After-Action Report/Improvement Plan - Southern Arizona ... · Web view2017/11/12 · After-Action Report/ Improvement Plan (AAR/IP) Southern Arizona Health Care CoalitionNovember

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2017 U of A Game Changer Full-Scale Exercise

After-Action Report/Improvement PlanNovember 12, 2017

FOR OFFICIAL USE ONLY

After-Action Report/ Improvement Plan (AAR/IP) Southern Arizona Health Care Coalition November 12, 2017 2017 U of A Game Changer Full-Scale Exercise

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FOR OFFICIAL USE ONLY

After-Action Report/ Improvement Plan (AAR/IP) Southern Arizona Health Care CoalitionNovember 12, 2017 2017 U of A Game Changer Full-Scale Exercise

ADMINISTRATIVE HANDLING INSTRUCTIONS1. The title of this document is the Southern Arizona Health Care Coalition, 2017 U of A Game

Changer Full-Scale Exercise, After-Action Report/Improvement Plan, November 12, 2017.

2. The information gathered in this After-Action Report/Improvement Plan (AAR/IP) is classified as For Official Use Only (FOUO). The Southern Arizona Health Care Coalition (SoAZHCC), 2017 U of A Game Changer Full-Scale Exercise (FSE) was conducted on October 11, 2017 and was an unclassified exercise. The control of information is based more on public sensitivity regarding the nature of the exercise than on the actual content. This AAR/IP contains response and operational material and should be handled as sensitive information not to be disclosed. This document should be safeguarded, handled, transmitted, and stored in accordance with appropriate security directives.

3. Reproduction of this document, in whole or in part, without prior approval from the SoAZHCC is prohibited.

4. For more information, please consult the following Point of Contact (POC):

Exercise Director: Dan StanleySoAZHCC Coalition [email protected]

Administrative Handling Instructions i FOR OFFICIAL USE ONLY

Homeland Security Exercise and Evaluation Program (HSEEP)


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Administrative Handling Instructions ii FOR OFFICIAL USE ONLY



TABLE OF CONTENTS

Administrative Handling Instructions.................................................................iTable of Contents................................................................................................iiiExecutive Summary.............................................................................................1

Overall Strengths and Areas for Improvement........................................................1Strengths and Areas for Improvements within Health Care Sectors.......................2

Exercise Overview................................................................................................4Objectives, Capabilities, and Sector Crosswalk...............................................7Analysis of Objectives.......................................................................................11Appendix A: Improvement Plan.......................................................................29Appendix B: Participating Organizations.......................................................36Appendix C: Acronym List................................................................................45

Table of Contents iii FOR OFFICIAL USE ONLY



EXECUTIVE SUMMARYThis After-Action Report/Improvement Plan (AAR/IP) documents the performance of capabilities demonstrated during the Southern Arizona Health Care Coalition (SoAZHCC), 2017 U of A Game Changer Full-Scale Exercise (FSE) conducted on October 11, 2017. Strengths and areas for improvement in performing specific capabilities and objectives have been documented in the Improvement Plan (IP) along with recommendations for meeting capability goals.

The exercise was sponsored by the SoAZHCC and aligned with requirements set forth by Centers for Medicare and Medicaid Services (CMS), capabilities outlined in the Office of the Assistant Secretary for Preparedness and Response (ASPR) 2017-2022 Health Care Preparedness and Response Capabilities and the Centers for Disease Control and Prevention, Office of Public Health Preparedness and Response, March 2011, Public Health Preparedness Capabilities: National Standards for State and Local Planning. Regional exercise participants included staff from all sectors of the health care system, including hospitals, long-term care, ambulatory care, home health/hospice, behavioral health, and public health.

The exercise was designed to establish a learning environment for participants to practice their response plans, policies, and procedures as they related to a simulated explosive incident resulting in medical surge. A Training and Exercise Committee comprised of representatives from a variety of organizations, provided input, advice, and assistance in developing the exercise, which followed the guidance set forth in the Federal Emergency Management Agency (FEMA), Homeland Security Exercise and Evaluation Program (HSEEP).

The exercise was conducted over the course of a half day in Pima County, Arizona (AZ). The exercise scenario involved an initial medical surge response following a simulated explosion incident at a crowded football stadium at the University of Arizona (U of A). The exercise provided opportunities for participating health care sectors and the SoAZHCC to participate in Incident Command System utilization, Command Center operations, medical surge coordination and patient decompression, information sharing, patient tracking, and simulated patient assessment and treatment.

After analyzing the overall performance of objectives demonstrated during the exercise, the following top three Strengths and Areas for Improvement were identified:

Overall Strengths and Areas for ImprovementStrengths:

1) Internal Teamwork – Internal facility and network teams worked together efficiently to solve problems and respond to the emergency.

2) Staff/Sector Participation – A diverse cross-section of health care sectors participated in the exercise. For many health care sites, this was their first emergency exercise.

Executive Summary 1 FOR OFFICIAL USE ONLY



3) Medical Surge Response/Staffing/Patient Care – Most facilities effectively responded to medical surge, with knowledgeable staff, and emphasis on patient care.

Areas for Improvement:

1) Internal and external communication inefficiencies were identified in facilities, networks and at the broader systemic level. These issues can be alleviated through further training and exercise participation.

2) Additional coordination between Emergency Support Function 8 (ESF-8)/SoAZHCC and the health care sectors is needed. Additional planning and collaboration is needed to increase the efficiency of patient transfer and transport within the health care system.

3) Some staff were not familiar with emergency plans and standard operating procedures. Additional training will assist health care sectors in emergency response activities.

Strengths and Areas for Improvements within Health Care SectorsThe following Strengths and Areas for Improvement were identified for each health care sector. There may be opportunities for facilities and networks to work within their sectors to address identified areas for improvement.

Hospital SectorStrengths Areas for ImprovementMedical Surge Response/Staffing/Patient Care Some staff were not familiar with Standard

Operating Procedures (SOPs)/emergency plansHospital Incident Command System (HICS) Activation

Internal Communications

HICS Staffing/Roles and Responsibilities

Behavioral Health SectorStrengths Areas for ImprovementInter-agency External Communications External Communications

Medical Surge Response/Patient Care Incident Command System (ICS) Activation/Response

Behavioral Health Services Coordination

ESF 8, County, Tribal, SoAZHCCStrengths Areas for ImprovementInter-agency (External) Communications Emergency plans outdated or incomplete

Inter-agency (External) Communications




Home Health/Hospice SectorStrengths Areas for ImprovementIntra-agency (Internal) Communications Some staff not familiar with SOPs/emergency

plansInternal Teamwork

Staff Participation and Preparation Inter-agency (External) Communications

Medical Surge Response/Staffing/Patient Care Inventory lists incomplete/outdated

Long Term Care SectorStrengths Areas for ImprovementMedical Surge Response/Patient Care Some Staff not familiar with SOPs/emergency

plans

Internal Teamwork Inventory lists incomplete and/or outdated

Staff Participation SOPs are incomplete/outdated

Ambulatory Care/Clinics/DialysisStrengths Areas for ImprovementEffective Medical Surge Response/Patient Care Intra-agency (Internal Communications)

Intra-agency (Internal) Communication Systems Some staff not familiar with SOPs/emergency plans

Internal Teamwork Inter-agency (External) Communications

Inventory list outdated/incomplete

Additional strengths and areas for improvement are detailed in the Analysis of Capabilities section of this AAR. The Improvement Plan (IP), which identifies corrective actions and timelines, is included in Appendix A.




EXERCISE OVERVIEW

Exercise Name 2017 U of A Game Changer Full-Scale Exercise

Exercise Dates October 11, 2017

Scope

The 2017 U of A Game Changer Full-Scale Exercise (FSE) was a full-scale exercise (FSE) designed to include all City of Tucson healthcare sector and public health partners. This exercise is being conducted to validate the ability of plans, equipment and personnel to respond to an acute medical surge situation and to test public health and healthcare coordination for the Southern Arizona Health Care Coalition (SoAZHCC), hereinafter known as the Coalition.

