Pandemic Table Top Exercise
<Facilitator Name>
<Organization Name>
<Date>
Slide 1
About This Tool
• This tool is the result of a collaboration between the Primary Care
Development Corporation (PCDC) and the National Association of
Community Health Centers (NACHC).
• It is intended to provide primary care centers, including community
health centers, an easy to use tool to test and improve their
business continuity plans.
• For assistance, questions or more information on this and other
business continuity and emergency preparedness tools and
resources, please contact PCDC (www.pcdc.org or 212-437-3900) or
NACHC (www.nachc.org or xxx-xxx-xxxx)
Slide 2
Today’s Agenda
• Review information about table top exercises
• Table Top Exercise
– Scenario injects
– Group decision and discussion
• Facilitator directed questions
• Hotwash
• Next Steps
– After Action Report (AAR)
– Corrective Action Plan (CAP)
Slide 3
What is a Table Top Exercise (TTX)
• A Tabletop Exercise, also known as a TTX, is one type of exercise
held in an informal setting intended to generate discussion of
various issues regarding a hypothetical, simulated emergency
incident.
• TTXs can be used to:
– Enhance general awareness
– Validate plans and procedures
– Assess the types of systems needed to guide prevention of, protection from, response
to, and recovery from a defined incident.
• Goal of TTXs are include
– Facilitating concept understanding
– Identifying strengths & weaknesses
– Achieving changes in attitudes.
Slide 4
Types of Exercises
Slide 5
Why do a TTX?
• Testing the plan, not the people
• Key organizational personnel discuss simulated scenarios in an
informal setting
• Assist in the promotion of understanding related concepts
• Used to assess plans, policies, procedures or the systems employed
by the organization
– Highlight strengths and areas for improvement within current plans, policies and
procedures
Slide 6
Exercise Roles
• Facilitator
– Facilitates the exercise
• Participants (Players)
– Key Staff & Decision Makers
– External Agencies
– Elected / Appointed Officials
• Evaluators
– Observe behavior in relation to plans & procedures
– Record Information without leading Players
– Report observations
• Observers
– Observe exercise; No interaction in exercise play
Slide 7
Hotwash, After Action Report (AAR), & Corrective Action Plan (CAP)
• Hotwash
– A debrief with the exercise planning team, controllers & evaluators held immediately following the
exercise.
– Allows controllers and evaluators to collect observations and thoughts about the conduct of the
exercise which leads to the development of preliminary analyses of exercise observations.
• After Action Report (AAR)
– Chronological narrative of discussion for each capability & associated activities
– Highlight both strengths and areas for improvement
– Identify discussion points relevant to your site’s ability to carry out the activities
– Demonstrate the capabilities being exercised
• Corrective Action Plan (CAP)
– Corrective actions are the concrete, actionable steps outlined in improvement plans that are
intended to resolve preparedness gaps and shortcomings experienced in exercises or real-world
incidents.
Slide 8
TTX Objectives & Capabilities
• For the purposes of this Table Top, our site is focused on testing the
following capabilities:
• Describe 1-3
•
•
capabilities of your
BCP that you are
testing for this
TTX.
Capabilities can
include certain
business processes,
BIA’s, or
disruptive action
policies
Be sure to delete
this box prior to the
TTX
• The objectives of today’s Table Top are:
•
•
•
Slide 9
Describe 1-3
SMART goals for
the exercise.
SMART stands for
Specific,
Measurable,
Achievable,
Realistic and
Timely
Be sure to delete
this box prior to the
TTX
TTX Intent
• This tabletop exercise was specifically developed to identify gaps in
business continuity plans
• The intent of this TTX will be to specifically target the discussion of
business continuity operations and response to an emergency event.
• Processes, discussion and decision-making are more important than
minute details.
Slide 10
BCP Topics to Consider During TTX
•
BIA Report
•
HVA Report
•
Incident Management Plan
•
Communications Plan
– Emergency Notification Plan
– Risk Communications Policy
•
Procedures
– Disruption Actions
– Individual Business Impact Analysis Forms
•
Appendices
–
–
–
Memorandums of Understanding (MOUs)
Key Contacts, Vendors & Suppliers
Other Important Documents
Slide 11
TTX Play
• Table Top Exercise
– Scenario injects
– Group discussion and decision
• Facilitator directed questions
• Hotwash
• Next Steps
– After Action Report (AAR)
– Corrective Action Plan (CAP)
Slide 12
Remember…
• Accept the artificialities of the scenario
– “Fight the problem not the scenario”
• Remember you are testing the plan, not the people
– There are no right or wrong answers
• Consider your current plan, facility, capacity & capabilities
• There will be time for group problem-solving, discussion and decision-making
• Even though a TTX is a “discussion-based” exercise, you will need to make actual decisions at the
end of each discussion
• Makes notes on your response
• Please direct all questions to the facilitator/controller
Slide 13
TTX Scenario
• Day 1
• Monday in September at 3:00 pm
• The weather is normal
• The site is experiencing a normal to high patient volume
• The site is running with 100% of staff. All systems are running
smoothly
Slide 14
TTX: Module 1
• The local health department has issued an advisory about a new strain of influenza
being reported in Central and South America. There are currently no known cases
in the United States, however sites are asked to report any patients with flu-like
symptoms that have recently traveled to this area.
