[INSERT AGENCY NAME] 2010 Tabletop Exercise Volunteers in Surge

2. [INSERT AGENCY NAME]2010 Tabletop ExerciseVolunteers in Surge Funded through a grant from NACCHO for Public Health Advanced Practice Centers

3. Schedule:

4. Purpose To identify the impact that surge medical incidents play in overwhelming staff in a rural hospital setting. To address the steps that need to be taken to identify potential areas of staff shortage- both medical and non-medical personnel. To assess current plans/policies for gaps in the hospital’s capacity for volunteer and donations management in medical surge scenarios. To apply ICS/NIMS principals to scenarios involving medical surge and volunteer assisted response.

5. Resources: [AGENCY NAME] Emergency Operations Resource Manual (from the EOP Workshop.) Target Capabilities • Medical Surge • Volunteer Management and Donations Participant Evaluation Anything else you brought One “Surprise” resource

6. Exercise Behavior: The injects are prompts for discussion- not opportunities to question the “reality” of the scenario or events. Focus should be placed on the exercise objectives, plans, training, and coordination systems that currently exist- not those that should exist. Breaks will occur- take your own if needed. Participate- don’t dominate/dictate. Allow everyone to consider the possibilities before passing judgment.

7. Objectives Participants will identify areas where staffing will need to be augmented/replaced by medical and non-medical volunteers. Participants will assess current plans/policies for gaps in the roles, credentialing, management, and training for the use of volunteers. Participants will effectively evaluate the impact of volunteer management on incident response. Participants will identify areas of planning and training necessary to an effective response using volunteers in rural hospitals and clinics.

8. Target Capabilities Medical Surge is defined as rapid expansion of the capacity of the existing healthcare system in response to an event that results in increased need of personnel (clinical and non-clinical), support functions (laboratories and radiological), physical space (beds, alternate care facilities) and logistical support (clinical and non-clinical equipment and supplies).

9. Target Capabilities: Volunteer Management and Donations is defined as the capability to effectively coordinate the use of volunteers and donations in support of domestic incident management. In this scenario it would be the capability to effectively identify roles/responsibilities for volunteers assisting in a situation where both medical and non-medical hospital resources are being overwhelmed.

10. Target Capability Assumptions: Offers of assistance will come from other cities, counties, organizations, jurisdictions. If not promptly and appropriately managed, attention to Volunteer Management and Donations will demand the diversion of resources away from service delivery. Allocation of resources to triage done in the field will have a significant impact on the subsequent healthcare surge capacity system. There will be a significant problem locating and providing information on displaced family members as well as victims at treatment facilities.

11. Target Capability Assumptions: Response to the overwhelming demand for services will require non-standard (Altered Standards of Care) approaches. There will be critical shortages of healthcare resources such as staff, hospital beds, medical equipment and supplies, patient holding areas, and temporary holding sites with refrigeration for storage of bodies and other resources. Routine medical admissions for acute medical and trauma needs will continue. Alternate healthcare facility plans are implemented.

12. Target Capability Assumptions: Healthcare providers are subject to the effects of disasters and may need decontamination, prophylaxis, or immunization measures before being able to perform their response roles. Public anxiety related to a catastrophic incident will require effective risk communication. There may be a denigration of healthcare staff numbers for a variety of causes. A large number (75 percent plus) of victims could self-present without field triage or evaluation.

13. STARTEX

14. Situation: 0900: A train with an unknown liquid becomes separated and derails during a routine railcar connection. More than 50 students/staff are exposed to a “plume” while arriving for school. Numerous resources are dispatched through 911 and the ED at [AGENCY NAME] is alerted. School staff is told to shelter-in-place for an “indefinite period of time”. It is projected that the operations will continue for at least the next 15 hours (until midnight.) 1a

15. Situation (cont.): While these events are taking place, [AGENCY NAME] Hospital becomes the Emergency Operations Center for the response due to the proximity to the incident, to medical care, and food service for responders and volunteers. It becomes apparent as the day drags on that volunteer support will be crucial to maintaining operations throughout the evening and the next day. [AGENCY NAME] ED begins seeing arrivals by POV at 0905. [CITY] PD are joint Incident Command on scene. 1b

16. High School Plume Wind Direction Location of Tanker with unknown liquid Time: 0900

17. Communication Questions: How/Is [AGENCY NAME] notified of an emergency at a school? Is there any communications systems that would be immediately activated? What is the role of [AGENCY NAME] in sharing incident information? What are the “controls” for information flow?

18. Resources: Are resources dedicated to the response that [AGENCY NAME] may rely on for routine operations? What resources (staff/equipment) are readily available to begin response? (even before staff are aware of the incident?)

19. Security: What plan/procedures would be needed/activated at this point?

20. Staffing: How will staff be alerted? Or will they? And when? What is the capacity/capability of [AGENCY NAME] to serve as an EOC in these circumstances? How would this request move through “the system”? Explain.