Mission Area(s) Response

Core Capabilities

Public Health Preparedness Program - Emergency Support Function 8: Public Health and Medical Services (ESF-8)

Capability 6: Information Sharing Function 3: Exchange information to determine a common operating

pictureCapability 10: Medical Surge Function 3: Support jurisdictional medical surge operations

Reference: Public Health Preparedness Capabilities: National Standards for State and Local Planning, March 2011, Centers for Disease Control and Prevention, Office of Public Health Preparedness and Response

Hospital Preparedness Program:

Capability 1: Foundation for Healthcare and Medical ReadinessCapability Objective 4: Train and Prepare the Health Care and Medical Workforce

Activity 1: Promote Role-Appropriate National Incident Management System Implementation

Capability 2: Health Care and Medical Response Coordination Capability Objective 2: Utilize Information Sharing Procedures and

Platforms Activity 3. Utilize Communications systems and platforms Capability Objective 3: Coordinate Response Strategy, Resources, and

Communications

Exercise Overview 4 FOR OFFICIAL USE ONLY



Activity 1. Identify and Coordinate Resource Needs during an Emergency

Capability 4: Medical Surge Capability Objective 2: Respond to a Medical Surge

Activity 1. Implement Emergency Department and Inpatient Medical Surge Response

Activity 2. Implement Out-of-Hospital Medical Surge Response

Activity 4. Provide Pediatric Care during a Medical Surge Response

Activity 8. Respond to Behavioral Health Needs during a Medical Surge Response

Reference: 2017-2022 Health Care Preparedness and Response Capabilities, Department of Health and Human Services, Office of the Assistant Secretary for Preparedness and Response, November 2016.

Objectives Public Health Emergency Preparedness - Emergency Support Function 8: Public Health and Medical Services (ESF-8)

1. Pima County Emergency Support Function 8: Public Health and Medical Services (ESF-8) will notify partners of the emergency incident and provide situational updates via the Arizona Health Alert Network (AzHAN).

2. Demonstrate the ability to exchange information to determine a common operating picture.

3. Demonstrate the ability to support jurisdictional medical surge operations.4. Utilize the Arizona Health Alert Network (AzHAN) system to notify the

Southern Arizona Health Care Coalition (SoAZHCC) and Arizona Pediatric Disaster Coalition (APDC) of situational status.

Hospital Preparedness Program1. Hospitals will practice decompression at 20% of inpatient census. Of the

20% of patients, 50% will be transferred to Long Term Care, 25% will be transferred to home health, and 25% will be discharged home.

2. Hospitals will transfer admitted inpatient pediatric patients to Tucson Medical Center and University Medical Center. Tucson Medical Center and University Medical Center will respond to the surge in pediatric in-patients by transferring them to Honor Health hospitals. (Note: In this exercise, twenty-five percent of all patients are pediatric patients.)

3. Hospitals will track transferred patients using EMTrack.4. Healthcare facilities will utilize the Healthcare Incident Command System

or other National Incident Management System aligned incident command system.




5. Local healthcare agencies and facilities will demonstrate their ability to share information with regional medical and healthcare facilities.

6. The Coalition Behavioral Health Sector will test the coordination of all Behavioral Health response teams, service request calls and response agency communication related to this exercise.

Threats/

HazardsExplosion at a large university sports stadium followed by medical surge

Scenario

On the evening of October 11, 2017, there are an estimated 60,000 people in attendance at a football game between U of A and ASU. There are several honored guests at the game, including the Governor; the Davis-Monthan Honor Guard; Tohono O’Odham, Pascua Yaqui, and other tribal veterans; and various high school marching bands. There is a loud explosion just as the game is about to begin and people stampede to the stadium exits. U of A law enforcement gain control of the scene. There are traffic gridlocks on streets surrounding the stadium. At least 300 people need to be transported by Emergency Medical Services (EMS) to local hospitals. At least 25% of the injured are pediatric patients.

SponsorSouthern Arizona Health Care Coalition (SoAZHCC) Training and Exercise Committee

Participating Organizations

Health Care Coalition member agencies, Pima County Health Department (PCHD), and the Medical Reserve Corps. A complete listing of participants can be found in the SoAZHCC 2017 U of A Game Changer Full-Scale Exercise Participant List. Pima County Office of Emergency Management and Homeland Security (PCOEM) will be simulated through the Simulation Cell (SimCell).

Point of Contact

SoAZHCC:Dan StanleySoAZHCC [email protected]




OBJECTIVES, CAPABILITIES, AND SECTOR CROSSWALKAligning exercise objectives and capabilities provides a consistent taxonomy for evaluation that supports preparedness reporting and trend analysis. The following table crosswalks the exercise objectives and aligned Public Health Preparedness (PHP) and Hospital Preparedness Program (HPP) Capabilities with Healthcare Sectors that were evaluated for each objective and capability.

Table 1. Objectives, Capabilities, and Sector Crosswalk

Objective Capability Evaluated Health Care Sectors

PHP Exercise Objective 1:Pima County Emergency Support Function 8: Public Health and Medical Services (ESF-8) will notify partners of the emergency incident and provide situational updates via the Arizona Health Alert Network (AzHAN) system.

PHP Capability 6: Information SharingFunction 3: Exchange information to determine a common operating picture

ESF-8

PHP Exercise Objective 2:Demonstrate the ability to exchange information to determine a common operating picture.


ESF-8

PHP Exercise Objective 3:Demonstrate the ability to support jurisdictional medical surge operations.

PHP Capability 10: Medical SurgeFunction 3: Support jurisdictional medical surge operations

ESF-8

PHP Exercise Objective 4:Utilize the Arizona Health Alert Network (AzHAN) system to notify the Southern Arizona Health Care Coalition (SoAZHCC) and Arizona Pediatric Disaster Coalition (APDC) of situational status.


ESF-8

HPP Exercise Objective 1:Hospitals will practice decompression at 20% of inpatient census. Of the 20% of patients, 50% will be transferred to Long Term Care, 25% will be transferred to home health, and 25% will be discharged home.

HPP Capability 2: Health Care and Medical Response CoordinationCapability Objective 3: Coordinate Response Strategy, Resources, and CommunicationsActivity 1. Identify and Coordinate Resource Needs during an Emergency

HospitalLong Term CareHome Health/HospiceAmbulatory Care

Objectives, Capabilities, and Sector Crosswalk 7 FOR OFFICIAL USE ONLY




HPP Capability 4: Medical SurgeCapability Objective 2: Respond to a Medical SurgeActivity 1. Implement Emergency Department and Inpatient Medical Surge Response Activity 2. Implement Out-of-Hospital Medical Surge Response

HospitalLong Term CareHome Health/HospiceAmbulatory Care

HPP Exercise Objective 2:Hospitals will transfer admitted inpatient pediatric patients to Tucson Medical Center (TMC) and University Medical Center (UMC). Tucson Medical Center (TMC) and University Medical Center (UMC) will respond to the surge in pediatric in-patients by transferring them to Maricopa County hospitals. (Note: In this exercise, twenty-five percent of all patients are pediatric patients.)

HPP Capability 4: Medical SurgeCapability Objective 2: Respond to a Medical SurgeActivity 4. Provide Pediatric Care during a Medical Surge Response

Hospital

HPP Exercise Objective 3:Hospitals will track transferred patients using EMTrack.

HPP Capability 2: Health Care and Medical Response CoordinationCapability Objective 2: Utilize Information Sharing Procedures and PlatformsActivity 3. Utilize Communications Systems and Platforms

HospitalAmbulatory Care

HPP Exercise Objective 4:Healthcare facilities will utilize the Health Care Incident Command System (HICS) or other National Incident Management System (NIMS) aligned incident command system.

HPP Capability 1: Foundation for Healthcare and Medical ReadinessCapability Objective 4: Train and Prepare the Health Care and Medical Workforce

Activity 1: Promote Role-Appropriate National Incident Management System Implementation

HospitalLong Term CareHome Health/HospiceAmbulatory CareBehavioral Health

HPP Exercise Objective 5:Local healthcare agencies and facilities will demonstrate their ability to share information with regional medical and healthcare facilities.

HPP Capability 2: Health Care and Medical Response CoordinationCapability Objective 2: Utilize Information Sharing Procedures and PlatformsActivity 3. Utilize Communications

HospitalLong Term CareHome Health/HospiceAmbulatory CareBehavioral Health





systems and Platforms

HPP Exercise Objective 6.The Behavioral Health Sector will test the coordination of all Behavioral Health response teams, service request calls and response agency communication related to this exercise.

