1. Who We Are Center for Mass Destruction Defense A CDC Center for Public Health Preparedness at the University of Georgia American Medical Association & the Medical College of Georgia –Our partners in BDLS/CDLS/ADLS curriculum offered in over 30 states Georgia Department of Public Health Georgia Hospital Association

2. This is a no fault exercise The purpose of this exercise is to evaluate current surge capacity and isolation plans. This exercise should bring awareness to participants of the good and “not so good” points of their plans and procedures, and allow them to make adjustments in the future.

3. Real Life over-rides the Exercise If for some reason it is determined that a situation exists at any of the hospitals that would be a major emergency or disaster then the exercise will be immediately terminated at that location. This determination will be made by the hospital in question and their decision is final and immediate.

4. Exercise Objectives Functional Exercise Simulating Pandemic Influenza Outbreak. Will test a regional hospital’s ability to respond in two main areas: –surge capacity –isolation Some regional hospitals have identified additional specialized/local needs and appropriate injects are in their individual handbooks

5. Our Exercise Process Individual RCH visits –Research with Los Alamos/CDC, etc. FluAid no spatial or temporal component Los Alamos model accounts for spatial and temporal variation but only runs on supercomputer –GPH/GHA inputs –Scenario design and Inject Customization

6. The Process (cont’d) –Recruiting RCH familiar experienced Evaluators/Controllers –Quality Assurance calculated bed needs for each regional hospital for different times during the pandemic –Adjustments made to account for expressed local needs and specific injects prepared

7. Flu Pandemic Background The Flu…what is it? What is an Influenza Pandemic? –History Detailed Assumptions Customizing to the RCH’s Los Alamos/Modeling

8. Influenza Avian (bird) influenza virus- –usually refers to influenza A viruses found chiefly in birds – infections can occur in humans – very rarely does it involve human to human transmission (then not beyond one person) Pandemic Influenza is a global outbreak – occurs when a wholly new strain of influenza emerges – has the ability to infect and be transmissible between humans

9. Influenza Respiratory infection Transmission: contact with respiratory secretions from an infected person who is coughing and sneezing Incubation period: 1 to 5 days from exposure to onset of symptoms Communicability: Maximum 1-2 days before to 4-5 days after onset of symptoms Timing: Peak usually occurs December through March in North America

10. America’s Forgotten Pandemic by Alfred Crosby “The social and medical importance of the 1918-1919 influenza pandemic cannot be overemphasized. It is generally believed that about half of the 2 billion people living on earth in 1918 became infected. At least 20 million people died. In the Unites states, 20 million flu cases were counted and about half a million people died. It is impossible to imagine the social misery and dislocation implicit in these dry statistics.”

11. Impact of Past Influenza Pandemics/Antigenic Shifts Pandemic, or Antigenic Shift Excess MortalityPopulations Affected 1918-19 (A/H1N1) 500-700,000Persons <65 years; 2 nd peak for 30 year olds 1957-58 (A/H2N2) 70,000Infants, elderly 1968-69 (A/H3N2) 36,000Infants, elderly 1977-78 (A/H1N1) 8,300Young (persons <20)

12. America’s deaths from influenza were greater than the number of U.S. servicemen killed in any war… Civil WWI 1918-19 WWII Korean Vietnam War Influenza War War Thousands

13. 1918 Flu

15. Flu Pandemic Simulation Population Affected USA Georgia Population (2006) 299m 9m Ill 90m 2.7m Outpatient care 45m 1.35m Hospitalization 9.9m297,000 ICU Care 1.5m 44,000 Mechanical Ventilation 0.75m 22,000 Deaths 1.9m 57,000 Estimates are based upon DHHS and Georgia DPH numbers

16. Los Alamos Influenza Model Los Alamos model rather than FluAid Allows determination of spatial and temporal characteristics of flu Works at census tract level and models interaction of people in clusters

17. Impact of R Value on Flu Pandemic in U.S.A. Our Simulation R Value (infection rate)1.61.92.12.4 Cumulative ill (millions)92122136151 Ill (% ill) 33%43%48%54% Daily New Cases at Peak (m) 2.34.56.07.9 Peak of Epidemic (day) 117 857564 Population in millions based on 2000 Census of 281 million for U.S. 2006 population is 299m R is the basic reproductive number – essentially the number of people you infect when you have the flu. Numbers calculated using Los Alamos Influenza Model

18. Flu Distribution on Day 60 R=1.9 Red = 3% ill Yellow 0.3% ill

19. How Were the Flu Figures Derived? DHHS Figures US – Georgia – Regional Hospital Regional Population Amounts – 20 mile radius New ill New ill by hospital 8 day running totals to get beds.

