TheMedical Surge Capacity and Capability (MSCC) Management Systemutilizes a six-tier framework to describe the coordination of public health and medical responses. In this hierarchy,Tier 6representsFederal Support to State, Tribal, and Jurisdiction Management. It is the highest level of the surge system, activated when the resources of the local, regional, and state levels are exhausted and a federal disaster or public health emergency has been declared.
The MSCC Tiers are organized as follows:
Tier 1:Individual Healthcare Organization (HCO)
Tier 2:Healthcare Coalition (HCC)
Tier 3:Jurisdiction (Local government)
Tier 4:State (State government)
Tier 5:Interstate (Interstate coordination, e.g., via EMAC)
Tier 6:Federal (Federal public health and medical assets)
At Tier 6, the federal government provides assets through theNational Response Framework (NRF), specificallyEmergency Support Function #8 (ESF #8 - Public Health and Medical Services). This includes resources like theNational Disaster Medical System (NDMS), theStrategic National Stockpile (SNS), and theUSNS Comfort/Mercyhospital ships. The role of Tier 6 is to "support, not supplant," the state and local efforts.
For theCEDPprofessional, understanding the Tier 6 trigger is vital forResource Management. Tier 6 assistance is typically requested by the Governor of an affected state and coordinated through theJoint Field Office (JFO). By the time a response reaches Tier 6, it is a catastrophic event requiring the full weight of the national medical infrastructure. Knowing the protocols for integrating these federal teams—such as providing "Credentialing" and "On-boarding" for DMAT teams—is a key competency for ensuring that federal help translates into immediate life-saving capability on the ground.
