Exercises and Training: Virginia Department of Health Emergency Preparedness and Response Programs

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Exercises and TrainingVirginia Department of
Health Emergency Preparedness and Response
Programs

• Lisa G. Kaplowitz, M.D., M.S.H.A.
• Deputy Commissioner

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Unique Aspects of Virginia

• Large state Significant urban, suburban and
  rural populations
• Large military presence (including Pentagon,
  Langley)
• Part of National Capital Region (Northern
  Virginia)
• Rural areas provide unique challenges

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Unique Aspects of Virginia Department of Health
(VDH)

• Most of local health districts are part of the
  state health department (32/35)
• Very close collaboration between health districts
  and VDH Central Office
• Created new regional teams to coordinate
  emergency planning and response efforts

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Regional Approach to Planning and Response

• Northern Region National Capital Region (with
  Maryland and Washington DC), involvement of
  federal agencies
• Eastern Region Military bases, tourism
• Central Region State government
• Northwest Region Rural and suburban Washington
  DC
• Southwest Region Rural, large geographic area
  with geographic barriers borders
  North Carolina, Tennessee,
  Kentucky, West Virginia
  

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Exercise Design, Control and Evaluation

• Phase 1 Exercise pre-planning
• Phase 2 Exercise planning
• Phase 3 Control
• Phase 4 Assessment and evaluation

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Phase I Exercise Pre-planning

• Develop
• Plan of Action and Milestones
• Mission Essential Task List
• Exercise Objectives
• Exercise Story Line
• Participant List
• In-house
• Partner Agencies

• Identify
• Exercise Audience
• Technologies to be Tested
• Policies, Procedures to be Exercised
• Exercise Locations
• Communications Requirements

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Phase II Exercise Planning

• Coordinate Use MOAs, Partner Agency Participation
  Support Requirements
• Develop Pre-exercise Training Plan
• Arrange Mentor / Facilitator Participation
• Prepare Exercise Concept Plan
• Core Scenario
• Master Events Scenario List
• Prepare Observation and Assessment Plan
• Observer Team
• Exercise Control Group

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Exercise Control

• Observers
• Record / review reaction.
• Elicit response.
• Measure task accomplishment.
• Collect data deliverables.
• Coordinate w/ Umpires.
• Conduct on-the-spot training.

• Umpires
• Control clock.
• Ensure timely and timed responses
• Input items from Master Events Scenario List
• Reconcile issues.
• Maintain a time log.
• Keep exercise on schedule/participants on task.

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Phase IV Analysis Reporting

• Record reactions to inputs against desired
  responses
• Evaluate degree to which objectives met
• Conduct an immediate Hot Washup
• Prepare an after-action report within 2 wks
• Develop a Lessons Learned database
• Establish an Implementation Panel

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VDH Exercises 2002-2003

• Multiple local, regional exercises, including
  National Capital Region
• Statewide exercises
• Hurricane Isabel in Sept, 2003
• Statewide bioterrorism exercise in Oct, 2003
• Anthrax event in Nov, 2003 VMI and medication
  clinic
• Collaboration with hospitals, laboratories, VDEM,
  MMRS, localities establishment of exercise
  calendar for all state agencies

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Bioterrorism Exercise October 2003

• Release of the plague at large alumni event
• Cases of pneumonia present to hospitals statewide
• Involve epidemiology and state laboratory to
  identify event and organism
• Strategic National Stockpile delivered to state
  and distributed statewide to 6 regions
• 6 mass medication/vaccination clinics established

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Bioterrorism Exercise October 2003

• All District Health Departments participated
• Multiple offices in VDH EPR, Epidemiology,
  Chief Medical Examiner
• CDC
• 82 of hospitals, state laboratory, state police,
  emergency management agencies, UPS, local
  governments and volunteers participated
• VDH Emergency Coordination Center (ECC) and state
  EOC operational
• Test of communication systems, as well as disease
  control and prevention

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Bioterrorism ExerciseObjectives Days 1-2

• Identification of pneumonia cases presenting to
  hospitals throughout Virginia, with deaths
• Recognition of outbreak situation
• Recognition that outbreak could be related to
  intentional release of organism (BT event)
• Request Strategic National Stockpile Push Pack,
  prior to identification of organism
• Identification of organism after SNS requested
• Key objectives Communication
• and decision making

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Bioterrorism ExerciseObjectives Day 3

• Response to BT event by VDH, other emergency
  response agencies/organizations
• Confirm identification of organism
• Identification of event where organism released
• Determination of infection control, treatment and
  prophylactic response
• Key objectives Communication and decision making

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Objectives Day 3Tabletop component

• Opportunity for district health directors and
  their response teams to discuss and make
  decisions with their local emergency manager(s)
  and their local hospital(s)
• 79/96 (82) acute care hospitals participated
• Provide a low stress event to clarify roles and
  responsibilities for the management of a large
  scale BT event

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Objectives Day 3Tabletop Component

• Decisions regarding surge capacity
• What facilities would be established?
• Procedures for patient movement
• Decisions regarding isolation and quarantine
• Analysis of impact on daily business (schools,
  EMTs, Fire, Law, transportation..)
• A checklist provided to each participating site
  to assist with work flow

