2.4.4. Oversee identification/designation of MTF key response personnel (e.g., local civilian
first responders/receivers) to allow appropriate access and credentialing to the installation
and the ability to perform assigned job functions.
2.4.5. Authorize direct purchase of emergency medical supplies without base contracting
approval when necessary to save life or prevent suffering. Use this means of procurement
only when Prime Vendor, decentralized blanket purchase agreement, or Government
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Purchase Card sources are unable to support emergency requirements (refer to AFI 41-209
for specific procedures).
2.4.6. Ensure the protection of health information IAW AFI 41-210, Patient Administration
Functions. Medical personnel may use and disclose protected health information as
necessary to ensure proper treatment of individuals and prevent the spread of communicable
diseases.
2.5. Public Health Emergency Officer. The PHEO is the central point of contact and
clearinghouse for health-related information during a suspected or declared public health
emergency and makes recommendations to the Installation Commander.
2.5.1. PHEOs advise the Installation Commander when it is appropriate to declare a public
health emergency and on the implementation of emergency health powers IAW relevant
public health laws, regulations, and policies. The PHEO will use the definition of a public
health emergency as defined in Paragraph 1.5 to aid in determining whether or not a public
health emergency exists.
2.5.1.1. Upon initial declaration of a public health emergency, the PHEO ensures
notification of the MTF/CC, MAJCOM/SGP, and installation Public Health (SGPM).
The MAJCOM/SGP will notify AFMSA/SG3P.
2.5.1.2. Following the initial declaration, the PHEO coordinates with SGPM to ensure
information is relayed to the United States Air Force School of Aerospace Medicine
(USAFSAM) and the local civilian health department. USAFSAM will become the
clearinghouse of epidemiological information to the MAJCOMs and Air Force Medical
Support Agency (AFMSA) during on-going public health emergencies.
2.5.2. In addition, PHEOs will work closely with other medical personnel (see Paragraphs
2.4 and 2.6 of this Instruction) and local public health authorities to identify, confirm, and
control a public health emergency that may affect the installation.
2.5.3. Qualifications for the PHEO and alternate PHEO:
2.5.3.1. Must have experience and training in functions essential to effective public
health emergency management (e.g., National Incident Management System (NIMS),
NRF) and have a Master of Public Health degree (or equivalent degree) or 4 years of
experience in public health, preventive medicine, and/or environmental health.
2.5.3.2. The primary PHEO should be the SGP. When necessary, for example when the
SGP is the MTF Commander, another senior Medical Corps officer, such as the Chief of
Medical Services (SGH), may serve as the primary PHEO.
2.5.3.3. The alternate PHEO must be a senior Medical Corps officer or senior Public
Health Officer. The alternate PHEO will perform all primary PHEO roles, which may
include advising incident commanders during a public health event, when the primary
PHEO is not available. As such, the alternate PHEO must complete all PHEO training
requirements and be fully engaged in public health emergency planning, preparedness,
and response activities.
2.5.3.4. PHEO training requirements are provided in Attachment 2.
2.5.4. The following are the PHEO roles and responsibilities:
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2.5.4.1. Serve as chair of the PHEWG and ensure all requirements established in
Chapter 4 are accomplished.
2.5.4.2. Develop procedures to implement the declaration of a public health emergency.
This includes implementation of procedures in the installation’s DCP, CEMP 10-2, and
the creation of/update to an annex to the MCRP on the MTF’s response to a public health
emergency.
2.5.4.3. maintain situational awareness of public health and medical threats to ascertain
the existence of cases suggesting a public health emergency.
2.5.4.4. Collaborate with the Public Health Office to ascertain the existence of cases
suggesting a public health emergency and conduct epidemiological investigations.
2.5.4.5. Collaborate with the Public Health Officer, Bioenvironmental Engineer, and
Infection Control Officer (ICO) to provide proper control measure recommendations to
the installation and MTF commanders.
2.5.4.6. Support the Installation Commander in the integration of public health and
medical preparedness with other installation/command emergency response planning and
exercises (e.g., DCP, CEMP 10-2, etc.).
2.5.4.7. In coordination with PA, communicate with the installation population and
appropriate local, State, Federal, territorial, and host nation public health officials during
declared public health emergencies. NOTE: The Public Health Office serves as the
primary liaison with civilian health officials and will facilitate this requirement for the
PHEO. The PHEO should have situational awareness of civilian agency preparedness
and response activities and develop contacts with key agency leaders.
2.5.4.7.1. Coordinate with PA on the development of communications materials to
educate base population on actions to take to limit the spread of a disease before,
during, and after a public health emergency.
2.5.4.7.2. Coordinate with civilian agencies to ensure that the assumption of public
health emergency responsibilities by civilian agencies for other-than-U.S. military
personnel and non-Air Force property is consistent with the protection of military
installations, facilities, and personnel. Responsibility will only be given to civilian
agencies with appropriate jurisdiction over the persons or property.
2.5.4.7.3. Coordinate with installation Public Affairs to share epidemiologic
information with local, State, Federal, or host nation officials responsible for public
health and public safety. Such information may include personally identifiable health
information IAW DoD 6025.18-R, DoD Health Information Privacy Regulation, only
to the extent necessary to protect the public health and safety and as otherwise
permitted by law.
2.5.4.8. Notify the installation Antiterrorism Officer and Threat Working Group through
applicable military channels of any information indicating a possible terrorist incident or
other crime. Cooperate with authorized law enforcement agencies investigating any such
incidents.
2.5.4.9. Establish procedures for all non-military personnel subject to quarantine or
isolation who contest their detention to present information requesting an exemption or
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14 AFI10-2603 13 OCTOBER 2010
release. If such persons dispute the decisions of the PHEO, the Installation Commander
will be the final authority for resolution.
2.5.4.10. Ensure every individual subject to quarantine or isolation is provided written
notice of the reason and the plan of examination, testing, and/or treatment designed to
resolve the reason for the quarantine or isolation.
2.5.4.11. Coordinate with the Mission Support Group to take reasonable and necessary
measures for testing and safely transferring or temporarily disposing of remains, to
include those of animals, in order to prevent the spread of disease. Ensure proper
labeling, identification, and records regarding the circumstances of death and disposition.
Ensure contaminated remains are handled IAW AFI 41-210 and AFI 34-242, Mortuary
Affairs Program.
2.5.4.12. Recommend to Installation Commanders when access to the SNS is warranted
to sustain the response to a public health emergency.
2.5.4.13. Recommend diagnosis, treatment, and prophylaxis of affected individuals or
groups and populations in consultation with appropriate clinical staff.
2.5.4.14. The PHEO may delegate oversight of select actions in this Instruction to the
alternate PHEO, Public Health personnel, or qualified individuals during a declared
public health emergency to better manage the evolving situation. Those to whom this
authority is delegated will keep the PHEO informed of the progress and outcomes of
those actions.
2.6. Other Medical Personnel. The following medical personnel have codified responsibilities
to provide key support to the PHEO in identifying, controlling, and mitigating a public health
emergency. During public health emergencies, these personnel will be responsible for
maintaining approved Air Force and DoD processes, as well as the following:
2.6.1. Public Health.
2.6.1.1. Conduct medical surveillance activities IAW AFI 48-105, Surveillance,
Prevention, and Control of Diseases and Conditions of Public Health or Military
Significance.
2.6.1.1.1. Provide reports to the PHEO of all public health assessments of installation
threats, and promptly report all suspicious disease rates, types, or trends that suggest a
public health emergency.
2.6.1.1.2. Monitor daily disease alerts and rates using ESSENCE IAW DoDI
6200.03.
2.6.1.2. Provide assistance to the PHEO in epidemiological investigations of all
suspected public health emergencies.
2.6.1.2.1. Collaborate with the PHEO in the development of a case definition of the
outbreak or event.
2.6.1.2.2. Investigate all suspected public health emergency cases for sources of
infection.
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2.6.1.2.3. Investigate individuals thought to have been exposed to the illness as part
of the epidemiological investigation to assist in positively identifying exposed
individuals and developing information relating to the source and spread of the illness
or health condition.
2.6.1.2.4. Perform epidemiological analyses of the public health emergency as
needed to include verification of the diagnosis and outbreak, case finding, descriptive
epidemiology, identification of exposure sources and risk factors, statistical
comparisons, and implementation of prevention and control measures.
2.6.1.3. In coordination with Bioenvironmental Engineering personnel and as directed by
the PHEO, examine facilities or materials that may endanger the public health. Provide
recommendations to the PHEO on exposure threats, control measures, the closing,
evacuation, or decontamination of any facility, or the need to decontaminate or destroy
any material contributing to the public health emergency.
2.6.1.4. Provide assistance in the development and delivery of risk communication
activities and products before, during, and after a public health emergency.
2.6.1.4.1. Assist the PHEO in notifying the public of the declaration and termination
of a public health emergency, the steps individuals should take to protect themselves,
and the actions being taken to control or mitigate the emergency.
2.6.1.4.2. Assist Public Affairs with developing communication materials for the
base population on actions to take to limit the spread of a disease before, during, and
after a public health emergency.
2.6.1.5. Provide assistance to the PHEO in the establishment of rules and protocols for
quarantine and isolation.
2.6.1.5.1. Issue quarantine and isolation orders per PHEO direction.
2.6.1.5.2. Ensure all requests for exemption or release of quarantine/isolation are
immediately reported to the PHEO.
2.6.1.6. Serve as the primary liaison with local, State, Federal, territorial, and host nation
public health officials. Maintain close contact and coordination with health officials who
track communicable diseases in the local community and who manage and respond to
public health emergencies. NOTE: Will facilitate the PHEO’s role of communicating
with civilian agency health officials by apprising the PHEO of meetings and exercises
attended with health agencies and assisting the PHEO in developing contacts with key
health agency leaders.
