Ebola TTXDivision of Public Health, Public Health Preparedness Wisconsin Department of Health Services INSERT DATE/LOCATION HERE Ebola Virus Table Top Exercise Unknown Patient 1

Ebola TTX Division of Public Health, Public Health Preparedness Wisconsin Department of Health Services Purpose To provide participants an opportunity to evaluate current response concepts, plans and capabilities in response to a possible outbreak of a viral disease with high mortality. 2

Ebola TTX Division of Public Health, Public Health Preparedness Wisconsin Department of Health Services Disclaimer The current Ebola Viruses Disease outbreak continues to evolve and guidance from the Centers for Disease Control and Prevention (CDC) and the Department of Health Services (DHS) frequently changes. The information presented in this exercise may be quickly outdated. Check the CDC and DHS websites for up-to- date information. 3

Ebola TTX Division of Public Health, Public Health Preparedness Wisconsin Department of Health Services Objectives Critical Transport: Discuss how critical transportation would occur in region/jurisdiction in the event of an Ebola case. 1.Determine criteria and process for transport to local hospital 2.Determine criteria for inter-hospital transport 3.Discuss responder safety as it relates to: Personal Protective Equipment (PPE), transport from one facility to another, decontamination of ambulance, etc... 4

Ebola TTX Division of Public Health, Public Health Preparedness Wisconsin Department of Health Services Objectives Operational Communications (Information Sharing and Emergency Public Information and Warning): Ensure timely, accurate, internal and external communication throughout response 1.Identify internal communication and info sharing needs 2.Identify external communication needs 3.Develop risk communication strategy for public 5

Ebola TTX Division of Public Health, Public Health Preparedness Wisconsin Department of Health Services Objectives Medical Services: Determine the ability to provide appropriate, safe care to an Ebola Virus Disease patient. 1.Provide lifesaving medical treatment to an Ebola Virus Disease patient 2.Ensure responder safety and health throughout the course of providing treatment 6

Ebola TTX Division of Public Health, Public Health Preparedness Wisconsin Department of Health Services Objectives Public Health Functions: 1. Surveillance and Epi Investigation: Investigate case and identify contacts to patient Assemble appropriate screening tools/forms/resources to ensure consistent data collection Identify/activate local, regional, state and/or federal resources for surge capacity in contact tracing 2. Quarantine (if needed): Ensure the ability to appropriately quarantine those who may have been exposed to Ebola in alignment with recommended guidance Ensure isolation/quarantine plans are updated and ready to be operationalized 7

Ebola TTX Division of Public Health, Public Health Preparedness Wisconsin Department of Health Services Objectives Fatality Management Services: Discuss the coordination of fatality management services as it pertains to a fatality caused by Ebola. 1.Ensure responder health and safety throughout processing of the deceased 2.Ensure most current guidance is followed as it relates to handling Ebola contaminated remains 3.Provide mental/behavioral health services for those impacted by event 8

Ebola TTX Division of Public Health, Public Health Preparedness Wisconsin Department of Health Services Exercise Instructions This is an exercise based on a possible event. Process the information just as you would in a real-life incident. Avoid the temptation to “solve” the entire scenario. There is no “hidden agenda” or any trick questions. Participation is the key to making this exercise a success. Feel free to make valid assumptions based on the information provided. Respond based on your knowledge of current plans and capabilities (you may use only existing assets). 9

Ebola TTX Division of Public Health, Public Health Preparedness Wisconsin Department of Health Services Rules of Engagement This is an open, low-stress, no-fault environment. Offer any suggestions or recommended actions that could improve response and preparedness efforts. Be respectful of others, as varying viewpoints, even disagreements, may occur. 10

Ebola TTX Division of Public Health, Public Health Preparedness Wisconsin Department of Health Services Scenario At 7 pm on Friday a 23-year-old male who is ill presents at the local emergency department. Vitals/Symptoms: Temp Headache Muscle pain Abdominal cramps 11

Ebola TTX Division of Public Health, Public Health Preparedness Wisconsin Department of Health Services Discussion Emergency Department: How would ER registration handle a patient that has flu-like symptoms or says “I think I have Ebola”? What symptom-related questions would you ask this patient? What travel history questions would you ask this patient? NOTE: Patient NOT being actively monitored. How would this scenario change if the patient had called 9-1-1? minutes for discussion

Ebola TTX Division of Public Health, Public Health Preparedness Wisconsin Department of Health Services Discussion Patient was in Liberia 11 days ago. Traveled from Africa to Germany, where spent a few days with friends. Upon return to United States, he did not end up on the Active Monitoring list. Assumption: Substantial patient history info needed from the time period of return to US. 13 NOTE: Patient worked for the American Red Cross teaching healthcare workers about infection control practices. He was considered low-risk.

