2015 Regional Medical & Health

Exercise Final Tabletop

1

Today: Tabletop Purpose • To prepare for the November 16-20, 2015 Medical and

Health Disaster Exercise • To Review:

– Exercise schedule – Daily exercise activities for you

• To assure good communication – Between facilities/agencies and the warehouse – Between facilities/agencies and delivery drivers – Between facilities/agencies and the PHD DOC

• Provide us a last chance to discuss and clarify key

communication and logistical assumptions in advance of the exercise.

Santa Barbara County Medical and Health Disaster Exercise Scenarios

Date Scenario

2015 Anthrax

2014 Ebola

2013 Foodborne EColi

2012 Earthquake

2011 Water Emergency

2010 Improvised Explosive Device

2009 Pandemic Influenza (Actual Event)

2008 Pandemic Influenza

2007 Bomb

2006 Bioterrorism and Receive, Store, and Stage Plan

2005 Chemical Plume

2015 Medical and Health Disaster

Exercise Scenario

ANTHRAX ATTACK!

You may be thinking…….

Why Anthrax?

Anthrax Attacks 2001- 7 letters mailed in 4 states

Inhalation Anthrax

• Onset of symptoms: – 2 days up to 60 days post-exposure (may be

1 day) • Antibiotics:

– most effective before onset of symptoms – Mortality 90-95% without treatment

• LD50 about 8000 spores – Infective dose probably less than 10 spores in susceptible

persons – Gram positive, rod shaped, spore forming baccilis

The CDC and federal

government have identified threats that

could require immediate mass distribution of medications in our

communities. These include:

Anthrax Smallpox Influenza Tularemia

Plague

Pharmaceuticals from the Strategic National Stockpile

Plans to Provide Prophylaxis to the Public

Points of Dispensing=POD’s “Closed” POD’s

Partner Program Non-medical operation

County Departments Private business or agency Distributes emergency

medications Business operates a small

POD for employees and their families

Optional to serve clients or vendors

“Open” PUBLIC PODS

Non-Medical Operations Primary method of mass

distribution Highly intensive staffing and

logistics requirements Potential long lines and wait

time for the public

What is your plan to provide mass prophylaxis to residents or staff?

Medical facilities

• Mass vaccination • Mass distribution of

oral antibiotics

Non-medical facilities/agencies • Mass distribution of

oral antibiotics

Regional Exercise Scenario • Thursday, 11/12: Los Angeles: letter with

white powder received at STAR Academy in Los Angeles County.

• Friday, 11/13: ER MD in LA reports potential anthrax in patient with group of small blisters that itch. Patient has a painless skin sore (ulcer) with a black center.

On Monday, November 16, 2015, Biowatch samples tested by Polymerase Chain Reaction (PCR) are

positive (+) for Bacillus anthracis (the causing agent for anthrax) from the majority of Biowatch sites in

Southern California.

For Official Use Only

Monday 11/16/15 Module 1: Region BAR (1000-1300)

Module 2 HO/MHOAC:

Alert and SitRep Requesting MCM

1130-1430

Module 3 Regional

Health Officer Decision Making

PIO Activation (1500-1700)

Tuesday 11/17/15

Module 4: Regional

Public Information and Risk

Communications (0730 - 1000)

Plans/Ops Strategy Meeting

12:00-1:30

Module 6: State RSS

(0800 – 1600)

Wednesday 11/18/15

Module 7: State to Local Distribution (0800-1200)

Module 8: Prophy

Receipt/Staging EOC, DOC,

Warehouse (1000 – 1500)

Thursday 11/19/15

Module 10: (0800-2000)

EOC

DOC Warehouse Truck Prophy Distribution

Public PODs Goleta and

Santa Maria Closed Business

PODs (hospital, county

departments, UCSB)

Friday 11/20/15

Module 11:

Demobilization Return of

Equipment Return of Prophy Exercise Materials

to State Warehouse

TBD and as needed:

(0800 – 1700)

So Cal Region 2015 Exercise Modules

http://static1.grsites.com/archive/sounds/trucks/trucks001.mp3

SNS Delivery Sequence

Fe

der

al

Storage & Transport

St

ate

County

RSS Site Loca

l

RSS Site POD

County Emergency Operations Center

Closed POD’s and Healthcare Partners

Open Public POD’s and Flu Vaccination Sites

Receive, Store, Stage “RSS” Warehouse

California State Public Health Department

Regional Warehouse

SNS Delivery by Truck or Aircraft

Santa Barbara RSS Warehouse

Coordination of transportation, security, communications,

material management

OpArea EOC

Public Health DOC

POD Dispensing Sites

Treatment Centers Hospitals, Clinics

Closed POD’s First Responder PODs, Jails, Skilled Nursing, Facilities, business, health care partners

