STATEWIDE MEDICAL AND HEALTH EXERCISE

PHASE III: TABLETOP EXERCISE

[Exercise Name/Exercise Date]

WELCOME & INTRODUCTIONS

3

SCHEDULE OVERVIEW

0000 Registration

0000 Welcome and Opening Remarks

0000Module 1: Communication and Medical Surge 30 Minutes

Briefing, Plenary Discussion, and Brief-Back

0000 Break

0000Module 2: Confirmed Case & Incident Command 30 Minutes

Briefing, Plenary Discussion, and Brief-Back

0000 Lunch

0000Module 3: Security & Fatality Management 30 Minutes

Briefing, Plenary Discussion, and Brief-Back

0000 Break

0000 Hot Wash

0000 Closing Comments

4

PRESENTATION GUIDE

BACKGROUND AND ADMINISTRATION

MODULE 1: COMMUNICATION & MEDICAL SURGE

MODULE 2: CONFIRMED CASE & INCIDENT COMMAND

MODULE 3: SECURITY & FATALITY MANAGEMENT

MODULE 4: DEBRIEF QUESTIONS & PLANNING FOR THE FUNCTIONAL EXERCISE

BACKGROUND AND ADMINISTRATION

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• Cell Phones• Restrooms• Exercise Materials• Breakout Discussion Groups• Parking validation• Mobile phones• Evacuation procedures

– “This is a real emergency.”

ADMINISTRATION

7

• Welcome– Name– Position– Agency/Organization– Optional: Icebreaker

• Logistics – Materials

• Situation Manual– Follow along!

• Feedback Form• Observer Handout

ADMINISTRATION

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EXERCISE OVERVIEW

• Name– Statewide Medical & Health Tabletop Exercise

• Date– [insert date]

• Scope– 4 phases in program

• Mission Areas– [insert selected]

• Capabilities– [insert selected]

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• Objectives– [insert selected]

• Threat/Hazard– Pandemic Influenza

• Scenario– Novel Strain of H5N1

• Sponsor– CDPH, EMSA, [insert your agency/organization]

• Participating Organizations– [insert]

EXERCISE OVERVIEW

GENERAL INFORMATIONKEY MATERIAL

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• Introduction• Objectives & Core Capabilities

– [agency/organization objectives & core capability detail]

• Participant Roles & Responsibilities– Players– Observers– Facilitators– Evaluators– Controllers

GENERAL INFORMATION

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• Exercise Structure– Module 1 – Communication and Medical Surge

• Breakout group discussion and group presentations

– Module 2 – Confirmed Case and Incident Command

• Breakout group discussions and group presentations

– Module 3 – Security and Fatality Management• Breakout group discussions and group

presentations

GENERAL INFORMATION

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• Exercise Guidelines– Use current plans/capabilities

• Exercise Assumptions & Artificialities– Impacts across response

community– See Situation Manual

(SitMan) for others

• Exercise Evaluation– Exercise Evaluation Guides

(EEG)– Feedback Forms

GENERAL INFORMATION

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• National Association of County and City Health Officials (NACCHO)/Centers for Disease Control (CDC) Program

• Currently in development• Major jurisdictions across California have

been engaged in initial planning and testing• See Appendix in the Situation Manual for

more information• This program will be addressed in Module

3

RESOURCE: FLU ON CALL™

MODULE ONECOMMUNICATION AND MEDICAL SURGE

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• Worldwide influenza pandemics occur when a novel virus emerges to which the population has little immunity

• The 20th century saw three such pandemics– Optional Videos:

http://www.flu.gov/video/2010/01/we-heard-the-bells.html

– http://www.un-influenza.org/?q=content/how-virus-changes-world

BACKGROUND INFORMATION

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• Strains of avian influenza interact with human influenza

• A mutation can occur, creating a virus capable of human-to human transmission, initiating a pandemic

• 25 to 35% of the population may become ill

• Nearly 200,000 Californians may die

• Impact of the pandemic could last for as long as 18 months, with waves of activity

BACKGROUND INFORMATION

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• Non-pharmaceutical containment measures are key to controlling the spread of virus– Optional Video:

http://www.un-influenza.org/?q=content/nhs-pandemic-flu-information-health-workers

• Vaccination and antiviral treatment are anticipated to be the most effective

• These may be delayed or in limited supply

BACKGROUND INFORMATION

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• Real concern for fear and panic among the public as well as the response community

• Will there be enough:– Staff?– Supplies? – Equipment? – Vaccine? – Medicines?

BACKGROUND INFORMATION

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• How will daily functions be impacted (e.g. schools, transportation, adult care, etc.)?

• Ability of Federal government to support the response in California will be limited at the onset

• Virus will be widespread and not limited to one jurisdiction, region or state

BACKGROUND INFORMATION

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• Five cases of human-to-human transmission in Cambodia

• Health care providers used stockpiled antiviral medication

• Many residents disregard isolation instructions

MODULE ONE

Communication & Medical Surge

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• H5N1 quickly spreads • 30% develop symptoms• Seasonal vaccine is

ineffective• Certain antiviral

medications have been shown to help alleviate symptoms

• Sporadic H5N1 cases appear throughout Southeast Asia and Australia

MODULE ONE

Communication & Medical Surge

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• CDC initiates enhanced surveillance at quarantine stations

• Viral isolates sent to the CDC/National Institute of Allergy and Infectious Diseases (NIAID)

• Hospitals and healthcare facilities asked to increase surveillance and reporting

• Influenza is the lead story for all major news outlets

• Public fear continues to grow

MODULE ONE

Communication & Medical Surge

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• Health departments try to purchase additional stockpiles of antiviral medications

• California already experiencing an above-average flu season

• Patient workups include testing for H5N1

MODULE ONE

Communication & Medical Surge

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• "They've brought in extra doctors to handle the overload," said Dr. [insert name] of [insert local hospital name]. "And even with that, you still end up with patients waiting in the emergency room for 24 hours for a bed."