2.6.1.7. Assist PHEO in the development of Memorandums of Understanding (MOU)
and MOAs for SNS access/request protocols, mass prophylaxis planning, and other topics
necessary to coordinate the base and community response during a public health
emergency. SGA should assist in the technical writing of MOU/As.
2.6.1.8. Ensure public health emergency declarations and case reporting information is
coordinated using established disease reporting directives. See AFI 10-206 for specific
reporting procedures.
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2.6.1.8.1. Provide reports to the USAFSAM Epidemiology Consult Service
(including via the Air Force Reportable Events and Surveillance System) and local
civilian health agencies.
2.6.1.8.2. Notify MAJCOM/SGPM of all public health emergency declarations, who
will notify AFMSA/SGPM.
2.6.2. Bioenvironmental Engineering.
2.6.2.1. Provide health risk assessment advice, to include associated development of
environmental sampling and monitoring.
2.6.2.1.1. Assessment advice will include recommendations for exposure threats,
protective equipment, decontamination, and other control measures.
2.6.2.1.2. Results of all environmental testing will be immediately reported to the
PHEO.
2.6.2.2. Collaborate with the Public Health Officer, ICO, and Mission Support Group
Commander to assist the PHEO in the identification of appropriate isolation and
quarantine facilities.
2.6.2.3. Work with Public Health to examine facilities or materials that may endanger the
public’s health as directed by the PHEO. Provide recommendations on the closing,
evacuation, or decontamination of any facility or the need to decontaminate or destroy
any material contributing to the public health emergency.
2.6.3. Pharmacy.
2.6.3.1. Report to the PHEO and Public Health unusual drug prescription rates, types, or
trends that suggest a public health emergency.
2.6.3.2. Develop Mass Prophylaxis Plans (MPP) and conduct prophylaxis distribution
operations IAW AFI 41-106, Unit Level Management of Medical Readiness Programs.
Employ a mass prophylaxis point of dispensing (POD) upon direction from the MTF
commander. ANG wings must ensure they are included in State and local MPPs.
2.6.3.3. Provide reports and updates to the PHEO and Public Health on the types and
amounts of medical countermeasures available, and actions needed for coordination with
State and local health officials regarding SNS assets.
2.6.3.4. Provide reports and updates to the MTF commander and PHEO regarding the
status of POD operations and mass prophylaxis activities.
2.6.4. Laboratory.
2.6.4.1. Report results associated with any recognized public health event or emergency,
in addition to all reportable events listed in the latest published Tri-Service Reportable
Events Guidelines, published by the Armed Forces Health Surveillance Center, to Public
Health and the PHEO. Clinical specimens and/or environmental samples with
presumptive test results for biological agents that could suggest a public health
emergency will be reported to the PHEO.
2.6.4.2. In coordination with Public Health, develop a mechanism to extract electronic
laboratory data to enable ongoing disease surveillance efforts.
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2.6.4.3. Maintain a current list of appropriate clinical laboratory facilities for testing of
known and unknown infectious agents, to include:
2.6.4.3.1. Specimen types and quantities required of all tests that can be performed
inhouse.
2.6.4.3.2. All tests that will need to be referred, as well as the name, address, and
contact information of acceptable testing facilities and specific shipping requirements.
Include specimen types and quantities required.
2.6.4.3.3. Presumptive, contingency, or unknown agent samples, including the name,
address, and contact information for appropriate referral testing facilities (e.g.,
Centers for Disease Control and Prevention (CDC), Lovelace Biomedical and
Environmental Research Institute, USAFSAM).
2.6.4.4. Provide reports and updates to the PHEO, in coordination with base logistics,
regarding the shipping of potentially infectious material including limitations on
transport.
2.6.5. Healthcare providers and/or medical examiners will immediately report to the PHEO
and Public Health reports of illnesses or health conditions that suggest a public health
emergency. In the event of an emergency, they will adhere to official guidance received
from the PHEO.
2.6.6. The MTF ICO will assist in developing infection control guidelines for the MTF,
control measures for the emergency, and quarantine or isolation protocols as requested by the
PHEO. This includes, but is not limited to, recommendation of appropriate healthcare
worker Personal Protective Equipment, appropriate disinfectants and guidelines for use, and
general infection control guidelines for the population at risk. The ICO will also assist with
the identification of appropriate isolation and quarantine facilities.
2.6.7. Immunizations personnel will support planning and response to a public health
emergency by:
2.6.7.1. Developing vaccination requirements for mass vaccination / mass prophylaxis
POD plans.
2.6.7.2. Providing vaccination services during mass vaccination / mass prophylaxis POD
operations.
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Chapter 3
EMERGENCY HEALTH POWERS FOR INSTALLATION COMMANDERS
3.1. Public Health Emergency Declaration. In response to a suspected or confirmed public
health emergency, the Installation Commander in consultation with the PHEO may declare a
public health emergency and implement relevant emergency health powers as described in this
chapter. To the extent necessary for protecting or securing military property or places and
associated military personnel, such powers may also extend to non-military personnel who are
present on Air Force installations.
3.1.1. Emergency health powers prescribed in this Instruction shall not provide for the
apprehension, detention, or conditional release of individuals except for the purpose of
preventing the introduction, transmission, or spread of such communicable diseases as may
be specified in Executive Orders of the President upon the recommendation of the National
Advisory Health Council and the Surgeon General (i.e., Executive Order 13295, Revised List
of Quarantinable Communicable Diseases, amended by Executive Order 13375, Amendment
to Executive Order 13295 Relating to Certain Influenza Viruses and Quarantinable
Communicable Diseases).
3.1.2. Overseas Installation Commanders will exercise emergency health powers in
agreement with host nation authorities under applicable international agreements. The PHEO
will function as the Installation Commander’s primary public health advisor during an
emergency regardless of host nation actions.
3.2. Legal Authorities. During a declared public health emergency, the Installation
Commander has the legal authority to:
3.2.1. Collect specimens and perform tests on installation property or on any animal or
disease vector, living or deceased, as reasonable and necessary for the emergency response.
3.2.2. Close, evacuate, decontaminate, or destroy any affected material, asset, or facility.
NOTE: Commanders can close base facilities or the entire base prior to confirmatory
identification, which may take several days.
3.2.3. Assert control over any animal or disease vector that endangers public health.
3.2.4. Use facilities, materials, and services for communications, transportation, shelter, fuel,
food, clothing, healthcare, and other purposes as appropriate to control or restrict the
distribution of commodities throughout the response.
3.2.5. Control evacuation routes, incoming, and outgoing traffic on the installation.
3.2.6. Take measures to safely contain and dispose of infectious waste as necessary.
3.2.7. Take reasonable and necessary measures, IAW AFI 41-209, to obtain needed
healthcare supplies, and control use and distribution of such supplies to achieve the greatest
public health benefit.
3.2.7.1. Installation Commanders have local purchase approval authority for medical
materiel, non-medical materiel, and services.
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3.2.7.2. Installation Commanders may delegate this approval authority to an authorized
representative (usually the MTF Commander).
3.2.8. Direct military personnel to submit to medical examinations and/or testing as
necessary to diagnose or treat the condition of public health significance. Non-military
personnel may be required to submit to a physical examination and/or undergo testing or
treatment as a condition of exemption or release from restrictions of movement. The PHEO
will coordinate such actions with local health authorities as necessary. Privileged providers
will be responsible for all examinations and testing.
3.2.9. Restrict movement of military and non-military persons to prevent the introduction,
transmission, and spread of communicable diseases or any contaminant that could affect
human health.
3.2.9.1. The needs of persons or groups of persons quarantined or isolated shall be
addressed in a systematic and competent fashion. Places of quarantine shall be
maintained in a safe and hygienic manner, designed to minimize transmission of
infection/contamination or other harm to persons subject to quarantine. Adequate food,
clothing, medical care, and other necessities will be provided.
3.2.9.2. Persons subject to quarantine or isolation shall obey the rules and orders
established by the Installation Commander in consultation with the PHEO, shall not go
beyond the quarantine premises, and shall not put himself/herself in contact with any
person not subject to quarantine, except as the Installation Commander authorizes.
Public Health will assist the PHEO with tracking of persons subject to quarantine or
isolation.
3.2.9.3. No person may, without authorization, enter quarantine or isolation premises. A
person who by reason of unauthorized entry poses a danger to public health becomes
subject to quarantine.
3.2.9.4. Quarantine or isolation will be accomplished through the least restrictive means
available, consistent with protection of public health. Quarantine or isolation of any
person shall be terminated when no longer necessary to protect public health.
3.2.9.5. In the case of military personnel, ROM including isolation or any other measure
necessary to prevent or limit transmitting a communicable disease may be implemented.
Military personnel may be ordered to submit to diagnostic or medical treatment for the
condition of public health significance IAW CDC and Food and Drug Administration
guidelines.
3.2.9.6. In the case of persons other than military personnel, ROM may include isolation
or limiting ingress and egress to, from, or on an Air Force installation. Persons other than
military personnel may be required, as a condition of exemption or release from ROM, to
submit to vaccination or treatment diagnostics as necessary to prevent the transmission of
a communicable disease and enhance public health and safety. Submitting to
vaccination, treatment, or diagnostic testing for the disease of public health significance
may be a requirement for returning to work or gaining access to an Air Force installation.
In the United States, coordinate all ROM actions involving non-military personnel
through the nearest CDC Quarantine Officer.
