ANNEX #: NATURAL DISASTERS
TABLE OF CONTENTS
OVERVIEW ......................................................................................................................................................................... 2
Purpose................................................................................................................................................................................................ 2
Situation .............................................................................................................................................................................................. 3
Assumptions ...................................................................................................................................................................................... 3
CONCEPT OF OPERATIONS......................................................................................................................................... 4
ORGANIZATION AND ASSIGNMENT OF RESPONSIBILITIES .......................................................................... 6
DIRECTION, CONTROL, AND COORDINATION ................................................................................................... 8
ADMINISTRATION, FINANCE, AND LOGISTICS ................................................................................................... 8
ANNEX DEVELOPMENT AND MAINTENANCE ..................................................................................................... 8
AUTHORITIES AND REFERENCES .............................................................................................................................. 8
Federal ................................................................................................................................................................................................. 8
State ...................................................................................................................................................................................................... 8
Regional .............................................................................................................................................................................................. 9
Tribal ..................................................................................................................................................................................................... 9
Local ...................................................................................................................................................................................................... 9
[Annex #]: Natural Disasters
[MATRAC]
The following organizations and agencies support efforts of the Mountain Area Trauma Regional Advisory
Committee (MATRAC) to prepare for and respond to Natural Disasters in the region.
Local Agencies:
County Emergency Management
Local Management Entities
Local (Municipal and County) Fire and Police Departments
County EMS
Local Hospitals
Regional
Agencies:
MATRAC
Level I Trauma Center
Public Health Regional Surveillance Teams
State Agencies:
North Carolina Department of Health and Human Services
North Carolina Office of Emergency Medical Services
North Carolina Division of Public Health
North Carolina Department Crime Control & Public Safety
North Carolina Division of Emergency Management
Federal Agencies:
Department of Homeland Security
Federal Emergency Management Agency
Department of Health and Human Services
OVERVIEW
Purpose
The Mountain Area Trauma region is susceptible to many different types of natural disasters such as
tornadoes, hurricanes, storms (winter and summer), or flooding. The purpose of this annex is to address
procedures and guidelines related to the medical and public health response to these type events, and
mitigations that can reduce or manage the impact on communities. This includes evacuation and
transport of patients, medical special needs, shelter and evacuation, hospital surge capacity, and multiple
other issues.
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[Annex #]: Natural Disasters
[MATRAC]
Situation
A natural disaster is the effect of a natural hazard (e.g., flood, severe weather or earthquake) that affects
the environment and leads to financial, environmental and/or human losses. Types of severe weather
phenomena vary, depending on the latitude, altitude, topography, and atmospheric conditions. The most
likely natural disasters within the MATRAC include snow and ice storms, hail, lightning strikes,
thunderstorms, high winds, and wildfires. Other examples of severe weather within the region may
include downbursts, excessive precipitation, tornadoes, waterspouts, hurricanes, blizzards, and droughts.
Severe weather has the potential to create situations that can overwhelm a jurisdiction’s resources and
may present life-threatening situations which may exceed its capabilities and resources. These situations
can arise regardless of the size and type of severe weather. These may include:

Loss of critical infrastructure to provide electricity, water, sewer, security, fire suppression, and
emergency medical care

Public health issues with food and water safety, sanitation, vector control, immunizations, and
controlling infectious diseases

Evacuation of citizens from homes, long-term care facilities, hospitals, schools, etc.

Shelter needs for first responders staying to re-establish critical infrastructure

Shelter needs for those citizens that did not evacuate and now need sheltering and those
returning to find homes uninhabitable

Long term recovery resources and agency support
Unlike many severe weather threats, the hurricane season has some predictability as to when and where
severe storms will hit the North Carolina coast. With sufficient warning, certain actions can be taken by
governments, facilities, and agencies within the MATRAC early in the process in order to reduce the
mortality and morbidity related to such storms. Severity will have a direct correlation with the category of
storm that makes landfall and the level and duration of support needed.
Assumptions

The region will continue to experience severe weather that may cause death, injury, and damage
or may necessitate emergency evacuation, search and rescue, sheltering, and mass care for at-risk
citizens.

Local capabilities could be overwhelmed.

Critical infrastructure and key resources, both public works and medical, may be affected for days
or weeks.

The evacuation of large numbers of people from vulnerable areas will stress the capabilities of
road networks, potentially increasing the time necessary to evacuate the threatened risk area.

The state will coordinate significant information-sharing across multiple jurisdictions and between
the public and private sectors to assist in key decision-making efforts regarding evacuation,
shelter operations, medical support and dissemination of public information.
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
Threats from tropical systems will result in numerous displaced people, disruption of normal life
support systems, and significant congestion of transportation networks, and will also cause stress
on local and state transportation resources.

Hurricane sheltering operations will be limited in high-risk counties. The state will provide
valuable assistance in activating inland county shelter operations to serve as host shelter
communities to those jurisdictions threatened by tropical systems.

