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2012 Phase III:
Tabletop Exercise
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The 2012 Statewide Medical and Health
Exercise is sponsored by:
• California Emergency Medical Services Authority (EMSA)
• California Department of Public Health (CDPH)
In collaboration with:
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California Hospital Association
California Association of Health Facilities
California Primary Care Association
California Emergency Management (Cal EMA)
Response partners representing local health departments,
emergency medical services, public safety and healthcare facilities
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Welcome and Introductions
 Introduction of Exercise Planners and
Facilitators
 Introduction of Participants, Subject Matter
Experts (SMEs), Department Officials and
Media
 Housekeeping Issues
 Agenda Review
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Exercise Purpose
Discussion-based exercise to
provide participants an
opportunity to evaluate current
response concepts, plans, and
capabilities for a response to a
loss of the power supply due
to an earthquake.
Tabletop discussions include
how partners can identify and
address gaps in a unified
response, improve and
coordinate their planning.
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2012 Statewide Medical and Health
Exercise Target Capabilities
 Communications
 Intelligence/Information Sharing and
Dissemination
 Medical Surge
 Emergency Operations Center Management
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Tabletop Exercise Objectives
Exercise Planners may insert
organization/agency specific objectives
found in the Situation Manual on pages 3-7,
may customize objectives consistent with the
tabletop exercise questions or may delete
this slide.
(Yellow font color signifies editable slides for
the organization/agency)
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Tabletop Exercise Objectives
OBJECTIVE: To discuss the planning and
response to a loss of power to the healthcare
delivery system and the community.
SCENARIO: Earthquake that results in a 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.)
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Exercise Customization
The tabletop exercise may be customized to
include discussion of Operational Area and
discipline specific issues, policies and
procedures, new equipment or training, and
gaps in planning that may be discussed
(This slide can be deleted once
customization is done)
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Exercise Customization
Response specific information and guidance, may
be accessed through subject matter experts,
including:
 Local and Operational Area utility authorities
 Communication partners
 Earthquake or seismic experts
 Medical and Health Operational Area Coordinator
 Mutual aid coordinators for health, law and fire
services
(Include those resources for your exercise on this
slide)
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Exercise Ground Rules
 Do not fight the scenario
 Assume the scenario is real and may impact
the jurisdiction and the participants
 Participate in a collegial manner: share
policies, plans and practices that may benefit
others
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Exercise Ground Rules
 Be respectful: allow others to speak and
finish their statements
 Follow communications etiquette: turn off cell
phones, smart phones, computers, and any
other electronic data equipment
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Purpose
To evaluate:
• Current response concepts, plans, and capabilities
for a power loss due to an earthquake, and
• Response and recovery coordination with other
partners.
In order to:
• Determine the level of preparedness and planning,
• Identifying both strengths and areas for
improvement.
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Background
Potential causes of loss of power include:
 Natural disaster such as earthquake,
hurricanes or flooding
 Wild land and urban fires
 Mechanical Failure
 Human Error
Historical Impact of Power Loss
1989 Loma Prieta Earthquake
 Primarily as a result of direct damage to transmission
substations, 1.4 million utility customers lost power
 Most difficulties resulted
from failure of backup
power systems or
insufficient backup
power capacity
 In areas of Watsonville
and Santa Cruz, power
loss lasted over a week
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Historical Impact of Power Loss
1994 Northridge Earthquake
 More than 60 fatalities and
8,700 more injured including
1,600 that required
hospitalization.
 Eight of ninety-one acute care
hospitals were evacuated
 Six cited nonstructural damage
such as water damage and loss
of electrical power as a major
reason for evacuation
Source: www.nejm.org/doi/full/10.1056/NEJMsa021807
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Historical Impact of Power Loss
2003 Northeast Blackout
 Impact: 50 million people without power, 11 deaths,
and $6 billion in damage
 The blackout was widespread, but not an isolated
incident. On average, a dozen large-scale blackouts
affecting at least 50,000 people each occur every year
 Hospitals become sites of refuge for vulnerable
individuals, including the elderly, children and persons
dependent on medical equipment
Source: http://www.publichealthreports.org/archives/issueopen.cfm?articleID=1578 and
www.MSN.com
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Historical Impact of Power Loss
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
 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
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Historical Impact of Power Loss
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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Tabletop Exercise
 The exercise consists of three modules plus an
addendum for planning the November 15, 2012
Functional Exercise
 Each module will identify the key issues followed by
questions for discussion
 Participants are encouraged to share their plans,
policies, strengths and gaps as identified in the
Organizational Self Assessments
Scenario
Over the past several weeks, a series of earthquakes with
a magnitude over 4.0 have been recorded in California.
There are no reports of damage, but the increase in both
frequency and intensity has spurred interest in personal
preparedness.
Media outlets report a
spike in sales of
disaster supplies,
along with increased
enrollments in citizen
emergency response
training and American
Red Cross
preparedness courses.
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Scenario (Continued)
There has also been an increase in inquiries both by
media and elected officials on the state of
preparedness among healthcare organizations and
public safety agencies.
The aging infrastructure and vulnerabilities from
earthquake to healthcare and public safety buildings,
as well as the status of bridges, roads, communication
systems and transportation systems are being
highlighted in media reports.
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Scenario (Continued)
With the 2013 deadline outlined in California Senate Bill
1953, there is concern over the status of the healthcare
infrastructure. Of particular focus is the threat of a
massive power failure that could occur if a major fault
line ruptures.
At the direction of the CDPH and EMSA, local health
departments and emergency medical services agencies
(through the MHOAC Program) have been working with
healthcare partners including hospitals, clinics and long
term care facilities, to determine their vulnerabilities in
the event there is a failure of the power supply.
Module 1: Incident Notification
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Intelligence/Information Sharing,
Dissemination and Communications
Key Issues
 Ability to receive and validate critical information during a
loss of power.
 Ability to assess threat through impact analysis on daily
and emergency operations.
 Risk communication messaging is developed within the
Joint Information System.
 Policy and procedure for dissemination of key messages
is established with the facility/agency/organization.
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Questions for Discussion
1. What is your role in receiving and disseminating critical
information internally and externally?
2. What mechanisms and/or technology are in place to
receive and disseminate information internally and
externally? Are there contingency plans in the event of
primary systems failure?
3. What is the process to develop an organization/agency
communications plan that includes all stakeholders in the
event of a power loss? How does your organization
utilize this process?
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Questions for Discussion
4. How will information be gathered and disseminated if
technology fails due to an interruption of the power
supply?

