Ambulatory Tabletop Exercise October 25, 2011

2. Ambulatory Tabletop Exercise October 25, 2011

3. Exercise Scenario • A powerful earthquake has hit Southern California, measuring 7.8 on the Richter Scale, centered on the southern end of the San Andreas fault in Imperial County, CA. The earthquake resulted in nearly 3 minutes of severe ground shaking along a 200 mile stretch of the fault heading northwesterly through the center of the state. San Bernardino and Riverside Counties have sustained substantial property damage and casualties. Although ground shaking on the West side of Los Angeles County was significantly less than areas farther east, the earthquake was intense for about 1 minute, causing any unsecure items to fall over and onto the floor. Buildings comprising the UCLA Health System have sustained some damages, but are structurally intact.

4. Scenario • Widespread power outageexcept for areas with redoutlets and emergency lighting. • Water pressure is very lowdue to broken pipes throughout the water distribution system. • Telephones are not operational (landline or cellular). • IT systems can be accessed via computers on backup power. • Fallen ceiling tiles and other unsecured items litter the floor. • Several staff members and patients have sustained minor injuries from falling items.

5. Departmental Response • Administration has activated a Code Triage External – Level III across the Health System • What are your initial departmental priorities?

6. Initial Department Assessment • Remove patients and staff from immediate danger • Visual inspection of facility and equipment • Request assistance for life threatening concerns • UDAR submission • Internal casualties should be assessed, serious injuries should be sent to the Emergency room for triage and treatment. • Equipment should be prepared for use, do not move equipment unless directed to do by the command center • If indicated staff should be assigned to clear the department of current patients, and then present to the Labor Pool at the medical center

7. Ambulatory Department Response Matrix • Ambulatory Clinics / FPG Locations • Level I –Maintain situational awareness and report issues to the Hospital Command Center • Level II – Inventory staff and supplies, send additional staff to the labor pool • Level III – Clear department of current patients; prepare to activate Alternate Care Site Plan • Additional Operating Room Facilities (ASC, JSEI) • Level I – Maintain situational awareness and report issues to the Hospital Command Center • Level II – Same as Level I • Level III - Clear department of current patients; prepare to activate Alternate Care Site Plan

9. Scenario • The eastern side of Los Angeles County and the counties to the east of us have sustained massive damage. All major highways leading to and from the Inland Empire are impassable. • Traffic around UCLA is gridlocked due to everyone trying to leave the area through debris-cluttered streets with non-functioning traffic signals.

10. Scenario • Ronald Reagan Medical Center is preparing to receive an influx of transfer patients from other facilities more seriously damaged by the earthquake. • The Hospital Command Center is doing everything possible to create surge capacity to accept the most critically ill and injured patients from throughout the region. • The Emergency Department is experiencing a steady influx of minor to moderate injuries from the local community, and occasional trauma patients by air and ground EMS.

11. Alternate Care Site Activation • The Hospital Command Center has decided to activate the Alternate Care Site Plan to utilize Medical Plaza to treat minor injuries. • The Command Center has also decided to move stable surgical recovery patients from RRMC to the Ambulatory Surgery Center and Medical Procedures Unit to free PACU beds for ICU overflow. • There is no emergency evacuation required from the Medical Center at this time.

12. Evacuation Assembly Location Triage Area Minor Gayley Ave Immediate Delayed Discharge Minor Triage Area 200 Med Plaza Charles E. Young Drive Minor Trauma Minor Medical Immediate Delayed 300 Med Plaza Discharge Ronald Reagan UCLA N Westwood Blvd

13. Triage/Registration Access Points Minor Trauma Minor Medical Patient Waiting

14. Mission Continuity Planning 2 2

15. Initial Response The First Few Hours Ensure Patient, Visitor, Staff, Faculty, and Volunteer safety Provide care for current patient population Develop ability to accept surge of patient care volume from the community What are the mission critical functions at the department level that must be maintained or can be deferred for an established period of time? 3 3

16. Response to Recovery • The Few Days After • Acclimate to changes in space, human resources, information systems, equipment, and supplies What mechanisms will be used to monitor long-term recovery staffing needs? How do we account for resource needs if there are supply chain disruptions with our primary vendors?

17. Full Recovery • Getting Back to Normal • Recovery: Resume Full Normal Operations Once the alternate care site has been demobilized, what is the recovery time objective for restoration of normal business functions within our ambulatory care departments? What are the upstream and downstream critical support dependencies that need to be in place to support restoration of normal operations (e.g. pharmacy, blood bank, etc)? Has each ambulatory department engaged in mission continuity planning to address these identified operational resiliency needs?

18. Incident Occurs Emergency Management Phases Mitigation Preparedness Response Recovery Before After Normal Operations During Disaster Planning + Business Continuity Planning Emergency Management Response Business Continuity Minimal Tolerable Level of Function Reactive Preventative Corrective Recovery Begins Restoration Ends TIME Zero Hour The Disaster Lifecycle: 10 10 Proactive BCP Activities Proactive BCP Activities Prevention and Preparedness Reactive BCP Activities Response, Recovery & Restoration

19. So, if you don’t want to be in this position… 19

20. Next Steps: • Designate a plan writing team with your department or unit manager (usually 2-3 staff) • Contact the Office of Emergency Preparedness to schedule a UC Ready plan building session • During the session your team will receive supportive materials and 1:1 guidance on how to develop your business continuity plan 20

21. Questions or Comments Office of Emergency Preparedness Website: http://disaster.mednet.ucla.edu/ (310) 267-7107 oep@mednet.ucla.edu