1. November 12, 2012 Meeting Objectives Ensure Everyone is Warm and Fuzzy on Statewide Exercise Processes and Activities Answer Any Outstanding Questions Disaster Preparedness Workgroup

2. Statewide Health & Medical Exercise 2012

3. CapabilityObservationRecommendation Intelligence/ Information Sharing & Dissemination County only collected status reports via ReddiNet; CCALAC had to translate into email and send/receive Assessment Polls from the EMS Agency should have an easily transportable form Intelligence/ Information Sharing & Dissemination Limited notification of CCALAC and MAC when clinics activated response procedures Increase awareness training to clinics on best practice response notification procedures Emergency Operations Center Management Many clinic staff not regularly involved in disaster plans were unfamiliar with their response roles Incorporate HICS Forms and Job Action Sheets into drills and exercise. 2011 Exercise Lessons Learned

4. 2011 Lessons Learned MOA Contracts with “Site Summary” forms Site-Specific Incident Management Team Designations Incident Command System / Incident Action Planning Training Quarterly Communications Drills 2012 Statewide Medical and Health Exercise Participation Putting It All Together

5. Our Clinic will be…..here to help!

6. Exercise Overview OBJECTIVE: To discuss the planning and response to a loss of power to the healthcare delivery system and the community. SCENARIO: Earthquake results in power loss. Earthquakes can cause a variety of problems and disruptions to infrastructure. Due to the limited time, this exercise will focus on power loss. Participants can customize the exercise and objectives to address other issues.

7. 2008 Sayre Wild Land Fire Olive View-UCLA Medical Center lost power and emergency generators failed -27 patients evacuated: 15 infants from Neonatal ICU, 4 critical care patients and 5 adult patients on ventilators -Patients evacuated down stairs with assistance of local fire department Source: ABC news: http://ABC.local.archives/SayreFire 7 Historical Impact of Power Loss

8. 2010 Palo Alto Plane Crash Power outage caused by the crash of a twin-engine Cessna in East Palo Alto, which toppled several major power transmission lines 8 Historical Impact of Power Loss Stanford Hospital & Clinics and Lucile Packard Children’s Hospital in Palo Alto, CA were without power; the hospitals functioned on emergency power, and all non-emergency cases were postponed for the day Source: www.mercurynews.com/peninsula/ci_14422658

9. September 2012: San Diego Power Failure 5 million people without power in California, Arizona and Mexico Roads gridlocked due to outage of traffic lights Gas stations without power and unable to dispense fuel Eisenhower Medical Center in Palm Springs served as a respite for the community Source: www.nbcsandiego.com 9 Historical Impact of Power Loss

10. Communications Intelligence/Information Sharing and Dissemination Medical Surge Emergency Operations Center Management 10 2012 Statewide Medical and Health Exercise Target Capabilities

11. Determine/Evaluate clinic’s ability to communicate with response partners Discuss/Test ability to communicate needs with outside sources for essential supplies, services, and equipment Focus on resource supply chains Target Capability: Communications 11

12. Communication with the MAC …from the 2012 LAC EMS Agency Communications Directory

13. Review/test adequacy of information management plans and technology internal and external Review/test risk communication and public information message dissemination Discuss/exercise ability to provide situational status and projected impact updates to: CCALAC/EMSA/DRC/Local EMD Target Capability: Intelligence/Information Sharing and Dissemination 13

14. COMMUNICATIONS DIRECTORY

15. Target Capability: Medical Surge 15 Determine/evaluate ability to expand patient capacity using non-traditional care areas for triage and treatment Determine/evaluate ability to prioritize, manage, and allocate resources Discuss/test capacity to provide care with out the use of power

16. Test EOP and hazard specific plans Discuss/exercise activation of Incident Management Team Exercise ability to initiate incident action plan Work through Incident Action Planning Process using HICS Forms Target Capability: Emergency Operations Center Management 16

17. MASTER SCENARIO EVENTS LIST (MSEL)

18. TimeIncident 06457.8 Earthquake : Official Activation of the EMS Operations Center 0700Reddinet / Email Damage Assessment Request: - Clinics with Reddinet complete Assessment Poll - Clinics without Reddinet complete fill-able PDF and email or fax to the Medical Alert Center @ (562) 944-5248 0830Clinics Respond to Scenario: -Patient Profiles: overwhelmed with worried well, ect. 0930Clinic _____ Reports Downed Power lines trapping staff. 1010Clinics testing Mass Fatality Plans activate plan, request coroner, and initial PsySTART triage of staff 1058Clinics testing MFI request MAC support 1300Official End of Exercise: Clinics conduct Hotwash Debrief with Staff and collect Evaluator/Controller Feedback Forms Key Injects