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Bioterrorism ExerciseDeliverables Day 3

• All districts asked to produce and submit
• Local press release coordinated with agency PIO
• Summary Report documenting communication with
  participating local emergency managers
• Dispensing Site Management Plan that identifies 2
  dispensing sites and outlines the staffing and
  management plans for each site.
• Incident Action Plan
• Surge Capacity Plan

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Bioterrorism Exercise Deliverables Day 3

• Conducted a Hot-Wash debrief immediately
  following the end of exercise activity at each
  site
• Top 10 things that went well
• Top 10 areas that need improvement
• Brainstorm list of issues/comments, checklist
  provided
• Submit an after action report
• Phase 1 All hot-wash notes (same day)
• Phase 2 District Director Report with action
  plan to address lessons learned. (within 2 weeks)

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Bioterrorism Exercise SNS Segment Day 3

• Push Pack arrived in Virginia in AM, transported
  to RSS facility in Richmond area
• Training Education Demonstration (TED) package
• Receive, Stage Store (RSS) Site Manager and
  State signatory authority at RSS facility
• Push Pack broken down, inventoried, managed and
  distributed to 6 dispensing sites and 6 treatment
  centers throughout Virginia transport by UPS

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Bioterrorism ExerciseSNS Segment (cont)

• Materials arrived by UPS at dispensing and
  hospital sites prior to 6 PM on Day 3
• Materials utilized on Day 4 at dispensing sites
  and treatment centers.
• Tracking and control were key issues.
• Dispensing sites dispensed materials for 2.5
  hours from 900-1130 AM.
• Materials returned to RSS site and then to CDC by
  7 PM on Day 4

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Bioterrorism ExerciseObjectives Day 4

• Distribution of SNS to all parts of state
• Establish 5 dispensing clinics in all parts of
  the state (6th site in No. VA 3 days later)
• Winchester, Norfolk, Richmond, Roanoke, Abingdon
• Non designated districts provided personnel to
  assist at dispensing sites.
• Two sites actually provided influenza vaccine
• Media involvement encouraged
• Evaluation of functioning of mass medication or
  vaccination clinics

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Bioterrorism ExerciseSNS Segment (cont)

• Fairfax County (Northern Virginia) operated a
  dispensing site on following Saturday
• Involve volunteers
• Use schools
• County transportation of public to dispensing
  site from distant site
• County law enforcement provide security

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Hurricane Isabel Sept, 2003 The Other
Exercise

• VDH Emergency Coordination Center established
• Staffed ESF 8 at state EOC for 10 days
• Water and power issues for hospitals, nursing
  homes, health departments, homebound
• Impact on hospital, institutional, home
  healthcare
• Public health and public information issues
• Water safety boil water alerts
• Hurricane related injury, disease and deaths
• Restaurant inspections, food safety
• Mosquito control

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Anthrax Scare, Nov 7 03

• Positive anthrax test at postal facility
• Partners
• Arlington HD
• DHS, HHS, CDC, USPS
• VA Office of Commonwealth Preparedness
• Antibiotics from VMI delivered, Arlington HD
• Dispensing clinic staffed/operational within 4
  hrs
• Confirmatory test negative
  no antibiotics given

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Assessment and Evaluation

• Lessons Learned combined for exercise, hurricane
  and anthrax event one document
• Lessons Learned Implementation Panel established
• Recommend changes in VDH and state emergency
  operations plans
• Institutionalize all lessons learned
• Report due by June, 2004
• Revise VDH emergency operations
  plan prior to DP 04

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Determine Promise 04

• Department of Defense exercise, August 2004
• Major components of exercise in Eastern and
  Central Virginia chemical and explosive events,
  biologic threats
• VDH major participant
• Test revised VDH emergency operations plan
• Response to chemical, explosive events and bio
  threat
• Test surge plan
• Bring in VDH personnel from other parts of the
  state as local resources become overwhelmed

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Education and Training

• Ensure the development and delivery of
  appropriate education and training to
• Public Health Professionals
• Physicians
• Emergency Response Personnel
• Other Healthcare Providers
• Collaboration with academic health centers,
  poison control centers

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Education and Training

• Training needs assessment done
• Public Health personnel
• Hospital personnel ER physicians and nurses,
  security officers
• Infection control practitioners
• Focus training efforts on greatest identified
  needs
• Chemical agents and exposures
• Incident command
• Communications

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Education and Training

• Link directly to exercises and programmatic
  initiatives
• Conduct and evaluation of exercises
• Incident command and emergency management
• Mental health response
• Special needs populations
• Collaborate with all emergency management
  agencies and organizations, avoid
  duplication of efforts

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Education and Training

• Use of new technologies to increase access to
  training programs
• Videoconferencing, DVD/CD
• Webcasting, internet based training
• TRAIN Learning Management System
  http/va.train.org
• Portal for EPR health training
• Search for courses
• Register online tracks individual learning
  records

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Other Training Resources

• Available through VDH web site
  www.vdh.virginia.gov
• Information on biologic and chemical agents
• Links to other resources, including CDC
• Recent VDH news and information