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Session 14

Session 14. Tabletop Exercise Design By Myra Socher. Objectives. Demonstrate an understanding of the Homeland Security Exercise Evaluation Program (HSEEP). Demonstrate an understanding of the need for conducting Tabletop Exercises (TTX) and their role in the exercise continuum.

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Session 14

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  1. Session 14 Tabletop Exercise Design By Myra Socher

  2. Objectives Demonstrate an understanding of the Homeland Security Exercise Evaluation Program (HSEEP). Demonstrate an understanding of the need for conducting Tabletop Exercises (TTX) and their role in the exercise continuum. Demonstrate the ability to design, conduct and evaluate a TTX. Discuss the different formats that can be used when developing a TTX and the accompanying benefits and pitfalls. Session 14: Catastrophe Readiness and Response Course

  3. HSEEP • Department of Homeland Security (DHS) was directed by HSPD-8 to coordinate with other Federal departments and agencies to establish a “national program and multi-year planning system to conduct homeland security preparedness-related exercises.” • The Homeland Security Exercise and Evaluation Program (HSEEP) is a capabilities and performance-based exercise program that provides a standardized methodology and terminology for exercise design, development, conduct, evaluation, and improvement planning.1 It constitutes a national standard for exercises. Session14: Catastrophe Readiness and Response Course

  4. We must apply the elements of HSPD-5 • To enhance the ability of the United States to manage domestic incidents by establishing a single, comprehensive national incident management system (NIMS). • Ensure that all levels of government have the capability to work efficiently and effectively together. • Cooperate in an acronym-free environment where we all talk the same language. Session14: Catastrophe Readiness and Response Course

  5. Preparedness Cycle • This is defined as “planning, training, equipping, exercising, evaluating, and taking action to correct and mitigate.” • The plan, train, exercise & evaluate formula will use the after action report to update Emergency Operation Plans (EOP)s; modify training plans; and prepare for the next exercise or all hazards incident response. Session14: Catastrophe Readiness and Response Course

  6. Exercise Phases Session14: Catastrophe Readiness and Response Course

  7. Why have exercises? • Well-designed and well-executed exercises are the most effective means of: • assessing and validating policies, plans, procedures, training, equipment, assumptions, and interagency agreements; • clarifying roles and responsibilities; • improving interagency coordination and communications; • identifying gaps in resources; • measuring performance; and • identifying opportunities for improvement. Session14: Catastrophe Readiness and Response Course

  8. Exercise Types • Discussion-Based Exercises • Seminars • Workshops • Tabletop Exercises • Games • Operations-Based Exercises • Drills • Functional Exercises • Full Scale Exercises Session14: Catastrophe Readiness and Response Course

  9. Building Block ApproachCrawl-Walk-Run Session14: Catastrophe Readiness and Response Course

  10. More Intense Pressure for Catastrophe Scenarios • Ensure that in the framework of a catastrophe, the players are overwhelmed and under extreme pressure • This can be achieved by: • An initial long period of little or no response; • No rapidly available mutual aid; • Creating a sense of isolation; • The loss of many colleagues - first responders and coordinating personnel; • Resultant issues of concerns about one’s own family and the families of responders and emergency management personnel; • Applying mental health stressors to both casualties and responders alike. Session14: Catastrophe Readiness and Response Course

  11. Exercise Components • Planning Conferences • Design and Development • Capabilities, Tasks, and Objectives • Scenario • Documentation • Logistics • Exercise Conduct Session14: Catastrophe Readiness and Response Course

  12. Exercise components (2) • Evaluation • Hot Wash and Debrief • After Action Report / Improvement Plan • Improvement Planning • Improvement Plan • Improvement Tracking and Planning • Lessons Learned and Best Practices • https://www.llis.dhs.gov/ Session14: Catastrophe Readiness and Response Course

  13. Exercise Planning Team • Determine objectives and what a scenario should cover. • Develop the scenario and accompanying documentation. • Team should be a manageable size with each member having a manageable span of control for their area of responsibility. • Structure along ICS principles • Command role – Team leader • Planning, Logistics, Finance & Admin, Operations • Define roles and responsibilities. • These are “trusted agents” so cannot be players too. Session14: Catastrophe Readiness and Response Course

