STATEWIDE MEDICAL AND HEALTH EXERCISE
PHASE III: TABLETOP EXERCISE
[Exercise Name/Exercise Date]
WELCOME & INTRODUCTIONS
SCHEDULE OVERVIEW
0000
Registration
0000
Welcome and Opening Remarks
0000
Module 1: Communication and Medical Surge
30 Minutes
Briefing, Plenary Discussion, and Brief-Back
0000
0000
Break
Module 2: Confirmed Case & Incident Command
30 Minutes
Briefing, Plenary Discussion, and Brief-Back
0000
0000
Lunch
Module 3: Security & Fatality Management
Briefing, Plenary Discussion, and Brief-Back
0000
Break
0000
Hot Wash
0000
Closing Comments
3
30 Minutes
PRESENTATION GUIDE
BACKGROUND AND
ADMINISTRATION
MODULE 3: SECURITY &
FATALITY MANAGEMENT
MODULE 1:
COMMUNICATION &
MEDICAL SURGE
MODULE 4: DEBRIEF
QUESTIONS & PLANNING
FOR THE FUNCTIONAL
EXERCISE
MODULE 2: CONFIRMED
CASE & INCIDENT
COMMAND
4
BACKGROUND AND ADMINISTRATION
ADMINISTRATION
•
•
•
•
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•
•
Cell Phones
Restrooms
Exercise Materials
Breakout Discussion Groups
Parking validation
Mobile phones
Evacuation procedures
– “This is a real emergency.”
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ADMINISTRATION
• Welcome
–
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Name
Position
Agency/Organization
Optional: Icebreaker
• Logistics
– Materials
• Situation Manual
– Follow along!
• Feedback Form
• Observer Handout
7
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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EXERCISE OVERVIEW
• Objectives
– [insert selected]
• Threat/Hazard
– Pandemic Influenza
• Scenario
– Novel Strain of H5N1
• Sponsor
– CDPH, EMSA, [insert your
agency/organization]
• Participating Organizations
– [insert]
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GENERAL INFORMATION
KEY MATERIAL
GENERAL INFORMATION
• Introduction
• Objectives & Core Capabilities
– [agency/organization objectives & core
capability detail]
• Participant Roles & Responsibilities
– Players
– Observers
– Facilitators
– Evaluators
– Controllers
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GENERAL INFORMATION
• 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
12
GENERAL INFORMATION
• 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
13
RESOURCE: FLU ON CALL™
• 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
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MODULE ONE
COMMUNICATION AND MEDICAL SURGE
BACKGROUND INFORMATION
• 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/201
0/01/we-heard-the-bells.html
– http://www.uninfluenza.org/?q=content/ho
w-virus-changes-world
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BACKGROUND INFORMATION
• 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
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BACKGROUND INFORMATION
• Non-pharmaceutical
containment measures
are key to controlling the
spread of virus
– Optional Video:
http://www.uninfluenza.org/?q=content/
nhs-pandemic-fluinformation-healthworkers
• Vaccination and antiviral
treatment are
anticipated to be the
most effective
• These may be delayed
or in limited supply
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BACKGROUND INFORMATION
• Real concern for fear
and panic among the
public as well as the
response community
• Will there be
enough:
–
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–
–
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Staff?
Supplies?
Equipment?
Vaccine?
Medicines?
BACKGROUND INFORMATION
• 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
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MODULE ONE
• Five cases of
human-to-human
transmission in
Cambodia
• Health care
providers used
stockpiled antiviral
medication
• Many residents
disregard isolation
instructions
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Communication & Medical Surge
MODULE ONE
• 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
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Communication & Medical Surge
MODULE ONE
• 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
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Communication & Medical Surge
MODULE ONE
• Health departments try
to purchase additional
stockpiles of antiviral
medications
• California already
experiencing an aboveaverage flu season
• Patient workups include
testing for H5N1
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Communication & Medical Surge
MODULE ONE
• "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
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Communication & Medical Surge
DISCUSSION FORMAT
• Elect a group spokesperson
• Use the Situation Manual and exercise materials to
take notes
• Focus on
– Strengths
– Areas for improvement
• As it pertains to:
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Doctrine
Organization
Personnel
Training
Equipment
Support
MODULE TWO
CONFIRMED CASE & INCIDENT COMMAND
MODULE TWO
• 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
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Confirmed Case & Incident Command
MODULE TWO
• 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
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Confirmed Case & Incident Command
MODULE TWO
• 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
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Confirmed Case & Incident Command
MODULE TWO
• 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
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Confirmed Case & Incident Command
MODULE TWO
• 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
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Confirmed Case & Incident Command
MODULE TWO
• 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
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Confirmed Case & Incident Command
DISCUSSION FORMAT
• Elect a group spokesperson
• Use the Situation Manual and exercise materials to
take notes
• Focus on
– Strengths
– Areas for improvement
• As it pertains to:
–
–
–
–
–
–
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Doctrine
Organization
Personnel
Training
Equipment
Support
MODULE THREE
SECURITY & FATALITY MANAGEMENT
MODULE THREE
• 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
36
Security & Fatality Management
MODULE THREE
• 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
37
Security & Fatality Management
MODULE THREE
• 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
38
Security & Fatality Management
MODULE THREE
• 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
39
Security & Fatality Management
MODULE THREE
• 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
40
Security & Fatality Management
MODULE THREE
• 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
41
Security & Fatality Management
DISCUSSION FORMAT
• Elect a group spokesperson
• Use the Situation Manual and exercise materials to
take notes
• Focus on
– Strengths
– Areas for improvement
• As it pertains to:
–
–
–
–
–
–
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Doctrine
Organization
Personnel
Training
Equipment
Support
CONCLUSION OF THE
DISCUSSION-BASED TABLETOP
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MODULE FOUR
DEBRIEF QUESTIONS & FUNCTIONAL EXERCISE PLANNING
MODULE FOUR
• Debrief questions
• Exercise levels
– Level of play
– DOC/EOC activation
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•
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Exercise duration
Scenario development
Participation
Testing of plans & procedures
Role of State agencies
CONCLUSION
• 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
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STATEWIDE MEDICAL AND HEALTH EXERCISE
PHASE III: TABLETOP EXERCISE
[Exercise Name/Exercise Date]