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Designing, Conducting, and Evaluating Tabletop Exercises for Pandemic Influenza Business Continuity Planning. Kristine Moore, MD, MPH Medical Director Jill DeBoer, MPH Associate Director. Workshop Outline. Overview of Exercises (30 minutes)
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Designing, Conducting, and Evaluating Tabletop Exercises for Pandemic Influenza Business Continuity Planning Kristine Moore, MD, MPH Medical Director Jill DeBoer, MPH Associate Director
Workshop Outline • Overview of Exercises (30 minutes) • The Tabletop Exercise Planning Process: From Conception to Action (60 minutes) • Facilitating a Tabletop Exercise; Exercise Evaluation and Follow-up (30 minutes)
Presentation Outline • Steps in Business Continuity Planning • Purpose and Timing of Exercises • Five Major Types of Exercises • Unique Features of Pandemic Influenza Exercises • Designing Exercises to Meet Your Needs
Steps in Business Continuity Planning • Conduct a Risk Assessment • Conduct a Business Impact Analysis (BIA) • Develop a Business Continuity Plan (BCP) • Implement the BCP • Test, Refine, and Revise the BCP
Steps in Business Continuity Planning • Conduct a Risk Assessment • Identify internal and external threats, hazards, and vulnerabilities that could impact your company • Hazards may be industry-specific or may be general • Rank hazards by probability and severity • Pandemic influenza is a hazard with a high potential severity and high probability (at some point)
Steps in Business Continuity Planning • Conduct a Risk Assessment • Conduct a Business Impact Analysis (BIA) • Define how different hazards (such as pandemic influenza) could impact your business • Identify critical job functions and operations • Assess assets for response • Consider minimal requirements for continuing operations
Steps in Business Continuity Planning • Conduct a Risk Assessment • Conduct a Business Impact Analysis (BIA) • Develop a Business Continuity Plan (BCP) • Utilize an all-hazards approach with annexes for specific issues • Make key decisions (based on the BIA) • Develop policies and procedures as necessary • Define trigger points as needed • For pandemic planning, consider unique stresses (CIDRAP 10-point framework)
Steps in Business Continuity Planning • Conduct a Risk Assessment • Conduct a Business Impact Analysis (BIA) • Develop a Business Continuity Plan (BCP) • Implement the BCP • Educate staff and conduct training as needed • Conduct steps necessary to implement policies and procedures
Steps in Business Continuity Planning • Conduct a Risk Assessment • Conduct a Business Impact Analysis (BIA) • Develop a Business Continuity Plan (BCP) • Implement the BCP • Test, refine, and revise the BCP
Purpose and Timing of Exercises An exercise is a focused practice activity that places the participants in a simulated situation requiring them to function in the capacity that would be expected of them in a real event. Excerpt from FEMA Emergency Management Institute Independent Study Course, Exercise Design (March, 2003)
Why Exercise? • Identify successes and strengths to be maintained and built upon • Plans, policies, and procedures • Resources • Reveal areas needing further improvement • Plans, policies, and procedures • Resources • Educate on plans, policies, and procedures • Educate on the complexities of a specific emergency scenario
Why Exercise? (continued) • Improve organizational coordination and communications • Train personnel in roles and responsibilities • Improve individual performance • Satisfy regulatory and/or funding requirements • Evaluate response systems
When to Exercise • According to planned exercise program schedule • But also… • Revision of Business Continuity Plan • Changes in key personnel • Shifts in sector/industry trends • New regulatory requirements • Changes in information technology systems • In response to recent past incidents or events • In anticipation of upcoming events
Exercise Categories • Orientation • Drill • Tabletop Exercise • Functional Exercise • Full Scale Exercise
Orientation • Purpose • Familiarize staff to organization’s emergency response plan • Familiarize current staff to changing information or procedures • Bring together various departments for better understanding and coordination • Identify planning and response priorities prior to plan development
Orientation • Methods • Talk Through • Brain Storming • Case Study • Training Workshop
Orientation • Example • Cross Border Orientation Exercise
Scenario 1: Foodborne Botulism Outbreak
Suspect Botulism Cases • Cranial nerve dysfunction • Bilateral proximal muscle weakness
