1. PRESENTED BY OHIO CENTRAL REGION HOSPITALS Mass Fatality Management Tabletop Exercise (TTX) www.ParatusSolutions.org

2. BEFORE WE BEGIN Restrooms Exits Drinks Materials Breaks and Lunch

3. TODAY’S AGENDA Introductions Purpose and Scope of Exercise Exercise Objectives Exercise Participants & Guidelines Presentation of the Exercise Scenario Hot wash & Close Out

4. PURPOSE AND SCOPE Purpose  To measure response effectiveness against current response concepts, written plans, procedures and capabilities for mass fatality management (MFM). Scope  This exercise examines Central Region Hospital (CRH) response to an incident that generates in-hospital deaths that exceed morgue capacity with limited or no local decedent management resources.

5. EXERCISE OBJECTIVES www.ParatusSolutions.org Incident Command Decedent Management: Identification and Tracking Resource Management Communications Medical Surge

6. PARTICIPANTS Players Evaluators Facilitators/Controllers Observers

7. EXERCISE STRUCTURE Module 1: Response and Notifications Module 2: Incident Escalation Module 3: Reconstitution – Return to Normal

8. TYPES OF EXERCISE Full Scale Functional Table Top THIS IS A TABLE TOP EXERCISE

9. EXERCISE GUIDELINES www.ParatusSolutions.org This is a low-stress, no-fault environment. Varying viewpoints, even disagreements, are expected. Respond based on your knowledge of your hospital’s current plans and capabilities, (i.e., you may use only existing assets) and insights derived from training. Decisions are not precedent setting and may not reflect your organization’s final position on a given issue. This is an opportunity to discuss and present multiple options and possible solutions.

10. ASSUMPTIONS The scenario is plausible. Events occur as they are presented. Everyone gets the same information. There are no trick questions. There are no hidden agenda. There is no one right answer.

11. Questions before we begin??

12. MODULE 1 RESPONSE AND NOTIFICATIONS

13. APRIL 20, 2011 The hospital has been receiving an influx of patient presenting with flu-like symptoms. Six (6) of these patients have died exhausting morgue capacity. Funeral homes have accepted receipt of these decedents per typical procedures.  A hospital staff member has just been admitted with flu symptoms.

14. APRIL 20, 2011  Labs show this virus to be consistent with recent CDC notifications regarding an outbreak of influenza (named H1NA) that appears to have originated in Mexico City, Mexico in late January.  Reports come too late to relocate Super Bowl XLV and post-event, the virus was quickly found in 10 states.  Two weeks ago, Ohio joined these ranks with four (4) H1NA patients, one of which died.

15. APRIL 20, 2011  The virus is virulent and is currently reflecting a 2.5% mortality rate.  630 dead in Mexico and 105 in the United States from H1NA.  CDC has been able to isolate the virus and a vaccine is being rapidly produced.  Healthcare workers will be included in Tier One distribution which is expected soon.  The hospital is not seeing a dramatic reduction in staff from fear/illness, however, they are a bit uneasy.

16. MODULE 1 DISCUSSION Would the Hospital Incident Command System be activated at this point? If so, what is the activation process? Which positions would currently be in play? Would the hospital’s mass fatality plan be activated at this point? If so, what MFM HICS positions would be activated? Would you have any security concerns at this point? Would you consider selecting alternate morgue space now? Where? What notifications, if any, would you make?

17. MODULE 1 DISCUSSION Would you request additional resources at this point? If so, what and from whom? What other hospital plans, if any, would be activated? Would you call in additional staff? What other actions would you take at this point?

18. MODULE 2 EVENT ESCALATION

19. APRIL 25, 20110935 HOURS www.ParatusSolutions.org In the last five (5) days, the hospital has seen a dramatic increase in patients with H1NA. Fifteen more H1NA deaths have occurred and more are inevitable. Only two (2) of the decedents were picked up by funeral homes which are now completely inundated and are asking hospitals to hold bodies until they can pick them up. Hospital morgue capacity has been exceeded by nine (9) bodies.

20. APRIL 25, 20110935 HOURS www.ParatusSolutions.org All but one CRH has exceeded their morgue capacity and staffed bed capacity.  Newscasters are reporting H1NA deaths in 2/3 of the country with 5500 deaths in the U.S. to date.  A Public Health Emergency has been declared by the Dept. of Health and Human Services Secretary.  Schools and businesses are closing due to lack of attendance and clientele.  Staff numbers are down by 10% and one has died from HINA

21. APRIL 25, 20112100 HOURS www.ParatusSolutions.org Three more patients have died since this morning, one of which expired in triage without any identification. Funeral homes have still not picked up the nine (9) bodies and are now reporting that they will be unavailable to assist the hospital with decedents for the foreseeable future. You now have 4 bodies in the morgue, and 12 bodies in alternate storage. Coroner was contacted for assistance. Answering machine messages states that they are unable to accept any bodies at this time. Mailbox was full.

22. APRIL 27, 2011 www.ParatusSolutions.org  Four more patients have died from H1NA. Your alternate morgue space is diminishing.  No local decedent resources have as yet come forward to assist the hospital with decedents.  Tier One distribution of the vaccine has been dispensed to hospital staff but not their families. Many hospital members are choosing to stay at work to avoid bringing the virus home.

23. MODULE 2 DISCUSSION www.ParatusSolutions.org Have any additional HICS positions been activated? Have any additional fatality management operations positions been activated that were not initially activated? Have you implemented any additional hospital plans since the initial response? Have you made any additional notifications? How will you handle staff housing? How are you tracking decedents?

24. MODULE 2 DISCUSSION www.ParatusSolutions.org Would you request additional resources at this point? If so, what and from whom? How is the hospital keeping current with local and national information? Have you made any implementations regarding staffing shortages? How are you keeping your staff informed of current information? What are your priority action items for consideration at this point in the incident? Do you have any security issues at this point?

25. MODULE 3 RECONSTITUTION – RETURNING TO NORMAL OPERATIONS

26. MAY 1, 2011 www.ParatusSolutions.org  In the last five days, seven (7) more patients have expired from H1NA. The county opened a community morgue yesterday and will accept the hospital’s bodies but has not way to pick them up.  Tier One vaccine distributed four (4) days ago has helped staffing levels. General public began receiving the vaccine two (2) days ago.  Hospital and public moral has shown improvement but many are suffering from stress-related issues.

27. MAY 3, 2011 www.ParatusSolutions.org Many staff that suffered from illness would like to come back to work but do not have the stamina to work a regular shift. Patient influx has diminished greatly in the past two (2) days alone with many alternate care areas of the hospital being returned to normal use. Local and national news is reporting signs of viral illness diminishing across the country.

28. MODULE 3 DISCUSSION www.ParatusSolutions.org Does your hospital have a plan to get the bodies to the community morgue? What are your priority action items at this point? What hospital recovery plans would be instituted? Do you have the resources to provide immediate and long-term stress management or mental health services to your personnel? If not, how can those services be obtained? What documentation needs to be initiated for the incident and future cost reimbursement submission?

29. www.ParatusSolutions.org

30. HOT WASH EVALUATORS PARTICIPANTS