Tornado Tabletop Exercise

1. Tornado Tabletop Exercise Photo courtesy of NOAA Photo Library

2. MERET worked with partners in Minnesota to adapt curriculum to support the Hospital Incident Command System (HICS) training Minnesota Emergency Readiness Education and Training Program (MERET) MERET is a program designed to educate and train Minnesota’s health care workers in emergency preparedness, tailoring efforts to the unique needs of specific communities as they prepare for a health emergency or bioterrorism event. MERET is funded by the Office of the Assistant Secretary for Preparedness and Response (ASPR) of the U.S. Department of Health and Human Services, and is administered by the University of Minnesota Schools of Nursing and Public Health. Carol O’Boyle, PhD, RN, at the School of Nursing, is the Principal Investigator. Minnesota Emergency Readiness Education and Training (MERET) is funded under grant #TO1HP06412 from the Office of the Assistant Secretary for Preparedness and Response (ASPR),DHHS, Bioterrorism Training and Curriculum Development Program.

3. Tabletop Objectives Using a tornado scenario: ● Demonstrate understanding and skill in opening an Incident Command Post ● Activate appropriate modules within the Incident Command System ● Demonstrate ability to perform roles and responsibilities ● Demonstrate ability to locate and implement Job Action Sheets (JAS) ● Verbalize understanding of a coordinated emergency response with other community agencies ● Assess needs for alternative modes of operation. ● Verbalize importance of contributing to team efforts ● Verbalize understanding of continuity of operations

4. Background Information • Sunday afternoon NWS issues Tornado Watch (insert general area e.g. SW and SC) Minnesota • At 4:40 PM National Weather Service issues Special Weather Statement of a line of severe storms developing over (insert general area e.g. SW and SC) Minnesota Photo courtesy of NOAA Photo Library

5. Are we doing anything with this information for the organization?

6. Background Information • At 5:45 PM NWS issues a Severe Thunderstorm Warningfor( insert general area e.g. Brown and Watonwan) Counties • NWS radar indicates a line severe thunderstorms between (insert general information e.g. Sleepy Eye and St. James) moving east Photographer: D. Burgess. Photo courtesy of NOAA Photo Library

7. Would we do anything with this new information?

8. Emergencies Present In 2 Ways… Unanticipated and/or Without Warning Anticipated and/or With Warning Oklahoma City Bombing Hurricane Katrina Tornado Midwest Floods Northridge Earthquake Pandemic Flu The Amount of Time We’re Given To Pre-Organize People and Pre-Stage Equipment Can Drastically Change Our Response Effectiveness Illustration courtesy of Pete Brewster – VA Medical System

9. Incident progression Reactive Phase Recognition Notifications Initial control and safety actions Establish ICP Primary Tools SOPs Job Action Sheets Primary Goal Prevent incident expansion Prevent responder injury Proactive Phase Situation assessed Objectives established Strategies / tactics Resources requested Primary Tools ICS Incident Action Planning Primary Goal Manage incident BOOM! Slide courtesy of John Hick Hennepin County Medical Center

10. What are the respective agencies doing with this Tornado Warning? • Fire • Law Enforcement • EMS/Ambulance • Emergency Management • Hospital

11. Establish an Incident Command Center/Post • Where will it be located? Is there a back-up location in case of destruction • Determine positions to be opened • Hand out Job Action Sheets (JAS) • Put on job vests • Begin Forms • Forms 201 Incident Briefing • Forms 202 Incident Objectives • Prepare/Practice/Anticipate

12. Scenario Development • At 6:10 PM NWS issues a Tornado Warning for (insert local info e.g.Blue Earth and Nicollet) Counties until 7:00 PM • At 6:15 PM weather spotter confirms tornado on the ground (insert local info e.g.NE of Lake Crystal on HWY 60) moving NE at 30 MPH Photo courtesy of NOAA Photo Library

13. How do we respond to this NWS Tornado Warning?

14. Scenario Development • At 6:20 PM sheriff deputies report tornado touchdown just west of (add local info e.g.Mankato near Minneopa Park) • At 6:30 PM local police notify dispatch of tornado on the ground in the city • At 6:35 PM power blinks off/on at Hospital facility • At 6:37 PM Tornado hits Hospital facility Photo courtesy of NOAA Photo Library

15. Job Action Sheets (JAS) 1. Title 2. Purpose 3. Towhom they report 4. Critical action considerations 5. Forms required by the job 6. Broken into operational periods JAS “prompts” the team member to take needed actions related to their roles and responsibilities Courtesy of HICS

16. HICS 201 Form (Incident Briefing) 1. Incident Name, 2. Date of Briefing 3. Time of Briefing 4. Event History 5. Current Actions 6. Summary 7. Current Organization 8. Notes (Accomplishments, Issues, Directives) 9. Name of the individual who prepared the document 10. Facility Name Courtesy of HICS 1. Incident Name, 2. Date of Briefing 3. Time of Briefing 4. Event History 5. Current Actions 6. Summary 7. Current Organization 8. Notes (Accomplishments, Issues, Directives) 8. Name of the individual who prepared the document 9. Facility Name

17. Scenario Development • Tornado hits south and west sides of building • Roof is off on the 5200 and 5400 wings • Windows are broken on the 5200 and 5400 wings on ALL floors • Tornado lasts about 10 minutes with severe winds and heavy rainfall Photo courtesy Mark Wolfe/FEMA