Departments and agencies at all levels of government and certain non-government organizations,
such as the American Red Cross, will likely be required to deploy resources on short notice to
provide timely and effective mutual aid and/or intergovernmental assistance.
CONCEPT OF OPERATIONS
Effective prevention and preparedness operations, early warning and evacuation, and well-trained and
equipped response forces will minimize preventable morbidity and mortality caused by natural disasters.
Effective prevention and mitigation initiatives can also reduce the amount of damage to ESF-8 resources
and facilities. Emergency response and recovery capabilities will be enhanced by employment of
supplemental resources through mutual aid agreements and actions.
Coordination between affected organizations across the state and the region is essential. State and
regional support and assistance will be quickly and efficiently provided when requested, based on priority
of need in accordance with the procedures outlined in the base plan.
A natural disaster will require the support of state and regional agencies (i.e., NCDEM, NCOEMS, and
ERRC/RMOC ) to coordinate ESF-8 resource requirements. For example, during any significant natural
disaster, local transportation assets for the care-dependent population and functionally- and medicallyfragile populations will not be sufficient. Working with the state and region, requests for resources to
supplement local jurisdictions with transportation resources will be handled as outlined in the base plan.
For planning purposes, ESF-8 support operations for a natural disaster are divided into two categories,
pre-event and post-event. The following outlines some of the key aspects that apply to all type incidents,
highlighting specifics as necessary.
Pre-event coordination sets the parameters for success. Coordination should include:

Develop procedures and processes for monitoring weather conditions and maintaining open
communication with the National Weather Service and the National Hurricane Center.

Coordinate with the state, regional, and local jurisdictions/agencies responsible for emergency
management activities in the event of a natural disaster to ensure the RAC plans are integrated
into and consistent with state, regional, and local plans. Due to the nature of hurricane response,
additional care should be taken to integrate plans as they can effect evacuation of large
populations over limited roadways.

Develop and maintain current contact lists of key resources and responders critical to evacuation
and sheltering of citizens, especially medical and functional needs citizens that may need special
transportation and sheltering.
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[Annex #]: Natural Disasters
[MATRAC]

Working with city/county/state emergency management to determine the need for resources to
provide support of citizens with medical and functional needs in the event they are unable to
remain in their place of residence.

Work with local hospitals and long-term care facilities to determine the level of support they may
require as a result of a natural disaster. Include contact with home health and hospice agencies in
the region.

Coordinate with law enforcement agencies to identify and provide procedures for securing routes
for transporting victims to identified facilities as needed.
The coordination requirements post-event are focused on response, re-entry, and recovery. Successful reentry operations are critical to the rapid restoration of infrastructure and services in the impacted area.
Coordination activities include:

As soon as safety and capability is feasible, work with city/county/state emergency management,
local hospitals, and long-term care facilities to determine their ESF-8 resource needs as a result of
the disaster.

Coordinate with law enforcement agencies to identify and provide procedures for securing routes
for transporting equipment and supplies to identified facilities, provide security for deployed
assets, and assist with traffic control at identified sites.

Maintain contact with state agencies involved in the response and work closely with Regional
Coordination Centers to deal with issues.
The RMOC/ERRC will work with county/state emergency management to determine the resources
necessary to provide support of citizens with medical and functional needs that may have remained within
the impacted area. Additionally, the RMOC will assist jurisdictions, agencies, and facilities in identifying
resources necessary for their recovery operations. This includes transportation of patients to and from
Functional and Medical Support Sheltering (FMSS) or supporting hospitals (see Patient Evacuation and
Movement Annex), patient care, surge operations (see Surge Capability and Capacity Annex), emergency
medical services, the restoration of critical ESF-8 infrastructure (see Critical Medical Infrastructure and Key
Resource Restoration Annex), and/or mortuary affairs.
Hurricanes are the most likely natural disaster to affect large portions of the MATRAC. All
local/regional/state jurisdictions/agencies/facilities will use the Coastal Region Evacuation and Sheltering
Standard Operating Guide (CRES-SOG) in response to a coastal hurricane threat that necessitates regional
evacuation and sheltering operations. The following information is specific to hurricane preparedness and
response, but can be applied to other incidents as well.
The purpose of the CRES-SOG is to establish and clarify the specific state responsibilities and tasks for
operational support of a coordinated and effective evacuation from the 20 North Carolina coastal
counties. These coastal counties border the Sounds and the Atlantic Ocean and have a long history of
executing evacuations for tropical systems of varying strengths. The document outlines five critical
components related to storm response: Evacuation, Sheltering, Transportation, the Sheltering of
Functionally and Medically Fragile Populations, and Public Information.
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[MATRAC]
ORGANIZATION AND ASSIGNMENT OF RESPONSIBILITIES
Agency/Department/Position
Responsibilities
STATE
North Carolina Division of
Emergency Management
North Carolina Office of
Emergency Medical Services
North Carolina Health and Human
Services

Maintain primary responsibility for the State Emergency
Response Team (SERT)

Manage and operate daily state emergency operations
center.

Approve requests for activation of SMRS resources.