HPP Capability 4: Medical SurgeCapability Objective 2: Respond to a Medical SurgeActivity 8. Respond to Behavioral Health Needs during a Medical Surge Response

Behavioral Health

Evaluation Ratings

Sectors were evaluated and rated on various tasks that were correlative to exercise objectives and capabilities. Evaluators scored Exercise Evaluation Guides based on two types of ratings. The first was a simple Yes/No system.

Yes – a particular task was accomplished. No – a particular task was not accomplished.

The second rating type included four discrete ratings categories. These included the following:

Performed without Challenges: The activities associated with the objective were completed in a manner that achieved the objective(s) and did not negatively impact the performance of other activities. Performance of this activity did not contribute to additional health and/or safety risks for the public or for emergency workers, and it was conducted in accordance with applicable plans, policies, procedures, regulations, and laws.

Performed with Some Challenges: The activities associated with the objective were completed in a manner that achieved the objective(s) and did not negatively impact the performance of other activities. Performance of this activity did not contribute to additional health and/or safety risks for the public or for emergency workers, and it was conducted in accordance with applicable plans, policies, procedures, regulations, and laws. However, opportunities to enhance effectiveness and/or efficiency were identified.

Performed with Major Challenges: The activities associated with the objective were completed in a manner that achieved the objective(s), but some or all of the following were observed: demonstrated performance had a negative impact on the performance of other activities; contributed to additional health and/or safety risks for the public or for emergency workers; and/or was not conducted in accordance with applicable plans, policies, procedures, regulations, and laws.




Not Performed The activities associated with the capability objective were not performed in a manner that achieved the objective(s). Occasionally, activities were not performed because they were not needed to achieve the objective(s) and this is discussed in the Analysis of Objectives section.




ANALYSIS OF OBJECTIVESThe following analysis of objectives was used to determine how well objectives and capabilities were met during this exercise and to identify strengths and areas for improvement. This information will help inform the Coalition of areas where it can support Coalition members, especially in the areas of regional planning, training, and exercises.

The first four (4) objectives relate to ESF-8, which had two (2) evaluators. The next six (6) objectives relate to various regional health care sectors. Of these sectors, eight (8) hospitals, nine (9) long term care facilities, twenty-nine (29) home health/hospice agencies, sixty-four (64) ambulatory care facilities, and four (4) behavioral health agencies provided evaluation data.

PHP Exercise Objective 1: Pima County Emergency Support Function 8: Public Health and Medical Services (ESF-8) will notify partners of the emergency incident and provide situational updates via the Arizona Health Alert Network (AzHAN) system.


Evaluated Sector:ESF-8

Summary:

1. ESF-8 communications through AzHAN were hampered by technical issues that occurred at the beginning of the exercise.

2. In addition to affecting initial communications, the technical issues with AzHAN also resulted in an inability to provide situational updates to health care partners through the AzHAN system.

3. The causes of the AzHAN technical problems were identified and corrected.

Observations/Analysis:

Most sectors were not notified of the emergency incident by the AzHAN within thirty (30) minutes of the incident. In some instances, health care networks who did receive notification of the incident notified the other facilities within their networks. The following table is a summary of the health care sector responses as to whether the sectors received notice of the incident via the AzHAN within 30 minutes of the incident.

Analysis of Objectives 11 FOR OFFICIAL USE ONLY



SectorNotified via AZHANYes No

Hospital 50% 50%Long Term Care 0% 100%Home Health/Hospice 7% 93%Ambulatory Care 44% 56%Behavioral Health 100% 0%

Strengths: The partial capability level can be attributed to the following strengths.

Strength 1: Some health care networks that did receive AzHAN notification of the initial incident immediately notified other facilities in their network.

Strength 2: The AzHAN system was recovered within about three hours of the beginning of the exercise.

Areas for Improvement: The following areas require improvement to achieve the full capability.

Area for Improvement 1: The AzHAN system had technical issues at the beginning of exercise resulting in no initial notifications via AzHAN of the incident for the majority of health care facilities.

Area for Improvement 2: The technical problems in AzHAN system also resulted in difficulties in provision of situational updates by ESF-8 to health care facilities during the exercise. Several facilities noted that they received little or no communications from ESF-8 during the exercise.Area for Improvement 3: ESF-8 did not utilize alternate means to provide situational updates.

References: SoAZHCC Communications Plan

PHP Exercise Objective 2: Demonstrate the ability to exchange information to determine a common operating picture.



Summary:

1. ESF-8 and health care partners exchanged information to determine a common operating picture.




2. Health care partners provided more situational feedback to ESF-8 than was provided by ESF-8 to Health care partners.

3. EMTrack was noted to be a useful tool for tracking patients.4. Health care facilities seemed to be able to manage the cell phone service disruption that was

built in to the scenario.


ESF-8 was evaluated by two (2) evaluators. One noted that ESF-8 provided periodic situational updates to health care partners, including the Arizona Pediatric Disaster Coalition (APDC). Both ESF-8 Evaluators indicated that health care partners provided ESF-8 with situational feedback. Both Evaluators noted that ESF-8 utilized available communication platforms such as telephones, AzHAN, and Survey Monkey, to receive or exchange information with healthcare partners.

Health care sectors were also evaluated on whether they received situational updates from ESF-8 and if they sent situational feedback to ESF-8. The evaluations indicate that more information was exchanged between ESF-8 and Ambulatory Care and Behavioral Health that between ESF-8 and Long Term Care and Home Health/Hospice. Some Long Term Care facilities noted that it would be helpful to have greater situational awareness of the community in order to conduct surge preparedness activities, e.g. updating supply inventory lists, acquiring additional supplies, and printing and reviewing various forms needed to admit patients. The following table summarizes situational update data among ESF-8 and health care partners.

Sector Received periodic situational updates from ESF-8

Provided situational feedback to ESF-8

Yes No No answer or unknown


Hospital 36% 50% 13% 88% 0% 13%Long Term Care 11% 89% 0% 0% 100% 0%Home Health/Hospice 13% 83% 3% 34% 62% 3%Ambulatory Care 48% 48% 3% 53% 44% 3%Behavioral Health 50% 50% 0% 75% 25% 0%


Strength 1: A variety of communication platforms are available to facilitate communications pathways.





Area for Improvement 1: ESF-8 was unable to send out updates due to the AzHAN technical problem. Health Care facilities needed regular, periodic situational updates from ESF-8 in order to maintain a common operating picture.


PHP Exercise Objective 3: Demonstrate the ability to support jurisdictional medical surge operations

PHP Capability 10: Medical SurgeFunction 3: Support jurisdictional medical surge operations


Summary:

1. ESF-8 supported jurisdictional medical surge operations by activating its Command and ICS Structure, the Mass Casualty Plan, the SoAZHCC Coordinator as part of ESF-8, and the Public Information Officer (PIO), Joint Information Center (JIC), and Joint Information System (JIS).

2. ESF-8 did not develop or disseminate public information messages. 3. ESF-8 responded to requests for licensing waivers, behavioral health support, and reunification

services.


ESF-8 activated the Command Structure, Incident Command System (ICS), ICS Structure, and Mass Casualty Plan with some challenges. The SoAZHCC Coordinator was effectively activated and integrated into ESF-8. ESF-8 was familiar with processes and procedures.

ESF-8 also responded to requests to support medical surge. Some hospitals requested licensing waivers and behavioral health support. About half of participating hospitals requested reunification support. Evaluators noted that reunification activities are an area that may benefit from additional exercises. Many hospitals contacted ESF-8 to coordinate public information activities with the JIC. Long Term Care, Home Health/Hospice, and Ambulatory Care sectors did not request support for licensing waivers. Some Evaluators noted that this was because these sectors did not need licensing waivers.

The following table summarizes ESF-8 performance for selected medical surge support operations.

Select Medical Surge Support Operations Evaluator responses




for ESF-8Activated the Command and ICS Structure Performed with

some challengesActivated Mass Casualty Plan Performed with

some challenges (per 1 of 2 Evaluators)

Activated the SoAZHCC Coordinator as part of ESF-8

Yes

Activated the PIO, JIC, and JIS YesDeveloped and disseminated public information messages

No

Received requests for licensing waivers from Health Care agencies

Yes

Received requests for Behavioral Health support

Yes

Provided agency support for reunification services

Yes (per 1 of 2 Evaluators)


Strength 1: ESF-8 effectively activated the Command/ICS structure, Mass Casualty Plan, SoAZHCC Coordinator, and PIO/JIC/JIS. ESF-8 staff is knowledgeable about ICS, processes, and procedures.

