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TOPOFF 2 Would we do it again? Leslee Stein – Spencer Chief Of EMS- IDPH

TOPOFF 2 Would we do it again? Leslee Stein – Spencer Chief Of EMS- IDPH. T2 Concept. Open exercise Year long planning and exercises Seattle, Wa—radiological dispersal device Chicago, Metro and Ill.—Pneumonic Plague Joint response by Canada. TOPOFF 2 Scenario Outline.

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TOPOFF 2 Would we do it again? Leslee Stein – Spencer Chief Of EMS- IDPH

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  1. TOPOFF 2Would we do it again?Leslee Stein – SpencerChief Of EMS- IDPH

  2. T2 Concept • Open exercise • Year long planning and exercises • Seattle, Wa—radiological dispersal device • Chicago, Metro and Ill.—Pneumonic Plague • Joint response by Canada

  3. TOPOFF 2Scenario Outline • Terrorist cell enters City and plans a biological attack • Biological agent is covertly released • Disease outbreak begins in collar counties and city • IDPH identifies pneumonic plague • IDPH requests SNS (Strategic National Stockpile)

  4. Objectives for Illinois Public Health • Disease Surveillance and Epidemiology • Laboratory Confirmation and Technical Assistance • Strategic National Stockpile Distribution • Hospital Response and Collaboration • IOHNO • Legal Authorities and Review

  5. Objectives for Illinois Public Health andthe Hospitals • Test the ability of PH and medical providers to detect and report clusters of unknown illnesses • Implement analytical and surveillance/epidemiological measures to identify a suspected biological agent and determine its impact on a specific geography • Implement the State Medical Disaster Plan to monitor the availability of resources

  6. TOPOFF 2Participants • United States Government • Canadian Government • State of Illinois • “Nation” of Chicago & collar counties • State of Washington • City of Seattle and King county

  7. Illinois and Chicago: 5 local health depts. 5 local Emergency Management IEMA Public Health Players: HHS CDC Hospitals Hospital Associations Pre hospital providers USPHS Legal teams Gov. of Illinois “Mayor” of Illinois Players for the Drill

  8. Hospital Players • 62 hospitals for Epi purposes( real and fax patients) • 4 additional hospitals including VA and specialty hospitals • 120 hospitals received either faxed patients or participated in the communications portion of the SMDP

  9. TOPOFF: Time Line • May 10th: releases occur • May 12th : Seattle gets bombed (are we at “RED”?) • May 12th: first patients appear in Illinois hospitals • IOHNO opens • 10p: Broadcast fax goes out regarding patients with similar symptoms • Tuesday: real patients continue to go to hospitals (many more than originally planned!)

  10. Play continues… Wednesday: JOC Opens last update for SMDP requested at 2p ( results by 4p) last patient was suppose to be 5p…DOJ calls for drill to end Thursday: EMTALA requirements waived for Ill.TOPOFF Tommy Thompson-info faxed to all hospitals Midway Airport plane crash and IMERT requested thru SEOC

  11. Final Numbers • Ill 5,349 • Dead 1,521 • Total 6870 I think????

  12. Tuesday May 13: 0900 Total beds: 8263 978 adult ventilators 312 peds ventilators Tuesday May 13: 2300 Total beds: 7038 396 Neg.Psr. rooms May 14th: Total beds: 6573 532 Isolations beds 905 Ventilators May 14th: Total beds: 6792 468 Isolation beds 819 Ventilators Hospital Information(obtained thru the State Medical Disaster Plan)

  13. A TOPOFF Debut: IMERT

  14. IMERT? • A multi-disciplinary team (MD’s RN’s EMT’s) • Volunteers with specialized training • Respond to scene venues TOPOFF: teams were prepared and deployed for 72 hours .

  15. Lessons Learned from TOPOFF • Could be divided into : • Communications • Logistics • Policies • Education OR……….

  16. The Good, The Bad andThe Ugly Lessons Learned from TOPOFF!!

  17. The Good… • Preparedness Activities and Pre-Planning • First Responder and Hospital Coordination • Strategic National Stockpile Distribution • State and Local Public Health Collaboration depending • Legal Team Development and Review • Defined Public Health Role • IOHNO • IMERT

  18. The Bad… • Too Many Command Centers • Sending Voice and Electronic Communications and Fax’s • Monitoring News Reports (VNN) • Highlighted Resource (Personnel) Needs • Input in Major Decisions (Schools and O’Hare)

  19. …The Ugly • Coordination with JOC/JIC • Coordination with Federal Government • Time Compressed Activities • Unrealistic Scenario • Hidden Agendas