  14. Stakeholder Participation • Identify a wide range of stakeholders to create a useful exercise : • representatives from all first responder disciplines • representatives from volunteer or non-governmental organizations, such as Citizen Corps Councils and the American Red Cross • representatives from important private sector entities • Federal, state, local, and tribal officials. • Buy-in is essential for coordinated response. Session14: Catastrophe Readiness and Response Course

  15. Planning Timelines • Establish timeframes for exercise milestones to include: • Planning conferences • Training • Exercise conduct • After action reporting • Improvement planning. • Needs to be consistent with Multi-Year Training and Exercise Plan. Session14: Catastrophe Readiness and Response Course

  16. Session14: Catastrophe Readiness and Response Course

  17. Design & Development • Capabilities, tasks, and objectives are the core components of design and development. • Each capability has specific tasks associated with it that should be identified and validated during the exercise. • These capabilities and tasks are derived from the Target Capabilities List (TCL) and Universal Task List (UTL). • We use them to formulate the exercise objectives, which will reflect the special needs of the organization. Session14: Catastrophe Readiness and Response Course

  18. Design & Development (2) • Well-defined objectives provide a framework for scenario development. • Use objectives that are (SMART) simple, measurable, achievable, realistic, and task-oriented. • Exercises designed for a catastrophic event will stress the players far more than those designed for a disaster. Session14: Catastrophe Readiness and Response Course

  19. The Scenario • This provides the backdrop and storyline that drives the exercise – think of it as the “spine” around which the “body” is built. • Identify the hazard to be used – suggest using the 15 national planning scenarios as a guide. • Realism is critical to engaging the participants. • Tailor the exercise to the community where it is being held. Session14: Catastrophe Readiness and Response Course

  20. Documentation • Situation Manual – SITMAN • Exercise Evaluation Guide • Participant Feedback Form Session14: Catastrophe Readiness and Response Course

  21. SITMAN • Provides background information. • Contains the scenario information. • Allows participants to read along during the multimedia/facilitator presentations. • All participants and observers should receive a SITMAN prior to STARTEX. Session14: Catastrophe Readiness and Response Course

  22. SITMAN (2) • Introduction gives exercise overview: • Scope • Capabilities • Tasks and objectives • Structure • Policies • Rules • Exercise Conduct • Agenda. • Next section is scenario. Session14: Catastrophe Readiness and Response Course

  23. SITMAN (3) • Scenario is divided into modules. • Chronologically sequenced. • Each module represents a specific time segment e.g. • Warning or intelligence • Notification • Response • Recovery • Exercise evaluation guides • Each linked to a target capability. • Enable evaluators to collect exercise observations • Provide the information used to complete the After Action Report and Improvement Plan (AAR/IP). Session14: Catastrophe Readiness and Response Course

  24. Logistics • Often overlooked but very important – can make or break an exercise: • Appropriate size meeting room with sufficient seating • Food and refreshments • Audiovisual equipment • Supplies for note-taking and facilitation • Registration table with sign-in, name tags. • It’s important that all participants wear some form of identification. Session14: Catastrophe Readiness and Response Course

  25. Evaluation Process • Exercise evaluation guides – sometimes called evaluation plans – are a tool to provide information for the After Action Report/Improvement Plan (AAR/IP). • Hot Wash – allows participants to provide immediate feedback for input to AAR/IP and can occur in functional break-out groups, plenary group or both. • Debrief – more formal forum for planners, facilitators, controllers and evaluators to provide feedback. • AAR/IP – documents following HSEEP format, provided to whoever conducted the exercise. Session14: Catastrophe Readiness and Response Course

  26. AAR/IP (continued) • AAR provides feedback to the participating entities on overall performance and capabilities. • It summarizes exercise events and analyzes performance of critical tasks that are pre-determined. • Evaluates achievement of exercise objectives. • The IP provides corrective actions for improvement with timelines for implementation and assignment to responsible people. • The IP converts lessons learned into concrete measurable steps to improve response capability. Session14: Catastrophe Readiness and Response Course