19. Communicate, Communicate, Communicate!!!! Respond to Everbridge Messages Complete and send in Situation Report Assessments Send in Resource Requests to EMS Agency Take Action Activate your Incident Management Team Work through the Incident Action Planning Process and MSEL Injects Complete HICS Forms 201, 202, 203, 204, 214 http://dp.ccalac.org/Policies/Incident%20Action%20Planning/Pages/default.aspx Complete Hotwash Debrief Create After Action Report Key Actions

20. Logistical issues Technological issues People issues Time issues Addressing Past Concerns 20

21. http://dp.ccalac.org/PREPAREDNESS/drills/SMHE http://ems.dhs.lacounty.gov/Disaster/Announcement.htm http://dp.ccalac.org/PREPAREDNESS/drills/SMHE http://ems.dhs.lacounty.gov/Disaster/Announcement.htm http://www.californiamedicalhealthexercise.com/exercises/phase3.php

22. Identify overarching goals Establish purpose Define extent of play Choose objectives Define exercise assumptions, artificialities Develop security plan (exercise safety) Define resource requirements and logistics plan Develop briefing materials (exercise handbooks and forms): Controller/facilitator Evaluator/data collector Note taker/scribe Player Create Exercise roster EXERCISE DESIGN/PLANNING

23. Convene IMT Announce Narrative Provide Position Specific IRGs Work through Injects IMT Staff practice Emergency Management Mentality, not day-to-day decision-making. Conclude Exercise Conduct Hotwash Draft After Action Report Tabletop Exercise - Basic

24. Convene IMT Announce Narrative Provide Position Specific IRGs Work through Injects Work through “Planning P” ; Incident Action Plan Establishment Ensure Staff Create Plan A and Plan B for key response strategies and tactics; Consider Having a “What-if” officer Conclude Exercise Conduct Hotwash Draft After Action Report Tabletop Exercise - Advanced

25. All that other stuff + actually “doing” something. Functional Exercise

26. Immediate Operational Period PositionActions-Operational Period Incident Commander 1.Receive notification about the incident from local officials 2.Activate the Command Staff and Section Chiefs 3.Activate the EOP 4.Establish operational periods 5.Establish operational objectives

27. Immediate Operational Period PositionActions-Operational Period Public Information Officer 1.Monitor media outlets for updates on the incident and possible impacts on the hospital 2.Establish a patient information center; coordinate with the Liaison Officer 3.Establish a media staging/briefing area initiate media/ communications plan

28. PositionActions-Operational Period Liaison Officer1.Establish communication with local EOC, DRC 2.Communicate with other health care facilities (situation status, surge capacity, supply/personnel lending capacity, etc.) Immediate Operational Period

29. PositionOperational Period-Action Safety Officer1. Monitor safety practices of staff, patients, facility and implement corrective actions, as needed Medical/Technical Specialist-Medical Assist Op Chief in identifying specific medical care management needs Medical/Technical Specialist-Mental Health Assist Op Chief in identifying specific mental health needs/Manage PsyStart Immediate Operational Period

30. PositionActions-Operational Period Operations1.Conduct clinic census/determine patients to send home/reschedule 2.Provide facility security, traffic and crowd control 3.Activate surge capacity plan and patient emergency procedures 4.Rapidly triage/prioritize patient care and resources Immediate Operational Period

31. PositionActions-Operational Period Planning1.Prepare and implement patient, room, material and personnel tracking 2.Establish operational periods and Incident Action Plan with IC Logistics1.Initiate staff call procedures 2.Conduct inventory of supplies, equipment, medication 3.Ensure IT functionality Immediate Operational Period

32. PositionActions-Recovery Incident Commander1. Oversee and direct demobilization and system recovery operations Public Information Officer 1. Provide final briefings as needed to patients/visitors/staff/media Liaison Officer1. Prepare summary of the status of the Clinic and disseminate to Command Staff, as appropriate Safety Officer1. Oversee safe restoration to normal operations Operations1. Return patient care and services to normal Planning1.Finalize IAP 2.Complete AAR 3.Ensure file of incident documentation Logistics1. Provide for mental health services for staff and patients Finance/ Administration 1.Submit final response expenses to IC for approval 2.Submit for reimbursement Recovery

33. Conduct participant hot wash Conduct controller, data collector/evaluator critique Collect observation/data collection forms (notes) Develop initial after action report (AAR) Coordinate and evaluate findings Conduct senior management post-exercise briefing Prepare final AAR POST EXERCISE Develop improvement plan Track corrective actions Share lessons learned EVALUATE THE EXERCISE