Inject Response Report
Treacherous Transport Tabletop Exercise
Tri-County Region
June 7, 2012
Utah Department of Health
Treacherous Transport Tabletop Exercise
Inject Responses – June 2012
This report contains the inject responses from the Treacherous Transport Tabletop Exercise. These
responses are unedited and are directly exported from the information typed into the ONX System during
the exercise. The purpose of this report is to provide documentation for your organization’s records of
exact responses captured during the exercise.
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Treacherous Transport Tabletop Exercise
Inject Responses – June 2012
Treacherous Transport - TriCounty - # 002
Chris Chestnut - Indian Health Service
All of the passengers in the mini-van are injured in the crash, with the tractor
trailer driver suffering significant injuries.
Part 1
Several people have stopped their cars to provide assistance to those injured in
the accident.
As the chemical release continues to grow, all of the people in the immediate
vicinity become overwhelmed by the fumes.
Briefly describe what the immediate concerns would be given this scenario.
Part 2 Is the chemical going to overwhelm the initial victims and the first responders
Part 3
Based on your agency’s role in responding to this event, what information would
you want to know?
Part 4
What is the chemical, what is the status of the individuals involved in crash and
response and have emergency response personnel been notified
Katie Potts - TriCounty Health Department
All of the passengers in the mini-van are injured in the crash, with the tractor
trailer driver suffering significant injuries.
Part 1
Several people have stopped their cars to provide assistance to those injured in
the accident.
As the chemical release continues to grow, all of the people in the immediate
vicinity become overwhelmed by the fumes.
Briefly describe what the immediate concerns would be given this scenario.
Isolate the scene and deny entry.
Part 2 Identify the Hazardous Material.
Concerns: exposures to bystanders, injured and other on-lookers.
Part 3
Part 4
Based on your agency’s role in responding to this event, what information would
you want to know?
Weather
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Wind direction
Staging area
Exposures to critical infrastructures
Who is the Incident Commander?
Treacherous Transport - TriCounty - # 003
Chris Chestnut - Indian Health Service
First responders arrive on scene and identify six patients with various injuries
from the crash and additional respiratory problems from breathing in the fumes
being released from the damaged tractor-trailer.
Part 1
Evacuation is initiated for the area immediately around the scene.
Identify the agencies that would likely be notified for this event.
Hospitals, ambulatory care facilities for potential augmentation of staff, Haz mat
Part 2 team, police for support in evacuation and scene security, and the ICT will form
at this point
Part 3
Briefly describe how the first responders will identify the chemical being
released.
Part 4
Identify the chemical placards located on the truck and then contacting the
transport company for a manifest to verify.
Katie Potts - TriCounty Health Department
First responders arrive on scene and identify six patients with various injuries
from the crash and additional respiratory problems from breathing in the fumes
being released from the damaged tractor-trailer.
Part 1
Evacuation is initiated for the area immediately around the scene.
Identify the agencies that would likely be notified for this event.
Health Department - Environmental Health
Part 2
Ambulance contacts the Hospitals - ER
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Roads
Search and Rescue
Water and Sewer Department
Part 3
Briefly describe how the first responders will identify the chemical being
released.
Placards
Shipping Papers
Part 4 Driver
Type of tractor trailer
ERG
Treacherous Transport - TriCounty - # 004
Chris Chestnut - Indian Health Service
During the initial response to the accident, a motorist who stopped to help was
mildly exposed to the chemical fumes. He immediately left the scene when he
realized hazardous materials were involved.
Part 1
Minutes later he began to experience symptoms including burning in his nose
and mouth and difficulty breathing.
The motorist arrived at the hospital and reported his symptoms, but did not
initially mention the hazardous materials.
At this point in the event, is the hospital likely to know an accident happened?
Part 2
No
Part 3
Describe how the hospital will learn of the incident and will prepare for
receiving contaminated patients.
Part 4
The ICT will notify everyone through a pre developed emergency calll list
Part 5
Typically, how long after an incident is the hospital notified?
Part 6
15 minutes
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Part 9
Briefly describe the procedures for limiting access the hospital.
Part 10
initiating the hospitals ICT that will coordinate with the on scene ict to very
possible needs and at that point determine if limiting access is necessary
Part 11 Is there a formal written policy for the above described procedures?