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3.2.9.7. Quarantine or isolation measures may be implemented in healthcare facilities,
living quarters, or other appropriate buildings on an Air Force installation. These
measures do not lessen the responsibilities of the medical unit to provide medical care to
infected persons to the standard of care feasible given resources available.
3.2.9.8. In the case of ROM of persons other than military personnel on U.S.
installations, the PHEO will coordinate through his/her respective medical chain of
command in relation to CDC actions under quarantine authorities provided in this
Instruction; DoDI 6200.03; Sections 243, 248, 249 and 264-272 of Title 42 of the U.S.
Code; Parts 70 and 71 of Title 42 of the Code of Federal Regulations (CFR); and
Executive Orders 13295 and 13375.
3.2.9.9. With regard to emergency health powers, an Installation Commander’s authority
may be limited in scope as it pertains to host-nation personnel. OCONUS installations
will review their respective host-nation agreements and incorporate into their DCP the
authority local commanders possess as it pertains to host nation personnel. Coordination
of ROM actions will be sought with the Department of State and appropriate host-nation
public health officials.
3.2.9.10. Additional information regarding ROM can be found in AFI 102604.
3.3. Violation of Restriction of Movement: The Installation Commander will inform military
members and groups subject to U.S. criminal jurisdiction who are also subject to any emergency
health powers that violators of orders may be charged with a crime under 42 U.S. Code 271,
50 U.S. Code 797, and applicable State law, and be subject to punishment of a fine up to $1000
or imprisoned for not more than one year, or both.
3.3.1. In the case of U.S. military personnel, these potential sanctions are in addition to
applicable provisions of the Uniform Code of Military Justice, to the extent allowed by law.
3.3.2. In the case of any non-military person who refuses to obey or otherwise violates a
lawful order under this Instruction, the commander of an Air Force installation, under his
inherent authority, may detain those not subject to military law until civil authorities can
respond per Title 42 of the CFR, Part 70, Interstate Quarantine.
3.4. Contesting Restriction of Movement: Any persons subject to quarantine or isolation who
contest the reason for quarantine/isolation will be provided an opportunity to present information
supporting an exemption or release. The Installation Commander will make the final
determination on all requests for exemption or release.
3.4.1. Upon receiving a request for exemption or release, the PHEO will immediately
provide the information to the Installation Commander.
3.4.2. The PHEO will consult with appropriate medical and legal personnel regarding the
request for exemption or release to ensure he or she is informed of all pertinent facts prior to
providing a recommendation to the Installation Commander.
3.4.3. The PHEO will provide the requesting member with the commander’s written
decision on the quarantine exemption as soon as possible, but no more than 24 hours after
receipt of the member’s initial request.
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Chapter 4
PUBLIC HEALTH EMERGENCY WORKING GROUP
4.1. Mission Statement. The PHEWG oversees the planning and management of public health
emergency preparedness and response activities for the installation.
4.1.1. The PHEWG establishes the program structure for medical and public health
emergency management. The PHEWG is chaired by the PHEO and must be aligned as a
sub-group to an emergency management program body that is chaired by the installation
commander. The EMWG is the preferred oversight for the PHEWG; however, if the EMWG
is not chaired by the installation commander, then the PHEWG should align as a sub-group
to another emergency management program body (e.g., Threat Working Group,
Antiterrorism Working Group, etc.) as appropriate for the installation.
4.1.2. At a minimum the PHEWG will meet semi-annually, or more often as determined by
the PHEO.
4.1.3. The PHEWG will stand up as necessary to review and discuss health threat situations
and potential local actions needed (e.g., identified spread of human-to-human transmission of
highly pathogenic avian influenza in another country or region).
4.1.4. Actions and activities will be documented in PHEWG minutes, which will be
forwarded to the EMWG or other identified oversight group for approval.
4.2. PHEWG Membership:
4.2.1. Chair: Public Health Emergency Officer (PHEO).
4.2.2. Required Members:
4.2.2.1. Alternate PHEO (serves as chair in the absence of primary PHEO).
4.2.2.2. Installation Antiterrorism Officer.
4.2.2.3. Installation Plans Officer.
4.2.2.4. Bioenvironmental Engineer.
4.2.2.5. Chaplain.
4.2.2.6. Readiness and Emergency Management Representative.
4.2.2.7. Fire Emergency Services Representative.
4.2.2.8. Intelligence Officer.
4.2.2.9. Installation Exercise Office Representative.
4.2.2.10. Judge Advocate (JA) Representative.
4.2.2.11. Logistics Readiness Representative.
4.2.2.12. Medical Laboratory Officer.
4.2.2.13. Medical Readiness Officer.
4.2.2.14. Operations Group Representative.
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22 AFI10-2603 13 OCTOBER 2010
4.2.2.15. Pharmacist.
4.2.2.16. Public Affairs Representative.
4.2.2.17. Public Health Officer.
4.2.2.18. Security Forces Representative.
4.2.2.19. Force Support Squadron Representative.
4.2.3. Other Members: As appointed by the PHEO (e.g., tenant organization representative,
Installation Protection Program Contract Logistic Support Representative).
4.3. PHEWG Responsibilities. The PHEWG will:
4.3.1. Assist the Wing XP (or equivalent as appointed by the Installation Commander) to
create, update, and revise the installation’s DCP IAW AFI 10-2604. The members of the
PHEWG will develop their respective sections of the DCP as directed. All required
attachments to the DCP, including the pandemic influenza appendix and the installation
MPP, will also be completed with PHEWG participation and support.
4.3.2. Implement procedures for response to public health events and emergencies.
4.3.3. Establish installation guidance for the enactment and enforcement of emergency
health powers on the installation.
4.3.3.1. Develop procedures for declaring and reporting a public health emergency.
4.3.3.2. Ensure local and national statutes are reviewed to allow public health
intervention and implementation of ROM measures (to include quarantine and isolation)
in a lawful and timely manner.
4.3.3.3. Identify personnel responsible for coordination of and enforcement of ROM,
quarantine, and isolation measures.
4.3.3.4. Ensure protocols to address the needs of persons subject to emergency health
powers are developed in installation regulations and/or plans.
4.3.4. Coordinate activities with the Medical Readiness Staff Function on public health
emergency matters to include mass prophylaxis planning and surge capability requirements.
4.3.5. Assist with the planning and execution of the annual DCP exercise IAW AFI 10-2604.
All exercises will be done in conjunction with the Installation Exercise Evaluation Team.
4.3.5.1. Scenarios should consider naturally-occurring outbreaks and contingencies that
result in public health incidents.
4.3.5.2. Exercise requirements are coordinated with the Installation Antiterrorism Officer
and may be combined with existing annual installation Antiterrorism/Force Protection
exercises.
4.3.5.3. Exercises will include participants from all emergency response functions on the
installation and, as appropriate, local, State, Federal, and host-nation participants.
Installations are encouraged to align exercise and training schedules with those of local
civilian or host-nation preparedness programs.
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4.3.5.4. Exercises must test the installation's ability to declare a public health emergency
and institute appropriate response activities such as instituting ROM, closing of facilities,
decontamination, exposure assessments, epidemiological investigations and/or patient
surge requirements (Note: not all of these examples are required, only those appropriate
for the scenario).
4.3.5.5. Exercises must test and evaluate the MTF's ability to stand up a mass
prophylaxis POD and distribute medical countermeasures. The number of exposed
persons should be sufficient to test and stress the MTF and its available resources,
resulting in installation-wide support of the POD. The exercise must test request
protocols for receiving SNS assets or DoD contingency material stockpiles.
4.3.6. Assist the PHEO to tailor AF/SG3 standard training (see Paragraph 2.1.4) to execute
an installation-specific Public Health and Disease Outbreak Emergency Response Training
Program for installation senior leadership once every 24 months.
4.3.6.1. Public Health and Disease Outbreak Emergency Response Training is a
mandatory requirement for the following installation leadership positions:
4.3.6.1.1. Installation Commander.
4.3.6.1.2. Installation Vice-Commander.
4.3.6.1.3. All Group Commanders
4.3.6.1.4. The following Squadron Commanders due to their prominent roles in the
execution of the provisions in this Instruction: Aerospace Medicine, Civil Engineer,
Logistics Readiness, Medical Operations, Security Forces, and Force Support.
4.3.6.2. All members of the PHEWG, Command Chief Master Sergeant and all Group
Chiefs, deputy group commanders, and other key individuals identified by the installation
are also highly encouraged to attend.
4.3.6.3. Training will address:
4.3.6.3.1. An overview of existing standards for public health and disease outbreak
response, to include those required by this Instruction, the installation DCP, and other
emergency response plans used by the installation.
4.3.6.3.2. A review of emergency health powers available to the installation
commander during a public health emergency as described in this Instruction.
4.3.6.3.3. Specific pre-incident implementation actions unique to the installation that
require Command involvement and that each functional is responsible for.
4.3.6.3.4. An overview of NIMS, NRF, and AFIMS, with emphasis on the area
commands established under them.
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Chapter 5
STRATEGIC NATIONAL STOCKPILE AND MEDICAL COUNTERMEASURE
PLANNING REQUIREMENTS
5.1. Medical Countermeasure Sources. Public health emergency medical countermeasures are
used to prevent or mitigate the health effects of chemical, biological, radiological, and nuclear
(CBRN) threats and naturally occurring epidemics. Medical countermeasures include both
pharmaceuticals (e.g., vaccines, antibiotics, antivirals, antitoxins, etc.) and non-pharmaceuticals
(e.g., diagnostics, ventilators, personal protective equipment such as face masks and gloves, and
other devices).
