11 2012 phase iii: tabletop exercise. 22 the 2012 statewide medical and health exercise is sponsored...

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2012 Phase III: Tabletop Exercise

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The 2012 Statewide Medical and Health The 2012 Statewide Medical and Health Exercise is sponsored by:Exercise is sponsored by:•California Emergency Medical Services Authority (EMSA) •California Department of Public Health (CDPH)

In collaboration with:•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

Welcome and IntroductionsWelcome 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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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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Exercise PurposeExercise Purpose

2012 Statewide Medical and Health 2012 Statewide Medical and Health Exercise Target CapabilitiesExercise Target Capabilities

Communications

Intelligence/Information Sharing and Dissemination

Medical Surge

Emergency Operations Center Management

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Tabletop Exercise ObjectivesTabletop 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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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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Tabletop Exercise ObjectivesTabletop Exercise Objectives

Exercise CustomizationExercise 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 CustomizationExercise 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 RulesExercise 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 RulesExercise 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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PurposePurpose

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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BackgroundBackground

Potential causes of loss of power include:

Natural disaster such as earthquake, hurricanes or flooding

Wild land and urban fires

Mechanical Failure

Human Error

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Historical Impact of Power LossHistorical 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

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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

Source: www.drj.com/drworld/content/w!-113.htm

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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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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2008 Sayre Wild Land FireOlive 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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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

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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

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 ExerciseTabletop 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

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ScenarioScenario 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.

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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.

Scenario (Continued) 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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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.

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Scenario (Continued) Scenario (Continued)

Module 1: Incident Notification Module 1: Incident Notification Intelligence/Information Sharing, Intelligence/Information Sharing,

Dissemination and CommunicationsDissemination and Communications

Key IssuesAbility 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 DiscussionQuestions 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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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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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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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?

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?

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Module 2: Incident Response Module 2: Incident Response Continuity of OperationsContinuity of Operations

Key IssuesAbility 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.

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1. Has your organization/agency evaluated its current power supply and identified vulnerabilities in the system?

Has the generator support been identified, including identification of fuel for continued generator operations?

Does the ability to sustain operations with emergency power consider the impact of an increased demand for services?

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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?

Is the cache secure? Does this include a fuel supply cache? Is the fuel supply cache in a seismically-safe location? Is the

fuel supply dependent on power? 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?

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3. Have the areas of the facility (including all buildings) supported by emergency power been identified?

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.)

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?

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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?

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Questions for DiscussionQuestions for DiscussionImpact of Power LossImpact 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 Agency1. 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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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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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 Agencies2. 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 Impact3. 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)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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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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4. Impact on Multi-Site Agencies4. Impact on Multi-Site Agencies

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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5. Providing Support for Other 5. Providing Support for Other Response PartnersResponse Partners

Module 2: Incident Response (Cont.) Module 2: Incident Response (Cont.) Emergency Operations Center Emergency Operations Center

ManagementManagementKey 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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1. How does your organization/agency use Incident Command System principles to organize and guide response and recovery operations in an emergency?

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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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?

3. How is information transfer validated?

4. If procedures are in place, is the process regularly tested?

5. Do you utilize action planning procedures and forms to document and guide the response and recovery?

6. Is the Action Plan shared with response partners in the jurisdiction?

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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?

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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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 Module 3: Ongoing Operations Medical SurgeMedical 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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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? Does routine maintenance and testing include a discussion of

the loss of power on continuation of services?

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3. Do you have a surge plan to address increased persons presenting to your facility for safety?

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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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 Conclusion of Discussion-Based TabletopDiscussion-Based Tabletop

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Planning for the November Planning for the November Functional ExerciseFunctional 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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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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Planning for the November Planning for the November Functional ExerciseFunctional Exercise

November ExerciseNovember ExerciseIssues for DiscussionIssues 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 DiscussionIssues 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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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 v Scenario Events List

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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 AgenciesRole 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.

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Thank You Thank You For Your ParticipationFor Your Participation

Additional materials may be found on: Additional materials may be found on:

California Statewide Medical and HealthCalifornia Statewide Medical and HealthTraining and Exercise Program website:Training and Exercise Program website:

www.californiamedicalhealthexercise.com

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11 2012 phase iii: tabletop exercise. 22 the 2012 statewide medical and health exercise is sponsored...

Documents

tabletop exercise slide

exercise purpose slide

tabletop exercise questions

exercise ground rules

discussionbased exercise

loss of power

power loss

unified response