Activate the CRES-SOG.

Activate Regional Coordination Centers

Provide support in accordance with the State of North
Carolina Emergency Operations Plan.

Provide support in accordance with the State of North
Carolina Emergency Operations Plan.

Direct deployment of SMRS resources as required.

Coordinate and direct the activation and deployment of
state resources of medical personnel, supplies, equipment,
and pharmaceuticals (with Public Health as needed) to a
disaster-affected area.

Assist in the development of local capabilities for the onsite
coordination of all emergency medical services needed for
triage, treatment, transportation, tracking, and evacuation of
the affected population during a natural disaster.

Establish and maintain the cooperation of the various state
medical and related professional organizations in
coordinating the shifting of Emergency Medical Services
resources from unaffected areas to areas of need.

Coordinate the evacuation of special medical needs from the
disaster area as necessary.

Coordinate the catastrophic medical sheltering response by
implementing the Medical Support Sheltering Plan.

Provide support in accordance with the State of North
Carolina Emergency Operations Plan.

Provide leadership in directing and coordinating state efforts
to provide public health assistance to the affected area.

Establish monitoring systems for the protection of public
health.
[Annex #]-6
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[MATRAC]

Provide guidance and assistance to local public health
departments, health care entities and the general public.

In coordination with the SERT Infrastructure Branch, test
water supplies.

Investigate disease outbreaks.

Assume overall responsibility for coordination of all region
ESF-8 resources during a natural disaster.

Coordinate RAC disaster activities during any SMAT
deployment or other event where the OEMS activates the
SMRS assets and/or resources.

Serve as official liaison between local ESF-8 agencies and the
state, coordinating RAC ESF-8 resources during natural
disasters.

Perform all duties of the SMAT II Team Leader as defined by
the lead hospital with input from the RAC’s Disaster
Preparedness Committee and the OEMS.
County Emergency Management

Develop and coordinate emergency preparedness, response
and recover within the community.
EMS

Develop and maintain standard operating guidelines for
emergency medical service activities during emergency and
disaster situations.

Plan for coordination of ambulance/rescue activities
throughout the region during a natural disaster.

Identify equipment and manpower limitations and develop
mutual aid agreements for needed resources during natural
disaster events.

Coordinate with regional hospitals concerning receipt of
patients during natural disaster events.

Coordinate with the County Health Director and Social
Services Director to determine emergency transportation
needs for special needs populations.

Coordinate the identification of special needs populations
and maintain a current list of those identified.

Provide for inspections of mass care facilities to assure
proper sanitation practices are followed.

Coordinate with the proper authorities to establish a
REGIONAL
Regional Emergency Response &
Recovery Coordinator
SMAT II Team Leader
LOCAL
Local Public Health
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[Annex #]: Natural Disasters
[MATRAC]
temporary morgue, if necessary, following an emergency /
disaster.
Local Hospital

Provide a public health nurse at all Disaster Application
Centers.

Develop, maintain, and exercise a hospital evacuation plan.

Be prepared to provide medical support to the community
during a natural disaster.
DIRECTION, CONTROL, AND COORDINATION
Direction and Control provides for an efficient response to an emergency by coordinating all medical
response and public health activities. In general, direction, control, and coordination of ESF-8 operations
during a natural disaster will be in accordance with the procedures outlined in the base plan. Local and
regional agencies and facilities will coordinate with the NCEM Regional Coordination Center (if activated)
during hurricane response.
ADMINISTRATION, FINANCE, AND LOGISTICS
Per Base Plan
ANNEX DEVELOPMENT AND MAINTENANCE
Per Base Plan
AUTHORITIES AND REFERENCES
Appropriate references identified in the base plan apply to this annex. In addition, the following should
be used.
Federal

American Red Cross, Tornado Response Alerts, June 29, 2010. Website:
http://newsroom.redcross.org/tag/tornado/

FEMA Disaster Assistance Policy 9525.4, Emergency Medical Care and Medical Evacuations, dated
July 16, 2008
State

Disaster Assistance Recovery Guide
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[MATRAC]

North Carolina Coastal Region Evacuation and Sheltering Standard Operating Guide, October
2007

North Carolina Emergency Management Information on Tornadoes

North Carolina Emergency Operations Plan: Annex A, Appendix 4, Tab B (Weather Support);
Annex B (Event Specific Plans), Appendix 1 (Hurricane Operations Plan), Appendix 2 (Winter Storm
Operations), Appendix 3 (Drought Assessment and Response Plan)
Regional

Mountain Area Trauma Regional Advisory Committee (MATRAC) (available online at:
http://www.matrac.com/index.html)
Tribal

FEMA Tribal Policy (Online at: http://www.fema.gov/government/tribal/natamerpolcy.shtm)

Cherokee Code, Chapter 166, Emergency Management (Online at :
http://www.narf.org/nill/Codes/ebcicode/166emergency.pdf
Local

All local county Emergency Operations Plans

All local hospital’s Emergency Operations Plans

All county EMS Service Plans
[Annex #]-9