20. New Cases by Day of Pandemic Flu

21. Regional Coordinating Hospitals with 20 mile Buffers

22. Hospital Players: Who is Participating? Regional Coordinating Hospital (RCH) Staff, including Emergency Planner (Regional Coordinator) and other disciplines Community Partners Other Regional Hospital staff, including Emergency Planners

23. Hospital Players: Roles and Responsibilities Emergency Planners (Regional Coordinators) facilitate exercise Hospital Command Center is base of operations WebEOC and LiveProcess are primary communication channels

24. Roles of the RCHStaff Emergency Planners (Regional Coordinators) are typically the Incident Commander for the Exercise Incident Command Structure for Exercise should be reviewed by Emergency Planner as Exercise Players are introduced prior to Exercise play All Players should participate in the Hot Wash via the Conference Call

25. General Guidance General Guidance for: Evaluators: Evaluators are listeners that record player reactions to the MSELs. (Master Scenario Event Log) Controllers: Controllers are on-site exercise team members who are responsible for maintaining the intended direction of the exercise.

26. Controllers And Their Role Controllers are the coordinators of the exercise at their locations. They are responsible for the continuity of flow of the exercise at their location. They may interact with the players, but not coach them. They are the link between the players and the SIMCELL and may, with concurrence of the SIMCELL, interject additional tasks into the exercise to bring the exercise back on track or speed exercise response to ensure that the exercise proceeds smoothly.

27. Evaluators And Their Role Evaluators are responsible for observing all the actions and decisions of the players and recording them for submission and inclusion in the “After Action Report”. Evaluators are observers and do not interact with the players.

28. SIMULATION CELL The “SIM CELL”, responsible for sending the injects into the exercise, will be located at the Department of Human Resources EOC and will initiate the exercise from that location. The SIM CELL will control all injects into the exercise and may at its discretion add additional injects to either keep the exercise on point or to adjust the speed or flow of the exercise. All communications relative to these decisions will be implemented through WebEOC and/or communicated through the Controllers.

29. “HOT WASH” Immediately following the exercise the controller leads the “Hot Wash” and allows players to provide immediate feedback. This enables controllers and evaluators to capture information about events while they are still fresh in the players’ minds. The “Hot Wash” is an opportunity to ascertain the level of satisfaction with the exercise, identify issues or areas of concerns and propose items for improvement.

30. “HOT WASH” con’t Immediately after the termination of the exercise the Controller, assisted by the Evaluator, will conduct an “in Hospital Hot Wash”. There are 15 Minutes allowed for this before the start of the overall “Hot Wash” where all of the participating Regional Hospitals will have input. The items discussed at the “in hospital” portion of the “Hot Wash” should be germane to that facility and those discussed in the overall should be germane to the overall exercise.

31. REPORTING Exercise Evaluation Guides (EEGs) –EEGs will be completed by both Coordinators and Evaluators independently. –EEGs are designed to provide an organized method of capturing pertinent observations that relate to specific injects or MSELs. EEGs are located in appendix F and are organized by MSEL and provide appropriate space for notations. If sufficient space is not available on the form please notate the MSEL number and your comments and attach them to your report.

32. REPORTING con’t Controllers and Evaluators will complete all EEGs, their individual observations of the discussions occurring during the “Hot Wash”, and a written synopsis of all observations to include impressions of the exercise and recommendations for improvements in both hospital operations and the exercise performance. These items along with the Exercise Handbook should be placed in the return UPS envelope and sent to be received by CMADD no later than the Thursday following the conclusion of the exercise.

33. COMMUNICATIONS SIM CELL: Evaluators and Controllers may call the SIM CELL with questions on the following telephone numbers: –Controllers – 404-463-1007 –Evaluators – 404-463-1232 These numbers are at Appendix D in your handbook RCH’S – Communications between RCH’S will be done through the Controller only. Exercise communications will be done, in order of preference, through WebEOC. If WebEOC becomes unavailable communications will be then by Fax, and if needed, then by individual reading of MSELs by the Controllers. OTHERS – If applicable, communications between RCH’s and their hospitals should be done utilizing Live Process first and then by other means as appropriate.

34. To facilitate this process evaluators and controllers must take an objective view

35. The UGA CMADD Exercise Team, The Georgia Department of Public Health and the Georgia Hospital Association would like to thank all of you for your assistance in bringing this unique exercise to fruition for the benefit of the Hospitals participating and the citizens of Georgia.