1 alameda county disaster preparedness health coalition · alameda county disaster preparedness...

Alameda County Disaster Preparedness

Health Coalition

11

Medical and Health Tabletop

Exercise - January 22, 2015

ScopeScope

��This tabletop exercise was planned for This tabletop exercise was planned for Alameda County Disaster Alameda County Disaster Preparedness Health Coalition partners Preparedness Health Coalition partners and county response agencies. and county response agencies.

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and county response agencies. and county response agencies.

Assumptions and ArtificialitiesAssumptions and Artificialities

�� In any exercise, assumptions and artificialities may In any exercise, assumptions and artificialities may

be necessary to complete play in the time allotted. be necessary to complete play in the time allotted.

During this exercise, the following apply:During this exercise, the following apply:

�� The scenario is plausible, and events occur as they The scenario is plausible, and events occur as they

are presented.are presented.

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are presented.are presented.

�� There is no hidden agenda, and there are no trick There is no hidden agenda, and there are no trick

questions.questions.

�� All players receive information at the same time.All players receive information at the same time.

Exercise Core CapabilitiesExercise Core Capabilities

� Medical Surge

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� Intelligence & Information Sharing

Exercise ObjectivesExercise Objectives

1.1. Increase understanding of medical surge planning Increase understanding of medical surge planning

among healthcare partners.among healthcare partners.

2.2. Increase understanding of medical surge response Increase understanding of medical surge response

capabilities among healthcare partners. capabilities among healthcare partners.

3.3. Increase understanding of roles and Increase understanding of roles and

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3.3. Increase understanding of roles and Increase understanding of roles and

responsibilities of county response and responsibilities of county response and

coordination agencies.coordination agencies.

4.4. Describe how your agency/facility would Describe how your agency/facility would

communicate situation status and resource communicate situation status and resource

requests to the Alameda County Emergency requests to the Alameda County Emergency

Operations Center.Operations Center.

Exercise ObjectivesExercise Objectives

5.5. Discuss coordinated patient care for the Discuss coordinated patient care for the

communities within the geographic hubs.communities within the geographic hubs.

6.6. Describe how your organization would identify and Describe how your organization would identify and

share resource needs and communicate them share resource needs and communicate them

within your geographic hub. within your geographic hub.

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within your geographic hub. within your geographic hub.

7.7. Identify medical surge and communication gaps.Identify medical surge and communication gaps.

Exercise Ground RulesExercise Ground Rules

� Assume the scenario is real and may impact the jurisdiction, the participants and the community.

� Participate in a collegial manner: share policies,

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� Participate in a collegial manner: share policies, plans and practices that may benefit others.

� Follow communications etiquette: turn off cell phones, smart phones, computers, and any other electronic data equipment.

Exercise Sections Exercise Sections

� Earthquake Introduction & Background

� Medical Surge Definitions

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� 6.9 Hayward Fault Earthquake Scenario & Tabletop Discussion

Alameda County Medical Surge PlanAlameda County Medical Surge Plan

� Provides a methodology to augment the healthcare

delivery system

� The expansion during a healthcare surge may

include health care system-wide disaster response

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include health care system-wide disaster response

to ensure a continuum of patient care and

integration with the healthcare partners.

� May require the surge plan activation with the close

coordination and cooperation of Alameda County

partners.

Alameda County Medical Surge PlanAlameda County Medical Surge Plan

�� Is linked with ACPHD, EMS providers, and health care Is linked with ACPHD, EMS providers, and health care

partners all of which are involved in the planning and partners all of which are involved in the planning and

response process. response process.

�� May May not be accomplished in a vacuum of planningnot be accomplished in a vacuum of planning. .

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�� Serves in concert with existing health care facility plansServes in concert with existing health care facility plans

�� Each implementation is unique and dependent on the Each implementation is unique and dependent on the

nature of the disaster, population served, type and level nature of the disaster, population served, type and level

of care, duration of operation, and access to resources. of care, duration of operation, and access to resources.

6.9 Hayward Fault Earthquake6.9 Hayward Fault Earthquake11

What Can What Can

WEWE

Expect?Expect?

Photo by FEMA: Eilis Maynard - Aug 27, 2014

Scenario Scenario –– January 22, 10:00amJanuary 22, 10:00am12

� A magnitude 6.9 Earthquake struck the Hayward

Fault South of Fremont. Heavy shaking was felt for

as long as 45 seconds in some areas.