Strength 2: ESF-8 supported medical surge requests.


Area for Improvement 1: U of A Campus Health facilities need additional planning for moving their clinic, staff, and patients to an alternate location.

Reference: Pima County Health Department Medical Surge PlanU of A Campus Health Emergency Plans

Area for Improvement 2: Hospitals did not have enough transportation support to move patients from hospitals to Long Term Care (LTC) or Home Health (HH)/Hospice facilities during hospital decompression activities.

Reference: Pima County Health Department Medical Surge Plan




PHP Exercise Objective 4: Utilize the Arizona Health Alert Network (AzHAN) system to notify the Southern Arizona Health Care Coalition (SoAZHCC) and Arizona Pediatric Disaster Coalition (APDC) of situational status.



Summary:

1. As part of the exercise scenario, hospitals experienced a surge in pediatric patients. 2. Two large Tucson hospitals with pediatric units simulated the transfer of pediatric patients to

Maricopa County hospitals with pediatric units. 3. ESF-8 was unable to notify Health Care partners and the Arizona Pediatric Disaster Coalition of

the community situational status via the AzHAN during the exercise.


For the majority of the exercise, technical problems within the AzHAN system prevented ESF-8 from utilizing AzHAN for notifications and situational updates regarding pediatric surge and the transfer of patients to Maricopa County hospitals. The AzHAN system was recovered about three hours following the start of the exercise, but many of the situational update communications that would normally occur through AzHAN did not occur.

ESF-8 was able to provide some situational updates to health care partners but not sufficiently to maintain a common operating picture among the entire health care system. ESF-8 may need to consider an alternate means of providing mass notifications in the event that either technical limitations or other issues prevent the use of AzHAN. The following table shows that about half or fewer of Health Care partners received periodic situational updates from ESF-8.

Sector Received periodic situational updates from ESF-8Yes No No answer or unknown

Hospital 36% 50% 13%Long Term Care 11% 89% 0%Home Health/Hospice 13% 83% 3%Ambulatory Care 48% 48% 3%Behavioral Health 50% 50% 0%





Strength 1: ESF-8 was able to provide some situational updates even though they were unable to use the AzHAN system.


Area for Improvement 1: The technical problems in AzHAN system also resulted in difficulties in provision of situational updates by ESF-8 to health care facilities during the exercise. Several facilities noted that they received little or no communications from ESF-8 during the exercise


HPP Exercise Objective 1: Hospitals will practice decompression at 20% of inpatient census. Of the 20% of patients, 50% will be transferred to Long Term Care, 25% will be transferred to home health, and 25% will be discharged home.

HPP Capability 2: Health Care and Medical Response CoordinationCapability Objective 3: Coordinate Response Strategy, Resources, and CommunicationsActivity 1. Identify and Coordinate Resource Needs during an Emergency

Evaluated Sectors:HospitalLong Term CareHome Health/HospiceAmbulatory Care

HPP Capability 4: Medical SurgeCapability Objective 2: Respond to a Medical SurgeActivity 1. Implement Emergency Department and Inpatient Medical Surge ResponseActivity 2. Implement Out-of-Hospital Medical Surge Response

Evaluated Sectors:HospitalLong Term CareHome Health/HospiceAmbulatory Care

Summary:

1. All hospitals achieved patient decompression at the required percentages and activated their Mass Casualty Plans.

2. About half or fewer of other Health Care sectors activated Mass Casualty Plans. 3. Some hospitals and a few ambulatory care facilities contacted ESF-8 for support in requesting

licensing waivers. 4. Additional medical surge activities were accomplished by all Health Care sectors and are

detailed in the Observations/Analysis section below.





Hospital Sector:

All hospitals accomplished patient decompression. Most achieved decompression without challenges. All hospitals activated their Mass Casualty Plans. Most were able to accomplish this without challenges. Some hospitals contacted ESF-8 for support in requesting licensing waivers; however, not all hospitals needed licensing waivers to manage the medical surge in this exercise. Additional information on hospital medical surge activities is summarized in the table that follows.

Hospital Sector: Select Medical Surge Activities


Entire facility network activated Mass Casualty Plan

75% without challenges25% with some challenges

0% 0%

Achieved patient decompression at the required percentages.


0% 0%

Triaged all patients and complete all required treatment processes

100% 0% 0%

Implemented strategies to provide pediatric care during a medical surge response


25% 13%

Requested Behavioral Health services through ESF-8

25% 50% 25%

Activated Mass Fatality Plan 25% without challenges25% with some challenges13% with major challenges

13% not performed

25%

Requested reunification support from ESF-8 (Note: 2 of 8 did not answer the question)

38% 38% 25%

If has access to EMTrack, utilized it to enter information about patients received at the facility

88% 13% 0%

Contacted ESF-8 for support in requesting licensing waivers

25% 50% 25%

Facility worked with the ESF-8 Joint Information Center prior to addressing public information issues (Note: 1 of 8 did not answer the question)

63% 25% 13%

Non-hospital Sectors:




Few Long Term Care facilities or Home Health/Hospice agencies were contacted by hospitals. This may represent a largely untapped resource in managing hospital patient decompression. Additional collaboration and coordination among sectors may be needed to fully utilize these resources. Long Term Care facilities and Home Health/Hospice agencies also completed patient assessments. While not all Long Term Care facilities and Home Health/Hospice agencies were able to complete all five (5) patient assessments, some were able to complete two (2) to (3) patient assessments. The table below summarizes hospital contact for patient transfer and the capability of facilities/agencies to complete the required number of patient assessments.

Sector Contacted by at least one hospital to arrange patient transfer to your facility/agency in order to decompress hospital patient surge?

Staff able to complete patient assessments for up to 5 patients

Yes No Yes NoLong Term Care 22% 78% * 89% 11%Home Health/Hospice 24% 76% 69% **31%* One facility reported that they had proceeded as if they had been contacted by a hospital.**Some agencies were able to complete two to three patient assessments.

About half or fewer of non-hospital sectors were able to activate their Mass Casualty Plans without challenges. Several were able to complete this activity with some challenges, and a few encountered major challenges. The table below summarizes this information for Non-hospital health care Sectors.

Non-hospital sectors Activation of Mass Casualty PlanPerformed without challenges

Performed with some challenges

Performed with major challenges

Not performed

Long Term Care 22% 33% 0% 44%Home Health/Hospice 48% 28% 0% 24%Ambulatory Care 33% 63% 3% 2%

Few non-hospital sectors contacted ESF-8 for support in requesting licensing waivers. Some facilities/agencies noted that licensing waivers were unnecessary. The table below summarizes this data.

Non-hospital sectors Contacted ESF-8 for support in requesting licensing




waiversYes No No answer or unknown

Long Term Care 0% 100% 0%Home Health/Hospice 0% 100% 0%Ambulatory Care 5% 83% 13%

Note: No Long Term Care or Home Health/Hospice agencies contacted ESF-8 for licensing waivers. One reason given by some facilities is that licensing waivers were not needed.Forty-four percent (44%) of Ambulatory Care facilities offered to provide staff/ supplies to hospitals or accepted walk-in patients; forty-eight (48%) did not; eight (8%) of facilities did not answer the question. Of Ambulatory Care facilities that were willing to accept walk-in patients directly from the stadium, at least eleven (11) saved patient records and labeled evidence (i.e. clothing) for law enforcement agencies. Thirty-nine percent (39%) of Ambulatory Care facilities without EMTrack access were able to keep track of patients on paper forms and send them to ESF-8.

As an optional component to this exercise, two (2) Long Term Care facilities chose to implement internal evacuation plans. This exercise component will be evaluated by individual facilities that selected to complete this activity.


Strength 1: Hospitals were able to effectively decompress patient surge, activate Medical Surge Plans, and transfer pediatric patients for care.

Strength 2: Many non-hospital facilities participated in this exercise; it was the first exercise for several non-hospital facilities/agencies.


Area for Improvement 1: Hospitals only reached out to a small percentage of LTC facilities and HH/Hospice agencies.

Area for Improvement 2: Some hospital networks require hospitals to reach out to affiliated LTC and HH/Hospice resources before outsourcing. Additional planning and coordination is needed to more efficiently outsource to LTC and HH/Hospice resources.

