Session 14

1. Session14: Catastrophe Readiness and Response Course Session 14 Tabletop Exercise Design

2. Objectives Demonstrate an understanding of the Homeland Security Exercise Evaluation Program (HSEEP) and the role of the tabletop in the exercise continuum. Demonstrate an understanding of the need for conducting Tabletop Exercises (TTX). Demonstrate the ability to design, conduct and evaluate a TTX. Session 14: Catastrophe Readiness and Response Course

3. HSEEP 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. 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

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

6. 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 Pans (EOP)s, modify training plans and prepare for the next exercise or all hazards incident response. Session14: Catastrophe Readiness and Response Course

7. Exercise Phases Session14: Catastrophe Readiness and Response Course

8. 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

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

10. 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

11. Exercise Planning Team • Determine objectives and what 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

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

13. Session14: Catastrophe Readiness and Response Course

14. 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) Session14: Catastrophe Readiness and Response Course

15. Design & Development (2) • Capabilities and tasks are used to formulate exercise objectives that reflect the special needs of the organization • Well-defined objectives provide a framework for scenario development • Use objectives that are (SMART) simple, measurable, achievable, realistic, and task-oriented Session14: Catastrophe Readiness and Response Course

16. 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 15 national planning scenarios Realism is critical to engaging the participants Tailor the exercise to the community where it is being held Session14: Catastrophe Readiness and Response Course

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

18. 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

19. 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

20. SITMAN (3) • Scenario is divided into modules • Chronologically sequenced • Each module represents 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

21. Evaluation Process • Exercise evaluation guides – sometimes called evaluation plans – 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 group, plenary group or both • Debrief – more formal forum for planners, facilitators, controllers and evaluators to provide feedback Session14: Catastrophe Readiness and Response Course

22. 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

23. AAR/IP 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

24. 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

25. 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

26. Facilitation • Plenary group requires one or two very strong facilitators who can control a large group • Pitfall is 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

27. 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

28. 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

29. 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

30. 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

31. 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

32. 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

33. 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

34. 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. Session14: Catastrophe Readiness and Response Course

35. 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

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

37. 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

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

39. 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

40. 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

41. 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

42. 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

43. 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

44. 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

45. 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 schedules 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

46. 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

47. 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

48. 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

49. Scenario 2Module One Recognition

50. Day Two at 7:30 pm • Emergency departments throughout all four cities (New York, Washington DC, Chicago and Los Angeles have been much busier than usual. • Last week the CDC had announced an early start to the flu season and urged high-risk individuals to get flu shots. • Emergency departments had seen several cases of flu-like illness over the past two weeks. Session14: Catastrophe Readiness and Response Course