Office of Preparedness and Response OP

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Maryland 2007 Statewide Pan Flu Exercise

• Office of Preparedness and Response (OPR)
• Maryland Department of Health and Mental Hygiene
  (DHMH)

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Speakers

• Isaac Ajit, MD, MPH
• Deputy Director
• Office of Preparedness Response
• Al Romanosky, MD, PhD
• State Preparedness Coordinator
• Ivan A. Zapata, MS, CHES
• State Pandemic Influenza Coordinator
• Bruce Chief Baker
• State SNS Coordinator
• Terry Sapp
• State CRI Coordinator

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Acknowledgement

• The 2007 Maryland Statewide Pan Flu Exercise was
  supported in part by
• Department of Health and Human Services
• Office of the Assistant Secretary for
  Preparedness and Response
• Hospital Preparedness Program Grant
• Centers for Disease Control and Prevention
• Public Health Preparedness Cooperative Agreement

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Maryland 2007 Statewide Pan Flu Exercise
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Agenda

• Goal and Objectives
• Exercise Design
• Exercise Participants
• Exercise Activities
• Questions and Answers

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2007 Pan Flu Exercise Dates

• Took place on July 31, Aug 1 2, 2007

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Exercise Goals and Objectives
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Exercise Goal

• To test non-pharmaceutical community containment
  interventions during an influenza pandemic as
  well as health and medical surge

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Exercise Priority Areas

• DHMH Command and Control Function (Functional)
• Strategic National Stockpile Receiving Staging
  and Storage (RSS) (Functional)

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Exercise Priority Areas

• Health and Medical Surge
• Hospital and EMS readiness for Pan Flu
  (Functional)
• Hospital Surge / Disaster Reconfiguration
• 911 Call Center Phone Triage
• EMS Transport Diversion
• Internal Counter Measure Distribution (Functional)

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Exercise Priority Areas

• Personal and Community Preparedness
• Enhanced Surveillance (Functional/Modified
  Functional)
• Self Isolation / Quarantine
• Community Needs Assessment (Functional)

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Exercise Priority Areas

• PIO Communications (Functional)
• State Emergency Operations Center

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Exercise Design
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Tripartite Exercise Design

• Office of Preparedness and Response (OPR)
• Sub-committee Regional Planning Teams
• Contractor

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Design Collaboration

• Office of Preparedness and Response
• Lead State Agency for ESF 8
• OPR Umbrella Coordinating Team
• Statewide Planning Committee
• Planning Sub-committee (Regional Planning Teams)

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Design Collaboration

• Sub-Committee Regional Planning Teams
• Tiered
• Multi-disciplinary
• Multi-jurisdictional
• Addressed exercise components / activities
  specific to regional emergency preparedness plans
• Component Goals
• Objectives
• Injects
• Performance Criterion

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Design Collaboration

• Contractor
• Review and Enhancement of MSELs
• Subcommittee initiated
• Provision of SIM Cell
• Managed exercise
• Provision of Observer-Controller Evaluators
• Subject Matter Experts
• Training
• Hot Wash Discussions
• Draft After Action Meeting
• After Action Report

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Design Collaboration

• Greater buy-in and awareness by participants
• Cost Effectiveness of Collaboration
• Truly statewide
• Multiple participants
• Several different disciplines
• Exercise design and evaluation
• Participants Emergency Operations Plans
• Value/benefit for cost
• Expedient Exercise Design

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Key Activities

• Planning meetings
• Statewide meetings
• Regional sub-committee meetings
• Pre-Exercise Training
• Open to all participants
• 1 month before exercise
• Review of all participant planning activities and
  MSELs

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Key Activities

• Observer Controller Evaluator Training
• Three regional trainings
• Non-contractor Observer-Controller Evaluators
• Consistency in Exercise Evaluation
• Exercise
• Immediate Hot Wash
• Site Specific/ Primary Nodes

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Key Activities

• Draft After Action Meeting
• Afternoon of last day
• Open to all participants
• Lessons Learned
• Sustainable Activities
• Needs Improvement
• Written After Action Report

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Exercise Participants
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Participants

• Open to all Federal, State and Local Partners
• Healthcare Facilities
• Emergency Medical Services
• Emergency Management Agencies
• Local Health Departments
• State Agencies
• Critical Infra-structure / Private Organizations
• Law Enforcement (State and Local)

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Participants

• 32 organizations/agencies were represented and
  participated in exercise planning
• 17/24 counties represented in the exercise
• Two Towns
• Approximately 1000 Volunteers

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Participating Organizations

• Health Departments (9)
• Health Care
• Hospitals (16)
• Community Health Centers (2)
• State facilities (10)
• Law Enforcement (12)
• Emergency Management Agencies (4)

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Participating Organizations

• Emergency Medical Services (5)
• Volunteer organizations (4)
• CERT/neighborhood watch
• American Red Cross
• RACES
• State agencies / departments (20)
• Military (2)
• Maryland Air National Guard
• Maryland National Guard

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Participating Organizations

• Federal agencies (observers)
• FEMA
• DHHS
• Community residents
• (community needs assessment 300 families)

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Participants

• Primary sites
• DHMH / contractor provided Observer Controllers
• Secondary Sites
• Invited to participate in all planning activities
• Provided their own Observer Controllers
• Contractor trained in HSEEP EEG
• Had access to materials developed for Primary
  sites
• Operational Milestones, Measurable Objectives /
  Evaluation Sheets and After Action Report (AAR)
  templates

