tabletop exercise - · pdf filewhat is a tabletop exercise? • people come together to...

HCA Education and Research

Supported with Funding from the NYSDOH 1

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TABLETOP EXERCISE

Radiological Dispersal Device

HCA Education & Research Supported with funding from the New York State Department of Health

WHAT IS A TABLETOP EXERCISE?

• People come together to review and discuss a hypothetical emergency situation

• Designed to allow participants to talk through plans and problems

• NOT designed to measure anyone’s performance

• Serves as a springboard for further planning and more comprehensive exercises

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EXERCISE FORMAT

• The scenario has five sections

• Discussion questions follow each section

• At the end of the scenario, everyone will participate in a debriefing or “hotwash”

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EXERCISE ROLES• Facilitator

• Provide instructions, tell the story, introduce the questions, guide the discussion

• Participants• Immerse yourself as if the scenario were truly occurring in your jurisdiction,

using resources that are available to you (Emergency Operations Plan, policies, procedures, references)

• Participate in the group discussions

• Evaluators• Observe the exercise to evaluate the process

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GROUND RULES

• Respond as if the scenario is real

• Play the role of your department, agency or community throughout the exercise

• Operate within current resource constraints and realities

• This is a test of your plan, so you must react according to your plan!!!

• Take notes for discussion and plan evaluation

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OBJECTIVES

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By the end of this exercise, you should be able to:

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•

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Describe your individual and your agency’s roles in the response

Identify at least one gap in your agency’s existing Emergency Operations Plan (EOP)

Contact the appropriate partnering agencies during business hours as well as after hours



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Today in Your Area

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EXPLOSION!

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• A plume of smoke rises and disperses over most of the city

9 DAY 1, 10:30 a.m.

On a bright, sunny morning…

Without warning, a large explosion occurs in downtown Metropolis



• 20 nearby vehicles are immediately destroyed

• Eight surrounding buildings suffer significant blast damage

• Broadway and the interstate ramp suffer extensive damage

10 DAY 1, 10:45 a.m.

Destruction and Devastation

• Local TV and radio interrupted by news of explosion

• Eyewitnesses report seeing rental truck just before the explosion

• Local officials indicate that terrorism cannot be ruled out

11 DAY 1, 11:00 a.m.

Breaking news

• People flee the area in every direction

• Gridlock

• Public transportation overwhelmed

12 DAY 1, 11:00 a.m.

Panic



• First responders declare a mass casualty incident

• Rescue operations impeded by fires and downed power lines

• Some civilians remain to assist initial search and rescue efforts

13 DAY 1, 11:15 a.m.

First responders arrive

• Fires blaze at ruptured gas lines

• Unstable buildings and debris pose immediate hazards to rescue workers

14 DAY 1, 11:15 a.m.

Rescue efforts hampered

• Using radiation detection equipment, first responders discover the bomb contained radioactive material (Radiological Dispersal Device or RDD)

• Immediately cordon off the affected area

15 DAY 1, 11:20 a.m.

Dirty bomb!



• First responders set up decontamination sites outside hot zone

• Other first responders begin to triage victims to determine treatment needs

16 DAY 1, 11:20 a.m.

Mass triage and decontamination

• Hospitals and ED’s quickly fill with walking wounded; nearby hospitals taking diverted patients

• As people evacuate, they spread radioactive dust or “groundshine”

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DAY 1, 11:30 a.m.

Contamination spreads

• Police control the flow of people and materials in and out of the affected area

• An Emergency Operations Center (EOC) is set up a half-mile upwind from the blast site to coordinate operations and resource management

• HAZMAT personnel take the lead in response, victim rescue and recovery

18 DAY 1, 11:45 a.m.

EOC established



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• Clean clothes and blankets needed as victims shed contaminated belongings

• Many people resist giving up personal items

19 DAY 1, 12:00 p.m.

Mass care efforts

fire stations and hospitals set up decontamination facilities

• Radiological experts arrive on the scene

• Identify the radioactive agent as cesium-137

20 DAY 1, 12:15 p.m.

Radioactive agent identified

QUESTIONS

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What is a dirty bomb? What is the FIRST rule regarding exposure to a radio active substance?

What should your first response be when you hear of this event?

What will your agency be doing at this point and what is your role?

What is your agency’s plan for a radioactive event?



QUESTIONS

• What type of injuries typically result from an explosion?• According to your plan, what education will you need to give

staff?• Discuss “ground shine.” How much do you need to know

about it?• If patients call and ask if their nurse or aide will be able to

come today, who takes the call and what should they be told/asked?