21. Utilities: How might threats to infrastructure be assessed & monitored? By who? Where will this information go?

22. Patient Care: Given the small amount of information, what are the concerns for patient care? Patient surge/triage?

23. Plume High School Wind Direction Location of Tanker with unknown liquid Time: 0915

24. Situation: 0915: Resources dispatched through 911 arrive on scene and being to don appropriate PPE. Many of the students/cars seen in the parking lot have left the area (unknown as to where), and [CITY] Police have begun cordoning off access to the main parking lot (west) as well as the access to the east parking lots behind the school. The [CITY] 8-9 school is put on “lock-down shelter-in-place” and classes continue normally. [CITY]Police, hospital Eds, and School officials begin receiving related and concerning calls. 2a

25. Situation (cont.): [AGENCY NAME] Hospital begins getting calls regarding where the Emergency Operations Center for the response is located. [AGENCY NAME] and [AGENCY NAME] Community Hospital, and [AGENCY NAME] are notified via email and phone regarding the incident and are told by (unknown person) to send representatives to the EOC. A nurse at [AGENCY NAME] receives a text message from their child indicating that the school as been locked-down and they smell something “funny”. The nurse states “she needs to leave due to a family emergency”- her supervisor says “OK”. 2b

26. Incident Command Post: • _______is identified as the Incident Commander on scene. Incident Command Post is located downwind from the railcar. • An Area Command is setup at [AGENCY NAME] and first response agencies are notified. ICP 2c

27. First Case: A 15 yr old male has presented to the ED complaining of “burning eyes and skin” and is “having difficulty breathing.” States that he got a ride there with 3 other friends that he went to school with. When asked where they were he states that they planned to “wait it out” at Burger King. 2d

28. Patient Care: What is the “surge capacity” for inpatient and ED staffing to ensure that patient care continues? Patient surge/triage? What safety concerns might there be at this point?

29. Communication Questions: What “partners” would be notified in the first 15 minutes? How? What communication obstacles would be encountered in the first 15 min? What is the extent of “call down” given that only one or two patients have arrived at the ED?

30. Resources: What resources are available beyond those at [AGENCY NAME] hospital? What is the capability/capacity of “patient beds”, and how will it be determined? How will this information be shared with responders? Response partners?

31. Security: What plan/procedures would be needed/activated at this point?

32. Staffing: How will staff concerns be addressed at this point? What is the capacity for staffing for EOC operations? IT, food, workspace, communications? How will those “new” response partners be directed to the EOC? Describe the process? Who/How will staff be informed?

33. Utilities: What businesses/organizations can provide needed support for housekeeping, IT, water, decontamination if needed? What MOU’s exist or should be activated at this time?

34. High School Plume Wind Direction Time: 1400

35. Situation: 1400: Responders inform the hospital “EOC” personnel that the “leak” has been contained. Identification of the component chemicals is still unknown as the car belonged to an petroleum company and the exact mixture has been deemed “proprietary”. Responders were told that it may be “aminoethylethanolamine… a corrosive chemical that is used to make lubricant oil additives, fuel additives and fabric softeners and other products.” 3a

36. The numbers: Area Command reports: [AGENCY NAME]’s ED has seen 18 patients (all high school age), treated and release 12, and admitted 3 with respiratory distress. [AGENCY NAME] has seen 8 patients (7 high school, 1 “middle school”), [AGENCY NAME] Community Hospital has received 2 patients (1 referral from PCP), and [AGENCY NAME] current has 6 patients that “walked into the waiting area” over the lunch hour. In the last 4 hours Approximately 3 housekeeping, 1 maintenance, 4 nurses and 2 senior leadership have reported that they will be absent/unavailable due to a “family emergency”. 3b

37. Staffing: How will family of staff/patients be informed/managed? How will staff concerns be addressed at this point? Who/How will staff be informed? What “Just-in-time training” has taken place by this point? What needs to happened in the next 4 hours?

38. Patient Care: How have patient care protocols changed at this point? What is the plan for triage at facility entrances? What safety concerns might there be now?

39. Communication Questions: How are media being handled/routed? What is being done to track questions/information requests? How have responders and volunteers been verified with agencies/organizations? How has that communication taken place?

40. Resources: Who has been notified regarding supply needs, waste, food? How will this information be shared with responders? Response partners?

41. Security: How are credentials/personal information being tracked? How are exits/entrances secured/monitored?

42. Utilities: What businesses/organizations can provide needed support for housekeeping, IT, water, decontamination if needed? What MOU’s exist or should be activated at this time?

43. Facility Layout:

44. High School Wind Direction Time: 2200

45. Situation: 2200: [AGENCY NAME] Hospital is receiving a steady flow of calls to various lines in the hospital. Family members of those admitted to “hospitals” have been calling, as well as the media trying to confirm “reports” of terrorist attempts, accidents, or high school pranks. Hospital Board members have been calling the hospital regarding confusing reports on the TV and radio. 4a

46. The numbers: Area Command reports: [AGENCY NAME]’s ED has seen 36 patients (high school and middle school age), treated and release 22, and admitted 5 with respiratory distress. [AGENCY NAME] has seen 18 patients (10 high school, 8 “middle school”), [AGENCY NAME] Community Hospital has received 12 patients (4 referral from PCP), and [AGENCY NAME] is seeing a “steady flow” . [AGENCY NAME/COUNTY] volunteers have been contacting the coordinator to offer “overnight” and morning hours. 4b

47. Staffing: What are the plans for “afterhours” staffing by this point? What are the implications for “family leave”? How is staff/volunteer time being tracked? By whom?

48. Patient Care: How have patient care protocols changed at this point? What are the requirements for health history screening? Medical Assessment? Who can perform these? What is the plan for triage at facility entrances?

49. ENDEX

50. Consider: Could there be problems with information flow within the hospital? Are adequate systems in place for: • Triage? • Staffing/Credentialing? • Communication within the hosptial • Communication with IC • Communication with Media • Communication with the community