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Exercise
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Scenario

• Novel Flu virus is identified in the pacific
  Asian rim
• Exhibits efficient human to human transmission
  with significant morbidity and mortality (WHO
  Phase 6/US Stage 3)
• Some cases have been identified in California (US
  Stage 4/5)
• A few suspected cases have been identified in
  Maryland awaiting lab conformation

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Exercise Time Line

• Compressed Time Line
• Two and half days
• 12 Week Pan Flu Wave
• Simultaneous Time Lines and Activities

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Exercise Time Line
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2007 Pan Flu Exercise Overview Day 1
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2007 Pan Flu Exercise Overview Day 2
Western MD Health Systems, Braddock Campus, City
of Cumberland, Internal Countermeasures
Distribution
Dorchester General Hospital, City of Cambridge,
Disaster, Reconfiguration/Surge
Prince Georges County Health Department, City of
Largo, Enhanced Surveillance / Community
Containment
Southern Maryland Hospital, City of Clinton,
Enhanced Surveillance / Community Containment
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Community Needs Assessment
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Community Needs Assessment

• Activation of Prince Georges County Community
  Emergency Response Team (CERT) for needs
  assessment

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Community Needs Assessment

• CERT conducted just in time training and set up
  ICS

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Community Needs Assessment

• Approximately 300 homes in two towns placed
  window placards in their windows
• CERT teams drove through the areas counting the
  number of sick residents

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Community Needs Assessment

• Results were reported by Amateur radio to the
  local EOC
• Data transmitted to DHMH

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Community Needs Assessment

• Highlights
• Ground-breaking and efficient utilization of
  Community Emergency Response Teams
• The state can benefit from using this event as
  the standard for CERT team proficiency and this
  exercise as an example of training with the
  resources you will use in an actual response.

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Community Needs Assessment

• Assessment and Lessons Learned
• The prompts for the information collected on the
  placards were confusing and could introduced
  errors in data collection.
• Provide census tracts to the CERT with sampling
  sets to reduce the number of homes requiring
  monitoring.
• Develop collection tools and provide basic
  training to volunteer groups on the forms
  pre-event.

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Hospital and EMS Medical Surge
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Hospital and EMS Medical Surge

• Full functional surge reconfiguration of two
  eastern shore hospitals
• Four counties including LE, LHD, EMS, EMAs, State
  facilities
• Reverse 911 calling of all residents in two
  counties advising them of the exercise at the
  hospitals

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Hospital and EMS Medical Surge

• Establishment of alternative care sites (ACS) on
  hospital grounds for Pt receipt, triage and
  treatment
• EMS diversion from the Emergency Department to
  ACS of flu patients

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Hospital and EMS Medical Surge

• Test of a prototype 911 Call Center Emergency
  Medicine Dispatch pan flu protocol

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Hospital and EMS Medical Surge

• Mixed in trauma patients to the medical surge
• Transfer of mental health pts to the nearby state
  facility

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Hospital and EMS Medical Surge

• Assessment and Lessons Learned
• Extremely effective hospital reconfiguration in
  response to patient surge
• Hospital and EMS Medical Surge were assessed as a
  STRENGTH
• Sustain Activity

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Internal Countermeasure Distribution and
Dispensing
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Sub-Committee for Countermeasure Distribution

• DHMH (State Health Dept.)
• Allegany County Health Dept. (LHD)
• Western Maryland Health System
• Memorial Campus
• Braddock Campus
• Local Office of Public Safety Homeland Security
  
• MEMA (State EMA)

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Planning Phase

• Defined objectives
• Identified gaps in existing plans
• Determined participants level of play
• Regular updates provided on exercise progress
• Operational/Logistical aspects discussed

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Operational Phase

• Three Command centers activated on the local
  level
• Two days of hands-on activity
• Day 1 Request and Receipt of SNS assets
• Communication with staff (Infection Control
  POD Activation)
• Day 2 POD Activation
• Yellow Alert broadcast
• Dispensing in-hospital to staff

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Local Health Department Command Center Activation
Day 1 Day 2
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Braddock Campus Day 1
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Braddock Campus Day 1
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Memorial Campus Day 1
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Memorial Campus Day 1
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Braddock Campus Day 2
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Memorial Campus Day 2
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Results

• 1,203 of people who physically visited hospital
  medication dispensing center
• 3,264 of courses of medication handed out within
  6 hours with no disruption to hospital operations
• Communication tools tested
• Distribution and Security plans exercised
• ICS utilized
• Medication Dispensing Center operational within 1
  hour of activation request

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Lessons Gained

• Gaps were identified in dispensing
  plansdifferences between the two facilities
• Yellow Alert and hospital communication worked
  wellidentified gap in reaching staff who worked
  off campus
• Logistics and Chain of Custody worked
  wellSecurity served many different purposes,
  including preventing bottlenecks.

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2007 Pan Flu Exercise Summary

• Pan Flu Exercise testing Medical Surge and
  Community Containment
• One of the biggest most comprehensive statewide
  exercises
• Valuable Lessons Learned

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Acknowledgement

• This exercise was made possible with the support
  and participation of
• Federal Partners
• State Partners
• All participants
• OPR Staff

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Questions and Answers
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Iván A. Zapata, MS, CHESState Pandemic
Influenza CoordinatorOffice of Preparedness and
Response, DHMH410.767.0823izapata_at_dhmh.state.md.
us
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The EndThank you