� The Alameda County Emergency Operations Center

and the Alameda County Health Care Services

Agency Department Operations Center (HCSA DOC)

have been activated.

� This Earthquake is more than 15 times larger than

Napa Earthquake.


� Hospitals are quickly being overwhelmed with high

acuity/critical adult and pediatric patients and will need

to expand capacity and capability to take more critical

patients.

� Some hospitals including at least one bay area pediatric � Some hospitals including at least one bay area pediatric

referral center may be partially functional. Both acute

care and critical care capacity and capability need to be

maximized.

� You should expect approximately150 patients requiring

emergency care in the first two operational periods.


� Caldecott Tunnel is currently closed for assessment.

The BART Rail Transit Tunnel has a train trapped in the

side waiting for response crews to assist with

evacuation and assess the need for medical care.

� Ambulance Transports are hindered by road conditions -� Ambulance Transports are hindered by road conditions -

field treatment sites will likely need to be established.

� Healthcare facilities are temporarily isolated due to road

closures.

� Assume you are on your own for the first 24-48 hours.

Do not expect mutual aid for up to 3 days.

Road Conditions – 11:30am

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� The 580/238 Interchange has been damaged and is

currently impassible – the 580 East has severe

congestion and Westbound is down to 2 lanes.

Image: SF-info.org

The 580/980 Interchange

and 880/580 Interchange

are currently closed to

traffic.

Scenario Scenario –– January 22, 12:00pmJanuary 22, 12:00pm

The EOC phone line is receiving damage The EOC phone line is receiving damage

reports from cities and other facilities and reports from cities and other facilities and

dispatch is receiving numerous calls of dispatch is receiving numerous calls of

serious injuries and fatalities from all cities serious injuries and fatalities from all cities

along the Hayward Fault. Although the true along the Hayward Fault. Although the true

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along the Hayward Fault. Although the true along the Hayward Fault. Although the true

extent of the damage and casualties cannot extent of the damage and casualties cannot

be assessed for several more hours, images be assessed for several more hours, images

of damaged freeways, buildings and schools of damaged freeways, buildings and schools

are already circulating on the internet. are already circulating on the internet.

Scenario Scenario –– January 22, 12:00pmJanuary 22, 12:00pm

�� City and special district EOCs are in the City and special district EOCs are in the process of activating. Most impacts are in process of activating. Most impacts are in North, Central, & South County. Aftershocks North, Central, & South County. Aftershocks have occurred & were felt throughout the Bay have occurred & were felt throughout the Bay Area. Numerous fires & collapsed building Area. Numerous fires & collapsed building responses are in progress. responses are in progress.

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responses are in progress. responses are in progress.

�� The OES Coastal Region EOC has been The OES Coastal Region EOC has been activated. Sheriff has declared local activated. Sheriff has declared local emergency for all of Alameda County and is emergency for all of Alameda County and is asking the Governor to declare a State of asking the Governor to declare a State of Emergency. Emergency.

Alameda County 6.9 Hayward EarthquakeAlameda County 6.9 Hayward Earthquake

Expected High Damage Areas

Community Impact Community Impact

�� Water Supply Contamination Water Supply Contamination

�� Water Supply AvailabilityWater Supply Availability

�� Population Displacement Population Displacement

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�� Population Displacement Population Displacement

�� Public Utilities Disruption Public Utilities Disruption

�� Transportation Disruption.Transportation Disruption.

�� Mass Transit/BART DisruptionMass Transit/BART Disruption

Key IssuesKey Issues

1.1. Casualties and injuries countywideCasualties and injuries countywide

2.2. Communication systems intermittentCommunication systems intermittent

3.3. Transportation capabilities reducedTransportation capabilities reduced

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3.3. Transportation capabilities reducedTransportation capabilities reduced

4.4. Some loss of infrastructureSome loss of infrastructure

Scenario AssumptionsScenario Assumptions

�� Hospital Command Centers (HCCs) are activated. Hospital Command Centers (HCCs) are activated.

�� Clinics and Long Term Care Facilities will implement and Clinics and Long Term Care Facilities will implement and

ICS structure to respond to command and control the ICS structure to respond to command and control the

incident and activate a command center as possible.incident and activate a command center as possible.

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incident and activate a command center as possible.incident and activate a command center as possible.

