Capability/Task Number Key: C=Communications; MS= Public Health and Medical Services; O=Operational Coordination/On-Site Incident Management; P =Public and Private Services and Resources (E = Epidemiological Surveillance and Investigation for local public health) Note: Number’s seen listed under the column “Objective/Task” refer to the corresponding “Activity/Task” found in the associated Exercise Evaluation Guide. Inject No. Inject time Actual Objective Joint Commission Standard From To Message Expected Outcomes/Action Observed Outcome/ Comments 1 0900 Start of exercise CAHAN alert Preparedness Office (EPO) Duty Officer Exercise participants Exercise activities for the 2014 Statewide Medical and Health Exercise have begun Exercise participants will initiate play 2 Medical and Health Center (MHCC) activation CAHAN alert Objective C1 CDPH-EPO Duty Officer CDPH and Emergency Medical Services Agency (EMSA) exercise participants, California state Warning Center, State Operations Center, Regional Operations Centers CDPH, EMSA and Cal OES staff identified as participants in the 2014 Statewide Medical and Health Exercise should report to their assigned positions within one hour Ready to start exercise at 9am. CDPH, EMSA and Cal OES staff with an assigned role in the exercise will report to their positions at the MHCC within one hour 0900 Objective O4 O5 Public Health Director or LEMSA Public Health Staff and/or LEMSA Notification of LEMSA or Public Health Department Operations Center (DOC) activation Respond to LEMSA or Public Health DOC activation and assume assigned roles. Assist in the implementation of Incident Command System including the development of an Incident Action Plan 3 0905 Objective 1 (Additional CDPH via CAHAN and Local health departments Health Alert: MERS-CoV has been laboratory confirmed in Public health and medical providers are notified of the
objectives E 10 and E 13 for local public health) Exercise Plan Handout and Healthcare partners the Operational Area. emerging infectious disease. 5 0915 Objective C1 MS3 EMS Providers and/or 911 Dispatch Centers EMS Providers/ Local EMS Agency (LEMSA) 911 dispatch centers are reporting an unusually high number of 911 calls have been occurring over the past 24 hours. Current EMS resources are having difficulty in keeping up with the demand and they are starting to experience delays in hospital patient turnovers. Implement EMS medical surge plans including calling in additional staff and deploying additional units Evaluate and monitor hospital status utilizing local systems and procedures (EMResource, ReddiNet, LiveProcess, Command Aware, WebEOC, etc.) 6 0915 Objective MS3 O4 EM01.01.01 (7) EM02.01.01 (2,5,6,7) EM03.01.03 (1,2,3,4,5) Charge Nurse/ Supervisor (Community Health Centers and Hospitals) Administrative personnel Patients are pouring in. We have more patients than we can handle. There are multiple patients complaining of Influenza-like-symptoms. Activate healthcare facility Emergency Operations Plan and Incident Command System (E.g., HICS) Activate facility influx or Surge Plans Notify local Licensing and Certification of activation 0915 Objective C1 O4 LA EMS MAC MHOAC System, RDMHC System, Other Key Partners MAC will notify MHOAC, RDMHC, and other key partners of activation MAC will notify MHOAC, RDMHC, and other key partners of activation 7 0920 Objective C1 EM02.02.01 (12) Local Health Department EMS Providers LEMSA Healthcare Providers Public Health issues a CAHAN advising of MERS-CoV cases imported into Los Angeles County. EMS will redistribute through ReddiNet. Acknowledge receipt of notification and communicate information as well as any specific instructions to appropriate EMS/healthcare community providers Activate the MHOAC Program and notify RDMHS
Skilled nursing facilities activate NHICS 8 0920 Objective C1 O5 O6 O7 EM01.01.01 (7) EM02.02.01 (1) EM02.02.01 (2) EM03.01.03 (8) Healthcare Partners Command Centers (Community Health Centers, Hospitals, Skilled Nursing Facilities, etc.) All units and departments throughout the facility (Including satellite organizations) Gather and report Situation Status of units and departments to the Command Center Gather and analyze event specific information Units and departments will report their current operational status and any impacts of medical surge to the Command Center Ensure documentation in the Incident Action Plan 0925 Objective C1 O6 O7 EM 01.01.01 (7) EM 02.02.02 (1, 2, 8) LEMSA/ MHOAC All OA Healthcare Partners LEMSA/MHOAC requesting situational status from all OA Healthcare partners Provide agency/healthcare partner situational status to LEMSA/MHOAC according to local procedures within locally determined timeframes 0930 Objective C1 Multiple Local Health Departments California Infectious Disease Branch Potential clusters of ILI are reported across the State. Simulate: Schedule a conference call with affected Jurisdictions and MHCC to discuss and share information. Work with local jurisdictions to initiate interviews of key cases (hypothesis generating questionnaires). Schedule follow-up conference calls with the Infectious Disease Branch. Refine questionnaires as necessary - clarify additional information with select cases. Conduct analytical study 0935 Objective O5 EM01.01.01 (7) Organization/ Agency Incident Commander Command and General Staff Request completed Incident Command System (ICS) Form 204 (Assignment List) detailing Operational Period/ Section/ Branch objectives, strategies and tactics, and needed Completed ICS Form 204 (Assignment List) are completed and provided to the Planning Chief for development of the Incident Action Plan within two hours 3