  27. Tabletop Formats • Can use: • Breakout groups (usually according to function e.g. fire, medical, law enforcement) • Plenary sessions • Combination of both. • Pros and cons to both • Sometimes physical space will drive format – are there areas to “break-out”? Session14: Catastrophe Readiness and Response Course

  28. Facilitation • A plenary group requires one or two very strong facilitators who can control a large group. • The pitfall is that some participants may be “take charge” while others are reticent. A good facilitator will overcome this and draw out the shy ones while not offending the stronger players. Session14: Catastrophe Readiness and Response Course

  29. Facilitation (2) • Break-out groups will require a larger number of facilitators skilled in the various disciplines. • Once the groups re-convene to report back on their findings the plenary group format will be followed. • Plenary groups allow for more cross-fertilization of ideas. Session14: Catastrophe Readiness and Response Course

  30. Common Features • Group problem-solving • Critical issues related to senior officials’ responsibilities • Group message interpretation is examined. • Participants share information within functional areas and between groups. Session14: Catastrophe Readiness and Response Course

  31. The Discussion Questions • While the scenario is the “spine”, the questions used by the facilitators to drive the discussion constitute the “cerebral cortex.” • The appropriate selection of questions is critical for: • Drawing out the participants • Achieving the end product. Session14: Catastrophe Readiness and Response Course

  32. The End Product • Evaluation is the cornerstone of exercises. • It will provide an indicator of the overall level of preparedness – what works, what doesn’t and how to fix it. • Lessons learned will provide mechanisms for improving existing plans. • The early interaction between participants creates relationships which will be critical to a coordinated response during a real event. Session14: Catastrophe Readiness and Response Course

  33. Exercise Tips • A good exercise is like a Broadway show: • It’s well choreographed with something for everyone. • You walk out of it feeling better than when you went in. • It leaves you with food for thought. • Humor is an essential component: • An exercise is a dry run. • Most of us only get one shot at a catastrophic event. • We need to do it right the first time! Session14: Catastrophe Readiness and Response Course

  34. Exercise Tips (2) • Exercises are like Lego for Adults • Planning, dialogue and integration are key components. • Block by block we have to build the essential components of the response initiative. • All the pieces need to fit to make it work well. • It’s a game with serious implications. Session14: Catastrophe Readiness and Response Course

  35. What constitutes a beneficial tabletop exercise? • A scenario which realistically sets the scene & provides appropriate discussion points • Providing a forum to get to know one’s partners & develop relationships. • Integrating the different disciplines and uniting the military with the civilian communities, both private and public sectors. • Allowing the participants to problem solve and to identify strengths & areas for improvement. Session14: Catastrophe Readiness and Response Course

  36. An example of what constitutes a questionable/dangerous exercise • A county commission meeting was interrupted by three men and a woman with guns drawn and claiming to take hostages. • One man threatened to detonate a bomb with the device he was holding and another fired a shot (turned out to be a blank). • As the meeting dissolved – the director of EMA announced that it was “only a drill”. • The city police were not aware of the drill and responded to what they thought was a real hostage situation – could have had a serious outcome. Session14: Catastrophe Readiness and Response Course

  37. Anthrax Tabletop Exercise Session14: Catastrophe Readiness and Response Course

  38. Participant Introductions • Moderator and facilitators • Federal partners • State partners • Local agencies: • Public health • Hospitals • Fire, rescue • Law enforcement • NGOs • Observers Session14: Catastrophe Readiness and Response Course

  39. Agenda Registration Welcome and Overview Introduction Module 1 Module 2 Working Lunch Module 3 Hotwash Session14: Catastrophe Readiness and Response Course

  40. Primary Objectives • Create a quality learning environment. • Identify key essentials for an integrated response. • Evaluate effectiveness of incident command system, policies, procedures and roles and responsibilities. • Provide a forum for discussing response issues. • Identify strengths and areas for improvement. Session14: Catastrophe Readiness and Response Course

  41. Rules for Players • Relax – you are in a no-fault, low stress environment. • Respond based on your current capability. • Interact with other breakout groups (if used). • Allow for artificialities of the scenario – it’s a tool and not the primary focus. • Feel free to improvise – think outside the box. Session14: Catastrophe Readiness and Response Course

