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Exercises
and Training:
Virginia Department of Health Emergency Preparedness and Response Programs
Lisa G. Kaplowitz, M.D.,
M.S.H.A.
Deputy Commissioner
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
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
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
Exercise
Design, Control and Evaluation
Phase 1:
Exercise pre-planning
Phase 2:
Exercise planning
Phase 3:
Control
Phase 4:
Assessment and evaluation
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
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
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.
Phase
IV: Analysis & Reporting
Record reactions
to inputs against desired responses
Evaluate
degree to which objectives met
Conduct an
immediate 00ot Washup00
Prepare an
after-action report within 2 wks
Develop a
00essons Learned00database
Establish
an Implementation Panel
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
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
Bioterrorism
Exercise: October 2003
All District
Health Departments participated
Multiple
offices in VDH: EP&R, 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
Bioterrorism
Exercise
Objectives: 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
Bioterrorism
Exercise
Objectives: 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
Objectives:
Day 3
Tabletop 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
Objectives:
Day 3
Tabletop 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
Bioterrorism
Exercise
Deliverables: 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
Bioterrorism
Exercise Deliverables: Day 3
Conducted
a 00ot-Wash00debrief 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 00
All hot-wash notes (same day)
Phase 2 00
District Director Report with action plan to address lessons learned.
(within 2 weeks)
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
Bioterrorism
Exercise:
SNS 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 9:00-11:30 AM.
Materials
returned to RSS site and then to CDC by 7 PM on Day 4
Bioterrorism
Exercise
Objectives: 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
00on
designated00districts 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
Bioterrorism
Exercise:
SNS 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
Hurricane
Isabel; Sept, 2003:
The 00ther00Exercise
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
Anthrax
Scare, Nov 7 003
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
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 004
Determine
Promise 004
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
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
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
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
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
EP&R health training
Search for
courses
Register
online: tracks individual learning records
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
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