resources to be included in the Incident Action Plan. of activation. (Facilities may also use the newly developed IAP Quick Start) 0935 Objective C1 O6 O7 CDPH/ EMSA/ RDMHS LEMSA/ MHOAC Local/Operational Area (OA) medical and health situational status information is being requested by CDPH/EMSA/RDMHS MHOAC Program/LEMSA coordinate with appropriate agencies/providers to collect data on incident situation Provide Situation Status Report according to EOM procedures to CDPH/EMSA/ RDMHS within two hours 0940 Objective O5 EM01.01.01 (7) EM02.02.01 (12) Operational Area Emergency Operations Center/ Medical Health Branch All Healthcare Partners DOCs There is no indication to the source or the extent of the outbreak. Healthcare providers are reporting a large influx of patients. Please provide information on what specialty supplies and equipment may be required by your agency/organization to address the medical surge Develop an Incident Action Plan within 2 hours of activation Utilize FEMA, HICS, or NHICS forms to guide and document Incident Action Plan Health care agency/provider coordinates status updates; projects needs and consolidates into the situational status report for submission to Operational Area Emergency Operations Center Medical Health Branch As needed submit resource request form DOCs to submit OARRS report exercsie Objective C1 EM01.01.01 (7) EM02.O2.03 (1,2,3,12) Healthcare providers (Community Health Centers, Hospitals, Skilled Nursing Facilities, EMS, etc.) MHOAC/ LEMSA We are running critically short on adult supplies and PPE (e.g. 500mL and 1000mL IV bags of Normal Saline, nebulized medications, Flumist,) and our partners and vendors have exhausted their supplies. Submit resource request to EMS Agency Long Term Care Centers and Skilled Nursing Facilities to submit request to HFID Provide healthcare sender notification of receipt of request within 15 minutes out
Health Providers partner healthcare providers and government agencies due to overwhelmed systems with the public calling in for information. GETS/WPS, radio communications, etc.) 1020 Objective MS3 EM01.01.01 (7) Community Healthcare Clinic and Hospital Triage Area Command Center or Hospital Command Center The waiting area is overflowing with sick people. What protective measures should be used to protect staff and other patients? Liaison Officer confer with Infection Prevention Practitioner and Local Health Department Information Officer develop messaging for Triage, and all staff 1030 Objective C1 CDPH/EMSA LEMSA/ RDMHS and MHOAC The media has reported that MERS and influenza are widely circulating in the community. Worried people are presenting to community hospitals and clinics in increasing numbers. CDPH/EMSA requesting updated Situation Status report. Acknowledge CDPH/EMSA Situation Status update request. Include information relating to reported surge in an updated Situation Status OA to poll healthcare providers on impact of the emerging infectious disease 1045 Objective MS3 EM02.02.01 (2) EM02.02.01 (3,4) Hospitals District Licensing and Certification Office We are requesting authority to deploy and position triage tents in the parking lot of the hospital in efforts to mitigate further potential introduction of the source inside the facility Licensing and Certification provides decision to hospitals on tent deployment Hospitals activate surge tent protocols 1045 Objective MS3 Skilled Nursing Facility HFID/Local Health Department We need transfer guidelines for multiple patients at our facility who have developed symptoms and we don’t want it spread to other residents. Local health department will coordinate with MHOAC/LEMSA on transfer guidelines 1050 Objective MS3 EM02.02.01 (13) EM02.02.03 (9,10) Hospitals MAC Request for inter-facility transfers of adult patients to provide surge beds at hospitals. Consider activation of ACS at surgery centers Provide bed availability and facilitate network information through the MAC. Communicate and coordinate with RDMHS
regarding patient transportation resources, coordinate with adjacent LEMSA's/OAs for mutual aid resources as necessary May include request for Ambulance Strike Team resources if necessary Consider need for and utilization of FTS/ACS 1050 MS3 C1 NA LEMSA/DHS DOC Ambulatory Surgery Centers Acute care hospitals requesting assistance with non-infectious minor patients ASCs should activate their surge plan and respond with their availability and level of participation 1050 MS3 C1 NA LEMSA/DHS DOC Home Health and Hospice Acute care hospitals requesting available HHH agencies to accepts early discharges due to surge in patients HHH to activate their surge plan and respond if able to accept new patients 1100 Objective MS3 C1 Skilled Nursing Facilities Licensing and Certification District Office Request for program flex to meet needs for surge patients to help hospitals off-load adult patients. Licensing and Certification approve and support