References: Medical Surge Plan

HPP Exercise Objective 2:Hospitals will transfer admitted inpatient pediatric patients to Tucson Medical

HPP Capability 4: Medical SurgeCapability Objective 2:

Evaluated Sector:Hospital




Center (TMC) and University Medical Center (UMC). Tucson Medical Center (TMC) and University Medical Center (UMC) will respond to the surge in pediatric in-patients by transferring them to Maricopa County hospitals. (Note: In this exercise, twenty-five percent of all patients were pediatric patients.)

Respond to a Medical SurgeActivity 4. Provide Pediatric Care during a Medical Surge Response

Summary:

1. Of the hospitals that performed this activity, half were able to perform this activity without challenges.

2. One (1) hospital that performed this activity experienced some challenges.3. Two (2) hospitals did not perform this activity. 4. Challenges included difficulties in contacting receiving hospitals and patient transportation

coordination.


Hospital Evaluators noted that they used “normal care guidelines” to stabilize and transfer out pediatric trauma patients. They also noted that pediatric patients were first admitted to pediatric beds, as possible, before transfer. The table below summarizes the hospitals’ performance in transferring pediatric patients during medical surge.

Sector Transfer pediatric patientsPerformed without Challenges

Performed with Some Challenges

Performed with Major Challenges

Not Performed

No answer

Hospitals 50% 13% 0% 25% 13%

Strengths: The partial capability level can be attributed to the following strength.

Strength 1: Hospital Evaluators noted that staff understand their limitations and know who to call to assist.

Areas for Improvement: The following areas require improvement to achieve the full capability level.

Area for Improvement 1: Some hospitals had difficulty contacting TMC and UMC. This may have been due to multiple hospitals trying to coordinate placement activities simultaneously.




Area for Improvement 2: Some hospitals had challenges in transferring pediatric patients to other hospitals during a medical surge event.

References: SoAZHCC Medical Surge Plans


HPP Capability 2: Health Care and Medical Response CoordinationCapability Objective 2: Utilize Information Sharing Procedures and PlatformsActivity 3. Utilize Communications Systems and Platforms

Evaluated Sectors:HospitalAmbulatory Care

Summary:

1. The majority of hospitals tracked patients received at their facilities using EMTrack.2. ESF-8 did not have full incident view access to EMTrack and was unable to maintain situational

awareness of tracked patients.3. Of the Ambulatory Care facilities that received patients from the stadium, thirty-nine percent

(39%) of them reported that they did send paper tracking forms to ESF-8; forty-two percent (42%) did not and 19% either did not answer the question or did not know the answer.

4. Evaluations showed that some Ambulatory Care networks were more successful at utilizing patient tracking forms.


The tables below summarize how hospitals and Ambulatory Care networks utilized EMTrack and paper tracking forms.

Sector Utilized EMTrackYes No

Hospitals 88% 13%

Sector Sent paper tracking forms to ESF- 8Yes No No answer or

unknownAmbulatory Care 39% 42% 19%





Strength 1: Most hospitals with access to EMTrack have a good understanding of its capability and how to use the system.

Strength 2: Thirty-nine percent (39%) of the Ambulatory Care facilities utilized paper tracking forms and sent the forms to ESF 8.


Area for Improvement 1: ESF-8 did not have full incident view access to EMTrack and could not maintain situational awareness of tracked patients.

References: ADHS EMTrack procedures

Area for Improvement 2: Forty-two percent (42%) of Ambulatory Care facilities did not successfully access, utilize, and send paper patient tracking forms to ESF 8. Staff was not familiar with specific SOPs and related forms (paper patient tracking forms).

References: Paper patient tracking forms Facility SOPs


HPP Capability 1: Foundation for Healthcare and Medical ReadinessCapability Objective 4: Train and Prepare the Health Care and Medical WorkforceActivity 1: Promote Role-Appropriate National Incident Management System Implementation

Evaluated Sectors:HospitalLong Term CareHome Health/HospiceAmbulatory CareBehavioral Health

Summary:

1. All facilities/agencies in the Hospital, Long Term Care, and Behavioral Health sectors were able to activate their Incident Command Centers and structures, although many reported challenges.

2. Most Long Term Care facilities and Home Health/Hospice agencies contacted their Incident Command Centers to request supplies and staffing.

3. Not all command and support staff were familiar with their roles and responsibilities specific to emergency plans and procedures.





Within all sectors, the majority of agencies/facilities were able to activate their Command Centers. For some Ambulatory Care agencies, it was noted that they didn’t actually “activate” their command system because they served as support agencies and weren’t sure of the specific activities within their hospital Incident Command Centers.

Sector Activation of Incident Command Center/StructurePerformed without Challenges



Not Performed

Unknown

Hospitals 63% 25% 13% 0% 0%Long Term Care 67% 22% 11% 0% 0%Home Health/Hospice 52% 38% 0% 7% 3%Ambulatory Care 38% 38% 3% 25% 0%Behavioral Health 50% 25% 25% 0% 0%

For the Long Term Care and Home Health/Hospice facilities evaluations showed that most facilities successfully contacted their Incident Command Centers to request supplies and staffing. Sector Alert Command Center about supplies/staffing

Yes NoLong Term Care 78% 22%Home Health/Hospice 76% 24%


Strength 1: Health care facilities have good knowledge of the Health Care Incident Command System.

Strength 2: Long Term Care facilities and Home Health/Hospice agencies understood how to contact their Command Center to request additional supplies and staff.

Strength 3: Many facilities reported a well-coordinated, quick response to affiliated facilities.


Area for Improvement 1: The Ambulatory Care, Home Health/Hospice, and Behavioral Health sector agencies/networks reported challenges in activating their Command Structure/System.

Area for Improvement 2: Some command and support staff were unfamiliar with their roles and responsibilities specific to emergency plans and procedures.




References: Facility Standard Operating Procedures and Emergency Operations Plan


HPP Capability 2: Health Care and Medical Response CoordinationCapability Objective 2: Utilize Information Sharing Procedures and PlatformsActivity 3. Utilize Communications systems and Platforms

Evaluated Sectors:HospitalLong Term CareHH/HospiceAmbulatory CareBehavioral Health

Summary:

1. Hospitals and Behavioral Health agencies utilized the available communication platforms to exchange information with ESF-8 more than the other sectors.

2. Long Term Care facilities did not utilize the communication platforms to provide situational feedback to ESF-8; some communication platforms may not be accessible to these facilities.


The evaluation data showed the Hospital and Behavioral Health sectors were most successful at exchanging information with ESF-8. Home Health/Hospice agencies and Ambulatory Care facilities appeared to exchange information with ESF-8 less frequently. One (1) Long Term Care facility noted they had no contact with ESF-8; another noted they had no contact with any health care partners.

Evaluators noted that WebEOC was not utilized as a communication platform in this exercise since the Pima County Emergency Operations Center was simulated. Evaluators commented that it may have been helpful in maintaining situational awareness. The table below shows how well each sector utilized accessible communication platforms to exchange information with ESF-8.

Sector Utilize communication platforms to receive/exchange information with ESF 8Yes No No answer or

unknownHospital 88% 13% 0%Long Term Care 0% 100% 0%Home Health/Hospice 66% 34% 0%Ambulatory Care 58% 34% 8%Behavioral Health 100% 0% 0%Hospitals and Behavioral Health agencies provided the most situational feedback to ESF-8. Long Term Care facilities did not provide situational feedback to ESF-8. The table below displays a summary of how well each sector was able to provide situational feedback to ESF-8.




Sector Provided situational feedback to ESF-8Yes No No answer or unknown

Hospital 88% 0% 13%Long Term Care 0% 100% 0%Home Health/Hospice 34% 62% 3%Ambulatory Care 53% 44% 3%Behavioral Health 75% 25% 0%

Forty-five (45) Ambulatory Care facilities were asked if their facilities worked with all corporate locations to address disaster situation. Of these, most did work with all their corporate locations, although several did not provide an answer to this question.

Sector Work with all corporate locations to address disasterYes No No answer

Ambulatory Care 73% 9% 18%


Strength 1: Health care facilities utilized accessible communication platforms to reach ESF -8 and provide situational updates.

Strength 2: Most Ambulatory Care facilities reported successfully working with all corporate locations within their networks to address the disaster.


Area for Improvement 1: Some health care facilities did not have access to or knowledge of available communication platforms.

Area for Improvement 2: Some health care facilities were not able to provide situational updates to ESF-8.