• 9-1-1 had triple the number of calls compared to this same time last year

MODULE ONE

Communication & Medical Surge

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• Elect a group spokesperson• Use the Situation Manual and exercise materials to

take notes• Focus on

– Strengths– Areas for improvement

• As it pertains to: – Doctrine– Organization– Personnel– Training– Equipment– Support

DISCUSSION FORMAT

CONFIRMED CASE & INCIDENT COMMAND

MODULE TWO

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• On Monday, a 33-year old woman in a neighboring county becomes the first confirmed H5N1 case in California

• While ill, she attended a large fair with over 5,000 attendees in the neighboring county last week

• Hospitals in the neighboring county experience a wave of ILI cases, many who attended the same fair

MODULE TWO

Confirmed Case & Incident Command

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• Monday - 12:30 PM: First confirmed H5N1 fatality in CA in a neighboring county

• Tuesday– The [insert your jurisdiction]

public health department operations center (DOC) is activated

– Strategic National Stockpile (SNS) assets are requested

• Wednesday– SNS assets are available for

distribution

MODULE TWO

Confirmed Case & Incident Command

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• Extra security requested for:– Healthcare facilities– Government buildings– Point of Dispensing (POD) Sites

• Local public health– Distribute vaccines to hospitals

and local health departments– Activate a select number of

PODs

• At least 80 suspect H5N1 cases in the neighboring county

MODULE TWO

Confirmed Case & Incident Command

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• 9:00 AM on Thursday: three patients, a mother with two children ages six and nine, present at a local hospital

• They attended the fair with several members of their church last week

• Also, the mother attended an event at her children’s school three days ago

MODULE TWO

Confirmed Case & Incident Command

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• Healthcare facilities experience a surge of ILI cases, many of whom had contact with the confirmed H5N1 cases

• Several individuals calling in with questions about their symptoms

• Many confirm they were at the county fair or school event three days ago

• The mother and the youngest of her two children become the first confirmed local H5N1 fatalities

MODULE TWO

Confirmed Case & Incident Command

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• The Local Health Officer is faced with an onslaught of crucial decisions to make:– Ongoing risk

communications strategies– DOC/EOC coordination– Disease

investigation/surveillance and coordination with authorities

• The Governor declares a state of emergency

MODULE TWO

Confirmed Case & Incident Command

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• Elect a group spokesperson• Use the Situation Manual and exercise materials to

take notes• Focus on

– Strengths– Areas for improvement

• As it pertains to: – Doctrine– Organization– Personnel– Training– Equipment– Support

DISCUSSION FORMAT

SECURITY & FATALITY MANAGEMENT

MODULE THREE

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• In the following days:– Healthcare facilities

continue to experience a surge

– Concerned citizens present at healthcare facilities asking for antiviral medications and vaccines

– News crews camp out in front of hospitals, public health departments, and City Hall seeking more information

MODULE THREE

Security & Fatality Management

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• Local public health begins a contact tracing campaign

• Officials asked to publish guidance on: – appropriate diagnosis and

treatment – public information for

proper hygiene, hand washing, and contact with others

• 15 additional cases present

MODULE THREE

Security & Fatality Management

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• State and local agencies again asked to intensify influenza surveillance and communications

• CDPH considers special programs

• Asymptomatic citizens begin to:– Seek medical attention– Demand prophylactic

treatment– Buy out over-the-counter

medications

MODULE THREE

Security & Fatality Management

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• News commentators criticize government officials

• Local hospitals reporting staff absenteeism

• Law enforcement agencies respond to civil unrest calls

• Dispatcher reports an increase in the number of calls

• Of the confirmed H5N1 cases, roughly 25% have been fatal

MODULE THREE

Security & Fatality Management

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• Local Department of the Medical Examiner/Coroner’s Office: – activates their DOC– contacts EOC for mutual-aid

assistance

• Hospitals implement mass fatality management plans

• PODs are activated• Hospitals experience their

most significant medical surge yet

MODULE THREE

Security & Fatality Management

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• Medical personnel are at the breaking point in dealing with:– fears of the worried well – surge in decedents

• Personnel in key positions are absent due to:– Illness/exhaustion/burn

out– fear of illness– caring for ill family

members

MODULE THREE

Security & Fatality Management

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• Elect a group spokesperson• Use the Situation Manual and exercise materials to

take notes• Focus on

– Strengths– Areas for improvement

• As it pertains to: – Doctrine– Organization– Personnel– Training– Equipment– Support

DISCUSSION FORMAT

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CONCLUSION OF THE DISCUSSION-BASED TABLETOP

DEBRIEF QUESTIONS & FUNCTIONAL EXERCISE PLANNING

MODULE FOUR

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• Debrief questions• Exercise levels

– Level of play– DOC/EOC activation

• Exercise duration• Scenario development• Participation• Testing of plans & procedures• Role of State agencies

MODULE FOUR

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• Please complete your Participant Feedback Form or Evaluation Notes/EEGs and return them to an Exercise Facilitator at Registration

• Please clean up your area and take all your materials with you

• Additional materials can be found at the Statewide Medical and Health Exercise Program website: www.californiamedicalhealthexercise.com

CONCLUSION

STATEWIDE MEDICAL AND HEALTH EXERCISE

PHASE III: TABLETOP EXERCISE

[Exercise Name/Exercise Date]