November 12, 2012

Meeting Objectives

• Ensure Everyone is Warm and Fuzzy on Statewide Exercise Processes and Activities

• Answer Any Outstanding Questions

Disaster Preparedness Workgroup

Statewide Health & Medical Exercise

2012

Capability Observation Recommendation

Intelligence/ Information Sharing & Dissemination

County only collected status reports via ReddiNet; CCALAC had to translate into email and send/receive

Assessment Polls from the EMS Agency should have an easily transportable form

Intelligence/ Information Sharing & Dissemination

Limited notification of CCALAC and MAC when clinics activated response procedures

Increase awareness training to clinics on best practice response notification procedures

Emergency Operations Center Management

Many clinic staff not regularly involved in disaster plans were unfamiliar with their response roles

Incorporate HICS Forms and Job Action Sheets into drills and exercise.

2011 Exercise Lessons Learned

• 2011 Lessons Learned

• MOA Contracts with “Site Summary” forms

• Site-Specific Incident Management Team Designations

• Incident Command System / Incident Action Planning Training

• Quarterly Communications Drills

• 2012 Statewide Medical and Health Exercise Participation

Putting It All Together

Our Clinic will be…

..here to help!

Exercise Overview

OBJECTIVE: To discuss the planning and response to a loss of power to the healthcare delivery system and the community. SCENARIO:

Earthquake results in power loss. Earthquakes can cause a variety of problems and disruptions to infrastructure. Due to the limited time, this exercise will focus on power loss. Participants can customize the exercise and objectives to address other issues.

2008 Sayre Wild Land Fire

Olive View-UCLA Medical Center

lost power and emergency

generators failed

- 27 patients evacuated: 15

infants from Neonatal ICU, 4

critical care patients and 5

adult patients on ventilators

- Patients evacuated down

stairs with assistance of local

fire department Source: ABC news: http://ABC.local.archives/SayreFire

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Historical Impact of Power Loss

2010 Palo Alto Plane

Crash

Power outage caused by the crash of a twin-engine Cessna in East Palo Alto, which toppled several major power transmission lines

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Historical Impact of Power Loss

Stanford Hospital & Clinics and Lucile Packard Children’s Hospital in Palo Alto, CA were without power; the hospitals functioned on emergency power, and all non-emergency cases were postponed for the day

Source: www.mercurynews.com/peninsula/ci_14422658

September 2012: San Diego Power Failure 5 million people without power in California, Arizona and Mexico

Roads gridlocked due to outage of traffic lights

Gas stations without power and unable to dispense fuel

Eisenhower Medical Center in Palm Springs served as a respite for the community

Source: www.nbcsandiego.com

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Historical Impact of Power Loss

Communications

Intelligence/Information Sharing and

Dissemination

Medical Surge

Emergency Operations Center Management

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2012 Statewide Medical and Health

Exercise Target Capabilities

Determine/Evaluate clinic’s ability to communicate with response partners

Discuss/Test ability to communicate needs with outside sources for essential supplies, services, and equipment

• Focus on resource supply chains

Target Capability: Communications

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Communication with the MAC

…from the 2012 LAC EMS Agency Communications Directory

Review/test adequacy of information management plans and technology

• internal and external

Review/test risk communication and public information message dissemination

Discuss/exercise ability to provide situational status and projected impact updates to: CCALAC/EMSA/DRC/Local EMD

Target Capability: Intelligence/Information Sharing and Dissemination

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COMMUNICATIONS DIRECTORY

Target Capability: Medical Surge

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Determine/evaluate ability to expand patient capacity using non-traditional care areas for triage and treatment

Determine/evaluate ability to prioritize, manage, and allocate resources

Discuss/test capacity to provide care with out the use of power

Test EOP and hazard specific plans

Discuss/exercise activation of Incident Management Team

Exercise ability to initiate incident action plan

Work through Incident Action Planning Process using HICS Forms

Target Capability: Emergency Operations Center Management

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MASTER SCENARIO EVENTS LIST (MSEL)

Time Incident

0645 7.8 Earthquake : Official Activation of the EMS Operations Center

0700 Reddinet / Email Damage Assessment Request: - Clinics with Reddinet complete Assessment Poll - Clinics without Reddinet complete fill-able PDF and email or fax to the Medical Alert Center @ (562) 347-1703

0830 Clinics Respond to Scenario: - Patient Profiles: overwhelmed with worried well, ect.

0930 Clinic _____ Reports Downed Power lines trapping staff.

1010 Clinics testing Mass Fatality Plans activate plan, request coroner, and initial PsySTART triage of staff

1058 Clinics testing MFI request MAC support

1300 Official End of Exercise: Clinics conduct Hotwash Debrief with Staff and collect Evaluator/Controller Feedback Forms

Key Injects

Communicate, Communicate, Communicate!!!!