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15 minutes to discuss

Communication…

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• Officials publicly confirm that explosive was a radiological dispersal device (RDD), a.k.a. a “dirty bomb”

• Hundreds killed or severely injured

• Thousands may be contaminated

• Many TV channels are explaining potential effects of dirty bomb, providing instructions and urging the public to remain calm

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DAY 1, 12:30 p.m.

Breaking news!



• Large numbers of “worried well” concerned about contamination

• They overwhelm hospitals that are already full of patients

• A mother brings in her two young children:“We don’t live near the explosion area but my children need to be checked for contamination!”

25DAY 1, 2:00 p.m.

Due to nonstop news coverage…

• State radiation monitoring team arrives along with additional responders from:• Fire and rescue

• Emergency Medical Services (EMS)

• State Police arrive to provide security

• Additional state and federal authorities contacted for assistance

• Authorities debate evacuation versus sheltering in place

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DAY 1, 3:00 p.m.

Help arrives

QUESTIONS

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Your agency’s disaster response plan will be activated. Who does this, and what is the chain of command?

What will be the extent and type of injuries resulting from a RDD?

What will be the difference in your agency’s response depending on whether the County & City recommend evacuation or sheltering in place?

10 minutes for discussion



CRISIS…

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29DAY 1, 3:45 p.m.

The crisis intensifies

Roads are closed

Intense security surrounds the city, air ways around the city are closed, airports and trains are shut down

Rescue and recovery efforts at the blast site continue

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DAY 2, 8:00 a.m.

Search for the missing



• 9:15 a.m.

State radiation monitoring

team begins an environmental assessment of the area

• 10:30 a.m.

• 11:15 a.m.

Federal response teams and

Strategic National Stockpile

(SNS) material arrive31

DAY 2

Assisting the local response

National Guard troops arrive to relieve local law enforcement securing the blast area

• The mayor and police chief hold a press conference• Emergency rescue officials indicate 180 known fatalities

• Hospitals have treated 270 individuals directly injured by the blast; hundreds more are not injured by have high rates of contamination from being directly downwind of the event

• City asks citizens to remain at home (SIP) and issues a “hotline” number for citizens who need aid

32DAY 2, 12:00 p.m.

Situation update

QUESTIONS

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Is it safe to be outside yet? How do you know? What is the primary result of a RDD?

How will you locate patients and track staff and patients who have been exposed? What do they need to know?

Who should be called in? Hospice? Mental Health?




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INVESTIGATION…

• Law enforcement officials pursue intense investigation

• FBI establishes hotline for tips and leads

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DAY 2, 1:00 p.m.

Looking for leads

• Emergency shelters are overflowing

• Mental health workers called in to care for people traumatized by the event

36DAY 2, 1:15 p.m.

Shelter Challenges



• State radiation monitoring team reports preliminary results:• Winds spread contamination unevenly, creating “hot spots” of radioactivity

• Radiation has entered air intakes and contaminated interiors of several large downtown buildings

• Main sewage treatment plant contaminated

• River concerns

37DAY 7

Environmental assessment results

QUESTIONS

• Discuss your agency’s EOC, contact information and your role or participation.

• Who will be in charge of providing shelter?• Who would you contact to locate patients?• If area hospitals need to do a “surge discharge,” how do you

determine how many additional patients you can admit?• Who do you need to be able to contact?

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INJECT

• BTW – How is your family?

• What plans do you have as a family?

• How much does everyone know about radiation?

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QUESTIONS

• What are the long term affects of exposure?

• Should Potassium Iodide (KI) be recommended to staff and patients?

• What messages should you be giving to your patients?

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Resolution…

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Over the next six months…

Many businesses closed while being decontaminated

Demolition and rebuilding, along with streetscape reconstruction, make parts of downtown inaccessible and hinder economic recovery



QUESTIONS

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What might be the negative economic impacts on the community and home care patients?

Is your mental health support plan adequate for this situation?

How will you monitor long-term health effects from the exposure to radioactivity in your patient population?

How do you establish environmental surety of the agency offices, your and your patient homes?


End of RDD Scenario

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NEXT STEPS

• Where is your knowledge lacking?

• What do you need to do?

• Agency wise, does your COOP cover this kind of event? What work do you need to do?

• Overall, how do you think you responded?

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CONTACT INFORMATION

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Alexis Silver

Vice President for Clinical Policy

HCA Education and Research, Inc.

(518) 810-0658

[email protected]

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