Ebola TTX Division of Public Health, Public Health Preparedness Wisconsin Department of Health Services Discussion- Initial transport A unified command teleconference is held between the local hospital, state public health, local public health, and the CDC. Based on policy and criteria, what would the likely recommendation be for initial management? Should the patient remain where he is or be transferred? 14

Ebola TTX Division of Public Health, Public Health Preparedness Wisconsin Department of Health Services Discussion- Transport Unified Command decision that patient should be seen at the nearest Category II facility. 15

Ebola TTX Division of Public Health, Public Health Preparedness Wisconsin Department of Health Services Update- Testing What testing should be performed in a rule-out scenario? What lab capabilities and employee protections need to be in place to perform this testing? Is the facility able to perform this testing (Category II) or only screen and isolate the patient (Category III)? How about YOUR hospital? 16

Ebola TTX Division of Public Health, Public Health Preparedness Wisconsin Department of Health Services Update- Testing Patient arrives at the nearest Category II facility for monitoring/assessment/initial care. Discuss the process of specimen collection, packaging, transport. Ensure permission is received to transport. Is there a written protocol? What technical support might be needed? 17

Ebola TTX Division of Public Health, Public Health Preparedness Wisconsin Department of Health Services INJECT- Decon The EMS unit that transported the patient from home to the Category II hospital is requesting guidance on how to properly decon the rig. What is your guidance to them? Where would you turn for technical support? 18

Ebola TTX Division of Public Health, Public Health Preparedness Wisconsin Department of Health Services Update- Patient Care and Responder Safety and Health Please discuss your internal hospital response plan to ensure the following: Appropriate patient care Appropriate isolation Appropriate PPE to ensure Responder Safety and Health Appropriate monitoring of healthcare workers and coordination with public health NOTE- Include specific names of policies/procedures where appropriate 19

Ebola TTX Division of Public Health, Public Health Preparedness Wisconsin Department of Health Services INJECT- RISK COMMUNICATION Due to media and public interest, activate your Risk Communication Plan. Do you have one? If so, describe it. How will the messaging be consistent between: Hospital Local public health Local government State government CDC 20

Ebola TTX Division of Public Health, Public Health Preparedness Wisconsin Department of Health Services Update- Patient Deteriorates While at the hospital and awaiting test results, the patient begins to deteriorate. A decision is made between Unified Command at all levels to transport to a Category I facility. INJECT: INITIAL TEST FOR EBOLA POSITIVE 21

Ebola TTX Division of Public Health, Public Health Preparedness Wisconsin Department of Health Services Inter-hospital Transport How would this process occur? Has the EMS that would be transporting already been identified? If not, which EMS would transport the patient? Where would you turn for technical support? Once patient is transported: Who monitors staff? How is waste handled? How does hospital return to normal operations? 22

Ebola TTX Division of Public Health, Public Health Preparedness Wisconsin Department of Health Services The investigation... How is contact tracing/investigation occurring? Who is the lead? Where can you get surge capacity for contact tracing? How are you handling the ‘worried well?’ Is there a hotline/phone bank option? 23

Ebola TTX Division of Public Health, Public Health Preparedness Wisconsin Department of Health Services Investigation Update: Extensive contact tracing has identified three close contacts (girlfriend and two co-workers). There are other possible contacts that are being investigated. How would you monitor these contacts? What restrictions would you put on their movements? Who handles contact tracing and monitoring? Who can assist? 24

Ebola TTX Division of Public Health, Public Health Preparedness Wisconsin Department of Health Services OPTIONAL INJECT- Patient dies at your facility Activate fatality management plan for an Ebola victim How are Ebola infected remains handled? What is the guidance? What is your recommendation to the Medical Examiner/Funeral Home Director? 25

Ebola TTX Division of Public Health, Public Health Preparedness Wisconsin Department of Health Services DHS Ebola Website Frequently updated by DHS Incident Command structure to reflect the most current guidance: Go to: es/ebola.htm es/ebola.htm OR These are the two most current, up-to-date sites 26

Ebola TTX Division of Public Health, Public Health Preparedness Wisconsin Department of Health Services Hotwash 27