�� Response agencies and facilities have activated their Response agencies and facilities have activated their

medical surge plans. medical surge plans.

�� Medical surge plan is activated.Medical surge plan is activated.

�� Your facility has several staff with minor injuries requiring Your facility has several staff with minor injuries requiring

first aid treatment.first aid treatment.


�� 10% of your staff has indicated they will not be able 10% of your staff has indicated they will not be able

to report to work for their next shift.to report to work for their next shift.

�� 15% of your staff indicates they will require childcare 15% of your staff indicates they will require childcare

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�� 15% of your staff indicates they will require childcare 15% of your staff indicates they will require childcare

in order to report to work as many schools have had in order to report to work as many schools have had

to close due to damaged facilities. to close due to damaged facilities.

�� 10% of your inpatients need to be evacuated and/or 10% of your inpatients need to be evacuated and/or

relocated internally due to damage.relocated internally due to damage.


�� During Operational Period, aftershocks will be likely During Operational Period, aftershocks will be likely and building evacuation will need to be continuously and building evacuation will need to be continuously considered. considered.

�� An initial assessment by facility engineers have An initial assessment by facility engineers have

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�� An initial assessment by facility engineers have An initial assessment by facility engineers have verified 20% damage to your facility, but a final verified 20% damage to your facility, but a final damage assessment will not be completed for 24damage assessment will not be completed for 24--72 72 hours.hours.

�� Transportation can only occur within the Transportation can only occur within the geographical hubs as indicated temporarily until geographical hubs as indicated temporarily until roads and infrastructure can be restored.roads and infrastructure can be restored.

Temporary Geographical “Hubs”Due To Road Conditions

Kaiser

Oakland

Children’s

Hospital

University Health

Services

Highland

Hospital

Alameda Hospital

Willow Rock

Valleycare Medical Axis Community

Alta Bates Summit,

Berkeley

Alta Bates Summit,

Oakland

Kaiser San Leandro

San Leandro

Hospital

Eden Medical

Center

Axis Community

Center

680

580

580

80

Washington

Hospital

Valleycare Medical

CenterAxis Community

Center

Axis Community

Center

Kaiser

Hayward

St. Rose

Hospital

880

680

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1.1. Describe your top medical surge priorities and Describe your top medical surge priorities and

immediate action plans for this incident.immediate action plans for this incident.

2.2. What is your organization’s current surge What is your organization’s current surge

capacity and capability for patient care? capacity and capability for patient care?

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Questions for Discussion Questions for Discussion –– All ParticipantsAll Participants

capacity and capability for patient care? capacity and capability for patient care?

a)a) How will you expand capability to take care of How will you expand capability to take care of increasing numbers of patients? increasing numbers of patients?

b)b) How will you decompress and offload less critical How will you decompress and offload less critical patients?patients?

c)c) Are your prepared to receive more patients, Are your prepared to receive more patients, remain open and functional?remain open and functional?

3. How can your organization be self3. How can your organization be self--sufficient sufficient

when mutual aid is not immediately available? when mutual aid is not immediately available?

a.a. What resources needs do you think you will What resources needs do you think you will

have?have?

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b.b. What partner organizations might you rely What partner organizations might you rely

upon?upon?

4. What vital medical surge operational area 4. What vital medical surge operational area

(county) forms and communications systems do (county) forms and communications systems do

you need for this event? you need for this event?

5. How do you see ambulance companies,

hospitals, clinics and long term care facilities

supporting each other? Given the geographic

restrictions in this scenario, how would you work

together?

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together?

6. What internal/external (county) response plans

will you be referencing and/or are relevant to this

event?

Tabletop Discussion Breakout Tabletop Discussion Breakout

� Exercise Planning & Planners

� Facilitators, Subject Matter Experts (SMEs), Evaluators & Department

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(SMEs), Evaluators & Department Officials

� Review of Tabletop Discussion Schedule

Tabletop DiscussionTabletop Discussion

� Participants will break out into groups by geographic

area or “hub” to discuss medical surge and

communications.

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� Participants will report back from their “hubs” for a

broader understanding of current medical surge and

communication capabilities.

Report BackReport Back

� Please report the key highlights from your groups’ discussion.

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� 5 Minutes per group

Exercise DebriefExercise Debrief

1.1. What went well?What went well?

2.2. What needs improvement?What needs improvement?

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3.3. Did the exercise structure provide Did the exercise structure provide sufficient stimulation for discussion?sufficient stimulation for discussion?