• Respond to Everbridge Messages

• Complete and send in Situation Report Assessments

• Send in Resource Requests to EMS Agency

Take Action

• Activate your Incident Management Team

• Work through the Incident Action Planning Process and MSEL Injects

• Complete HICS Forms 201, 202, 203, 204, 214 http://dp.ccalac.org/Policies/Incident%20Action%20Planning/Pages/default.aspx

• Complete Hotwash Debrief

• Create After Action Report

Key Actions

• Logistical issues

• Technological issues

• People issues

• Time issues

Addressing Past Concerns

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http://dp.ccalac.org/PREPAREDNESS/drills/SMHE http://ems.dhs.lacounty.gov/Disaster/Announcement.htm

http://dp.ccalac.org/PREPAREDNESS/drills/SMHE http://ems.dhs.lacounty.gov/Disaster/Announcement.htm http://www.californiamedicalhealthexercise.com/exercises/phase3.php

Identify overarching goals

Establish purpose

Define extent of play

Choose objectives

Define exercise assumptions, artificialities

Develop security plan (exercise safety)

Define resource requirements and logistics plan

Develop briefing materials (exercise handbooks and forms): • Controller/facilitator

• Evaluator/data collector

• Note taker/scribe

• Player

Create Exercise roster

EXERCISE DESIGN/PLANNING

Convene IMT

Announce Narrative

Provide Position Specific IRGs

Work through Injects

• IMT Staff practice Emergency Management Mentality, not day-to-day decision-making.

Conclude Exercise

Conduct Hotwash

Draft After Action Report

Tabletop Exercise - Basic

Convene IMT

Announce Narrative

Provide Position Specific IRGs

Work through Injects

• Work through “Planning P” ;

• Incident Action Plan Establishment

• Ensure Staff Create Plan A and Plan B for key response strategies and tactics;

• Consider Having a “What-if” officer

Conclude Exercise

Conduct Hotwash

Draft After Action Report

Tabletop Exercise - Advanced

All that other stuff + actually “doing” something.

Functional Exercise

Immediate Operational Period Position Actions-Operational Period

Incident Commander

1. Receive notification about the incident from local officials 2. Activate the Command Staff and Section Chiefs 3. Activate the EOP 4. Establish operational periods 5. Establish operational objectives

Immediate Operational Period

Position Actions-Operational Period

Public Information Officer

1. Monitor media outlets for updates on the incident and possible impacts on the hospital

2. Establish a patient information center; coordinate with the Liaison Officer

3. Establish a media staging/briefing area initiate media/

communications plan

Position Actions-Operational Period

Liaison Officer 1. Establish communication with local EOC, DRC

2. Communicate with other health care facilities (situation status, surge capacity, supply/personnel lending capacity, etc.)

Immediate Operational Period

Position Operational Period-Action

Safety Officer 1. Monitor safety practices of staff, patients, facility and implement corrective actions, as needed

Medical/Technical Specialist-Medical

Assist Op Chief in identifying specific medical care management needs

Medical/Technical Specialist-Mental Health

Assist Op Chief in identifying specific mental health needs/Manage PsyStart

Immediate Operational Period

Position Actions-Operational Period

Operations 1. Conduct clinic census/determine patients to send home/reschedule

2. Provide facility security, traffic and crowd control

3. Activate surge capacity plan and patient emergency procedures

4. Rapidly triage/prioritize patient care and resources

Immediate Operational Period

Position Actions-Operational Period

Planning 1. Prepare and implement patient, room, material and personnel tracking

2. Establish operational periods and Incident Action Plan with IC

Logistics 1. Initiate staff call procedures 2. Conduct inventory of supplies, equipment, medication 3. Ensure IT functionality

Immediate Operational Period

Position Actions-Recovery

Incident Commander 1. Oversee and direct demobilization and system recovery operations

Public Information Officer

1. Provide final briefings as needed to patients/visitors/staff/media

Liaison Officer 1. Prepare summary of the status of the Clinic and disseminate to Command Staff, as appropriate

Safety Officer 1. Oversee safe restoration to normal operations

Operations 1. Return patient care and services to normal

Planning 1. Finalize IAP 2. Complete AAR 3. Ensure file of incident documentation

Logistics 1. Provide for mental health services for staff and patients

Finance/ Administration

1. Submit final response expenses to IC for approval 2. Submit for reimbursement

Recovery

Conduct participant hot wash

Conduct controller, data collector/evaluator critique

Collect observation/data collection forms (notes)

Develop initial after action report (AAR)

Coordinate and evaluate findings

Conduct senior management post-exercise briefing

Prepare final AAR

POST EXERCISE

Develop improvement plan

Track corrective actions

Share lessons learned

EVALUATE THE EXERCISE