Largest Foodborne Botulism Outbreak Reported in North America 176 cases
Small Group Discussion • Review Identified Issues • Prioritize Issues • Brainstorm Realistic Action Steps
Orientation • Good for: • Educating, building awareness • Gathering new ideas or feedback • Exercising before a plan is started • Exercising before a plan isfinalized
Drill • Purpose • Instruct thoroughly through repetition and practice • Focus is usually on one aspect of the response plan in one organization • Can be used to test staff training, response time, interdepartment cooperation and resources, manpower and equipment capabilities • Can be preceded by orientation
Drill • Sometimes referred to as: • Procedure verification exercise • Validation exercise • Walk-through exercise
Drill • Examples • After Hours Notification Drill • Emergency Operations Center Drill • IT System Recovery Drill • Mass Dispensing Site Drills
Tabletop Exercise • Purpose • Focus on constructive problem solving as a group • The success of a tabletop exercise is determined by feedback from participants and the impact this feedback has on evaluation and revision of policies, plans, and procedures
Tabletop Exercise • Methods • A discussion guided by a facilitator based on a simulated emergency situation • BasicTabletops: Participants discuss problems as a group; leader summarizes conclusions • Advanced Tabletops: Series of messages requiring rapid response; facilitator guides the discussion
Tabletop Exercise • Advantages(FEMA Exercise Design Manual) • Is a good way to acquaint key personnel with emergency responsibilities, procedures, and one another • Is an effective method for reviewing plans, procedures, and policies • Requires only a modest commitment in terms of time, cost, and resources
Tabletop Exercise • Disadvantages(FEMA Exercise Design Manual) • Lacks realism and thus does not provide a true test of an emergency management system’s capabilities • Provides only a superficial exercise of plans, procedures, and staff capabilities • Does not provide a practical way to demonstrate system overload
Functional Exercise • Purpose • Fully simulated interactive exercise that tests the capability of an organization to respond to a simulated event • Tests multiple functions and coordinated response in a time-pressured, realistic simulation (without deploying resources)
Functional Exercise • Methods • Participants gather where they would actually operate in an emergency (usually an EOC or other operating center) • Participants are briefed immediately prior to the start of the exercise as to objectives, procedures, time frame and recording requirements • Simulated information is delivered to players by paper, telephone, or radio
Functional Exercise • Methods (continued) • Players respond as they would in a real emergency, in real time, making on-the-spot decisions and taking on-the-spot actions • Similar to full-scale exercise without the equipment • Involves controllers, simulators, and evaluators • May consider “no-notice” design
Functional Exercise • Sometimes referred to as: • Simulation exercise • Operational exercise
Functional Exercise • Examples • Strategic National Stockpile Exercises • Nuclear Power Plant Exercises
Full Scale Exercise • Purpose • Tests the comprehensive response capacity of multiple organizations by simulating a real event as closely as possible
Full Scale Exercise • Methods • Field personnel proceed to the location of a mock emergency • EOC activities are combined with on-scene use of simulated victims, equipment, and manpower (enactment) • Activities at the scene serve as input and require coordination with the simulation at the EOC
Full Scale Exercises • Example • City/County Emergency Management Exercises • Airport Disaster Exercises
Exercises are Everywhere • Military • Emergency Management • Hospital Disaster Planning • Nuclear Power Plants • Airports • Businesses • Public Health
Unique Features of Pandemic Influenza Exercises • Rapid decision-making with limited information • Staged decision-making • Long term event • Global event • Impacts all sector of society • Exploring relationships with the public health system • Anticipated public panic
Designing Exercises to Meet Your Needs • Choose Type of Exercise Carefully • Based on Exercise Goal and Objectives • Choose Exercise Format Carefully • Unlimited possibilities • Consider the Roles of Internal Teams and External Consultants
Early in the Design Process: Visualize “That was a smashing success!”
Three Key Questions: What did the participants learn? What was documented? How do the participants feel?