Legend Communication: Transportation:

Deliveries and Delivery Information Only

Date Activity Closed POD

Partners Status Report Only Partners

PHD DOC/EOC/RSS

November 16

Exercise Begins

11:30-12:45 PHD alert via CAHAN, conference call X

11:30-12:30 PHD submits Situation Report to CDPH X

12:30 PHD Department Operations Center Opens X

1:00 Alert and activation of county Office of Emergency Management, request for EOC

12:00-1:30 PHD operational planning for mass dispensing X

1:00 PHD conference call with CDPH to request prophylaxis X

1:00-2:00 PHD makes formal resource request X

2:00-2:30 Federal, State, and PHD SNS conference call X

2:30 Alert and activation of RSS warehouse/staff

3:00-4:00 Regional Health Officer decision making teleconference X

November 17

Alert and activation

0730 CAHAN alert of PHD PIO’s X

8:00-9:00 Regional risk communication coordination teleconference X

9:00-10:00 PHD Information and Guidance branch strategy meeting and resource need identification

X

11:00-3:00 Healthcare partners alerted to event via CAHAN and request to confirm number of courses of antibiotics needed.

X

November 18

Product arrives at RSS Warehouse

9:00-3:00 EOC, PHD DOC, and RSS warehouse open to coordinate with closed POD’s and receive product from state regional warehouse

X

10:00-12:00 Closed POD partners: Receive and respond to email from PHD RSS Warehouse confirming address and contact phone number for drop off of faux antibiotics.

X X X

12:00-3:00 RSS warehouse inventories and packs shipments for closed POD’s including candy prophy packages.

X

November 19

Exercise Day: Mass Prophylaxis Shipment and POD

Operations

0800-0900 Closed POD partners: RSS will call the contact person to inform of approximate arrival time of truck.

X

X

0830 Shipments leave warehouse X

0900 All healthcare partners receive CAHAN informing of event and requesting a status report X X X

0930 Health officer teleconference with all healthcare partners X X X

0900-12:00 Closed POD partners receive antibiotics. Driver will call contact when arrives at site. Identification must be provided. Form signed. Recipient will inventory product and return it to driver.

X X

0900-1200 Closed POD partners activate distribution operations for staff and residents. X X

10:00 Public information teleconference with healthcare partners to coordinate messages and information for staff and patients X X X

Shipments picked up from recipients and returned to warehouse

9:30-12:00 Partners submit status reports, resource requests, inventory reports, and completed exercise checklist to DOC. Conduct internal after action discussions.

X X X

1:00 POD sites in Goleta and Santa Maria set up X

3:00-7:00 POD sites open X

County Emergency Operations Center

Closed POD’s and Healthcare Partners

Open Public POD’s and Flu Vaccination Sites

Receive, Store, Stage “RSS” Warehouse

Checklists for Exercise Partners

Take a few minutes to: • Review the right checklist for your type of

agency or facility participation • Ask questions in advance • Use the checklist to guide your participation • Return a copy of the completed checklist to

the PHD/EMSA per instructions

Tuesday, November 17: Partners answer a CAHAN “poll” and submit Mass Prophy Numbers

Wednesday, November 18-Closed POD’s only Respond to the email to confirm delivery address, name, and phone

Status Report

Status Reports from Hospitals: Reddinet Use in Exercise

• “This is a Drill” in all messages • 0900-1100

– “The 2015 medical health exercise has begun please answer the Reddinet polls.”

– Hospital Command Center standard poll – Status poll for anthrax suspect patients, surge of worried well,

decon, and mass prophylaxis status

• Reddinet messages with resource requests must be followed up with a written signed request.