5.1.1. Air Force installations will maintain a medical initial response capability for
responding to public health emergencies through the Home Station Medical Response
(HSMR) program. AFTTP 3-42.32, Home Station Medical Response to Chemical,
Biological, Radiological, Nuclear, or High-Yield Explosive (CBRNE) Events, provides
additional information on the HSMR program.
5.1.2. Air Force installations will maintain an initial response supply of medical
countermeasures using the Allowance Standard 886E, Pharmaceutical, which provides a
capability to support up to 300 CBRN casualties and 150 first responders.
5.1.3. Air Force installations will consider and plan for the use of DoD contingency material
stockpiles to respond to a public health emergency.
5.1.3.1. The DoD has established a limited number of contingency material stockpiles in
CONUS, Europe, and the Pacific Rim.
5.1.3.2. The DoD has established agreements with HHS and CDC for access to SNS
assets in the event of a domestic public health emergency. In addition, DoD has the
capability to send medical countermeasures from various sources via the Defense
Logistics Agency to both CONUS and OCONUS military installations.
5.1.3.3. During a public health emergency, the installation PHEO will contact his/her
MAJCOM PHEO Consultant and/or HAF PHEO for information on availability of DoD
contingency material prior to requesting access to SNS material. For additional
information on DoD contingency material stockpiles, contact AFMSA/SGXH at
[email protected] .
5.1.4. The SNS is a national repository of antibiotics, chemical antidotes, antitoxins,
life-support medications, intravenous administration fluids and sets, airway maintenance
supplies, and medical/surgical items established by the CDC. The SNS is designed to
supplement and re-supply State, local, tribal, and territorial public health agencies in the
event of a national emergency. It is capable of delivering vast amounts of medical
countermeasures (e.g., sufficient antibiotics for 10-day regimens for over 400,000 people)
within 12 hours to anywhere in the U.S. or its territories. The SNS is the primary domestic
source for medical countermeasures in a large-scale public health emergency. As such, Air
Force installations must develop agreements with their State, local, or territorial health
officials to be able to receive material from the SNS.
5.2. Strategic National Stockpile Planning Guidance.
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AFI10-2603 13 OCTOBER 2010 25
5.2.1. All Air Force installations in the United States and its territories must develop
MOU/As with their State, local, or territorial health agencies to receive SNS assets during a
public health emergency.
5.2.1.1. These agreements will be signed by the Installation Commander and the senior
representative from the coordinating agency (e.g., Director of the County or State Health
Department) and reviewed by the installation JA.
5.2.1.2. All MOU/As will contain a minimum of the following sections: introduction
and/or background, purpose of the memorandum, agreement terms and conditions,
effective period, modifications or amendments, and termination.
5.2.2. Air Force installations must also coordinate and integrate their CBRN response plans
with State, local, and territorial emergency response plans. This coordination and integration
will result in installations receiving SNS assets as part of the State, local, or territorial
government’s SNS distribution plan, as specified in the MOU/A. Military installations are
likely to receive SNS-managed inventory rather than a 12-hour Push Package. SNS assets
can be requested by the installation through its local health agency (i.e., PULLED) during a
public health emergency or assets can be delivered by their local health agency to the
installation as part of a State or National SNS distribution (i.e., PUSHED).
5.2.3. PULLED Requests. The decision to request SNS material must be made by the
Installation Commander in conjunction with his/her PHEO’s recommendation and should
only be made after a public health emergency has been declared. The need for medical
countermeasures must exceed the amounts available through the HSMR and any other
readily available materials. The installation will need to specify the amount and type of
materials needed and describe the scope and details of the public health emergency.
5.2.3.1. When SNS assets are requested to mitigate and respond to a public health
emergency, the Installation Commander must add this information (or send amendment)
to the OPREP-3 PINNACLE Report declaring a public health emergency. This report is
sent to the NMCC, who forwards it to the Secretary of Defense.
5.2.3.2. In addition to the OPREP-3 Report, the installation PHEO must forward the
information through the following chain using Section 1 of Attachment 6: PHEO to
MTF Commander, to MAJCOM (PHEO, SGP, and SGX), to AFMOA/SGAL and
AFMSA (PHEO, SGP, and SGX), to the AF/SG. The AF PHEO will forward the
information to OASD/HA and the appropriate Geographic Combatant Commander.
5.2.4. PUSHED Requests. The decision to accept SNS material being pushed for local area
distribution by the State, local, or territorial health agency must be made by the MTF
Commander in conjunction with his/her PHEO’s recommendation. This decision must
consider the material needs of the installation versus quantities already on hand and also with
consideration to the needs of the local civilian community versus the capability already on
hand by the installation. It should be a collaborative decision between the leadership of the
MTF and the State, local, or territorial health agency. The PHEO will notify the decision to
receive material through the following chain using Section 2 of Attachment 6: PHEO or
MTF Commander to MAJCOM (PHEO, SGP, and SGX), to AFMOA/SGAL and AFMSA
(PHEO, SGP, and SGX), to the AF/SG. The AF PHEO will forward this information to
ASD(HA) when requested.
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26 AFI10-2603 13 OCTOBER 2010
5.2.5. All material received from the SNS by the installation must be managed appropriately.
SNS material should be placed in a customer-owned assemblage by Medical Logistics and
tracked in the Defense Medical Logistics Standard Support (DMLSS) system. The Cost
Center 5233 has been created for installations to use as a means to track all material received.
Along with oversight by Medical Logistics, the Pharmacy Team Chief will manage all
pharmaceutical material and the Clinical Team Chief will manage all personal protective
equipment (PPE) for health care workers. Other team chiefs (as appropriate based on items
received) will be indentified to assist in managing and safeguarding the material.
5.3. Mass Prophylaxis Point of Dispensing.
5.3.1. A POD refers to the set-up and operations of a mass prophylaxis or vaccination clinic
to rapidly distribute and administer medication regimens to identified populations and to
educate recipients about the risks and benefits of the medical countermeasure regimen during
a public health emergency.
5.3.2. In accordance with DoDI 6200.03, military installations are prohibited from serving as
open PODs for SNS assets. An open POD is open to the public and available to all members
of the local community who arrive for treatment. Installations may not provide medical
countermeasures to non-beneficiary populations.
5.3.3. Installations are strongly encouraged to serve as closed PODs for SNS assets. A
closed POD is only available to certain target populations. Target populations for
installations to consider include initial victims or cases, emergency responders, critical and
mission essential personnel, population living on base, population working on base, or the
entire beneficiary population at risk. Installations should consider the following factors when
deciding on the scale of their MPP: (1) the size and number of target populations needed to
maintain installation operations and carry out the base’s mission, (2) the availability of local
civilian medical and public health resources during a public health emergency response, and
(3) the ability of the installation and its MTF to serve as a POD and provide medical
countermeasures to its entire beneficiary population.
5.3.4. All Air Force installations must have an MPP that is incorporated by (i.e., an annex
of) the installation’s DCP. The installation's MPP must contain planning factors for the
maximum number of DoD beneficiaries that can be treated, as well as which populations will
be treated by a base capability versus those that will be sent off base for treatment via local
supporting public health agencies. The MPP must describe the overall dispensing
procedures; the scale of response that is planned for; the organizational structure and teams
that will operate the POD; how operations will be conducted; and how the POD will be
activated, employed, and deactivated. A template Air Force MPP is available on the AFMS
KX, AFMSA/SGXH – Homeland Medical Plans Division website
(https://kx.afms.mil/kxweb/dotmil/kjPage.do?functionalArea=ForceProtection&cid=CT
B_103973).
5.3.5. All installations with plans to operate a closed POD must develop an MOU/A with
their State, local, or territorial health agencies. This information can be combined with the
MOU/A developed for receiving SNS assets (Paragraph 5.2.1). The MOU/A must specify
the planned installation capability and the planned support capability by the local health
agency and contain the components specified in Paragraph 5.2.1.2.
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AFI10-2603 13 OCTOBER 2010 27
5.4. Receiving, Staging, and Storage Sites.
5.4.1. Receiving, staging, and storage (RSS) sites are designated locations to accept SNS
assets, store the material long-term, and either have plans to set up an adjacent POD or
rapidly ship the material to designated PODs. As such, RSS sites require significant
warehouse space, as well as cargo management and logistical assets, in order to apportion,
palletize, and ship material. Warehouses for RSS sites typically require anywhere from
10,000-50,000 square feet of available space. Personnel who support RSS sites must have
complete availability to support the site during a public health emergency.
5.4.2. Air Force installations are authorized to serve as RSS sites. This decision must be
made by the Installation Commander in consultation with his/her PHEO and other applicable
persons (e.g., MTF Commander, Mission Support Group Commander, JA, etc.). However,
the decision to serve as an RSS site should be made very judiciously and must consider the
requirements of the RSS site, the ability of the installation to operate the RSS site during a
public health emergency, and the populations that the material at the RSS site is intended to
cover.
5.4.2.1. Costs and manpower requirements associated with becoming an RSS site should
be incurred by the installation (and not the MTF).
5.4.2.2. Installations should only serve as RSS sites in order to assist with storing
material designated for beneficiary populations or for other government agencies.
Installations should not serve as RSS sites to store material designated for mass civilian
populations. NOTE: an exception to this point may be made for Air National Guard
installations.
5.4.2.3. All installations that will serve as an RSS site must develop an MOU/A with
their State, local, or territorial health agencies. This MOU/A must be separate from any
other established MOU/As, signed by the Installation Commander, and contain the
components specified in Paragraph 5.2.1.
5.4.3. Installations that agree to serve as an RSS site must gain approval prior to signing the
MOU/A.