HPP Exercise Objective 6.The Behavioral Health Sector will test the coordination of all Behavioral Health

HPP Capability 4: Medical SurgeCapability Objective 2:

Evaluated Sector:Behavioral Health




response teams, service request calls and response agency communication related to this exercise.

Respond to a Medical SurgeActivity 8. Respond to Behavioral Health Needs during a Medical Surge Response

Summary:

1. The majority of behavioral health agencies were able to activate their Mass Casualty Plans.2. Most behavioral health agencies conducted medical surge activities.3. Some behavioral health agencies reported that they did not receive regular situational updates.


The majority of behavioral health agencies were able to activate their Mass Casualty Plans without challenges or with some challenges. One agency noted the need for clarification of whether agency activation of the Mass Casualty Plan is determined by their network’s Incident Command. The table below shows the percentage of behavioral health agencies that activated their Mass Casualty Plans.

Sector Activate Mass Casualty PlanPerformed without Challenges



Not Performed

Behavioral Health 25% 50% 0% 25%

Behavioral health agencies were also evaluated for selected medical surge activities. The table below describes the activities and the percentage of agencies that performed the activities.

Select Behavioral Health Medical Surge Activities Yes NoWorked with the Behavioral Health Emergency Operations Center to coordinate resources

75% 25%

Received requests for behavioral health support 100% 0%Provided requested behavioral health services 75% 25%


Strength 1: All behavioral health agencies reported receiving requests for behavioral health support.

Strength 2: Most behavioral health agencies were able to provide behavioral health support that was requested by other health care agencies.





Area for Improvement 1: Not all behavioral health agencies have or were able to activate a Mass Casualty Plan.

Area for Improvement 2: Even though behavioral health agencies reported working within the Behavioral Health Emergency Operations Center to coordinate resources, some reported they were not regularly updated and therefore, did not have a good perspective on emerging community needs.

Area for Improvement 3: Behavioral health was not well integrated into the ESF-8 communication pathway, preventing the Behavioral Health Emergency Operations Center from having a common operating picture of the region.

References: ESF-8 Emergency Response Plans Behavioral Health Communications Plan




APPENDIX A: IMPROVEMENT PLANThis Improvement Plan has been developed specifically for the Southern Arizona Health Care Coalition for the 2017 U of A Game Changer Full-Scale Exercise conducted on October 11, 2017. Note: Capability Elements include Planning, Organization, Equipment, Training, or Exercise.

Objective Issue/Area for Improvement (AFI) Corrective Action Capability

ElementResponsible

Sector Sector POC Start Date Completion Date

Public Health Preparedness Exercise Objective 1:Pima County Emergency Support Function 8: Public Health and Medical Services (ESF-8) will notify partners of the emergency incident and provide situational updates via the Arizona Health Alert Network (AzHAN) system.

The AzHAN system had technical issues at the beginning of exercise resulting in no initial notifications via AzHAN of the incident for the majority of health care facilities.

The failure point in AzHAN has been corrected. The SoAZHCC Communications Plan provides for the use of an alternate system. Future exercises will also utilize the alternate system in addition to AzHAN..

Exercise SoAZHCC Dan Stanley

10-11-2017 10-13-2017

The technical problems in AzHAN system also resulted in difficulties in provision of situational updates by ESF-8 to health care facilities during the exercise. Several facilities noted that they received little or no communications from ESF-8 during the exercise

Appendix A: Improvement Plan 29 FOR OFFICIAL USE ONLY



ESF-8 did not utilize alternate means to provide situationalUpdates.

In 12-2017, the AzHAN and alternate system will be tested


10-11-2017 TBD


ElementResponsible


PHP Exercise Objective 2: Demonstrate the ability to exchange information to determine a common operating picture.

ESF-8 was unable to send out updates due to the AzHAN technical problem. Health Care facilities needed regular, periodic situational updates from ESF-8 in order to maintain a common operating picture.

Both AzHAN and an alternate communications system will be used in future exercises.


10-11-2017 10-13-2017

PHP Exercise Objective 3:Demonstrate the ability to support jurisdictional medical surge operations.

U of A Campus Health facilities need additional planning for moving their clinic, staff, and patients to an alternate location.

Update emergency plans to include moving the clinics, staff, and patients to an alternate location.

Planning U of A, ESF-8, and SoAZHCC

Harry McDermottLouis ValenzuelaDan Stanley

10-11-2017 2-11-2018

Hospitals did not have enough transportation support to move patients from hospitals to Long Term Care (LTC) or Home Health (HH)/Hospice facilities during hospital decompression activities.

Additional planning and collaboration is needed among hospitals, ESF-8, and SoAZHCC to develop plans for transporting patients to LTC or HH/Hospice agencies. Non-Advanced Life Support/Basic Life Support agencies

Planning Hospitals, ESF-8, SoAZHCC

Louis Valenzuela

Dan Stanley

10-11-2017 2-11-2018




should be included in planning activities.


ElementResponsible


PHP Exercise Objective 4:Utilize the Arizona Health Alert Network (AzHAN) system to notify the Southern Arizona Health Care Coalition (SoAZHCC) and Arizona Pediatric Disaster Coalition (APDC) of situational status.

The technical problems in AzHAN system also resulted in difficulties in provision of situational updates by ESF-8 to health care facilities during the exercise. Several facilities noted that they received little or no communications from ESF-8 during the exercise

The failure point in AzHAN has been corrected. The SoAZHCC Communications Plan provides for the use of an alternate system. Future exercises will also utilize the alternate system in addition to AzHAN.

Planning SoAZHCC Dan Stanley

10-11-2017 10-13-2017

HPP Exercise Objective 1:Hospitals will practice decompression at 20% of inpatient census. Of the 20% of patients, 50% will be transferred to Long Term Care, 25% will be transferred to home health, and 25% will be discharged home.

Hospitals only reached out to a small percentage of LTC facilities and HH/Hospice agencies.

Continue to exercise decompression within the region, including all health care sectors

Exercise Hospital SectorSoAZHCC

Dan Stanley

11-02-2017 11-02-2018

Some hospital networks require hospitals to reach out to affiliated LTC and HH/Hospice resources before outsourcing. Additional planning and coordination is needed to more efficiently outsource to LTC and HH/Hospice resources.

Develop SoAZHCC plans to include a centralized system when outsourcing for LTC and HH/Hospice resources. Planning should include an ESF-8 or SoAZHCC point of contact that can identify facilities that can support hospital decompression activities.

Planning Hospital SectorSoAZHCC

Dan Stanley

11-02-2017 03-02-2018





ElementResponsible


HPP Exercise Objective 2:Hospitals will transfer admitted inpatient pediatric patients to Tucson Medical Center (TMC) and University Medical Center (UMC). Tucson Medical Center (TMC) and University Medical Center (UMC) will respond to the surge in pediatric in-patients by transferring them to Maricopa County hospitals.(Note: In this exercise, twenty-five percent of all patients were pediatric patients.)

Some hospitals had difficulty contacting TMC and UMC. This may have been due to multiple hospitals trying to coordinate placement activities simultaneously

Develop SoAZHCC plans to include a centralized system when outsourcing for coordinated placement with TMC and UMC. Planning should also include a central point of transportation coordination for pediatric patients.

Planning HospitalsSoAZHCC

Dan Stanley

11-03-2017 03-03-2018

Some hospitals had challenges in transferring pediatric patients to other hospitals during a medical surge event.

Include pediatric patient transfer procedures in future exercises


10-11-2017 10-11-2018


ESF-8 did not have full incident view access to EMTrack and could not maintain situational awareness of tracked patients.

Arizona Department of Health Services (ADHS) and ESF-8 (SoAZHCC) need to work together to develop full incident view access for ESF-8.

Planning Arizona Department of Health Services

SoAZHCC

Tim Singleton

Dan Stanley

10-13-2017 12-13-2017





ElementResponsible


HPP Exercise Objective 3 cont’d.

Forty-two percent (42%) of Ambulatory Care facilities did not successfully access, utilize, and send paper patient tracking forms to ESF-8. Ambulatory Care staff was not familiar with specific SOPs and related forms (paper patient tracking forms).

Develop Just in Time training to familiarize staff with patient tracking systems, procedures, and specific forms.

Training SoAZHCC Dan Stanley

2-13-2017 06-13-2017


The Ambulatory Care, Home Health/Hospice, and Behavioral Health sector agencies/networks reported challenges in activating their Command Center Structure/System.