• PHD DOC medical health branch staff will request a follow up resource request

Partner Communication

Healthcare Partners Status reports, requests, and inventory reports go to either: • EMS FAX or • Outpatient Branch

email DOCOpsCB@sbcphd.org

Hospitals and non-medical Closed POD’s

– Status reports from hospitals will be submitted via Reddinet

– Closed POD inventory reports AND

– Signed resource requests via email:

– DOCOpsMB@sbcphd.org

Prophylaxis Delivery

1. Contact name on spreadsheet will be called 2. Must provide work/cell to assure contact can be

called 3. Driver will require ID to confirm recipient 4. Recipient must inventory product 5. Sign chain of custody 6. Return shipment (either immediately or at a later

pick up time in Santa Maria)

Healthcare Delivery Requirements

• Would your processes for delivery be different?

• Do you have a locked area where you would be able to securely store prophy?

• Any other procedures that would need to be followed in a real event?

• Who will receive product at your facility?

What will I receive?

• Antibiotic Faux Bottles • Pallet of either Cipro or

Doxy OR • Cases of Cipro and Doxy

• Candy prophy lolipops

What do I need to provide?

• Staffing to conduct the prophy screening

• Location to conduct the screening

• Tables/chairs/pens or clipboards

• Copies of the screening form (English/Spanish)

• Copies of the algorithm • Options:

– Email both forms out to staff or residents in advance

SCREENING CHILDREN

If a child or adult is allergic to Doxycyline and cannot swallow pills they must be sent to medical consultation.

SCREENING EXAMPLES

1. Holly Lolipop Age: 2 allergic to Cipro cannot swallow pills

2. Jose Doxinon Age: 4 allergic to Doxy cannot swallow pills

3. Rose Klencher Age:92 no allergies cannot swallow pills

4. Lilly Pensquno Age: 54 allergic to both Cipro and Doxy

Number of Courses Received= How many bottles of faux antibiotics did you receive? - 1 Case = 100 bottles - 1 Pallet= 9,600 bottles

Number of Courses Dispensed - Number of staff/residents

that received Doxy or Cipro Count the screening forms to fill in these numbers.

Submitting the Form: Email or Fax • Hospitals & Non Medical

Closed POD Partners DocOpsMB@sbcphd.org

• All Other Partners DOCOpsCB@sbcphd.org

Communication Methods Communication Method: Video Conference Cell Landline Email

800 MHz radio Reddinet

Participating Site:

Lompoc Valley Medical Center X-Neil Imano ? X X X X

Santa Ynez Valley Cottage Hospital X-Judy Blockdyke ? X X X X

Goleta Valley Cottage Hospital NO ? ? X X X

Santa Barbara Cottage Hospital NO ? ? X X X

Marian Medical Center, Lisa Abeloe X-Lisa Abeloe ? X X X X

RSS Direct Relief X-George Linker X X X X

POD 1 Goleta Valley X X X X X

POD 2 Santa Maria X X X X X

SBC EOC X X X X X

PHD DOC X X X X X

County Dept POD's No X X X

Healthcare Partner POD's No X X X

Communication

• We will be conducting video conferencing during the exercise to receive a status report from the hospital HCC, the warehouse, and PHD DOC.

• We have used video conferencing with your facilities in the past and that there have been some issues.

• We can now use Skype for Business which can make things easier.

• Is your facility willing to participate via video conferencing/Skype?

• If so who can our IT contact to discuss and test in advance of the exercise?

How do I know who to call? –On your exercise checklist AND Exercise Phone Book –Phone/Fax/email for All Agencies/Players –Exercise Controllers Cell phones (hospital

HCC and PHD DOC/Warehouse/EOC) –Teleconference lines for Health Officer

and PIO meetings

Public Information

Do’s and Don’ts • Do NOT film outside of warehouse. • Do communicate with PHD PIO if you plan to

have press or media at your site. – Media has already begun publicizing mass

vaccination flu clinics. – Media may want to film delivery to hospital sites.

PIO’s should contact the PHD.

County Emergency Operations Center

Closed POD’s and Healthcare Partners

Open Public POD’s and Flu Vaccination Sites

Receive, Store, Stage “RSS” Warehouse

Media Discussion

• What media if any do you anticipate at your site?

• Provide your media contact.

Report Your Exercise Plan

• Hospitals • Outpatient • Long Term Care/SNF • All others

Final Schedule

• Tuesday, 11/10, CAHAN test with poll • Wed, 11/11, Direct Relief meeting • Friday, 11/13, Final Exercise

Teleconference, – final questions and clarification

• November 16-20 Exercise

After the Exercise! Action Improvement Plans

• After Action Meeting • Week of December 7-11th • Improvements and changes to

plans

Thank You! • We look forward to working with you

November 16-20th

POD TO YOU!