5.4.3.1. The Installation Commander must report the request through his/her chain of
command to the Secretary of the Air Force for approval.
5.4.3.2. The PHEO must provide notification through the following chain using Section
3 of Attachment 6: PHEO to MTF Commander, to MAJCOM (PHEO, SGP, and SGX),
to AFMOA/SGAL and AFMSA (PHEO, SGP, and SGX), to the AF/SG. The AF PHEO
will forward the request to OASD/HA and the appropriate Geographic Combatant
Commander.
5.4.3.3. ANG units will coordinate requests for approval to be RSS sites through their
chain of command and their JFHQ-State and not through the DoD.
5.5. Overseas Installations.
5.5.1. Air Force OCONUS installations have an initial response capability for responding to
public health emergencies through the HSMR program. HSMR provides a capability to
manage and treat at least 300 CBRN casualties for at least 24 hours using the 886 AS
equipment packages, including AS 886E, Pharmaceuticals.
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28 AFI10-2603 13 OCTOBER 2010
5.5.2. In the event of a larger scale public health emergency, Air Force OCONUS
installations will receive additional medical countermeasures and material from DoD
contingency material stockpiles or from other sources acquired by DoD. Material will be
shipped via DLA, who will send the material through the appropriate Theater Lead Agent for
Medical Material. OCONUS PHEOs will coordinate with the MAJCOM PHEO Consultant
to ensure appropriate coordination requirements for requesting and receiving medical
countermeasures are described within their DCPs.
5.5.3. Should a public health emergency occur at an OCONUS Air Force installation and
exceed the capabilities of the HSMR program, the decision to request additional medical
countermeasures must be made by the Installation Commander in conjunction with his/her
PHEO’s recommendation and should only be made after a public health emergency has been
declared.
5.5.3.1. The installation will need to specify the amount and type of materials needed
and describe the scope and details of the public health emergency. This request must be
made through the installation’s chain of command to the Geographic Combatant
Commander, who will forward the request to the Secretary of Defense.
5.5.3.2. The PHEO must also report the request through the following chain using
Section 1 of Attachment 6: PHEO to MTF Commander, to MAJCOM (PHEO, SGP,
and SGX), to AFMSA (PHEO, SGP, and SGX), to the AF/SG. The AF PHEO will
collaborate on the request with the OASD/HA and the appropriate Geographic
Combatant Commander.
5.5.4. All OCONUS Air Force installations will develop plans to serve as a closed POD to
that installation’s entire beneficiary population. The installation must have an MPP as part of
its DCP that contains the required components as described in Paragraph 5.3.4.
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Chapter 6
AIR NATIONAL GUARD
6.1. Purpose. This chapter specifies the role of the ANG and outlines the flow of information in
the event of a public health emergency. It identifies the roles and responsibilities of key players
in the reporting and information flow. ANG units may not have the resident capability and
personnel to prepare for and respond to a public health emergency; as a result, units must refer to
JFHQ-State and the NGB for guidance and rely primarily on the State and civilian agencies/local
authorities for emergency response.
6.2. Roles and Responsibilities
6.2.1. Governor. The governor of each state, acting as Commander in Chief of the State
militia, may activate National Guard troops under the limitations of the laws of the state.
Usually, State law permits the governor to activate the National Guard as a State militia to
respond to a need for governmental services that exceed local and State civilian capabilities.
6.2.2. The Adjutant General. The adjutant general (TAG), in most states, is appointed by the
governor and serves as commander of that state’s National Guard. Some TAGs also serve as
the Director of the Division of Emergency Management and Director of Homeland Security
for their state.
6.2.3. State Air Surgeon. The State Air Surgeon (SAS) is the primary liaison among TAG,
Joint State Surgeon, Air Surgeon (NGB/SG), the Medical Group (MDG), or Aeromedical
Evacuation Squadron and enhances the ability of the ANG to properly perform their State
and Federal missions related to medical aspects of force protection, homeland security, and
other matters. The SAS ensures that the state maintains a viable and healthy force for
worldwide deployment. The SAS coordinates with other ANG SASs within the Federal
Emergency Management Agency region to identify military medical capabilities.
6.2.4. Joint Force Headquarters - State. JFHQ-State is responsible to:
6.2.4.1. Provide command and control of all National Guard forces in the state or
territory for the governor, or in the case of the District of Columbia, the Secretary of the
Army.
6.2.4.2. Support Joint Task Force - State (JTF-State) Commanders and all National
Guard units within the state, and act as an information channel to the NGB Joint
Coordination Center and combatant commanders for public health emergencies.
6.2.4.3. Coordinate any additional support required, such as mobilization of extra forces
or providing other support.
6.2.4.4. Support units in their state or territory, providing command and control of
National Guard medical forces. In turn, they will serve as the liaison between the
State/local medical authorities, NGB, and Wing PHEO-LNO.
6.2.5. Joint Task Force - State. JTF-State provides command and control of all State
military assets deployed in support of civil authorities or a specific incident, and facilitates
the flow of information between the JFHQ-State and the deployed units. Specifically, the
JTFState commander:
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30 AFI10-2603 13 OCTOBER 2010
6.2.5.1. Works closely with the incident commander in an effort to maintain situational
awareness of local, State, and Federal actions to ensure the adequacy and effectiveness of
response, support, and safety activities.
6.2.5.2. Serves as the senior military commander on the scene and is therefore
responsible for the safe and efficient employment of all assigned military forces.
6.2.5.3. May request JFHQ-State activate and deploy additional units (e.g., Emergency
Management Assistance Compact requests), if additional forces are required.
6.2.6. State ANG Public Health Emergency Officer - Liaison Officer. The State ANG
PHEOLNO will be designated at the JFHQ-State level and should be a full-time senior
ranking individual, preferably a member of the Medical Corps. This individual will serve in
the role of State ANG PHEO-LNO until the SAS is available to assume the role, as
necessary. The State ANG PHEO-LNO will:
6.2.6.1. Coordinate emergency medical activities and information between the
State/territory, Wing PHEO-LNO, and ground support units.
6.2.6.2. Maintain a contact list of all ANG PHEO-LNOs in their State/territory.
6.2.7. National Guard Bureau. The NGB serves as both a staff and forward operating
agency. NGB provides guidance for the federal functions of the ANG; however, the State
has primary control.
6.2.7.1. NGB/SG Chief of Aerospace Medicine. The NGB/SGP will serve as the
primary PHEO consultant for the ANG and will:
6.2.7.1.1. Complete all PHEO training requirements listed in Attachment 2 with the
exception of the requirements specified in Paragraph A2.5.
6.2.7.1.2. Provide expertise and guidance as needed to State and Wing PHEOLNOs.
6.2.7.1.3. Maintain contact information for all State PHEO-LNOs.
6.2.7.1.4. Provide NGB-specific guidance on public health emergency planning
activities to supplement guidance from Office of the Secretary of Defense (OSD), AF,
and JFHQState, as necessary.
6.2.7.1.5. Coordinate information and requirements to OSD, AF, JFHQ-State, and
ANG wings during public health emergencies.
6.2.7.1.6. Coordinate all formal communications with the ANG Crisis Action Team
for relay to Wing Command Centers.
6.2.7.1.7. NGB/SGPA or NGB/SGPM will assume the role of alternate PHEO and
accomplish all training as outlined in Attachment 2 with the exception of the
requirements specified in Paragraph A2.5.
6.2.8. ANG Wing Commander. The ANG Wing Commander will:
6.2.8.1. Review their respective emergency response plans and incorporate measures that
are reasonable and appropriate given their situation. At a minimum, such measures will
include coordination of emergency response procedures and plans with applicable local
and/or State authorities.
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AFI10-2603 13 OCTOBER 2010 31
6.2.8.1.1. Commanders of ANG units not collocated on active duty military
installations (stand-alone units) are encouraged to communicate identified health
threats to the DoD Installation PHEO in their catchment area.
6.2.8.1.2. Commanders of ANG units collocated on a military installation will follow
the installation commander’s guidelines and response plans upon which the unit
resides.
6.2.8.2. Coordinate all public health emergency activities with JFHQ-State and with
NGB, as necessary.
6.2.8.3. Appoint a senior ranking, full time medical staff member as the Wing PHEO-
LNO to assist until the MDG/SGP or appointed medical professional with public health
emergency response experience are activated, as necessary.
6.2.8.4. Ensure that the Wing PHEO-LNO has adequate support and resources to
accomplish their mission.
6.2.8.5. Ensure involvement with State/local public health exercises and training using
scenarios that consider naturally-occurring outbreaks and contingencies that result in
public health emergency incidents.
6.2.8.6. Document involvement of public health/medical exercises with the state/territory
and lessons learned in wing-level working group minutes.
6.2.9. Wing Public Health Emergency Officer - Liaison Officer. The Wing PHEO-LNO
will:
6.2.9.1. Act as an information transfer center to coordinate medical activities and
information with the State ANG PHEO-LNO, wing commanders, Public Affairs, and unit
personnel.
6.2.9.2. Establish contact with NGB/SGP PHEO if further guidance or subject matter
expertise is required.
6.2.9.3. Maintain an emergency contact/coordination list for all assigned ground support
units.
6.2.10. Medical Group Chief of Aerospace Medicine. MDG/SGP will assume the role of
wing level PHEO-LNO immediately upon recall, if necessary. If the MDG/SGP is
unavailable, the MDG/CC or MDG/SGP will appoint a senior ranking medical provider with
public health emergency response experience.
6.2.11. Other Medical Personnel. All other ANG medical personnel will follow roles and
responsibilities as outlined in Paragraph 2.6.