Part 12 Yes
Part 13
Identify the individual(s) that determine when the procedures for monitoring the
ED would be activated.
Part 14 the incident commander
Katie Potts - TriCounty Health Department
During the initial response to the accident, a motorist who stopped to help was
mildly exposed to the chemical fumes. He immediately left the scene when he
realized hazardous materials were involved.
Part 1
Minutes later he began to experience symptoms including burning in his nose
and mouth and difficulty breathing.
The motorist arrived at the hospital and reported his symptoms, but did not
initially mention the hazardous materials.
At this point in the event, is the hospital likely to know an accident happened?
Part 2
Yes
Part 3
Describe how the hospital will learn of the incident and will prepare for
receiving contaminated patients.
EMS Pagers
Part 4
Initiate lock-down and redirect patients to the decon tent. ARMC would
immediately set up their tents UBMC will await further instructions.
Part 5
Typically, how long after an incident is the hospital notified?
Part 6
Immediately
Part 9
Briefly describe the procedures for limiting access the hospital.
Part 10
ER would contact the Safety Engineer. Funnel patients through a specific
decon area in the hospitals.
Part 11 Is there a formal written policy for the above described procedures?
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Part 12 Yes
Part 13
Identify the individual(s) that determine when the procedures for monitoring the
ED would be activated.
Part 14
ER staff will contact the On-Call Administrator, if they are unavailable the ER
Physician determines if it is an emergency.
Treacherous Transport - TriCounty - # 005
Chris Chestnut - Indian Health Service
Briefly describe how decontamination is performed for this type of event.
Part 1
(Explain if gross decon is performed in the field with technical decon performed
at the hospital or are other methods employed.)
depending on the type of chemical a larger area may need to be evacuated at
Part 2 which point the haz mat clean-up crew will respond with the appropriate gear to
begin decon after all individuals are rescued
Part 3
Does the hospital have adequate training, staff and resources to undertake
decontamination?
Part 4 No
Part 5
If the above answer is yes. – List the resources that are available at the
hospital.
For the IHS facility most of the needed gear for decon is not available. However
Part 6 several staff nurses, doctors etc... do have sufficient training to augment
personnel and assist in a coordinated response.
Part 7
If the above answer is no. – Briefly describe how the hospital will coordinate
decon with external resources.
Part 8 IHS will coordinate with the emergency response to backfill staff as necessary
Katie Potts - TriCounty Health Department
Briefly describe how decontamination is performed for this type of event.
Part 1
Part 2
(Explain if gross decon is performed in the field with technical decon performed
at the hospital or are other methods employed.)
Evacuate within 1000 feet of the established Hot Zone
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Treacherous Transport Tabletop Exercise
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Set-up the decon in the warm zone
Keep everyone in the cold zone
Transport patients to the most appropriate facility. More severe cases will be
sent to SLC via local helicopter.
IC would establish command channels
Part 3
Does the hospital have adequate training, staff and resources to undertake
decontamination?
Part 4 No
Part 5
If the above answer is yes. – List the resources that are available at the
hospital.
Part 6
Part 7
If the above answer is no. – Briefly describe how the hospital will coordinate
decon with external resources.
The hospital has enough staff to decon for 1.5 hours. Additional Hazmat
resources would be sent via dispatch.
Part 8
A total of 50 Volunteer Firefighters are available. Response time is approx. 3040 minutes.
Treacherous Transport - TriCounty - # 006
Chris Chestnut - Indian Health Service
Part 1 How will the hospital know the chemical to which the patients were exposed?
Part 2
The ICT or the first responders will notify them as soon as possible after they
know.
Part 5
Describe how EMS will ensure their vehicles are not contaminated by the
chemical.
EMS will keep vehicles out of the red zone and in the green zone. In the event
the vehicle is in the red zone it will remain there until it is properly
Part 6
decontaminated unless it is absolutely necessary to move for use. Then it will
be decontaminated for use immediately if possible.
Part 7
The tractor-trailer was carrying two chemicals identified as FE-1A Acidizing
Composition and VICON NF BREAKER.
