# Presentation: 383716

## [Exercise Name]

**[Exercise Name]**

**[Date]**

## A [Length of play] interagency exercise focused on field-level and hospital response to a terrorist incident
No-inspection, no-fault, learning environment
“A training tool”

**No-inspection, no-fault, learning environment**
**“****A training tool”**

**Exercise Overview**

## Exercise Design Objectives

**Exercise Design Objectives**

- [List Exercise Design Objectives]

## Exercise Players

- List participating agencies/organizations

**Hazard Assessment by First Responders**
**Incident Command Established**
**Exclusionary Zones Identified & Isolated**
**Protective Actions & Decision Making**
**Perimeter Security**
**Agent Identification**
**Staging Area**
**Secondary Device Sweep/Disposal**
**Medical Services**
**Patient Identification**
**Patient Extraction**
**Patient Decontamination**
**Patient Triage and Treatment**
**Patient Evacuation**
**Other Incident Site Activities**
**Interagency/Mutual Aid Coordination**
**Responder Decontamination**

**What Happened On Scene?**

**Notes:**
Evaluator Notes Go Here

## Numerous patients 
Mixed severity, mixed symptoms
Combination of EMS delivery and self-referrals 
Various age groups
All hospitals participate?
Triage, decontamination, and treatment per hospital plan
Communication with the scene
Medical community response coordinated  

**Mixed severity, mixed symptoms**
**Combination of EMS delivery and self-referrals **
**Various age groups**
**All hospitals participate?**
**Triage, decontamination, and treatment per hospital plan**
**Communication with the scene**
**Medical community response coordinated  **

**What Happened Off Site ?**

**Notes:**
Evaluator Notes Go Here

## Discussion Issues

**Resources**
**Facility Security**
**PPE**
**Decontamination**

**Patient Care**
**Patient Record-keeping**
**Pharmaceutical Cache and Other Supplies**
**Other Planning Issues**

**Discussion Issues**

**Notes:**
Here is an agenda of topics related to incident response, which we will address in chronological order.

## How was the problem recognized?

**What did you do next?**
** ****Disaster plan implemented-all/part?**
** ****Clear out beds?**
** ****Set up decontamination/treatment area(s)?****                                              **
**Who did you notify?**
**Do you set up a Hospital Emergency Incident Command System?**
**Sentinel detection system?**

**How was the problem recognized?**

**Notes:**
Slide Notes Go Here

## Notification – Did it Work?

-   Page
-   Radio
-   Telephone

- External news
-   EMS
-   Health Dept
-   CNN

**Notification – Did it Work?**

**Notes:**
Slide Notes Go Here

## With Whom Did You Consult?

- In House
- Department of Health
- Poison Control Center
- CHEMTREC
- National Response Center
- Centers for Disease Control and Prevention
- Agency for Toxic Substances and Disease Registry
- Others

**With Whom Did You Consult?**

**Notes:**
Slide Notes Go Here

## Tomes Plus (Micromedex)
Toxnet/Toxline (National Library of Medicine)
Internet
http://www.dhs.gov 
http://www.cdc.gov
http://www.bt.cdc.gov
http://www.atsdr.cdc.gov
http://hld.sbccom.army.mil
http://ntp-server.niels.nih.gov
http://www.nbc-med.org
http://www.fema.gov/rris
http://www.usdoj.gov
http://www.pepid.com

**Toxnet/Toxline (National Library of Medicine)**
**Internet**
- _[http://www.dhs.gov](http://www.dhs.gov/)_** **
- _[http://www.cdc.gov](http://www.cdc.gov/)_
_**http://www.bt.cdc.gov**_
_**http://www.atsdr.cdc.gov**_
- _[http://hld.sbccom.army.mil](http://hld.sbccom.army.mil/)_
_**http://ntp-server.niels.nih.gov**_
_**http://www.nbc-med.org**_
- _[http://www.fema.gov/rris](http://www.fema.gov/rris)_
_**http://www.usdoj.gov**_
_**http://www.pepid.com**_

**Computer Programs**

**Notes:**
Slide Notes Go Here

## North American Emergency Response Guidebook
Hazardous Materials Injuries-Stutz/Ulin (Bradford Press)
Emergency Care for Hazardous Materials Exposure-Bronstein/Currance (Mosby)
Tox. texts-Goldfrank, Schonwald, Krieger, Haddad
Hazardous Materials Toxicology-Krieger/Sullivan
Medical Mgmt. of Biological Casualties/Chemical Casualties/Radiological Casualties
Jane’s Chem–Bio Handbook

**Hazardous Materials Injuries-Stutz/Ulin (Bradford Press)**
**Emergency Care for Hazardous Materials Exposure-Bronstein/Currance (Mosby)**
**Tox. texts-Goldfrank, Schonwald, Krieger, Haddad**
**Hazardous Materials Toxicology-Krieger/Sullivan**
**Medical Mgmt. of Biological Casualties/Chemical Casualties/Radiological Casualties**
**Jane’s Chem–Bio Handbook**

**Reference Texts**

**Notes:**
Slide Notes Go Here

## Who Did You Ask For Help?

- Fire Department
- Law Enforcement
- Health Department
- Laboratories
- Medical Examiner
- Department of Public Works
- Local/State Emergency Management
- Each Other
- Others

**Who Did You Ask For Help?**

**Notes:**
Slide Notes Go Here

## What about facility security?    

- Did you have enough of your own?
- Do you have an agreement with local law enforcement ?
- What if you are a secondary site?
- What about getting your people in and out?
- Parking lot/perimeter patrol?
- Heightened suspicions-not paranoia?