  20. Overall Successes of TOPOFF • Significant Increase in awareness of the implications of terrorist attacks • Counter-terrorist and consequence management working more closely together • Demonstrated the critical role of health services in the response • Confirmed that Illinois has appropriate structures and procedures in place Illinois

  21. Planned Drills: The Bad • Too much time allowed: Inject of personal agendas Power struggles Too much information was obtained by players Too much information went to the media

  22. Planned Drills: The Good • Chance for education of all hospital staff on disaster plans • Time to think how to use “paper patients”-used cardboard cut out people • After months of planning, staff on units were active participants and enjoyed being involved • Good involvement by administration and other hospital staff

  23. Lessons Learned: Communications(IDPH level) • Communications (are we surprised?) • IDPH: external/internal • IDPH to hospitals • IDPH to federal agencies • The IDPH/LHD/Hospital Connection ( or lack of) • Influence of outside agencies

  24. Communications cont. • Lots of Operation Centers in Illinois (who’s on first?) • SEOC • ROC • SIOC • IOHNO • JOC • JIC • City EOC And then some

  25. HELPFUL HINT: NOTHING SAYS COMMUNICATION BETTER THAN FOOD

  26. Other Communication Issues • Not enough EMS staff at IOHNO • E-Mail & fax not the way to communicate • Designate 1 person to watch TV • Information given-Ill. unaware(VNN) • Broadcast fax to hospitals-2 hours at times • IDPH/EMS needs to number the faxes • Number of cases reported –not consistent • Plague released at O’Hare Terminal 5(Air Canada is main terminal 2) • Aircraft: 757 or a 747 or a 757 ???? • LHD vs. State Health Department: different definitions and terms

  27. Concerns • Previously established good working relationships: where are they now? • Hospitals needs to understand the importance of disaster preparedness • Hospitals need to understand the State is busy as well with calls and coordination • Better understanding by IDPH on the stresses of drill play and taking care of real patients……

  28. THE GOOD: • New and improved relationships established with playing agencies and providers • Excellent job done by hospitals despite the many unexpected challenges presented to them

  29. The Good: An opportunity to develop new relationships • Illinois Council of Health-System Pharmacists-Directors of Hosp. Pharmacy’s Surveyed hospitals on inventory levels Antibiotics to treat pneumonic plague 93% hospitals participated (180) Information received within 23 hours: Doxy Capsules 162,130 Cipro Caps 250 mg-10,412 info on Gentamycin, Doxy oral suspension

  30. Lessons Learned: Hospitals • Communication • Logistics • Policies • Education

  31. Lessons Learned: Communications • Faxes • State and Local Injects (conflicted) • Interpretation of messages • ? Call for additional drugs, supplies etc

  32. Lessons Learned:Communications • Automated emergency paging system to key personnel on staff • Computerized disaster forms • Videoconferencing • Good communication with State when in need of direction • As a result: • HHAN • Many ED’s put in dedicated fax machines for urgent incoming messages

  33. Lessons Learned:Logistics • Logging/ tracking of patients • Lockdown issues • Quarantine units • Set up multiple areas for treatment of infected vs. non infected patients • Not enough PPE • Temporary morgues

  34. Lessons Learned;Polices/Planning • HEICS • Increase awareness by administration • Pharmacy involvement • Lab involvement • Infectious Disease Involvement • Security Issues • Knowledge of State Medical Disaster Plan

  35. Lessons Learned: Jurisdiction We should all know our “borders” We should understand all the different roles and respect them We should continue to work together towards one plan instead of lots and lots of plans

  36. And some other good stuff learned • Need for additional ventilators-where to get them • Easy to make hospital rooms neg flow rooms and even make temporary morgues • Nursing agencies for additional staff • New and improved working relationships-internal and external • On site child care and back up plan • Security enhancement: BOUNCERS

  37. A TOPOFF “FIRST” • Treatment for First Responders

  38. Just who is a First Responder? • Fire* • EMS* • Law enforcement* • Hospitals* • Health Care Agencies* • *and their immediate family members in the domicile

  39. The TOPOFF Experience in Chicago • Police personnel 13.500 • Fire Personnel 5,000 • OEM staff 800 • CDPH 350

  40. The Distribution Timeline Utilized • 1000 hrs: arrive at O’Hare airport • 1400 hrs: depart for regional centers • 1530 hrs: arrives in city of Chicago • 1900 hrs: repackaged into “groups” • 2000 hrs: police and fire receive • 2200 hrs: police begin distribution

  41. And Finally…. • To all of those/us who remained patient, tolerant, flexible and maintained their sense of humor……… TOPOFF 2 was a SUCCESS!

  42. QUESTIONS ? Leslee Stein-Spencer Lstein@idph.state.il.us 217-785-2080 or 312 814 3882

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