Albert Romanosky MD, PhD
Office of Preparedness and Response
Maryland Department of Health and Mental
Hygiene

 Give a brief Overview of the Maryland 2008
Statewide Pan Flu Exercise
 Review the Role of Countermeasures
Response Administration (CRA) in the
Exercise
 Identify the CRA Sustainable/Key Strengths and Needs Improvement Activities
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Modified Functional Exercise:
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Full Scale Components
Three Days ( June 17-19, 2008)
Compressed Pandemic Wave Weeks 6-12 and Recovery
Designed to Address:
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Corrective actions following previous exercises
Office of Preparedness & Response identified statewide pan flu priorities and operational activities
Federal Pan Flu Priorities
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The overall goal of the exercise was to test the expertise and capability of several components of the healthcare system to adequately identify and respond to unusual work and patient loads during a pandemic influenza outbreak.
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Specific Exercise Testing Requirements and Guidelines
 Homeland Security Exercise and Evaluation Program
(HSEEP)
 Assistant Secretary for Preparedness and Response (ASPR)
Hospital Preparedness Program (HPP) Exercise Standards and
Requirements
 CDC Public Health Emergency Preparedness Cooperative
Agreement Guidance and CDC Pan Flu Appendix 12:
Overarching Exercise Objectives by Priority Area: Pandemic
Flu Exercise Guidelines for Medical Surge
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ASPR Hospital Preparedness Program (HPP)
Exercise Standards and Requirements
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Evaluation of medical surge components of the tiered healthcare system
 Develop adequate evaluation tools and methods
 Develop an After Action Report (AAR)
Specifics:
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Coordination with Public Health
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Risk Communication
Medication Distribution
Surveillance
Laboratory Capacity
Volunteer Activation (ESAR-VHP)
Staff Support
Communications
Healthcare System Triage and Admission
 Incident Command System (Integration and Coordination)
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CDC Cooperative Agreement and Pan
Flu Exercise Requirements
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Maryland State Pan Flu Operational Plan
 Based Upon CDC evaluation
Appendix 12: Overarching Exercise Objectives by Priority Area:
 Mass Vaccination
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Continuity of Operations
Surveillance/ Lab Exercise
Community Mitigation
Communications
Antiviral Distribution
Strategic National Stockpile (SNS) Medical Countermeasure
Distribution
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 DHMH Coordination/Command Center and Continuity of
Operations Plan
 Health and Medical Surge (Facilities, Personnel, Equipment and Supplies)
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Medical Surge – Alternate Care Sites
Strategic National Stockpile / Receipt Staging and Storage
Enhanced Surveillance
Governor’s Wellmobiles
Laboratory Surge
Countermeasure Response Administration
EMS – Emergency Medical Dispatch
EMS – Transport Diversion Protocol
EMS On-Scene Triage and Assessment Protocol
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 Personal and Community Preparedness
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Community Emergency Response Teams (CERT)
Critical Infrastructure
Internal Countermeasure Distribution
Educational Facilities
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Volunteer Activation
Joint Information Center – Public Information
 Interoperable Communications
 Mass Fatality Management
 Vulnerable Populations
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Open to all Federal, State and Local Partners:
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56 Local Agencies
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Emergency Medical Services
Emergency Management Agencies
Local Health Departments
Law Enforcement
25 State Agencies
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4 Federal Agencies
50 Health Care Systems and Organizations
12 State Hospitals / Residential and Day Program Service
Providers
8 Community Based Service Providers
8 Critical Infrastructure/Key Resources/Critical
Manufacturing
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Total Number of Exercise Personnel:
 Players 4,000+
 Contractor Controller/Evaluators/Observers 50
 Peer Controller/Evaluators/Observers 100
 Exercise Design and Development 75-100
DHS Target Capabilities :
 29 of 45
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Pre-Exercise:
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Exercise Planning/Development
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CRA Access
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T raining (open to all)
Exercise:
Just-In-Time Training
S upport for R eal-time D ata E ntry
Situational Awareness / Data Reporting
 State Level Data Access
Post-Exercise:
 Hotwash and After Action Report
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Countermeasure Response Administration
Exercise Objectives
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Establish and implement CRA to collect data:
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Offline stand alone scenario
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Online web interface (Real Time/Delay)
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Assess CRA ease of use
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Track and report on antivirals dispensed at a public and private agency Points of Dispensing
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Track and report on community antiviral dispensing
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CRA Activation
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Data Entry
Direct: Web based
Indirect/Off-Line: Delayed Upload
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Monitoring and Tracking
Dispensing of Medications
Adverse Reactions to Antiviral Medications
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Howard County Health Department
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Hammond Middle School POD (Real-time Data Entry)
POD in Howard County dispensing antivirals to head-of-household for surrounding community
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Chateau Lake Ridge Community (Post-dispensing Data Entry)
Community dispensing with limited social distancing
Chester River Hospital (Real-time Data Entry)
 Fixed POD dispensing antivirals to employees
City of Laurel (Real-time Data Entry)
 Community dispensing with voluntary Isolation and Quarantine
Note: Two sites anticipated using CRA
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119
9
128
Chester River
Howard Co (Hammond School
POD)
Howard Co (Chateau Lake Ridge)
Laurel City
172
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Overall Exercise:
 CRA data collection and entry
Key Strengths:
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The “just-in-time” training was very successful and was a key to proficiency;
 Data entry into the CRA application flowed well;
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Key Strengths:
 Within a short amount of time participants were able to enter information;
 Data entry into CRA described as simple and
‘intuitive’ by participants;
 (Data entry maybe labor intensive)
 Users were able to pull data and track progress;
 CRA reports were useful in providing data of antivirals dispensed at the local and state level;
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Areas for Improvement:
 Ability to track individuals that present at a dispensing site but do not receive countermeasures;
 Ability to support Head-of-Household data collection;
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Support interoperability with other systems;
Not all regions of the state participated in CRA exercise activities;
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Recommendations:
 Expansion of CRA participation in the
Public and Private Sectors;
 Continue to train hospitals and health departments on the CRA program;
 Increase recruitment for CRA access ;
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Pre-population and Uploading of Data
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Health Department Personnel (State HAN)
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Private Sector Expanded Data Entry and
Participation:
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Healthcare Systems
Public-Private Partnership
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Critical Infra-structure/Key Resources/Critical Manufacturing
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Essential Staff and Personnel
Expanded Application
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Fatality Registration
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DAX 2008 (Seasonal Influenza Vaccination
Exercise)
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Increase CRA Training and Access
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All Maryland Participation
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24 Counties
Combination:
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Real-Time and Delayed Data Entry
On-Line Web Based vs Off-Line Data Entry
Aggregate vs individual Data Entry
Regional Clinic Integration and Coordination
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Maryland Department of Health and
Mental Hygiene
Office of Preparedness and Response
410.767.0823
aromanosky@dhmh.sate.md.us
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