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Treacherous Transport Tabletop Exercise
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Katie Potts - TriCounty Health Department
Part 1 How will the hospital know the chemical to which the patients were exposed?
Part 2 Through dispatch to hospitals.
Part 5
Describe how EMS will ensure their vehicles are not contaminated by the
chemical.
Part 6
Could condomize the vehicles but would use rapid decon. New EMS will need
additional training.
Part 7
The tractor-trailer was carrying two chemicals identified as FE-1A Acidizing
Composition and VICON NF BREAKER.
Treacherous Transport - TriCounty - # 008
Chris Chestnut - Indian Health Service
Additional motorists in the area of the crash begin to self-report to the ED with
complaints of burning eyes, nose and mouth.
Part 1
The ED begins to reach capacity.
Is the Hospital Command Center (HCC) activated at this point?
Part 2
Yes
Part 3
Describe how and when the HCC would be activated.
Part 4
When an emergency event that overwhelms or could potentially overwhelm
the system the HCC is activated
Part 7
Are the trigger points defined in a formal plan?
Part 8
Yes
Part 9
Briefly describe how the HCC staff will be notified upon the activation of the
HCC.
For IHS an emergency calling tree has been developed that when necessary
Part 10 is used to activate the ICT and to notify any individuals required for support of
the HCC
Part 11
Briefly describe any changes in the staff notification procedure if the event
occurred overnight or on a weekend.
Part 12 Secondary numbers and standby staff are identified to fill needed positions
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Treacherous Transport Tabletop Exercise
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Katie Potts - TriCounty Health Department
Additional motorists in the area of the crash begin to self-report to the ED with
complaints of burning eyes, nose and mouth.
Part 1
The ED begins to reach capacity.
Is the Hospital Command Center (HCC) activated at this point?
Part 2
Yes
Part 3
Describe how and when the HCC would be activated.
Part 4
Would have been activated once the number of victims was identified. HCC
would expand with the size of the incident.
Part 7
Are the trigger points defined in a formal plan?
Part 8
Yes
Part 9
Briefly describe how the HCC staff will be notified upon the activation of the
HCC.
Part 10 Set-up the HCC depending on the incident size.
Part 11
Briefly describe any changes in the staff notification procedure if the event
occurred overnight or on a weekend.
Part 12 They would use a calling tree regardless of the time
Treacherous Transport - TriCounty - # 009
Chris Chestnut - Indian Health Service
Part 1
List the positions that would be activated within the HCC and identify by name
the individual that would be assigned to each position.
(Example: Logistics Section Chief – John Harper)
Delaine Alley CEO - Incident Commander
Chris Chestnut - Safety Officer
Part 2
Johanna Bizcardi - Logistics
Frances Kagevenema - Planning
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Treacherous Transport Tabletop Exercise
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Joann Perank or Eric Reynolds - PIO
Katie Potts - TriCounty Health Department
Part 1
List the positions that would be activated within the HCC and identify by name
the individual that would be assigned to each position.
(Example: Logistics Section Chief – John Harper)
Part 2 Activate HCC within the IC system
Treacherous Transport - TriCounty - # 010
Chris Chestnut - Indian Health Service
Hospital security reports to the HCC that members of the public are gathering
near the ED entrance and are creating a disturbance.
Part 1
One man in particular is agitated complaining that is 18-month old daughter was
in the car when he drove near the accident scene. While she is not exhibiting
any symptoms, he insists she is seen by a doctor immediately.
Security officers would like to know if additional support can be dispatched to
the ED entrance to assist.
Identify and briefly describe what additional resources can be used to help
security.
The Security Officer has only the BIA police to assist in this type of incident for
Part 2 the IHS facility so depending on their involvement in the incident additional staff
may need to assist the security officer.
Katie Potts - TriCounty Health Department
Hospital security reports to the HCC that members of the public are gathering
near the ED entrance and are creating a disturbance.
One man in particular is agitated complaining that is 18-month old daughter was
in the car when he drove near the accident scene. While she is not exhibiting
Part 1 any symptoms, he insists she is seen by a doctor immediately.
Security officers would like to know if additional support can be dispatched to
the ED entrance to assist.
Identify and briefly describe what additional resources can be used to help
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Treacherous Transport Tabletop Exercise
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security.