Is information technology and communications
infrastructure supported by emergency power?

Discuss various technology used by the
organization/agency, including satellite phones, amateur
radio, disaster cell phones, etc.
5. Does your organization/agency participate in a Joint
Information System?
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Questions for Discussion
6. How is information received and disseminated within the
organization/jurisdiction?
7. How would you share your agency’s information with the
Joint Information System? Who approves information to
be shared?
8. How would messages be coordinated and
disseminated? What is the contingency plan if
communications and/or information technology is
interrupted due to a loss of power?
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Questions for Discussion
9. Who would provide guidance to the community on the response
actions to take for an interruption of the power system?

Who has the final authority on messages released to the public?
10. Do you have a plan to notify staff, patients, clients, and/or
stakeholders of an alteration in service due to a loss of power?
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What individuals or groups require notification?
What are the communication methods to disseminate this
information and the safety measures to be taken due to a loss of
power?
11. Does your organization use social media to disseminate
information?
 Is it dependent on continued power or emergency power at your site?
 Is there a contingency plan to support social media if there is a local
power loss?
Module 2: Incident Response
Continuity of Operations
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Key Issues
 Ability to assess impact of an interruption of the power
supply due to an earthquake on the organization/agency’s
ability to maintain operations.
 Determine the adequacy of generator support, fuel
supplies and vendor contracts to provide emergency
power if there is an interruption of the power supply due to
an earthquake.
 Project the impact of an interruption of the power supply
due to an earthquake on response partners.
Questions for Discussion
1.
Has your organization/agency evaluated its current
power supply and identified vulnerabilities in the
system?
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Has the generator support been identified, including
identification of fuel for continued generator operations?
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Does the ability to sustain operations with emergency
power consider the impact of an increased demand for
services?
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Questions for Discussion
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2. Does your organization/agency have a cache of
generators (portable or fixed) to support services to staff,
clients, patients and visitors if there is an interruption of the
power supply?
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Is the cache secure?
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Does this include a fuel supply cache?
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Is the fuel supply cache in a seismically-safe location? Is the
fuel supply dependent on power?
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Do you have multiple sources to access additional generators
and fuel, including vendor agreements, access to local
businesses and distributors or retail outlets, etc.?

Have you identified vendor support outside the immediate
area?
Questions for Discussion
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3. Have the areas of the facility (including all buildings)
supported by emergency power been identified?
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Have vulnerable areas that would be without emergency
power been identified?
Have contingency plans for maintaining critical services been
established?
Is this information available in the Command Center/EOC?
4. Do you have a cache of portable equipment to support
operations (deployable oxygen cylinders, fire suppression,
spot chillers, etc.)
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Is there a master inventory of the supplies and equipment?
Do you have vendor agreements or retail sources to rapidly
secure additional equipment if needed?
Questions for Discussion
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5. Do you have a plan to control or limit access during an
emergency?

