1. PRESENTED BY OHIO CENTRAL REGION HOSPITALS Evacuation/Shelter-in-Place (SIP) Tabletop Exercise (TTX) www.ParatusSolutions.org

2. BEFORE WE BEGIN Restrooms Exits Drinks Materials Breaks

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 evacuation/shelter-in-place (SIP). Scope  This exercise examines Central Region Hospital (CRH) plans to effectively evacuate and/or receive patients from an evacuation, and also evaluates decision-making regarding evacuation and SIP.

5. EXERCISE OBJECTIVES www.ParatusSolutions.org Incident Command Evacuation and/or Shelter-in-Place Protection Resource Management Communications Medical Surge

6. PARTICIPANTS Players Evaluators Facilitators/Controllers Observers

7. EXERCISE STRUCTURE Module 1: Decision Making and Notifications Module 2: Shelter-in-Place (SIP) Response Module 3: Evacuation Response Module 4: Hospital Receipt of Evacuees

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 DECISION MAKING AND NOTIFICATIONS

13. APRIL 20, 20111630 HOURS Shift change has just occurred at the hospital. Many first shift staff have decided to wait out the storm at the hospital rather than wade into traffic. The hospital still has full power and is monitoring the weather radio. The hospital is at 85% capacity.  Tornado warnings have been issued until 1830 Hours but no touchdowns have as yet been reported.  Predicted storms have arrived in the Central Region with a vengeance. Heavy rain and high winds are wreaking havoc with power lines. Rush hour traffic is at a standstill.

14. APRIL 20, 20111710 HOURS Tornado sirens begin blaring and emergency weather reports indicate that a tornado has just touched down 10 miles west of the hospital with reports that another, one mile north, has also touched down. Both are heading east towards the hospital at 25 miles per hour. Code Gray – Tornado Warning is paged overhead and patients are moved into hallways away from danger of shattering glass.

15. APRIL 20, 20111740 HOURS  Sounds of wind outside are deafening. Debris in the air is hurl against the west side of the hospital and shattering glass can be heard inside the building.  The electricity goes out briefly and comes back on.  Emergency power is operational in many areas but is not functioning in some areas requiring the need to pass out flashlights to be able to see at all.  The noise outside begins to slowly fade.

16. APRIL 20, 20111815 HOURS www.ParatusSolutions.org  A building assessment has been made. All glass on the west side of the hospital, mostly patient rooms (50% of hospital total) and administrative offices has been blown out.  A switch on the generator’s panel has blown leaving some areas of the hospital without emergency power including the Med/Surg unit and ICU.  A replacement switch for the generator is not onsite. Hospital vendors report at least a 36-hour timeframe for delivery of the new one.

17. 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 consider evacuation or SIP at this point? Who would make this decision based on what critical factors? What notifications would you make at this point? Would you request additional resources at this point? If so, what and from whom?

18. MODULE 2 DISCUSSION What other hospital plans, if any, would be activated? Would the hospital go on diversion? How will you keep yourselves current regarding the event. What other actions would you take at this point?

19. MODULE 2 SHELTER-IN-PLACE (SIP) RESPONSE

20. APRIL 20, 20111850 HOURS www.ParatusSolutions.org Hospital Incident Commander has decided to immediately evacuate 50% of your inpatients due to limited patient care areas left in the hospital. Critical care patients have been evacuated to other areas within the hospital capable of continuing their care. The Hospital Incident Liaison (HIL) has been contacted for support assistance.

21. APRIL 20, 20111905 HOURS www.ParatusSolutions.org Fifteen minutes after the request for assistance from the HIL, the HIL responds that the Emergency Management Agency has indicated that transportation to support the evacuation is currently unavailable due to damaged infrastructure, and debris clogged traffic arteries around the hospital.  The EMA recommends that the hospital SIP until further notice.

22. MODULE 2 DISCUSSION Would the Hospital Incident Command System be activated or changed at this point? In what ways? What activities would now need to occur for SIP? Would you continue preparations for an eventual evacuation? If yes, what activities would be included in this preparation. Would you have any security issues at this point? What other hospital plans, if any, would be activated?

23. MODULE 2 DISCUSSION Would the hospital go on or stay on diversion? How will you keep yourselves current regarding the event.

24. MODULE 3 EVACUATION RESPONSE

25. APRIL 21, 20110330 HOURS www.ParatusSolutions.org The hospital’s Liaison Officer has just received word from the HIL (via EMA) that the roadways are becoming more clear though some areas are still impassable. The HIL reports that the Ohio Fire Chiefs’ Association (OFCA) Emergency Response Plan has been activated and they are standing by to assist with transportation for your hospital’s evacuation. They are requesting a contact for transportation coordination.

26. APRIL 21, 20110330 HOURS www.ParatusSolutions.org The OFCA has 20 + ambulances for immediate assistance with more available as necessary. The local community transportation agency is also standing by with several city buses. Staff that stayed to avoid storm traffic is now involved in the emergency response.

27. MODULE 3 DISCUSSION www.ParatusSolutions.org Now that the evacuation can proceed, what notifications will you make? Would you call in any additional staff? What security measures would you take now. What HICS positions would you consider activating now? How will you find destinations for your evacuating patients?

28. MODULE 3 DISCUSSION www.ParatusSolutions.org How will you coordinate internal patient movement for transportation out of the hospital? How will you locate the appropriate transportation you need to evacuate? How will you track patients throughout the evacuation process (internally and to the receiving hospital)? How will you notify patient family members regarding transfer location of loved ones? Who else needs to be notified?

29. MODULE 4 HOSPITAL RECEIPT OF EVACUEES (SURGE)

30. APRIL 20, 20111920 HOURS www.ParatusSolutions.org You have been watching the news and hearing reports about severe damage to a large hospital in your County. You realize that your hospital will likely be receiving a surge of community injured as well as evacuees from this hospital. Just as you realize this, a page comes through from the HIL…

31. MODULE 4 DISCUSSION www.ParatusSolutions.org What types of information do you think the HIL will be requesting? Would HICS be activated at this point? If yes, in what capacity or positions? How would you accommodate an influx of patients to your hospital when these patients are from an evacuating facility? Would you call in additional staff at this time? Would you require additional resources?

32. www.ParatusSolutions.org THANKS FOR PLAYING!!

33. HOT WASH EVALUATORS PARTICIPANTS