Closing Comments & EvaluationsClosing Comments & Evaluations

�� Thank you for your participation today!Thank you for your participation today!

�� Please be sure to fill out and submit a Please be sure to fill out and submit a participant feedback form.participant feedback form.

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participant feedback form.participant feedback form.�� Discussion and feedback captured during todayDiscussion and feedback captured during today’’s tabletop will be utilized s tabletop will be utilized

for revisions and improvement of the plans presented today.for revisions and improvement of the plans presented today.

�� Additionally, comments, suggestions, recommendations, and feedback from Additionally, comments, suggestions, recommendations, and feedback from

participant feedback forms will be reviewed. participant feedback forms will be reviewed.

�� Comments and discussion will be included in the After Action Report.Comments and discussion will be included in the After Action Report.

Conclusion of Conclusion of DiscussionDiscussion--Based TabletopBased Tabletop

Thank you!Thank you!

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1.1. Based on the scenario where you are isolated based on your geography, you will get a surge of patients, Based on the scenario where you are isolated based on your geography, you will get a surge of patients, how will you expand your capacity to take more patients including critical care patients, pediatrics, how will you expand your capacity to take more patients including critical care patients, pediatrics, neonatal and behavioral/mental health patients?neonatal and behavioral/mental health patients?

2.2. Given the scenario, interGiven the scenario, inter--facility transport will be very difficult, how will you decompress your hospital to off facility transport will be very difficult, how will you decompress your hospital to off load less acute patients? load less acute patients?

3.3. What resources What resources you willyou will need to increase you capacity to take more patients, equipment and personnel.need to increase you capacity to take more patients, equipment and personnel.

4.4. What would be your incident objectives as it relates to medical surge in the 1st operational period? What What would be your incident objectives as it relates to medical surge in the 1st operational period? What about the 2nd and 3rd operational periods? about the 2nd and 3rd operational periods?

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Questions for Discussion Questions for Discussion -- HospitalsHospitals

about the 2nd and 3rd operational periods? about the 2nd and 3rd operational periods?

5.5. Describe the makeup of the various sections and branches you would activate in the 1st operational Describe the makeup of the various sections and branches you would activate in the 1st operational period. What about the 2nd and 3rd operational period? period. What about the 2nd and 3rd operational period?

6.6. What considerations should be made at your facility if you receive an immediate surge of the following What considerations should be made at your facility if you receive an immediate surge of the following types of victims (based on an earthquake scenario)? types of victims (based on an earthquake scenario)?

a. Crusha. Crush

b. Burnb. Burn

c. Pediatricc. Pediatric

7.7. For larger healthcare systems (e.g. Kaiser and Alameda) would you stay “in network” when accepting or For larger healthcare systems (e.g. Kaiser and Alameda) would you stay “in network” when accepting or transferring patients during a medical surge?transferring patients during a medical surge?

8.8. Describe how hospitals can/should operate under a “Hub” concept in the context of this scenario. Describe how hospitals can/should operate under a “Hub” concept in the context of this scenario.

1.1. Are you planning on staying open?Are you planning on staying open?

2.2. What level of care will you be able to provide?What level of care will you be able to provide?

3.3. What does medical surge mean to you? What does medical surge mean to you?

4.4. What is your surge capacity?What is your surge capacity?

5.5. Are you willing/able to be a triage center?Are you willing/able to be a triage center?

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Questions for Discussion Questions for Discussion -- ClinicsClinics

6.6. Can you provide Mental Health support?Can you provide Mental Health support?

7.7. Can you sustain operational hours for extended periods of time? If so how long?Can you sustain operational hours for extended periods of time? If so how long?

8.8. What resources do you think you will need to stay open?What resources do you think you will need to stay open?

9.9. If you stay open and high acuity patients show at your facility that exceed your If you stay open and high acuity patients show at your facility that exceed your capabilities, what would be done to get them transferred to a facility that can capabilities, what would be done to get them transferred to a facility that can provide a higher level of care? provide a higher level of care?

10.10. Describe how hospitals can/should operate under a “Hub” concept in the context Describe how hospitals can/should operate under a “Hub” concept in the context of this scenario. of this scenario.

1.1. What does medical surge mean to you?What does medical surge mean to you?

2.2. Do you feel you have any surge capacity?Do you feel you have any surge capacity?

3.3. What level of care can you provide if any to the community?What level of care can you provide if any to the community?