Would you require the assistance of law enforcement in
maintaining facility safety and security?
6. Is there a process and procedure to account for all persons
(patients, staff, visitors, customers) in your facility (including
all buildings) when there is a power loss?

Has staff been trained on the procedures? Has it been
included in testing or exercises?
7. What is the plan to provide emergency housing or shelter
for uninjured persons seeking shelter due to a loss of
power in the community?
Questions for Discussion
Impact of Power Loss
Determine all possible impacts of power loss as well as best
practices from actual experience with an interruption of the
power supply
 Review how the power loss will impact your response
partners
 Identify both gaps in planning and best practices that can
be shared as well as best practices in vendor
agreements and mutual aid agreements
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1. Impact on Individual Agency
 Can the facility maintain heating, ventilation and air
conditioning?
 What is the impact on provision of medical gases and
vacuum systems?
 Will water and sewage systems be operational? Does this
impact fire suppression systems? Is there a policy for fire
response if water systems fail?
 Will access controls, including security systems, be
operational?
 Will communication and information technology be
operational?
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1. Impact on Individual Agency
 Will critical records be maintained (patient records, dispatch
data, test results, etc.)
 What is the impact on internal and external lighting?
 Are your parking structures impacted by a power loss?
Can parking garages be accessed? Is lighting maintained?
 Will elevators be operational?
 Will automated dispensing systems (for medications,
supplies) be operational?
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1. Impact on Individual Agency
 Are all communications (both routine and redundant)
systems on emergency power?
 Are refrigeration and food preparation locations and
equipment on emergency power?
 Are diagnostic services such as laboratory and imaging
impacted by a power loss?
 Are these areas on emergency power?
 Are there partner or vendor agreements to assume these
services?
 How will clinical care be impacted?
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2. Impact on Partner Agencies
 What is the impact of power loss on non-affiliated
healthcare providers, including dialysis centers, surgery
centers, urgent care clinics and others?
 How will interruption of services at these sites impact
your operations? Are the services of these providers
critical to your patients?
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3. Community Impact
 What is the impact on vulnerable populations, including
the elderly, children and medically vulnerable?
 Discuss the impact of power loss to communication
systems (both landline and cellular telephones),
computer systems, traffic lights, media (television and
radio in addition to the Internet), street lights, security
systems, mass transit, etc.
 Will closure of daycare centers, elder care services, etc.
impact your ability to sustain operations?
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3. Community Impact (Cont’d)
 Are there pre-identified community support systems that
may be activated during a power loss, including
wheelchair charging stations, cooling or heating centers,
communication centers, etc.?
 Is there a community messaging service that provides
timely and consolidated information to citizens (ex.: 511
call centers)? Can your organization provide information
to this site for dissemination?
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4. Impact on Multi-Site Agencies
 Consider the organizations/agencies that have multiple
service sites (fire stations, hospitals, community care clinics,
police stations, community organizations, etc.).
 Can services be consolidated or relocated? Are backup sites
identified and stocked?
 Discuss the impact of a power loss on the community.
 Emphasis should include vulnerable populations, such as the
elderly, children and medically vulnerable persons on home
oxygen, respiratory equipment, motorized wheelchairs, etc.
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5. Providing Support for Other
Response Partners
Not all organizations/agencies will use the scenario of a
power loss due to an earthquake as the basis for the
November 15, 2012 Functional Exercise.
The provision of mutual aid to affected areas may be
used as the scenario to launch the actions and activities
undertaken during the exercise.
 Discuss the resources available to support response
partners, such as portable generators, portable
chillers, water filtration systems, oxygen delivery
systems, communications equipment, ability to accept
transfers or provide services and others.
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Module 2: Incident Response (Cont.)
Emergency Operations Center
Management
Key Issues
 Response is coordinated through the use of the
Incident Command System principles and
operations centers.
 Action Plans are developed to guide and document
the response and recovery phases.
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Questions for Discussion
1. How does your organization/agency use Incident
Command System principles to organize and guide
response and recovery operations in an emergency?
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Does the use of the Incident Command System principles
address, when necessary, the application of unified
command?
2. How is your command/operations center/EOC (e.g.,
Hospital Command Center, Nursing Home Command
Center, Department Operations Center) activated to
support Incident Command System operations? Is it a
written plan?
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Questions for Discussion
3. Does your organization/agency have a policy and
procedure to communicate and share information and
intelligence with other members of the Incident
Management Team or Command Center/EOC personnel?

How is information transfer validated?

If procedures are in place, is the process regularly tested?
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Do you utilize action planning procedures and forms to
document and guide the response and recovery?
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Is the Action Plan shared with response partners in the
jurisdiction?
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Questions for Discussion
4. How is information and intelligence gathered and disseminated
if there is a loss of communications technology?