  42. Two Options are presented for an Anthrax Scenario • The first focuses on the BioWatch program where filters are collected daily and assayed for certain pathogens – this will alert to an attack within a reduced time frame. • http://www.cidrap.umn.edu/cidrap/content/bt/bioprep/news/biowatch.html • The second is much more covert with symptomatic patients presenting to doctors offices and hospitals – more of a puzzle and more challenging to the participants who must identify the agent. • Select the option most suited to the sophistication level of the players. Session14: Catastrophe Readiness and Response Course

  43. Commonalities • Both scenarios will involve the prophylaxis and treatment of large numbers of patients. • There will be activation of the Strategic National Stockpile and other federal assets to assist state and local entities. • Resources will be scarce due to the overwhelming numbers of people descending on hospital emergency departments and doctors’ offices. • Additionally there will not be enough critical care beds and ventilators. • Mass fatality management will be needed. Session14: Catastrophe Readiness and Response Course

  44. Commonalities (2) • Adjustments to standard of care will be needed and necessary legal authorities will need to provide oversight to ensure maximum care with limited resources is available to as large a sector of the population as possible – triage will become critical. • Activation of federal teams – DMATs, DMORTs, etc will be needed and decisions will need to be made at the federal level on how best to apportion these. • At the local & regional levels the Metropolitan Medical Reserve Systems, Medical Reserve Corps and Citizen Emergency Response Teams will be activated. Session14: Catastrophe Readiness and Response Course

  45. What is the CRI Program? • The Cities Readiness Initiative (CRI) is a federally funded effort to prepare major US cities and metropolitan areas to effectively respond to a large scale bioterrorist event by dispensing antibiotics to their entire identified population within 48 hours of the decision to do so. • It focuses on a covert outdoor release of aerosolized anthrax covering a large geographic region. • It was a pilot program started in 2004 with 21 cities that has grown to 72 cities – at least one for each state. Session14: Catastrophe Readiness and Response Course

  46. Scenario One • On Day One the BioWatch filters in Los Angeles, the District of Columbia, New York City and Chicago are picked up and sent for analysis. • That evening the Centers for Disease Control schedule multiple conference calls to contact all four area city and state labs. • A “PCR verified positive for Anthrax” of multiple filters collected across the four city areas is declared. • The National Operations Center is notified and the CDC sets up a bridge conference call for H+2 (two hours after initial notification) to discuss the dispatch of the SNS to affected areas. • The cities affected will implement their CRI plans Session14: Catastrophe Readiness and Response Course

  47. How did this Happen? • The previous day (Day 0) specially fitted flat-bed trucks enter the cities in question towards the end of morning rush hour. • A concealed spraying device aerosolizes a Bacillus anthracis slurry • This potentially exposes upwards of 330,000 individuals (in each location) which is likely to result in approximately 13,000 cases per city of inhalational anthrax Session14: Catastrophe Readiness and Response Course

  48. Scenario 2 • Instead of BioWatch filters quickly being used to identify the existence of anthrax in the communities, use the following model based on the same release in four major cities on Day 0: • Emergency departments and doctors’ offices are experiencing a large upsurge in patients with fever and respiratory complaints (would occur between 2 - 10 days after exposure). • Some patients are initially hospitalized with pneumonia diagnosis. • Businesses are experiencing increased call-in of sick employees. • Schools and universities also have increased absenteeism. • Rapid flu tests are negative. • Sentinel physician reporting system for influenza-like illness identifies increase in respiratory illness and absenteeism. Session14: Catastrophe Readiness and Response Course

  49. Exercise Format • This is an interactive facilitated tabletop exercise with three modules – recognition; response and system surge; and recovery. • There are breakout group sessions after the first two modules, which are both followed by a moderator facilitated discussion with each breakout group reporting back on the actions taken. • After the third and final module there is a facilitated plenary discussion with all participants. • A Hot Wash is the final component of the exercise followed by completion of an participant evaluation form. Session14: Catastrophe Readiness and Response Course

  50. Scenario 2Module One Recognition

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