• Local department of health enhances surveillance and outreach efforts to:
– Hospitals, Community Health Centers
– Laboratories
– Central and South American communities
• DISCUSS & DECIDE (5 minutes)
• Discuss how you would response based on the above injects
• Make decisions based on current plans and capabilities
Photo Credit: http://trueslant.com/jennaweber/2009/09/04/be-prepared/
Slide 15
TTX: Module 2
• Day 3
• Wednesday at 10:00 am
• At the morning huddle, the facilities manger mentioned that PPE supplies were
running short due to a vendor issue and to conserve where possible.
• The site is running at 80% of staff. The site director suspects staff may be calling in
sick due to the recent department of health announcement.
• A Spanish-speaking 55-year-old man and his 31-year-old daughter walk into the
center coughing, appearing flushed and somewhat short of breath. They ask to see
a doctor because they have been having fevers and coughing badly for the last 3-4
days upon returning from a trip to Guatemala.
Photo Credit; http://fairfield-advance.whereilive.com.au/news/story/fairfield-hospital-staff-on-swine-flu-alert/
Slide 16
TTX: Module 2
• Day 3
• Wednesday at 1:00 pm
• A team from the department of health arrives at the health center to
interview the patients
• After the interview they ask the staff for the contact information of all
persons who have been through the facility that day due to the uncertainty
about the symptoms of the aforementioned patients
• Media begin to show up at your facility asking questions
• DISCUSS & DECIDE (5 minutes)
• Discuss how you would response based on the above injects
• Make decisions based on current plans and capabilities
Slide 17
TTX: Module 3
• Day 3
• Wednesday at 3:00 pm
• Due to the investigation and a strong suspicion, the local department of health has asked
that you close your facility for the remainder of the day. The health department will send a
unit to decontaminate the site overnight.
• Staff are concerned about exposure to the new influenza virus and exposure to their
families
• Phone lines are constantly ringing with patients, media, and other staff with questions
about appointments, asking for statements, and wondering about work the next day
• DISCUSS & DECIDE (5 minutes)
• Discuss how you would response based on the above injects
• Make decisions based on current plans and capabilities
Photo Credit: http://sunnysidepost.com/2010/02/04/daisys-closed-by-health-dept/
Slide 18
TTX: Module 4
• Day 3
• Thursday at 8:00 am
• There are almost 50 people waiting for the center doors to open.
– 5 of them have scheduled appointments
– 20 of them are walk-ins. You notice that some of them are coughing.
– 15 are members of the media
– 8 are volunteer nurses from the local hospital who are eager to help
Photo Credit: http://well.blogs.nytimes.com/2008/06/18/should-undercover-patients-check-up-on-doctors/
Slide 19
TTX: Module 4
• Payroll is due today and the staff in charge of this, as well as half of
front desk staff, have called in sick. A few nurses and doctors have
also called out sick.
• Patients and staff are demanding Tamiflu.
• DISCUSS & DECIDE (5 minutes)
• Discuss how you would response based on the above injects
• Make decisions based on current plans and capabilities
Photo Credit: http://well.blogs.nytimes.com/2008/06/18/should-undercover-patients-check-up-on-doctors/
Slide 20
TTX: Module 5
• Day 3
• Thursday at 3:00 pm
• The facilities manager informs you that you are almost completely out of PPE due
to the extensive use over the past few days. Your supplier is experiencing a
backlog of 1-2 weeks to refill orders.
• One of the nurses informs the site director that the electronic medical record
system has gone down. Upon contacting IT, there is no estimated time for
recovery.
• DISCUSS & DECIDE (5 minutes)
• Discuss how you would response based on the above injects
• Make decisions based on current plans and capabilities
Slide 21
Activity: Hotwash
• What did you learn from the TTX today about your site and your
BCP?
– What areas of your BCP are well developed?
– What areas of you BCP need improvement?
– What are your next steps?
Slide 22
Next Steps
• The site will use the information gathered from the hotwash
discussion to complete a draft version of the After Action Report
(AAR), including a Corrective Action Plan (CAP).
• The draft version will be circulated to site staff for feedback. The
feedback will be incorporated into a final draft of the AAR & CAP.
• Staff will meet for an After Action Conference (AAC) where the final
draft will be approved and plans to implement the CAP will be
adopted.
Slide 23
QUESTIONS?
Slide 24
<Site Logo>
Contact:
<Your Name>
<Phone Number>
<E-Mail>
<Site Web Address>
Slide 25