6.3. Public Health Emergency Working Group. The establishment of a PHEWG is not
required for the ANG. Chapter 4 will serve only as a reference document to assist the Wing XP
(or equivalent as appointed by the Wing Commander) to create, update, and revise the Wing
DCP IAW AFI 10-2604 and coordinate public health emergency activities.
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32 AFI10-2603 13 OCTOBER 2010
Chapter 7
PRESCRIBED AND ADOPTED FORMS
7.1. AF Form 847, Recommendation for Change of Publication.
PHILLIP M. BREEDLOVE, Lt Gen, USAF
DCS, Operations, Plans, and Requirements
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AFI10-2603 13 OCTOBER 2010 33
Attachment 1
GLOSSARY OF REFERENCES AND SUPPORTING INFORMATION
References
National Response Framework, January 2008
National Incident Management System, December 2008
Title 5, United States Code, Section 301
Title 10, United States Code, Sections 113, 142, 1074, 3013, 5013, 8013
Title 18, United States Code, Section 1382
Title 42, United States Code, Sections 243, 247d, 248, 249, 264-272, 319, 1856, 1856a
Title 50, United States Code, Section 797
Title 42, Code of Federal Regulations, Part 70, Interstate Quarantine, current edition
Title 42, Code of Federal Regulations, Part 71, Foreign Quarantine, current edition
Executive Order 13295, Revised List of Quarantinable Communicable Diseases, April 4, 2003,
http://www.archives.gov/federal-register/executive-orders/disposition.html
Executive Order 13375, Amendment to Executive Order 13295 Relating to Certain Influenza
Viruses and Quarantinable Communicable Diseases, April 1, 2005,
http://www.archives.gov/federal-register/executive-orders/disposition.html
Centers for Disease Control and Prevention, Public Health Guidance for Community-Level
Preparedness and Response to Severe Acute Respiratory Syndrome (SARS) Version 2,
Supplement D, January 8, 2004
Joint Basing Implementation Guidance, January 22, 2008
DoD Directive (DoDD) 6200.02, Application of Food and Drug Administration (FDA) Rules to
Department of Defense Force Health Protection Programs, February 27, 2008
DoDD 6205.3, DoD Immunization Program for Biological Warfare Defense, November 26,
1993
DoDI 2000.18, Department of Defense Installation Chemical, Biological, Radiological, Nuclear
and High-Yield Explosive Emergency Response Guidelines, December 4, 2002
DoDI 6055.17, Installation Emergency Management Program, January 13, 2009
DoDI 6200.03, Public Health Emergency Management, March 5, 2010
DoD Regulation 6025.18-R, DoD Health Information Privacy Regulation, January 24, 2003
HQ USAF/SG3 Memorandum dated 12 February 2010 SUBJECT: Public Health Emergency
Officer (PHEO) Appointment and Training Requirements
AFPD 10-8, Homeland Defense and Civil Support, 7 September 2006
AFPD 10-25, Emergency Management, 26 September 2007
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34 AFI10-2603 13 OCTOBER 2010
AFPD 10-26, Counter-Chemical, Biological, Radiological, and Nuclear Operations,
26 September 2007
AFI 10-206, Operational Reporting, 15 October 2008
AFI 10-801, Assistance to Civilian Law Enforcement Agencies, 15 April 1994
AFI 10-802, Military Support to Civil Authorities, 19 April 2002
AFI 10-2501, Air Force Emergency Management (EM) Program Planning and Operations,
24 January 2007 (Incorporating Through Change 2, 6 April 2009)
AFI 10-2604, Disease Containment Planning Guidance, 6 April 2007 (Incorporating Change 1,
12 November 2008)
AFI 34-242, Mortuary Affairs Program, 2 April 2008 (Incorporating Change 1, 30 April 2008)
AFI 41-106, Unit Level Management of Medical Readiness Programs, 14 April 2008,
(Incorporating Through Change 2, 28 July 2009)
AFI 41-209, Medical Logistics Support, 30 June 2006 (Incorporating through Change 4,
30 July 2009)
AFI 41-210, Patient Administration Functions, 22 March 2006
AFI 48-105, Surveillance, Prevention, and Control of Diseases and Conditions of Public Health
or Military Significance, 1 March 2005 (Incorporating Change 1, 1 August 2006)
AFI 51-701, Negotiating, Concluding, Reporting, and Maintaining International Agreements,
6 May 1994
AFI 90-1601, Air Force Lessons Learned Program, 26 June 2008
AFMAN 10-2502, Air Force Incident Management System (AFIMS) Standards and Procedures,
25 September 2009
AFMAN 33-363, Management of Records, 1 March 2008
AFMAN 44-156(I), Treatment of Biological Warfare Agent Casualties, 17 July 2000
(Incorporating Change 1, 8 July 2002)
Air Force Joint Instruction 48-110, Immunization and Chemoprophylaxis, 29 September 2006
AFTTP 3-2.33, Multiservice Tactics, Techniques, and Procedures for Installation CBRN
Defense, 1 November 2007
AFTTP 3-2.37, Multiservice Tactics, Techniques, and Procedures for Chemical, Biological,
Radiological, and Nuclear Consequence Management Operations, 12 December 2001
AFTTP 3-42.32, Home Station Medical Response to Chemical, Biological, Radiological,
Nuclear, or High-Yield Explosive (CBRNE) Events, 20 April 2004
Acronyms
AAR— After Action Report
AERO— Air Force Emergency Response Operations
AFI— Air Force Instruction
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AFI10-2603 13 OCTOBER 2010 35
AFIMS— Air Force Incident Management System
AFMAN— Air Force Manual
AFMS— Air Force Medical Service
AFMSA— Air Force Medical Services Agency
AFPD— Air Force Policy Directive
AFTTP— Air Force Tactics, Techniques, and Procedures
ANG— Air National Guard
ARC— Air Reserve Component
ASD(HA)— Assistant Secretary of Defense, Health Affairs
CBR— Chemical, Biological, and Radiological
CBRN— Chemical, Biological, Radiological, and Nuclear
CDC— Centers for Disease Control and Prevention
CEMP— Comprehensive Emergency Management Plan
CFR— Code of Federal Regulations
CONUS— Continental United States
DCP— Disease Containment Plan
DMLSS— Defense Medical Logistics Standard Support
DoD— Department of Defense
DoDI— Department of Defense Instruction
EMWG— Emergency Management Working Group
ESSENCE— Electronic Surveillance System for Early Notification of Community-based
Epidemics
GMRS— Global Medical Readiness Symposium
GSU— Geographically Separated Unit
HAF— Headquarters Air Force
HHS— Department of Health and Human Services
HLSMPC— Homeland Security Medical Professional Course
HSMR— Home Station Medical Response
IAW— In Accordance With
ICO— Infection Control Officer
JBIG— Joint Basing Implementation Guidance
JFHQ—State Joint Forces Headquarters - State
JTF—State Joint Task Force - State
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36 AFI10-2603 13 OCTOBER 2010
MAJCOM— Major Command
MCBC— Medical Management of Chemical and Biological Casualties
MCRP— Medical Contingency Response Plan
MDG— Medical Group
MOA— Memorandum of Agreement
MOU— Memorandum of Understanding
MPP— Mass Prophylaxis Plan
MTF— Medical Treatment Facility
NGB— National Guard Bureau
NIMS— National Incident Management System
NMCC— National Military Command Center
NRF— National Response Framework
OCONUS— Outside the Continental United States
OPREP3—Operational Status Reports-3
OSD— Office of the Secretary of Defense
PHEO— Public Health Emergency Officer
PHEO—LNO - Public Health Emergency Officer - Liaison Officer
PHEWG— Public Health Emergency Working Group
POD— Point of Dispensing
PPE— Personal Protective Equipment
ROM— Restriction of Movement
RSS— Receiving, Staging, and Storage
SARS— Severe Acute Respiratory Syndrome
SAS— State Air Surgeon
SGP— Chief of Aerospace Medicine
SGPM— Installation Public Health
SNS— Strategic National Stockpile
TAG— The Adjutant General
USAFSAM— United States Air Force School of Aerospace Medicine
Terms
12-hour Push Package— Part of the SNS, 12-hour Push Packages are caches of
pharmaceuticals, antidotes, and medical supplies designed to provide rapid delivery of a broad
spectrum of assets for an ill defined threat in the early hours of an event. These Push Packages
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are positioned in strategically located, secure warehouses ready for immediate deployment to a
designated site within 12 hours of the federal decision to deploy SNS assets.
Antiterrorism— Defensive measures used to reduce the vulnerability of individuals and
property to terrorist acts, to include limited response and containment by local military forces.
Biological Agent— A microorganism that causes disease in personnel, plants, or animals or
causes the deterioration of material.
CBRN Incident— The deliberate or inadvertent release of chemical, biological, radiological, or
nuclear devices with potential to cause significant numbers of casualties and high levels of
destruction.
Communicable Disease— An illness due to an infectious agent or its toxic product, which may
be transmitted from a reservoir to a susceptible host either directly as from an infected person or
animal or indirectly through an intermediate plant or animal host, vector, or the inanimate
environment.
Communicable Period— The time during which an infectious agent may be transferred directly
or indirectly from an infected person to another person, from an infected animal to humans, or
from an infected person to animals, including arthropods.