Exercise activation of incident command systems, within facilities, networks, and the region.


10-13-2017 10-13-2018

Some command and support staff were unfamiliar with their roles and responsibilities specific to emergency plans and procedures.

Health Care sectors should identify appropriate ICS training for staff (e.g. IS100, IS200, IS300). SoAZHCC will help support class coordination.

Training Health Care Sectors

SoAZHCC

Dan Stanley

2-13-2017 6-13-2018





ElementResponsible



Some health care facilities did not have access to or knowledge of available communication platforms.

Provide a training/workshop on regional emergency communication platforms and information sharing pathways during incident response.

Training/ Tabletop Exercise

SoAZHCC Dan Stanley

10-11-2017 6-13-2018

Some health care facilities were not able to provide emergency situational updates to ESF-8.

Continue to exercise regional communication platforms and information sharing pathways.


10-11-2017 10-11-2018


ElementResponsible





HPP Exercise Objective 6.The Behavioral Health Sector will test the coordination of all Behavioral Health response teams, service request calls and response agency communication related to this exercise.

Not all behavioral health (BH) agencies have or were able to activate a Mass Casualty Plan.

Continue planning within the BH sector to support development of Mass Casualty Plans.

Planning BH sector Dan Landers

10-13-2017 2-13-2018

Even though behavioral health agencies reported working within the Behavioral Health Emergency Operations Center to coordinate resources, some reported they were not regularly updated and therefore, did not have a good perspective on emerging community needs.

Provide education to BH agencies on the BH Communications Plan.

Training BH Planning Team

Dan Landers

2-13-2017 6-13-2018

BH was not well integrated into the ESF-8 communication pathway, preventing the BH Emergency Operations Center (EOC) from having a common operating picture of the region.

Consider strategies for better integration of BH liaison into ESF-8 communications pathways.

Planning BH sector Dan Landers

10-13-2017 2-13-2018




APPENDIX B: PARTICIPATING ORGANIZATIONS Ambulatory Care Agencies - Tucson

Arizona Digestive Institute

Carondelet Medical Mall at Rita Ranch

Center for Pain Management

DCI Desert Dialysis – Green Valley

DCI Douglas Dialysis - Douglas

Desert Senita Community Center

El Rio Community Health Center - Broadway

El Rio Community Health Center - Health On Broadway

El Rio Community Health Center- Administration - Manning House -Paseo Redondo

El Rio Community Health Center- Birth and Women's -Grant Road

El Rio Community Health Center-Codac and El Rio Whole Health - Alvernon

El Rio Community Health Center – Congress Congress-Peds (839 W Congress St)

El Rio Community Health Center – Congress Dental (839 W Congress St)

El Rio Community Health Center-El Pueblo - Irvington

El Rio Community Health Center- Northwest - Prince

El Rio Community Health Center – Northwest Dental (320 W Prince St)

El Rio Community Health Center- OB GYN - Irvington

El Rio Community Health Center- Pasqua Yaqui - Camino Oeste

El Rio Community Health Center- Southeast - Golf Links

El Rio Community Health Center- Southwest - Commerce Court

El Rio Community Health Center – Southwest Dental (1500 W Commerce St)