What are your redundancies?

Are the redundant systems routinely tested?
5. Does your organization/agency have a resource requesting
policy and procedure to request or share resources within the
operational area and beyond to the region or the State?
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If so, is this process regularly tested?

How is this resource requesting process coordinated with the
incident command structure for your agency/department/facility?

Is there a contingency in place if communications fails due to a
loss of power supply?
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Questions for Discussion
6. Who do you contact to request resources beyond partner
organizations and vendors? Is there a back-up plan if
communications fail due to a power loss?
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Module 3: Ongoing Operations
Medical Surge
Key Issues
 Continuity of operations has been addressed within
the organization/agency.
 Plans to surge services are developed in
conjunction and coordination with response
partners.
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Questions for Discussion
1. Does your organization/agency have a plan to alter
services if there is an interruption of the power supply?
 Within your organization/agency, what types of services can
be altered, postponed or relocated to other sites?
 Have clinical providers been active in the decision making
regarding alteration of services?
2. Do you have a Utility Management Plan?
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Does routine maintenance and testing include a discussion
of the loss of power on continuation of services?
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Questions for Discussion
3. Do you have a surge plan to address increased persons
presenting to your facility for safety?
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Does the surge plan address the convergence of patients
who use medical equipment (including oxygen) at home and
are now without power?
4. Are there partner organizations that can assist in
providing services that you must alter or suspend due to a
loss of power?

Do you have Memoranda of Understanding signed with
these partner organizations?
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Questions for Discussion
5. If patient evacuation is necessary due to the power loss, what
organization/agency oversees and coordinates patient
movement within the jurisdiction?
6. Who are the local/operational area authorities who will provide
information and intelligence regarding the power loss?

Do you have 24/7 contact information for these authorities?
7. Have you identified the areas of your facility that are on
emergency power and those that would need portable
generator support?

Does your organization/agency have the capability to redistribute
power to critical areas, within your facility, if needed? Who has the
authority to initiate redistribution?
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Conclusion of
Discussion-Based Tabletop
Planning for the November
Functional Exercise
The scenario will be an earthquake
due to the loss of power.
Earthquakes can cause many other
issues, but this exercise will
concentrate on power loss.
Customization of the exercise
allows incorporating other
objectives as needed into the
exercise. Examples include issues
identified in past exercises, new
training or equipment, or new policy
and procedures.
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Planning for the November
Functional Exercise
Note: Not all organizations and/or agencies will use
the scenario a loss of power due to an earthquake as the
basis for the November 15, 2012 Functional Exercise.
The provision of mutual aid to affected areas may be
used as the scenario to launch the actions and activities
undertaken during the exercise.
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November Exercise
Issues for Discussion
Exercise Level of Play
 What level of exercise play do the organizations/ agencies
represented today anticipate for the November 15, 2012
exercise?
- Examples include communications drill, functional and
full scale exercises; level of play may include use of
simulated patients, movement of patients to healthcare
facilities, perimeter lockdown, activation of the joint
information center, provision of mutual aid to affected
areas, etc.
 Will your organization/agency activate its Command
Center/EOC?
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Issues for Discussion
Exercise Times/Duration
 Exercise play is being developed to include a message
to begin the exercise. Participants may begin exercise
play at their discretion but are strongly encouraged to
collaborate with local/operational area partners.
 Can participants estimate their hours of exercise play at
this time?
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Issues for Discussion
Exercise Customization
 Discuss organization/agency impacts from power loss
due to earthquake
 Identify additional areas of impact for organization/agency
 Ensure exercise customization
is included in the Master
Scenario Events List
v
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Issues for Discussion
Exercise Customization (Cont.)
 Testing of Policy and Procedures

Are there any plans, policies or procedures which
individual departments or organizations/agencies
would like to test? Examples include: utilities
management, patient surge, fatality response,
continuity of operations plans, etc.

Identify the plans to be tested that should be included
in the customization of the Master Scenario Events List
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Role of State Agencies
On November 15, 2012, the California Department of
Public Health and the California Emergency Medical
Services Authority will open the Joint Emergency
Operations Center.
The California Emergency Management Agency is
anticipated to participate by opening the State
Operations Center and the Regional Emergency
Operations Centers to support local and regional
exercise play.
This will provide the opportunity for local participants to
request additional resources, submit and receive
situation status reports and respond to California Health
Alert Network (or other notification systems) messages
and receive further direction.
Thank You
For Your Participation
Additional materials may be found on:
California Statewide Medical and Health
Training and Exercise Program website:
www.californiamedicalhealthexercise.com
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