Part 2
Dispatch would coordinate the request for Citizen Corps-MRC CERT with the
assistance of Badged officers.
The hospitals actively monitor their radios.
Treacherous Transport - TriCounty - # 011
Chris Chestnut - Indian Health Service
Part 1
A nurse within the ED begins to exhibit symptoms similar to those of the
patients who were exposed to the chemical on scene.
Briefly describe the concerns associated with this new development.
Part 2 This means that the ED has potentially been contaminated.
Part 3
Briefly describe the actions that will be undertaken to determine if the ED has
been contaminated.
Part 4 haz mat / infection control team will determine
Katie Potts - TriCounty Health Department
Part 1
A nurse within the ED begins to exhibit symptoms similar to those of the
patients who were exposed to the chemical on scene.
Briefly describe the concerns associated with this new development.
The ER is potentially contaminated.
Part 2
Decon the nurse.
Attempt to determine the source of contamination.
Part 3
Briefly describe the actions that will be undertaken to determine if the ED has
been contaminated.
Lock down the ER and use a different entrance.
Part 4
Hazmat monitoring equipment.
Treacherous Transport - TriCounty - # 012
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Treacherous Transport Tabletop Exercise
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Chris Chestnut - Indian Health Service
It has been confirmed that the ED is contaminated.
Part 1
Prepare a list of all external agencies that should be notified about the
contamination of the ED.
Indian Health Service, Bureau of Indian Affairs, TriCounty Health Department,
State Health Department, HHS DSNS, Ute Tribe Emergency Management
Part 2
Office, Ashley Valley Regional Hospital, Uintah Duchesne and Dagget County
Emergency Management,
Part 3
Briefly describe how communications will occur with the above listed external
agencies.
Part 4
Though the PIO of the incident command team in coordination with the HCC
PIO and agency representatives.
Part 5
Briefly explain how the need for partial or full evacuation of the ED will be
determined.
To limit contamination evacuation may not be the best idea, this will be
determined by the HCC based upon the exact conditions and extent of
Part 6
contamination as the ED is a separate system from the rest of the hospital and
air handlers are separate from the main hospital
Part 7
Describe the process for notifying EMS of the need to divert patients to other
hospitals.
Part 8 the PIO will notify dispatch who will coordinate patient transport
Katie Potts - TriCounty Health Department
It has been confirmed that the ED is contaminated.
Part 1
Prepare a list of all external agencies that should be notified about the
contamination of the ED.
Contact dispatch to facilitate contacting:
Ambulance to re-route patients
Part 2
Health Department
Media
Sewage and Water
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Treacherous Transport Tabletop Exercise
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Public Works
Part 3
Briefly describe how communications will occur with the above listed external
agencies.
JIC's
Part 4
Telephone and radio communications
Part 5
Briefly explain how the need for partial or full evacuation of the ED will be
determined.
Part 6 Shut down the ER and redirect non-contaminated individuals to a triage area.
Part 7
Describe the process for notifying EMS of the need to divert patients to other
hospitals.
Part 8 Dispatch
Treacherous Transport - TriCounty - # 013
Chris Chestnut - Indian Health Service
The HCC has determined the best course of action is to evacuate the ED.
Part 1
Briefly describe the evacuation plan for the ED.
Part 2
IHS doesn’t have an ED so if our staff were assisting they would follow the
direction of the HCC as to what actions to take
Part 3 Identify the location to which patients and staff will be relocated.
Part 4
other hospitals, ambulatory care centers or possibly to a triage location such as
a tent outside.
Part 5
Due to contamination of the ED, describe what treatment or decon will the
patients and staff receive.
Part 6
full rinse with water for 15 minutes with all clothing removed (shower decon
tent)
Part 7
Describe what external resources, if any, will be needed to assist with decon,
patient movement, transportation and / or staffing.
Part 8 Emergency management teams, nurses, etc. from all of the EM response teams
Katie Potts - TriCounty Health Department
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Treacherous Transport Tabletop Exercise
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The HCC has determined the best course of action is to evacuate the ED.
Part 1
Briefly describe the evacuation plan for the ED.