program flex 1100 Objective C1 EM02.02.01 (12) Health care facility infection prevention staff Local Health Department We need guidance describing appropriate and necessary levels of patient isolation and personal protective equipment requirements for staff treating patients with MERS-CoV. Local health departments coordinate via California Conference of Local Health Officers (CCLHO) with State health department and Cal OSHA to develop and disseminate guidance 1100 Objective MS3 P8 EM02.02.03 (9,10) Hospitals LEMSA/ MHOAC Multiple healthcare facilities are reporting the need to move adult patients to other facilities in order to receive and care for surge of patients - local ambulance resources are unavailable due to 911 requests Provide healthcare facility sending notification receipt of request within fifteen minutes Communicate and coordinate with RDMHS, coordination with adjacent LEMSA's/OAs for mutual aid resources Request for Ambulance
gowns, eye protection and respiratory protection that is at least as protective as a N95 respirator. EMS providers verify current PPE supplies and ability to resupply through internal supply chain and current vendor sources LEMSA to liaison with local prehospital EMS providers to assure PPE directive is received 1120 Objective MS3 P8 Community Healthcare Clinic and Hospital Triage Area Command Center We have a backup of patients who are waiting to be seen and need to be fed. We don’t have enough water and food. Ventilators Security officers Assess needs for nutrition and supplies . 1125 Objective C1 Public Health Nurse Local Health Department One of confirmed cases is homeless and left against medical advice but is still infectious. Frequents cold weather shelters. Communication with community partners that serve the homeless, run the shelters for follow-up of case and exclusion from shelter while infectious Mechanism of follow-up of exposed at homeless shelters 1125 Objective P8 O7 EMS Providers MHOAC Program Multiple EMS providers are projecting a shortage of PPE supplies within the next 48-72 hours and are unable to resupply through routine methods. Resource request for PPE supplies submitted to MHOAC Program MHOAC Program verifies need and ability to supply PPE through local supply caches If unable to supply PPE through local caches/methods, resource need is communicated to RDMHS for regional/state assistance (formal Resource Request submitted by OA through appropriate channels)
(JIC) reviews talking points and incorporates into written and news media releases Local/OA Emergency Operations Center uses information in media releases 1135 Objective O4 Community Healthcare Clinic and Hospital Triage Area Command Center We have the masks you sent in the appropriate sizes but we can’t get the patients to keep them on or use them properly. What should we do? Provide additional guidance in the challenges with airborne isolation Activate Infectious Disease Medical Technical Specialist if needed Should this be droplet isolation? 1135 Objective MS3 Hospitals Licensing and Certification District Office We are requesting a program flexibility request form for utilization of surge tents as treatment sites Licensing and Certification approve support program flexibility request form 1136 Objective C1 EM02.02.01 (12) EM02.02.11 (14) Local Health Department All Participants Reminder to include appropriate special needs populations and pediatric information in emergency public information releases OA/agency/facility Public Information Officer to address special needs populations as appropriate 1140 Objective MS3 P8 P9 EM01.01.01 (7) EM02.02.01 (7) (9) Healthcare Facility MOHAC/ LEMSA We have exhausted all of our sources for staff nurses. We need additional registered nurses and licensed vocational nurses to present to the facilitate as soon as possible Submit a resource request for nurses Provide confirmation of receipt to facility sending request within 15 minutes Address personnel resources at the local, regional, and State level including Disaster Healthcare Volunteers system and Medical Reserve Corps 1140 All Healthcare Facilities and Agencies Command Centers With the MERS-CoV mortality and morbidity rates, should we be reviewing our Continuity of Operations Plans (COOP) and Business Continuity Plans Review Continuity of Operations Plans or Business Continuity Plans and whether they should be activated
(BCP)? 1159 Objective O3 EM01.01.01 (6,7) EM02.01.01 (4,5,6) EM03.01.03 (13,14,15,16) SIMCELL Incident Management Team Your organization/agency is able to operate under normal operating procedures Development of Demobilization and/or System Recovery Incident Action Plan Initiate demobilization of disaster emergency response activities and personnel Return to normal operations Assessment of impacts of medical surge to the organization/jurisdiction Initiation of After Action Report/Improvement Planning process 1200 End of exercise CAHAN alert CDPH-EPO Duty Officer Exercise participants Exercise activities for the 2014 Statewide Medical and Health Exercise have ended Exercise participants will discontinue play and begin Hot Wash activities Acronym List AAM After Action Meeting AAP American Academy of Pediatrics AAR After Action Report AAR/IP After Action Report/Improvement Plan ARI Acute Respiratory Infection