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A Report from Vigilant Guard and the Role of NARR in Rad Exercises
Bill StephensNACCHOTarrant County Public Health
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Exercise Overview
A 4-day, full-scale exercise for a 10KT IND detonated in the center of Phoenix, AZ following a tropical storm flood
Over 8,000 participants, 200 local, state and Federal agencies playing including 5 National Guard Civil Support Teams (CSTs)
Local and state public health involved, but primarily notional as observed at IC points
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Public Health Exercise Objectives
Objectives consolidated and focused on PHEP Capabilities 5, 6, 7,9,10, 11,13 Fatality Management Information Sharing Mass Care Medical Materiel Management and Distribution Medical Surge Non-pharmaceutical intervention Public Health Surveillance and Epi Investigation
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Command and Control
Arizona Division of Emergency & Military Affairs and State EOC Collated on Papago Military Reservation
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Key EM Operation Centers
91st Division of AZ National Guard Joint Operations Center (JOC)
State Division of Emergency Management Center
Maricopa Integrated Health System (County hospital)
Phoenix Fire Training Academy - simulated rubble pile with radiological contamination and manikin victims
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State DEM EOCWell located and equipped EOC with redundant comms.Large staffing with back-up and liaisons with multiple agencies throughout exercise. Using WebEOC for 3 weeks. Excellent plume modeling and DOE presence and support. Primary resource coordination focused on severely injured in the primary blast and fallout zones.
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Medium size hospital well connected with HaVABed system, EMSystems, redundant comm. equipment, and numerous other hospitals via voice and dataHave an excellent capability with level 1 trauma and burn center for both adult and pediatric in the same facility. Burn center is linked to 10+other hospitals via telemedicine systems
Maricopa Integrated Health System
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Extremely well organized with strong NIMS and ICS.Advanced life support and stabilization with advanced field OR at base-camp prior to transportNo presence or mention of public health liaisons PIO in communication with JIC. Victim sniffing dogs
Phoenix Fire Training – “Rubble Pile”
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Key Public Health Related Gaps Observed
Exercise gap – no public health liaisons present (exercise gap); notional only
Community reception center (CRC) function missing or notional and CHC’s only playing in sheltering mode (exercise gap)
Training on decon at base-camp and hospitals outdated – scrubbing with soap and brushes!
Decon on injured patients done before treating trauma - “it’s inevitable that in these [rad] MCI’s some patients will be lost [due to trauma injuries] but it’s to protect other patients and personnel in ER from radiological contamination.”
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Opportunities for NARR Support
Targeted training/exercise for EM and National Guard CSTs in roles and responsibilities of public health – CRCs must be included
First receiver medical response – updated training for medical staff on proper protocols for decon/trauma treatment (trauma first!)
Decontamination protocols for radiological contamination – REAC/TS training?
Altered standards of care for radiological MCIs Psychosocial/behavioral components not evident in protocols
Proper briefing and exercise with media First responders and receivers?
Table top exercise and seminar support early in cycle Selected tools cross-walked with identified gaps.