El Rio Community Health Center- Special Immunology Associates - St Mary's

Fresenius Kidney Care East - 5th Street

Fresenius Kidney Care Mammoth

Fresenius Kidney Care Midvale - Valencia Road

Fresenius Kidney Care Northwest - N. LaCholla

Appendix B: Participating Organizations 36 FOR OFFICIAL USE ONLY



Fresenius Kidney Care South - 6th Street

Fresenius Kidney Care West - Grant Road

Mesquite Gastroenterology and Surgery Center

MHC Healthcare - East Side Health Center

MHC Healthcare - Ellie Towne Health Center, Clinic and Dental

MHC Healthcare - Flowing Wells Family Health Center

MHC Healthcare - Marana Main Health Center-Clinic, Dental, OBGYN

MHC Healthcare - MHC Primary Care Health Center

MHC Healthcare - Santa Catalina Health Center

MHC Healthcare - West Side Health Center

MHC Healthcare - Wilmot Family Health Center

MHC Healthcare -Clinica Del Alma

MHC Healthcare -Dove Mountain Health Center

MHC Healthcare -Freedom Park Health Center

MHC Healthcare -Keeling Health Center

MHC Healthcare -Marana Counseling and Wellness -Behavioral Health

MHC Healthcare -Obstetrics and Women's Health Hospital Drive

MHC Healthcare -Ortiz Community Health Center

Northwest Allied Physicians - Medical Office Building-1521 Tangerine

Northwest Allied Physicians - Oro Valley Pediatrics-1856 Innovation Park Drive

Northwest Allied Physicians - Rancho Vistoso-13101 Oracle Road

Northwest Allied Physicians - Saddlebrook - 6371 Saddlebrooke Blvd

Northwest Allied Physicians - Sleep Lab -1521 Tangerine

Northwest Allied Physicians - Sleep Lab -6130 La Cholla

Northwest Allied Physicians - Tangerine Quick Med-3630 Tangerine

Northwest Allied Physicians at Innovation Park Drive 1850 Innovation Park Dr

Northwest Allied Physicians at Lambert- 10370 N La Canada

Oro Valley Hospital Cardiac Imaging

Rancho Vistoso Physical Therapy- 13101 N Oracle Road




Rancho Vistoso Urgent Care - 13101 N. Oracle Road

Tucson Gastroenterology

TMC One Knight Drive

TMC One Rita Road #100

TMC One Houghton

TMC One Ferguson

TMC One Harrison

TMC One Rita Road # 180

TMC One Swan Road

TMC One Wilmot

TMC One Wyatt Road

Tucson Surgery Center

U of A Campus Health Services

United Community Health Center

Primeros Pasos South

Ambulatory Care Agencies – Phoenix

Honor Health Medical Group & Heart Group - Glendale

Honor Health Medical Group 27th Avenue - Phoenix

Honor Health Medical Group 44th Street - Phoenix

Honor Health Medical Group 7th Street – Phoenix

Honor Health Medical Group and Occupational Health - Marina Heights - Tempe

Honor Health Medical Group Bariatric Center - Scottsdale

Honor Health Medical Group Beattitudes - Phoenix

Honor Health Medical Group Carefree Highway - Scottsdale

Honor Health Medical Group Cave Creek - Phoenix

Honor Health Medical Group Chaparral - Scottsdale

Honor Health Medical Group Comprehensive Care Center - Phoenix

Honor Health Medical Group Deer Valley - Phoenix

Honor Health Medical Group Dynamite - Cave Creek




Honor Health Medical Group Ear, Nose and Throat - Phoenix

Honor Health Medical Group Gastroenterology - Deer Valley - Phoenix

Honor Health Medical Group Gastroenterology - Osborn - Scottsdale

Honor Health Medical Group Gastroenterology - Shea - Scottsdale

Honor Health Medical Group Gastroenterology - Thompson Peak - Scottsdale

Honor Health Medical Group Gavilian Peak - Anthem

Honor Health Medical Group Hatcher - Phoenix

Honor Health Medical Group Heart Group - Scottsdale

Honor Health Medical Group Indian School - Phoenix

Honor Health Medical Group Lincoln - Phoenix

Honor Health Medical Group Lomax - Phoenix

Honor Health Medical Group McDowell Mountain Ranch - Scottsdale

Honor Health Medical Group McKellips - Mesa

Honor Health Medical Group Mesa Southern AZ - Mesa

Honor Health Medical Group Mescal - Scottsdale

Honor Health Medical Group Moon Valley - Phoenix

Honor Health Medical Group North Peoria - Peoria

Honor Health Medical Group North Phoenix and Pulmonology- Phoenix

Honor Health Medical Group Occupational Health - Deer Valley - Phoenix

Honor Health Medical Group Occupational Health - Glendale - Glendale

Honor Health Medical Group Occupational Health - Shea - Scottsdale

Honor Health Medical Group Occupational Health - Thompson Peak - Scottsdale

Honor Health Medical Group Occupational Health Osborn - Scottsdale

Honor Health Medical Group Osborn - Scottsdale

Honor Health Medical Group Paradise Valley - Scottsdale

Honor Health Medical Group Peoria Health Center - Peoria

Honor Health Medical Group Saguaro - Phoenix

Honor Health Medical Group Shea - Scottsdale




Honor Health Medical Group South Tempe - Tempe

Honor Health Medical Group Spine Group Arizona - Scottsdale

Honor Health Medical Group Tatum - Phoenix

Honor Health Medical Group Thompson Peak - Scottsdale

Honor Health Medical Group Tramonto - Phoenix

Honor Health Medical Group West Thunderbird Road - Peoria

Honor Health Medical Group West Union Hills Drive - Glendale

Honor Health Medical Group West - Tempe

Honor Health Cardiac Rehab and Therapy Services - Lincoln - Phoenix

Honor Health Cardiac Rehab Center - Deer Valley - Phoenix

Honor Health Cardiac Rehab Center - Shea - Scottsdale

Honor Health Outpatient Endoscopy - Phoenix

Honor Health Outpatient Therapy and PATTS - Scottsdale

Honor Health Outpatient Imaging Services - MRI - Phoenix

Honor Health Outpatient Infusion Services - Glendale

Honor Health Outpatient Infusion Services - Osborn – Scottsdale

Honor Health Outpatient Infusion Services - Peoria Health Center- Peoria

Honor Health Outpatient Infusion Services - Shea - Scottsdale

Honor Health Outpatient Medical Imaging Services -27th Ave - Phoenix

Honor Health Outpatient Medical Imaging Services -Tatum- Phoenix

Honor Health Outpatient Surgery Center - Deer Valley - Phoenix

Honor Health Outpatient Surgery Center - Lincoln - Phoenix

Honor Health Outpatient Therapy Services - Anthem - Anthem

Honor Health Outpatient Therapy Services - Glendale

Honor Health Outpatient Therapy Services - Moon Valley - Phoenix

Honor Health Outpatient Therapy Services - Osborn - Scottsdale

Honor Health Outpatient Therapy Services - Shea - Scottsdale

Honor Health Outpatient Therapy Services - South Tempe - Tempe




Honor Health Outpatient Therapy Services - Spine Group - Scottsdale

Honor Health Outpatient Therapy Services - Tatum - Phoenix

Honor Health Outpatient Therapy Services - Thompson Peak - Scottsdale

Honor Health Outpatient Therapy Services - West Union Hills - Glendale

Honor Health Outpatient Therapy Services 44th Street - Phoenix

Honor Health Seep Health Center - Scottsdale

Honor Health Sleep Health Center - Scottsdale

Honor Health Women's Diagnostic Center - Scottsdale

Neighborhood Access and Outreach to Health (NOAH )

NOAH Cholla Health Center - Scottsdale

NOAH Heuser Family Medicine Center - Scottsdale

NOAH Heuser Pediatric Dental - Scottsdale

NOAH Palomino Health Center - Phoenix

NOAH Balez Health Center - Phoenix

Sierra Health Center - Glendale

Sonoran Health and Emergency Center - Phoenix

Virginia G. Piper Cancer Center Network - Shea

Virginia G. Piper Cancer Center Network - Avondale

Virginia G. Piper Cancer Center Network - Chandler

Virginia G. Piper Cancer Center Network - Fountain Hills

Virginia G. Piper Cancer Center Network - Gilbert

Virginia G. Piper Cancer Center Network - Glendale

Virginia G. Piper Cancer Center Network - North Scottsdale

Virginia G. Piper Cancer Center Network - Pinnacle

Virginia G. Piper Cancer Center Network - South Scottsdale

Virginia G. Piper Cancer Center Network - Surprise

Virginia G. Piper Cancer Center Network - Wickenburg

Behavioral Health – Tucson

Bridgeway Health Solutions




Cenpatico Integrated Care

Cornerstone Behavioral Health - El Dorado

El Rio Community Health Center- Congress Gomez

Health Net Access

Community Resources – Tucson

Critical Incident Stress Management

Medical Reserve Corp - ESAR VIP

County Public Health

Pima County Health Department

Home Health/Hospice – Tucson

Agape Hospice

Amedisys Hospice

At Home Healthcare - Tucson

Banner Home Health

Bayada Home Health Care

Bayada Home Health Care - Green Valley - Assisted Care

Bayada Home Health Care - North Tucson - Home Health

Bayada Home Health Care - Tucson East - Home Health

Bayada Home Health Care - Tucson Skilled -Adult nursing, staffing, pediatric

Bayada Home Health Care - Tucson West Adult - Assisted Care

Bayada Home Health Care-Tucson East Adult assisted Living

Casa De La Luz Palliative Care

Casa De Luz Hospice

Casa Hospice at Fountains

Casa Hospice at the Hacienda

Dependable Home Health Inc Nogales

Dependable Home Health Inc Tucson

Dependable Nurses Inc

Desert Harmony Hospice




Hacienda Home Health Care Inc

Harbor Light Hospice

HCR Manor Care

Heartland Hospice Services

Hospice Family Care Inc

Interim Healthcare

Intrepid USA Home Health

Kanmar Place

Kindred at Home

Maxim Healthcare

Nurse Core

Nursing Solutions - Phoenix

Nursing Solutions Southern Arizona - Tucson

Patient Care Advocates

Santa Rita Home Health Care-Green Valley

Soulistic Hospice - Tucson

Valor Hospice Care - Cochise County

Valor Hospice Care - Pima County

Valor Hospice Care - Pinal County

Valor Hospice Care - Santa Cruz County

Hospitals – Tucson

Banner UMC Main

Banner UMC South

Cornerstone Hospital

Northwest Medical Center

Oro Valley Hospital

St. Joseph’s Hospital

St. Mary’s Hospital

Tucson Medical Center




Hospitals – Phoenix

John C Lincoln Medical Center

Greenbaum Specialty Surgical Hospital

Deer Valley Medical Center

Scottsdale Osborn Medical Center

Scottsdale Shea Medical Center

Scottsdale Thompson Peak Medical Center

Long Term Care – Tucson

Arizona State Veterans Home - Tucson

Avalon Southwest Health and Rehabilitation

Arroya Gardens Independent and Assisted Living

Brookedale - Santa Catalina

Brookedale

Casas Adobes Post-Acute and Rehabilitation Center

Copper Health Oro Valley

Devon Gables

Foothills Rehab Center

Hacienda at the River, The Springs

Handmaker

Haven of Tucson

Haven of Yuma

La Canada Care Center

Life Care Center of Tucson

Mountain View Care Center

Park Avenue Healthcare

Sabino Canyon Rehabilitation

Santa Rita Nursing and Rehab

Santa Rosa Care Center

Sante Tucson




Splendido at Rancho Vista

Villa Marie Care Center

Tribal

Tohono O’odham Nation

Pascua Yaqui Tribe




APPENDIX C: ACRONYM LIST

AAR After-Action ReportAAR/IP After Action Report/Improvement PlanADHS Arizona Department of Health ServicesAPDC Arizona Pediatric Disaster CoalitionASPR Assistant Secretary for Preparedness and ResponseASU Arizona State UniversityAZ ArizonaAzHAN Arizona Health Alert Network

BH Behavioral Health

CMS Centers for Medicare and Medicaid Services

EMS Emergency Medical ServicesEMTrack A web-based, patient tracking system used to track patients EOC Emergency Operations CenterESF-8 Emergency Support Function 8: Public Health and Medical Services

FEMA Federal Emergency Management AgencyFOUO For Official Use OnlyFSE Full-Scale Exercise

HH Home HealthHICS Health Care Incident Command SystemHPP Hospital Preparedness ProgramHSEEP Homeland Security Exercise and Evaluation Program

ICS Incident Command SystemIP Improvement Plan

JIC Joint Information CenterJIS Joint Information System

LTC Long Term Care

NIMS National Incident Management System

Appendix C: Acronym List 46 FOR OFFICIAL USE ONLY



PCHD Pima County Health DepartmentPCOEM Pima County Office of Emergency ManagementPHP Public Health PreparednessPOC Point of Contact

SimCell Simulation CellSoAZHCC Southern Arizona Health Care Coalition

TMC Tucson Medical Center

U of A University of ArizonaUMC University Medical Center

Appendix C: Acronym List 47 FOR OFFICIAL USE ONLY


Documents

After-Action Report/Improvement Plan - Southern Arizona ... · Web view2017/11/12 · After-Action Report/ Improvement Plan (AAR/IP) Southern Arizona Health Care CoalitionNovember