Confirmatory Testing— A process that provides for the identification of a suspect biological
warfare (BW) agent by means of devices, materials, or technologies that detect biological
markers using two or more independent biological marker results. The field confirmation
identification process can be accomplished in a matter of hours (6 to 8 hours). Examples might
include the findings of the presumptive biomarker identification with the addition of a positive
polymerase chain reaction, enzyme-linked immunosorbent assay, or electrochemiluminescence
results, using specific target nucleic acid sequences for the organism and antibody recognition of
agent specific antigen sites, respectively. This is equivalent to field sample or specimen
identification conducted by forward-deployed or forward-positioned laboratories such as the
United States Air Force biological augmentation team, the Army Medical Laboratory, forward-
deployed preventive medical unit (U.S. Navy), or homeland security Laboratory Response
Network Level B or C asset (U.S. Army community hospitals or medical centers). BW agent
field confirmation identification is also available aboard selected aircraft carriers and amphibious
ships, and selected medical facilities. These laboratories also have a reach-back capability with a
definitive lab for consultation.
Consequence Management— Air Force CBRN consequence management involves responding
to the effects of CBRN use against the U.S., its military forces, and its interests abroad, by
assisting the U.S. and its allies to restore essential services in a permissive environment.
Contact— A person or animal having contact with an infected person or animal or a
contaminated environment resulting in an opportunity to acquire the infection/disease of interest.
Close Contact. Having cared for, lived with or been in close proximity with an infected person.
Examples of close contact include kissing or embracing, sharing eating or drinking utensils,
close conversation (<3 feet), physical examination, and any other direct physical contact between
persons. Close contact does not include activities such as walking by a person or briefly sitting
across a waiting room or office.
Household Contact. A close contact living in the same household as an infected person.
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Crisis Management— Measures to identify, acquire, plan, and use the resources needed to
anticipate, prevent, and resolve a threat or act of terrorism.
Disease Vector— An organism, such as an insect, that transmits disease-causing pathogens.
First Responders— Firefighters, law enforcement and/or security personnel, and emergency
medical personnel who provide the initial, immediate response.
Force Protection— Security programs designed to protect Service members, civilian
employees, their family members, facilities, information, and equipment in all locations and
situations, accomplished through the planned and integrated application of combating terrorism
efforts, physical security, operations security, personal protective services, and supported by
intelligence, counterintelligence, and security programs.
Installation— A grouping of facilities, located in the same vicinity, which support particular
functions. Installations may be elements of a base.
Installation Commander— The individual responsible for all operations performed by an
installation.
Medical Treatment Facility— A facility established for the purpose of furnishing medical
and/or dental care to eligible individuals.
Memorandum of Agreement— An agreement that defines areas of responsibility and
agreement between two or more parties, normally at headquarters or MAJCOM level. MOAs
normally document the exchange of services and resources and establish parameters from which
support agreements may be authorized.
Memorandum of Understanding— An umbrella agreement that defines broad areas of mutual
understanding between two or more parties, normally at MAJCOM or higher level.
Natural Disaster— An emergency situation posing significant danger to life and property that
results from a natural cause.
Non-Military Personnel— Civilian personnel, dependents of military or civilian personnel,
contractors, and other individuals visiting or who are present on an Air Force installation.
National Response Framework— Guides how the Nation conducts all-hazards response. The
Framework documents the key response principles, roles, and structures that organize national
response. It describes how communities, States, the Federal Government, and private-sector and
non-governmental partners apply these principles for a coordinated, effective national response.
And it describes special circumstances where the Federal Government exercises a larger role,
including incidents where Federal interests are involved and catastrophic incidents where a State
would require significant support. It allows first responders, decision makers, and supporting
entities to provide a unified national response.
Public Health Emergency— An occurrence or imminent threat of an illness or health condition
that may be caused by a biological incident, manmade or naturally occurring; the appearance of a
novel or previously controlled or eradicated infectious agent or biological toxin; natural disaster;
chemical attack or accidental release; radiological or nuclear attack or accident; or high-yield
explosives that poses a high probability of a significant number of deaths, serious or long-term
disabilities, widespread exposure to an infectious or toxic agent, and/or healthcare needs that
exceed available resources.
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AFI10-2603 13 OCTOBER 2010 39
Quarantinable Communicable Disease— Consistent with Executive Order 13295, as amended
by Executive Order 13375, includes Cholera or suspected Cholera, Diphtheria, infectious
Tuberculosis, Plague, Smallpox, Yellow Fever, SARS, Viral Hemorrhagic Fevers (Lassa,
Marburg, Ebola, Congo-Crimean, South American, and others not yet isolated or named), and
influenza caused by novel or re-emergent influenza viruses that are causing, or have the potential
to cause, a pandemic. Any subsequent changes to Executive Order 13295 are automatically
incorporated into this definition.
Restriction of Movement— Limiting personnel movement to prevent or limit the transmission
of a communicable disease, including limiting ingress and egress to, from, or on a military
installation; isolation; and/or quarantine.
Social Distancing. Intervention applied to specific groups, an entire community, or a
region designed to reduce interactions and thereby transmission risk within the group.
Examples include implementing altered work schedules (e.g., telework, staggered shifts)
and replacing face—to-face meetings with teleconferences.
Quarantine. Voluntary or compulsory separation and ROM of persons who are not ill but have
been exposed to an infectious agent and therefore may become infectious, for the purpose of
preventing or limiting the spread of disease.
Working Quarantine. Persons are permitted to work but must observe activity restrictions
while off duty. Monitoring for fever and other symptoms before reporting for work is usually
required. Use of appropriate PPE while at work is required.
Isolation. The separation of a person or group of persons infected with a communicable disease,
while such disease is in a communicable stage, from other people to prevent the spread of
infection.
Strategic National Stockpile— A national repository of medicine and medical supplies
maintained by the CDC. The SNS supplements overwhelmed or depleted State and local
medical materiel to protect the American public if there is a public health emergency
(e.g., CBRN events, natural disasters, industrial accidents, terrorist attacks, and contagious
disease outbreaks) severe enough to cause local supplies to run out.
Terrorism— Any activity that involves an act that is dangerous to human life or potentially
destructive of critical infrastructure or key resources; and is a violation of the criminal laws of
the United States or of any State or other subdivision of the United States. This act appears to be
intended to intimidate or coerce a civilian population; to influence the policy of a government by
intimidation or coercion; or to affect the conduct of a government by mass destruction,
assassination, or kidnapping.
Vulnerability— The susceptibility of a nation or military force to any action by any means
through which its war potential or combat effectiveness may be reduced or its will to fight is
diminished.
Zoonotic Disease— A disease that can be transmitted from animals to people or, more
specifically, a disease that normally exists in animals but that can infect humans. There are
multitudes of zoonotic diseases that are caused by bacteria, viruses, or parasites. Zoonotic
diseases can be acquired from vector, food, or water sources or through direct contact with
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40 AFI10-2603 13 OCTOBER 2010
animals. Zoonotic diseases can cause a wide variety of symptoms such as diarrhea, muscle
aches, and fevers, and can be life threatening.
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Attachment 2
PUBLIC HEALTH EMERGENCY OFFICER TRAINING REQUIREMENTS
A2.1. The PHEO and alternate PHEO must possess certain skills and will be required to take
training courses both prior to and upon assignment to the position. These training requirements
provide the minimum knowledge necessary for a PHEO to effectively support the Installation
Commander during a public health emergency. This required training was outlined in the
HQ USAF/SG Memorandum, Public Health Emergency Officer (PHEO) Appointment and
Training Requirements, dated 12 February 2010, and is superseded by this Instruction.
A2.2. The following courses are pre-requisites and must be completed prior to appointment to
the position of PHEO or alternate PHEO:
A2.2.1. CBRN Web-Based Training Course (Clinical Long Module) available online
through Joint Knowledge Online (http://jko.jfcom.mil/).
A2.2.2. Air Force Emergency Response Operations (AERO) Course. AFIMS Training is
available through the Advanced Distributed Learning System on the Air Force Portal
(https://www.my.af.mil). The AERO course covers material in the Federal Emergency
Management Agency independent study (IS) courses 100, 200, 700, 775, and 800.
A2.3. Requisite training must be completed within one year of appointment as a PHEO or
alternate PHEO. AFMSA/SG3P and AFMSA/SGXH are working with applicable agencies to
develop a centralized and independent PHEO training course, where attendance will satisfy all
training requirements. Until the PHEO training course is developed there are three methods to
accomplish training requirements (one of the following three options is required):
A2.3.1. Attend the 2009 Global Medical Readiness Symposium (GMRS) or a subsequent
GMRS where basic PHEO training is provided. Attendees will receive PHEO training
certification upon completion of all required courses at the symposium.
OR
A2.3.2. Attend the Homeland Security Medical Professional Course (HLSMPC)
(in residence).
OR
A2.3.3. Attend the Medical Management of Chemical and Biological Casualties (MCBC)
course (prior to the end of 2009) or attend the HLSMPC or the GMRS PHEO training
(after 2009).
A2.4. Recommended training. Attendance at the below courses is highly encouraged. Course
handbooks (i.e., Medical Management of Biological Casualties and Medical Management of
Chemical Casualties) should be obtained and reviewed.
A2.4.1. MCBC Course. Handbooks available at the United States Army Medical Institute
for Infectious Disease and United States Army Medical Research Institute of Chemical
Defense homepages at no cost to military.
A2.4.1.1. Medical Management of Biological Casualties
(http://www.usamriid.army.mil/).
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A2.4.1.2. Medical Management of Chemical Casualties
(http://usamricd.apgea.army.mil/).
A2.4.2. Medical Effects of Ionizing Radiation Course. A new handbook on Medical
Management of Radiological Casualties is available through http://www.afrri.usuhs.mil/.
A2.5. PHEOs and alternate PHEOs will send copies of all training certification to their
MAJCOM/SGP, who will annotate on their PHEO listing whether or not the member has
completed all training requirements.
