Designing, Conducting, and Evaluating Tabletop Exercises for

Pandemic Influenza Business Continuity Planning

Kristine Moore, MD, MPHMedical Director

Jill DeBoer, MPHAssociate Director

Workshop Outline• Overview of Exercises (30 minutes)

• The Tabletop Exercise Planning Process: From Conception to Action (60 minutes)

• Facilitating a Tabletop Exercise; Exercise Evaluation and Follow-up (30 minutes)

Overview of Exercises

Presentation Outline• Steps in Business Continuity Planning• Purpose and Timing of Exercises• Five Major Types of Exercises• Unique Features of Pandemic Influenza

Exercises• Designing Exercises to Meet Your Needs

Steps in Business Continuity Planning

1. Conduct a Risk Assessment2. Conduct a Business Impact Analysis (BIA)3. Develop a Business Continuity Plan (BCP)4. Implement the BCP5. Test, Refine, and Revise the BCP

Steps in Business Continuity Planning

1. Conduct a Risk Assessment Identify internal and external threats, hazards,

and vulnerabilities that could impact your company

Hazards may be industry-specific or may be general

Rank hazards by probability and severity Pandemic influenza is a hazard with a high

potential severity and high probability (at some point)

Steps in Business Continuity Planning

1. Conduct a Risk Assessment2. Conduct a Business Impact Analysis (BIA)

Define how different hazards (such as pandemic influenza) could impact your business

Identify critical job functions and operations Assess assets for response Consider minimal requirements for continuing

operations

Steps in Business Continuity Planning

1. Conduct a Risk Assessment2. Conduct a Business Impact Analysis (BIA)3. Develop a Business Continuity Plan (BCP)

Utilize an all-hazards approach with annexes for specific issues

Make key decisions (based on the BIA) Develop policies and procedures as necessary Define trigger points as needed For pandemic planning, consider unique

stresses (CIDRAP 10-point framework)

Steps in Business Continuity Planning

1. Conduct a Risk Assessment2. Conduct a Business Impact Analysis (BIA)3. Develop a Business Continuity Plan (BCP)4. Implement the BCP

Educate staff and conduct training as needed Conduct steps necessary to implement policies

and procedures

Steps in Business Continuity Planning

1. Conduct a Risk Assessment2. Conduct a Business Impact Analysis (BIA)3. Develop a Business Continuity Plan (BCP)4. Implement the BCP5. Test, refine, and revise the BCP

Purpose and Timing of Exercises

An exercise is a focused practice activity thatplaces the participants in a simulated situation requiring them to function in the capacity that wouldbe expected of them in a real event.

Excerpt from FEMA Emergency Management Institute Independent Study Course, Exercise Design (March, 2003)

Why Exercise?• Identify successes and strengths to be

maintained and built upon Plans, policies, and procedures Resources

• Reveal areas needing further improvement Plans, policies, and procedures Resources

• Educate on plans, policies, and procedures• Educate on the complexities of a specific

emergency scenario

Why Exercise? (continued)

• Improve organizational coordination and communications

• Train personnel in roles and responsibilities• Improve individual

performance• Satisfy regulatory

and/or funding requirements

• Evaluate response systems

When to Exercise• According to planned exercise program

scheduleBut also…• Revision of Business Continuity Plan• Changes in key personnel• Shifts in sector/industry trends• New regulatory requirements• Changes in information technology systems• In response to recent past incidents or events• In anticipation of upcoming events

Exercise Categories• Orientation• Drill• Tabletop Exercise• Functional Exercise• Full Scale Exercise

OrientationPurpose• Familiarize staff to organization’s emergency

response plan

• Familiarize current staff to changing information or procedures

• Bring together various departments for better understanding and coordination

• Identify planning and response priorities prior to plan development

Orientation

Methods• Talk Through

• Brain Storming

• Case Study

• Training Workshop

Orientation

Example• Cross Border Orientation Exercise

Scenario 1:

Foodborne Botulism Outbreak

Suspect Botulism Cases•Cranial nerve dysfunction•Bilateral proximal muscle weakness