Part 2
Containing the contaminated patients. Use gurneys to move non-contaminated
patients to a triage facility.
Part 3 Identify the location to which patients and staff will be relocated.
Part 4
Shelter in place the contaminated patients. The LDS church across the street
has a verbal understanding that their building can be used.
Part 5
Due to contamination of the ED, describe what treatment or decon will the
patients and staff receive.
Part 6 Regular decon procedures.
Part 7
Describe what external resources, if any, will be needed to assist with decon,
patient movement, transportation and / or staffing.
Part 8 Firefighters will assist.
Treacherous Transport - TriCounty - # 014
Chris Chestnut - Indian Health Service
There are additional patients self-reporting to the hospital complaining of
symptoms similar to others exposed to the chemical.
Part 1
With the ED closed, how will these patients be received, triaged, treated and /
or transported?
Part 2
A triage tent will be placed outside to triage potential patients until the ED is
decontaminated and possibly throughout the incident.
Katie Potts - TriCounty Health Department
There are additional patients self-reporting to the hospital complaining of
symptoms similar to others exposed to the chemical.
Part 1
With the ED closed, how will these patients be received, triaged, treated and /
or transported?
Part 2
Redirected to decon if contaminated. If they are not contaminated they can be
diverted to the triage tent or additional entrance.
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Treacherous Transport Tabletop Exercise
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Treacherous Transport - TriCounty - # 015
Chris Chestnut - Indian Health Service
911 Dispatch receives a call from an Urgent Care Clinic in the area.
Three people have arrived at the facility with symptoms of respiratory distress.
The patients mentioned the accident and the hazardous material spill.
Part 1
The Urgent Care Clinic does not have the capability to decon these patients and
is looking for support.
Briefly describe the best course of action to care for these patients.
Part 2 triage the patients and transport them elsewhere if needed
Part 3
Briefly describe the ongoing communications that occur between healthcare
agencies during this event.
Part 4 constant feedback and reporting from all groups to the ICT and/or HCC
Katie Potts - TriCounty Health Department
911 Dispatch receives a call from an Urgent Care Clinic in the area.
Three people have arrived at the facility with symptoms of respiratory distress.
The patients mentioned the accident and the hazardous material spill.
Part 1
The Urgent Care Clinic does not have the capability to decon these patients and
is looking for support.
Briefly describe the best course of action to care for these patients.
Contact dispatch for further instructions. They do not have radios to monitor the
situation and would need to be contacted via dispatch at the on-set of this
Part 2
accident for lock-down instructions. CodeRed could be utilized to contact the
private healthcare facilities if they are registered.
Part 3
Briefly describe the ongoing communications that occur between healthcare
agencies during this event.
Part 4 See above
Treacherous Transport - TriCounty - # 016
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Treacherous Transport Tabletop Exercise
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Chris Chestnut - Indian Health Service
EMS has a patient to transport from Daggett County.
EMS calls the hospital en route only to find out that the ED is on divert.
Part 1 The patient has extensive injuries including lacerations and neck pain from
falling through a plate glass window.
Briefly describe how this patient will be treated and where he will be
transported.
The patient will need to be transported to the nearest facility not contaminated
Part 2 (Ashley Valley or UBMC) as these injuries could be made worse if contaminated
from exposure to the chemicals.
Katie Potts - TriCounty Health Department
EMS has a patient to transport from Daggett County.
EMS calls the hospital en route only to find out that the ED is on divert.
Part 1 The patient has extensive injuries including lacerations and neck pain from
falling through a plate glass window.
Briefly describe how this patient will be treated and where he will be
transported.
Part 2 Patients would be transported to Rock Springs via instructions through dispatch.
Treacherous Transport - TriCounty - # 017
Chris Chestnut - Indian Health Service
Part 1
As the response wraps up on scene and patients are being treated and sent
home, what actions should be considered for returning to normal operations?
Many of the treated and untreated individuals will need to be monitored by
someone for an additional 72hors because of the possibility of delayed onset.
Part 2
Additionally a PSA will need to be given to the local news, police and healthcare
centers for use.
Part 3
When the ED goes off diversion, how will this information be communicated to
EMS and other hospitals?