**What about facility security?****    **

**Notes:**
Slide Notes Go Here

## PPE- What did you wear?

- Where was it worn?
- How long?

- Work rotations?
- Enough suits?
- Medical surveillance?

**PPE- What did you wear?**

**Notes:**
Slide Notes Go Here

## Decontamination - How Did It Go?

- Gross
- Secondary
- Definitive
- Emergency
- Technical
- Equipment

- Ambulatory vs. Non-ambulatory
- Special needs patients
- What other treatment?
- Mass decontamination triage?

**Decontamination - How Did It Go?**

**Notes:**
Slides Notes Go Here

- Other patients
- Standardized assessment
- Lab assistance
- Treatment
- Allocating scarce resources
- Special patient needs
- Patient transfer**  **

**Patient Care- What are the Issues?**

**Notes:**
Slide Notes Go Here

## Pediatric/geriatric patients
Other special needs patients
Patients refusing care
Medical surveillance
Local/State/Federal
Patient valuables

- Other special needs patients
- Patients refusing care
- Medical surveillance
- Local/State/Federal
- Patient valuables

**Other Patient Care Concerns**

**Notes:**
Slide Notes Go Here

## Patient Tracking

- Triage tag
- EMS numbers match
- Patient names, etc.
- Integration with Paramedic Base
- Family notification
- Health Department

**Patient Tracking**

**Notes:**
Slide Notes Go Here

## Volunteer assistance 
Quarantine
Alternative treatment centers (Neighborhood Emergency Help Centers)
Mental health support
Patient
Family

- Quarantine
- Alternative treatment centers (Neighborhood Emergency Help Centers)
- Mental health support
- Patient
- Family

**Additional Considerations**

**Notes:**
Slide Notes Go Here

## Additional Resources

- National Medical Response System Hazard Mitigation Survey Teams
- Disaster Medical Assistance Teams
- Disaster Mortuary Operational Response Teams
- Health Department
- Others

**Additional Resources**

**Notes:**
Slide Notes Go Here

## Handling 9-1-1 calls for other things

Walk-ins

Burn unit capability not enough?

- Walk-ins
- Burn unit capability not enough?

**What About Other Patients?**

## Resources

*What did you run out of?*
** **Beds
-  Ventilators
-  Pharmaceuticals
-  Medical supplies
-  Other

- Whom did you notify?
- Do you have an acquisition plan?
- Do you have a distribution plan?
- Any staff familiarization issues?

**Resources**

**Notes:**
Slide Notes

## What About...?

-   Handling the deceased
-   Handling the families
-   Press and Media

**What About...?**

**Notes:**
Slide Notes

## What About...?

- Incorporating epidemiological investigations
- Criminal investigations
- Research
- Documentation requirements

**What About...?**

**Notes:**
Slide Notes

## What About...?

- Staff medication administration
- Staff support / absenteeism
- Staff injury / death

**What About...?**

**Notes:**
Slide Notes

## Will be unparalleled
Is current support system adequate?
Acute and extended need for patient / family and responder support

- Is current support system adequate?
- Acute and extended need for patient / family and responder support

**Mental Health Needs**

**Notes:**
Slide Notes

## How as facility restoration handled?

- Facility decontamination
- Staff rehabilitation
- Staff mental health
- Re-supply
- Public relations
- Financial recovery documentation

**How as facility restoration handled?**

**Notes:**
Slide Notes

## Continue planning together!
Joint Anti-Terrorism Working Group?
Involve the press and media?
What about a lawyer, clergy, and an ethicist?  
Develop a regional standard of care for Weapons of Mass Destruction casualties
Include police, fire, EMS in your planning
Buy it together!! 

- Joint Anti-Terrorism Working Group?
- Involve the press and media?
- What about a lawyer, clergy, and an ethicist?
- Develop a regional standard of care for Weapons of Mass Destruction casualties
- Include police, fire, EMS in your planning
- Buy it together!!

**Final Suggestions**

**Notes:**
Slide Notes

## What’s Next?

- Continue planning process
- Identify required resources
- Provide training
- Conduct exercises to validate plans

**What’s Next?**

**Notes:**
Slide Notes

## Questions or Comments?

**Questions or Comments?**

## Summary

- You have identified future areas for improvement.

- YOU CAN DO IT BETTER TOGETHER
- THAN YOU CAN DO IT ALONE!!

**Summary**

**Notes:**
Slide Notes