18. Tornado Implications • Main power has been interrupted – on generator • Phone system outside the hospital is disabled • Cell phone towers are down • Major damage reported (via AM radio) throughout the City/County Photo courtesy Marvin Nauman/FEMA

19. Facility System Status Report 1. Operational Period Date/Time 2. Date Prepared 3. Time Prepared 4. Building Name 5. System Status Checklist • IT system • Communication System • Infrastructure • Patient Care System • Security System • Utilities, External System • Utilities, Internal System • Certifying Officer • Facility Name Courtesy of HICS

20. Scenario Development • What are you going to do? • What are our priorities? • Incident Command • Who is in charge? • What resources do we have? • How to access more resources? • Communication? • Infrastructure assessment? • Evacuation/Off-site care? Photo courtesy of Mike Branick

21. Managing by Objectives Incident Action Plan (IAP) • There is only one Incident Action Plan at an incident which identifies • WHAT must be done? • WHO is responsible? • How information will be COMMUNICATED? • What if a responder is INJURED? • Overall Priorities • Life Saving • Incident stabilization • Property Preservation • Establish Incident Action Plan objectives, strategies, tactics Slide courtesy of FEMA

22. Establishment of Incident Objectives and Strategy • What are the Strategic Goals? • What are the immediate Tactical Objectives? • Remember – Documentation!

23. HICS 202 Form (Incident Objectives) • 1. Incident name • 2. Date prepared • 3. Time prepared • 4. Operational period ( date & time) • 5. General command & control objectives for the incident (including alternatives) • 6. Weather/environmental implications during the period (forecast, wind speed/direction, daylight) • 7. General safety/staff messages to be given • 8. Attachments (ex. medical plan, facility system status) • 9. Name of the individual who prepared the document • 10. Approval of the Incident Commander • 11. Facility name Courtesy of HICS

24. Incident Action Plan Establishes Objectives, Strategies, and Tactics • State what will be accomplished (agency exec and IC) Incident Objectives • Establish the general plan or direction for accomplishing the incident objectives (IC) Strategies Tactics • Specify how the strategies will be executed. (Operations) Slide courtesy of FEMA

25. Incident Command Staff • How much of the ICS is implemented? • Staff in the ICS organizational structure are appointed as the incident complexity expands Incident Commander Public Information Officer Command Staff Liaison Officer Safety Officer General Staff Operations Section Planning Section Logistics Section Finance/Admin Section Slide courtesy of FEMA

26. Sample “Build Outs”: Immediate Slide courtesy of FEMA

27. Communications • What do you communicate to the community? • Who is the spokesperson? • What is the plan for news media? • Who will be the Public Information Officer? • Is there a Joint Public Information Center? • Will a press conference be scheduled? • What are the key messages? • When/How will updates be done? Photo courtesy of FEMA Photographer Mike Howard

28. Incident Command Public Information Officer (PIO) Operations Emergency Department Safety Logistics Planning Finance Medical Director/Physician Nursing Infection Control Scenario Messages

29. How much of HEICS is implemented… OPERATIONS PLANNING COMMAND LOGISTICS FINANCE Images courtesy of USA.gov

30. Future Objectives & Strategies • Where might we relocate other essential functions? • How do you sustain prolonged incident like this while your facility is stabilized to resume care and treatment for your community (5-7 days) • What do you communicate to the community?

31. Sample “Build Outs”: Extended Slide courtesy of FEMA

32. Schedule for Operations briefing Planning Section Chief reviews agenda and facilitates ▼ IC presents objectives (sometimes defers to Planning Chief to present) ▼ Off-going Operations Section Chief – provides current assessment and accomplishments during last ops period ▼ Oncoming Operations Section Chief – covers work assignments and staffing ▼ Technical Specialist -Safety Officer – Special Operations –present updates ▼ May have specific Unit Leaders present information ▼ Final IC comments ▼ Planning Section Chief announces next briefing time/location, adjourn Slide courtesy of FEMA

33. Planning Meeting Develop strategies & tactics to Accomplish objectives Incident is recognized Notifications, assessment, Immediate needs are addressed Incident Manager Sets overall incident objectives & priorities Action Plan preparation & approval Management Meeting Evaluates & revises incident objectives On-going situation assessment & information processing Operations Briefing Briefs the operational leaders on the Action Plan Assess progress using measures of effectiveness Implement Action Plan United States Coast Guard

34. Next Steps/Follow-Up • Are their any large gaps that are identified? • What can be done to close those gaps? • Who is responsible? • What is the timeline?

35. Sample “Build Outs” Immediate Extended Slide courtesy of FEMA

36. THE END! Thanks for Participating

37. MERET Acknowledges its Partners: 1. Healthcare System Preparedness Program Partners a. Minnesota Department of Health–Office of Emergency Preparedness b. MDH Metropolitan Hospital Compact c. Regional Hospital Resource Center Focus Group: • Michelle Allen, Northwest • Clyde Annala, Northeast • Jill Burmeister, South Central • Chuck Hartsfield, Central • Marla Kendig, Southeast • Emily Parsons, MDH-OEP • Justin Taves, West Central • Eric Weller, South Central 2. FEMA Independent Study Program