  Largest Foodborne Botulism Outbreak Reported

in North America

176 cases

Small Group Discussion

• Review Identified Issues

• Prioritize Issues

• Brainstorm Realistic Action Steps

OrientationGood for:• Educating, building awareness

• Gathering new ideas or feedback

• Exercising before a plan is started

• Exercising before a plan is finalized

DrillPurpose• Instruct thoroughly through repetition and

practice

• Focus is usually on one aspect of the response plan in one organization

• Can be used to test staff training, response time, interdepartment cooperation and resources, manpower and equipment capabilities

• Can be preceded by orientation

Drill

Sometimes referred to as:• Procedure verification exercise

• Validation exercise

• Walk-through exercise

DrillExamples• After Hours Notification Drill• Emergency Operations Center Drill• IT System Recovery Drill• Mass Dispensing Site Drills

Tabletop ExercisePurpose• Focus on constructive problem solving as a

group

• The success of a tabletop exercise is determined by feedback from participants and the impact this feedback has on evaluation and revision of policies, plans, and procedures

Tabletop ExerciseMethods• A discussion guided by a facilitator based on a

simulated emergency situation

• Basic Tabletops: Participants discuss problems as a group; leader summarizes conclusions

• Advanced Tabletops: Series of messages requiring rapid response; facilitator guides the discussion

Tabletop ExerciseAdvantages (FEMA Exercise Design Manual)

• Is a good way to acquaint key personnel with emergency responsibilities, procedures, and one another

• Is an effective method for reviewing plans, procedures, and policies

• Requires only a modest commitment in terms of time, cost, and resources

Tabletop ExerciseDisadvantages (FEMA Exercise Design Manual)

• Lacks realism and thus does not provide a true test of an emergency management system’s capabilities

• Provides only a superficial exercise of plans, procedures, and staff capabilities

• Does not provide a practical way to demonstrate system overload

Functional ExercisePurpose• Fully simulated interactive exercise that tests the

capability of an organization to respond to a simulated event

• Tests multiple functions and coordinated response in a time-pressured, realistic simulation (without deploying resources)

Functional ExerciseMethods• Participants gather where they would actually

operate in an emergency (usually an EOC or other operating center)

• Participants are briefed immediately prior to the start of the exercise as to objectives, procedures, time frame and recording requirements

• Simulated information is delivered to players by paper, telephone, or radio

Functional ExerciseMethods (continued)

• Players respond as they would in a real emergency, in real time, making on-the-spot decisions and taking on-the-spot actions

• Similar to full-scale exercise without the equipment

• Involves controllers, simulators, and evaluators

• May consider “no-notice” design

Functional Exercise

Sometimes referred to as:• Simulation exercise

• Operational exercise

Functional ExerciseExamples• Strategic National Stockpile Exercises

• Nuclear Power Plant Exercises

Full Scale ExercisePurpose• Tests the comprehensive response

capacity of multiple organizations by simulating a real event as closely as possible

Full Scale ExerciseMethods• Field personnel proceed to the location of a mock

emergency

• EOC activities are combined with on-scene use of simulated victims, equipment, and manpower (enactment)

• Activities at the scene serve as input and require coordination with the simulation at the EOC

Full Scale ExercisesExample• City/County Emergency Management Exercises

• Airport Disaster Exercises

Exercises are Everywhere• Military

• Emergency Management

• Hospital Disaster Planning

• Nuclear Power Plants

• Airports

• Businesses

• Public Health

Unique Features of Pandemic Influenza Exercises

• Rapid decision-making with limited information

• Staged decision-making

• Long term event

• Global event

• Impacts all sector of society

• Exploring relationships with the public health system

• Anticipated public panic

Designing Exercises to Meet Your Needs

• Choose Type of Exercise Carefully– Based on Exercise Goal and Objectives

• Choose Exercise Format Carefully– Unlimited possibilities

• Consider the Roles of Internal Teams and External Consultants

Early in the Design Process: Visualize

“That was a smashing success!”

Three Key Questions:

What did the participants learn?

What was documented?

How do the participants feel?