Part 4 Dispatch will be able to notify EMS who are in their vehicles and the logistics
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officer will assist in notifying all of the agencies
Part 5
Briefly describe how hospitals can improve communication between one
another during an event such as this.
Part 6
If the logistics and PIO officers are in routine contact all the time it will be easier
for them to ensure smooth communication during an event
Part 7
Briefly describe the kind of debrief or after action, if any, that would be
performed by the hospital following an event such as this.
Debrief of all involved responders that identifies gaps successes and failures
Part 8 and incorporates those into a proposal for action. As well as soliciting public
feedback from the community and individuals involved in the incident.
Katie Potts - TriCounty Health Department
Part 1
As the response wraps up on scene and patients are being treated and sent
home, what actions should be considered for returning to normal operations?
Halliburton would be responsible for the clean-up while the Health Department
monitors.
Part 2
H.D. would provide speaking points for advising the Public when receiving
calls.
MRC can man hotlines to assist with incoming calls if activated. Dispatch can
divert calls to these hotlines.
Part 3
When the ED goes off diversion, how will this information be communicated to
EMS and other hospitals?
IC and Hospitals will use their Incident Command Center to contact dispatch.
JIC at Uintah EOC will be utilized to send out information. A representative
Part 4
from the media and radio should be involved to establish a relationship and
collaboration.
Part 5
Briefly describe how hospitals can improve communication between one
another during an event such as this.
Part 6 n/a
Part 7
Briefly describe the kind of debrief or after action, if any, that would be
performed by the hospital following an event such as this.
Part 8
All agencies involved would need to participate in a debriefing and after action
review. Dispatch will need to be involved.
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Treacherous Transport - TriCounty - # 018
Chris Chestnut - Indian Health Service
Based on the today’s exercise scenario, list all Memoranda of Understanding
(MOUs) or Memoranda of Agreement (MOAs) that the hospital currently has in
place. When listing the MOU / MOA identify the:
Part 1




Resource.
Agency the MOU / MOA is with.
If the MOU / MOA is a formal written document or informal agreement.
The date the MOU / MOA was last reviewed.
(Example: Wheelchair Accessible Bus – ABC School District – Formal –
Reviewed 12/2011)
Part 2
We have a verbal MOU with the Ute Tribe Emergency Management Office to
assist with personnel during incidents.
Part 3
Identify and describe any gaps in resources that an MOU / MOA may help
alleviate based on today’s exercise scenario.
Part 4
Personnel, resources are very limited and clearly there is a great possibility we
could be overwhelmed.
Katie Potts - TriCounty Health Department
Based on the today’s exercise scenario, list all Memoranda of Understanding
(MOUs) or Memoranda of Agreement (MOAs) that the hospital currently has in
place. When listing the MOU / MOA identify the:
Part 1




Resource.
Agency the MOU / MOA is with.
If the MOU / MOA is a formal written document or informal agreement.
The date the MOU / MOA was last reviewed.
(Example: Wheelchair Accessible Bus – ABC School District – Formal –
Reviewed 12/2011)
Fire has a MOU with the County
Part 2 Hospitals have them through the coalition and with neighboring facilities.
Bluemed in Price, Moab and St. George
Part 3
Identify and describe any gaps in resources that an MOU / MOA may help
alleviate based on today’s exercise scenario.
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Part 4 n/a
Treacherous Transport - TriCounty - # 019
Chris Chestnut - Indian Health Service
Exercise Feedback
Part 1
This feedback questionnaire is not the same as the Exercise Hotwash. The
Exercise Hotwash will need to be completed at the end of the exercise.
What did you like about the ONX System?
Part 2 It was easy to navigate and the instructions were clear and precise
Part 3 What improvements can be made to the ONX System?
I would have liked it if the exercise would have had an audio portion or perhaps
Part 4 a live facilitator that could review data presented in real time and facilitate
movement through the exercise.
Katie Potts - TriCounty Health Department
Exercise Feedback
Part 1
This feedback questionnaire is not the same as the Exercise Hotwash. The
Exercise Hotwash will need to be completed at the end of the exercise.
What did you like about the ONX System?
Part 2 This system is worth using.
Part 3 What improvements can be made to the ONX System?
Part 4 Redundancy
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