4.4. What kind of patients can you take? What level of acuity can you What kind of patients can you take? What level of acuity can you take? take?

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Questions for Discussion Questions for Discussion -- LTCFsLTCFs

5.5. Would you be able to care for a new patient 1/day 4/day?Would you be able to care for a new patient 1/day 4/day?

6.6. What skills can your LTCF provide that cannot be provided by What skills can your LTCF provide that cannot be provided by homecare? E.g., can you provide suctioning, feeding tube homecare? E.g., can you provide suctioning, feeding tube assistance, IVs, dialysis, catheterizations?assistance, IVs, dialysis, catheterizations?

7.7. Would you be able to accommodate patients from other LTCFs in the Would you be able to accommodate patients from other LTCFs in the area? Do you have any MOUs or Transfer Agreements in place?area? Do you have any MOUs or Transfer Agreements in place?

8.8. Describe how hospitals can/should operate under a “Hub” concept in Describe how hospitals can/should operate under a “Hub” concept in the context of this scenario. the context of this scenario.

1.1. How will you coordinate transport between clinics and How will you coordinate transport between clinics and hospitals, hospitals and LTCFs, hospitals and home?hospitals, hospitals and LTCFs, hospitals and home?

2.2. How will patients be directed to treatment facilities that can How will patients be directed to treatment facilities that can take specific patients? take specific patients?

3.3. How will you deal with MCIs in multiple scattered locations?How will you deal with MCIs in multiple scattered locations?

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Questions for Discussion Questions for Discussion -- TransportTransport

4.4. How will you assist in offHow will you assist in off--loading patients from hospital to less loading patients from hospital to less acute hospitals/facilities?acute hospitals/facilities?

5.5. Given the scenario and the likelihood of operating Field Given the scenario and the likelihood of operating Field Treatment Sites, what is your surge plan how will you get more Treatment Sites, what is your surge plan how will you get more ambulances?ambulances?

6.6. How will you sustain operations and what will you need from How will you sustain operations and what will you need from the county?the county?

Questions for Discussion Questions for Discussion -- CountyCounty

�� Public Health: Public Health: Describe what branches and teams Describe what branches and teams

will be staffed at the DOC immediately after the will be staffed at the DOC immediately after the

earthquake? earthquake?

�� Environmental Health: Environmental Health: What activities will be What activities will be

coordinated with other county agencies?coordinated with other county agencies?

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coordinated with other county agencies?coordinated with other county agencies?

�� Behavioral Health : Behavioral Health : How will you handle Mental How will you handle Mental

Health surge? Do you have Mobile Mental Health Health surge? Do you have Mobile Mental Health

Teams?Teams?

�� Describe the composition of these teams. Describe the composition of these teams.

�� How would they be notified and activated in a How would they be notified and activated in a

scenario such as this? scenario such as this?

Questions for Discussion Questions for Discussion -- CountyCounty

�� Emergency Medical Services: Emergency Medical Services: What kind of What kind of ReddiNet polling questions will be asked first to get ReddiNet polling questions will be asked first to get an accurate assessment of the situation?an accurate assessment of the situation?

�� Human Resources: Human Resources: What plans do you have in What plans do you have in place to address the reduction in staff for the overall place to address the reduction in staff for the overall

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place to address the reduction in staff for the overall place to address the reduction in staff for the overall county response?county response?

�� Alameda County Office of Emergency Services: Alameda County Office of Emergency Services: What activities will be coordinated with other county What activities will be coordinated with other county agencies?agencies?

�� General Services Agency: General Services Agency: What activities will be What activities will be coordinated with other county agencies?coordinated with other county agencies?

Alameda County Communication Alameda County Communication Coordination Questions Coordination Questions

1.1. What are your redundant communications? What are your redundant communications? How often do you practice using these How often do you practice using these communications?communications?

2.2. What kind of information will you send to the What kind of information will you send to the 2.2. What kind of information will you send to the What kind of information will you send to the county in the situation reports?county in the situation reports?

3.3. What kind of resources do you think you will What kind of resources do you think you will be requesting from the cities and the county to be requesting from the cities and the county to sustain your operations?sustain your operations?

4.4. What are you redundant communications if What are you redundant communications if cell phone service and/or power are cell phone service and/or power are interrupted?interrupted?

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