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AFI10-2603 13 OCTOBER 2010 43
Attachment 3
TEMPLATE: DECLARATION OF A PUBLIC HEALTH EMERGENCY
A3.1. General. The content that follows will be added to Installation or Wing letterhead (as
appropriate) with the appropriate information completed in the italicized fields contained within
brackets. The document will be signed by the Installation Commander. Upon signing, the
information therein must be communicated to the installation population using the most effective
and timely means available (e.g., featured at a Commander’s Call, an e-mail from the
commander to the base population, photocopies of the memorandum handed out at the gates,
closed-circuit television announcement, etc.). Additional guidance or information on the public
health emergency will be formulated by the PHEO and attached to this memorandum prior to
distribution. The content should be altered, as necessary, for use in overseas areas depending on
the Status of Forces Agreement, basing arrangements, or other understandings with local
officials.
{DATE}
MEMORANDUM FOR RECORD
FROM: {Wing or Installation Commander Designation}
SUBJECT: Declaration of a Public Health Emergency
I have been notified by my Public Health Emergency Officer (PHEO) of a possible public
health situation on our installation involving {agent or disease name} that requires immediate
action. Based on the PHEO’s recommendations and the results of a preliminary investigation, I
am declaring a public health emergency in accordance with Air Force Instruction (AFI) 10-2603,
Emergency Health Powers on Air Force Installations. This declaration will terminate
automatically 30 days from the date of this memorandum unless it is renewed and re-reported, or
terminated sooner by myself or a senior commander in the chain of command.
The installation PHEO and Public Health personnel are hereby directed to identify,
confirm, and control this public health emergency utilizing all the necessary means outlined in
AFI 10-2603. To implement my direction, the PHEO may issue guidance that affects installation
personnel and property, and other individuals working, residing, or visiting this installation
(e.g., closing base facilities, restricting movement, or implementing quarantine for select
individuals).
The installation command and the PHEO will coordinate activities and share information
with Federal, State, and local {NOTE: for OCONUS commands, replace “Federal, State, and
local” with “host nation”} officials responsible for public health and public safety to ensure our
response is appropriate for the public health emergency. Shared information may include
personally identifiable health information only to the extent necessary to protect the public health
and safety.
Any person who refuses to obey or otherwise violates an order during this declared public
health emergency will be detained. Those not subject to military law will be detained until civil
authorities can respond. Violators of procedures, protocols, provisions, and/or orders issued in
conjunction with this public health emergency may be charged with a crime under the Uniform
Code of Military Justice and/or under Title 42, United States Code, Section 271. Pursuant to 42
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44 AFI10-2603 13 OCTOBER 2010
U.S.C. 271, violators are subject to a fine up to $1,000 or imprisonment for not more than one
year, or both.
{Signature Block}
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AFI10-2603 13 OCTOBER 2010 45
Attachment 4
TEMPLATE: NOTICE OF QUARANTINE
A4.1. General. The content that follows will be added to Installation or Wing letterhead (as
appropriate) with the appropriate information completed in the italicized fields contained within
brackets. The document will be signed by the PHEO, and photocopies will be provided to all
individuals subject to quarantine. A copy of the Declaration of a Public Health Emergency
(Attachment 3) signed by the Installation Commander will be attached. Any supporting
information or guidance deemed necessary can also be attached to this notice. The content
should be altered, as necessary, for use in overseas areas depending on the Status of Forces
Agreement, basing arrangements, or other understandings with local officials.
{DATE}
MEMORANDUM FOR INDIVIDUALS SUBJECT TO QUARANTINE
FROM: Public Health Emergency Officer (PHEO), {Wing or Installation Designation}
SUBJECT: Notice of Quarantine
In response to a declared public health emergency by the Installation Commander, this is a
formal notice that we are invoking quarantine procedures. As the installation’s PHEO, I am
providing you the following directions and information on the situation.
{Name, identifying information or other description of the individual, group of individuals or
geographic location subject to the order.}
{A brief statement of the facts warranting the quarantine.}
{Conditions for termination of the order.}
{Specified duration of quarantine.}
{The place or area of quarantine.}
{No contact with non-quarantined individuals except as approved by the PHEO.}
{Symptoms of the subject disease and a course of treatment.}
{Instructions on the disinfecting or disposal of any personal property.}
{Precautions to prevent the spread of the subject disease.}
Any persons subject to quarantine have the right to contest the reason for quarantine.
Information supporting an exemption or release can be provided to me or one of my designated
representatives, who will provide the information to the Installation Commander (or a designated
representative) for final determination. The total time from submission to response will not
exceed 24 hours.
Procedures for the declaration of a public health emergency, quarantine, and the actions
prescribed above are found in Department of Defense Instruction 6200.03, Public Health
Emergency Management, and Air Force Instruction 10-2603, Emergency Health Powers on Air
Force Installations. It is Department of Defense and Air Force policy that military installations,
property, and personnel and other individuals working on, residing on, or visiting military
installations will be protected under applicable legal authorities against communicable diseases
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46 AFI10-2603 13 OCTOBER 2010
associated with biological warfare or terrorism or other public health emergency. Violators of
procedures, protocols, provisions, and/or orders detailed in this memorandum may be charged
with a crime under Title 42, United States Code, Section 271 and subject to punishment of a fine
up to $1,000 or imprisonment for not more than one year, or both.
A wide range of professionals, in addition to me, are working hard to bring this situation to a
resolution that guarantees your health and the safety of the general public.
{NAME IN ALL CAPS, Rank}, USAF
Public Health Emergency Officer
{Wing or Installation Designation}
Attachment:
Declaration of Public Health Emergency
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AFI10-2603 13 OCTOBER 2010 47
Attachment 5
TEMPLATE: NOTICE OF ISOLATION
A5.1. General. The content that follows will be added to Installation or Wing letterhead (as
appropriate) with the appropriate information completed in the italicized fields contained within
brackets. The document will be signed by the PHEO, and photocopies will be provided to all
individuals subject to isolation. A copy of the Declaration of a Public Health Emergency
(Attachment 3) signed by the Installation Commander will be attached. Any supporting
information or guidance deemed necessary can also be attached to this notice. The content
should be altered, as necessary, for use in overseas areas depending on the Status of Forces
Agreement, basing arrangements, or other understandings with local officials.
{DATE}
MEMORANDUM FOR INDIVIDUALS SUBJECT TO ISOLATION
FROM: Public Health Emergency Officer (PHEO), {Wing or Installation Designation}
SUBJECT: Notice of Isolation
Due to your diagnosis of {specify communicable disease of concern}, this is a formal notice
that we are invoking isolation procedures. As the installation’s PHEO, I am providing you the
following directions and information.
{Name, identifying information or other description of the individual, group of individuals or
geographic location subject to the order.}
{A brief statement of the facts warranting the isolation.}
{Conditions for termination of the order.}
{Specified duration of isolation.}
{The place or area of isolation.}
{No contact with non-isolation individuals (except as approved by the PHEO) or protocols
for individuals entering isolation premises.}
{Symptoms of the subject disease and a course of treatment.}
{Precautions to prevent the spread of the subject disease.}
Any persons subject to isolation have the right to contest the reason for isolation.
Information supporting an exemption or release can be provided to myself or one of my
designated representatives, who will provide the information to the Installation Commander for
final determination. The total time from submission to response will not exceed 24 hours.
Procedures for the declaration of isolation and the actions prescribed above are found in
Department of Defense Instruction 6200.03, Public Health Emergency Management, and Air
Force Instruction 10-2603, Emergency Health Powers on Air Force Installations. It is
Department of Defense and Air Force policy that military installations, property, and personnel
and other individuals working on, residing on, or visiting military installations will be protected
under applicable legal authorities against communicable diseases of public health concern.
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48 AFI10-2603 13 OCTOBER 2010
Violators of procedures, protocols, provisions, and/or orders detailed in this memorandum may
be charged with a crime under Title 42, United States Code, Section 271 and subject to
punishment of a fine up to $1,000 or imprisonment for not more than one year, or both.
A wide range of professionals, in addition to myself, are working hard to ensure you receive
the highest quality medical care and are released from isolation as soon as possible. These
actions are necessary to safeguard the health of your loved ones and ensure the safety of the
general public.
{NAME IN ALL CAPS, Rank}, USAF
Public Health Emergency Officer
{Wing or Installation Designation}
Attachment:
Declaration of Public Health Emergency
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AFI10-2603 13 OCTOBER 2010 49
Attachment 6
AIR FORCE REPORT FOR STRATEGIC NATIONAL STOCKPILE AND
MASS PROPHYLAXIS ACTIONS
Installation: _____________________________________________________________
PHEO: _________________________________________________________________
(rank, name, office symbol, phone, e-mail)
Description of Public Health Emergency (complete with items 1 or 2 below):
(1) SNS Request – PULLED
See AFI 10-2603, Paragraph 5.2.3 for additional detail/direction.
Amount and Description of Materials Needed:
Agency Material Requested From:
Did the Installation Commander include the request
with the OPREP-3 PINNACLE report to the National
Military Command Center (NMCC)?
(2) SNS Request – PUSHED
See AFI 10-2603, Paragraph 5.2.4 for additional detail/direction.
Amount and Description of Materials Receiving:
Agency Providing Material:
Is Material being Tracked in DMLSS
(Cost Center 5233)?
(3) RSS Request
See AFI 10-2603, Paragraph 5.4.3 for additional detail/direction.
Description of RSS Agreement:
Amount and Description of Materials Storing:
Agency / Community Supported:
RSS Specific MOU/A signed by Installation
Commander?
1. Only complete portion (1-3) pertaining to the request.
2. Completely answer all sections and send supplemental information as necessary.
