Designing, Conducting, and Evaluating Tabletop Exercises for Pandemic Influenza Business Continuity Planning

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Designing, Conducting, and Evaluating Tabletop
Exercises for Pandemic Influenza Business
Continuity Planning
Kristine Moore, MD, MPH Medical Director Jill
DeBoer, MPH Associate Director
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Workshop Outline

• Overview of Exercises (30 minutes)
• The Tabletop Exercise Planning Process From
  Conception to Action (60 minutes)
• Facilitating a Tabletop Exercise Exercise
  Evaluation and Follow-up (30 minutes)

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Overview of Exercises
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Presentation Outline

• Steps in Business Continuity Planning
• Purpose and Timing of Exercises
• Five Major Types of Exercises
• Unique Features of Pandemic Influenza Exercises
• Designing Exercises to Meet Your Needs

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Steps in Business Continuity Planning

1. Conduct a Risk Assessment
2. Conduct a Business Impact Analysis (BIA)
3. Develop a Business Continuity Plan (BCP)
4. Implement the BCP
5. Test, Refine, and Revise the BCP

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Steps in Business Continuity Planning

• Conduct a Risk Assessment
• Identify internal and external threats, hazards,
  and vulnerabilities that could impact your
  company
• Hazards may be industry-specific or may be
  general
• Rank hazards by probability and severity
• Pandemic influenza is a hazard with a high
  potential severity and high probability (at some
  point)

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Steps in Business Continuity Planning

• Conduct a Risk Assessment
• Conduct a Business Impact Analysis (BIA)
• Define how different hazards (such as pandemic
  influenza) could impact your business
• Identify critical job functions and operations
• Assess assets for response
• Consider minimal requirements for continuing
  operations

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Steps in Business Continuity Planning

• Conduct a Risk Assessment
• Conduct a Business Impact Analysis (BIA)
• Develop a Business Continuity Plan (BCP)
• Utilize an all-hazards approach with annexes for
  specific issues
• Make key decisions (based on the BIA)
• Develop policies and procedures as necessary
• Define trigger points as needed
• For pandemic planning, consider unique stresses
  (CIDRAP 10-point framework)

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Steps in Business Continuity Planning

• Conduct a Risk Assessment
• Conduct a Business Impact Analysis (BIA)
• Develop a Business Continuity Plan (BCP)
• Implement the BCP
• Educate staff and conduct training as needed
• Conduct steps necessary to implement policies and
  procedures

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Steps in Business Continuity Planning

• Conduct a Risk Assessment
• Conduct a Business Impact Analysis (BIA)
• Develop a Business Continuity Plan (BCP)
• Implement the BCP
• Test, refine, and revise the BCP

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Purpose and Timing of Exercises
An exercise is a focused practice activity
that places the participants in a simulated
situation requiring them to function in the
capacity that would be expected of them in a real
event.
Excerpt from FEMA Emergency Management Institute
Independent Study Course, Exercise Design (March,
2003)
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Why Exercise?

• Identify successes and strengths to be maintained
  and built upon
• Plans, policies, and procedures
• Resources
• Reveal areas needing further improvement
• Plans, policies, and procedures
• Resources
• Educate on plans, policies, and procedures
• Educate on the complexities of a specific
  emergency scenario

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Why Exercise? (continued)

• Improve organizational coordination and
  communications
• Train personnel in roles and responsibilities
• Improve individual
  performance
• Satisfy regulatory
  and/or funding
  requirements
• Evaluate response
  systems

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When to Exercise

• According to planned exercise program schedule
• But also
• Revision of Business Continuity Plan
• Changes in key personnel
• Shifts in sector/industry trends
• New regulatory requirements
• Changes in information technology systems
• In response to recent past incidents or events
• In anticipation of upcoming events

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Exercise Categories

• Orientation
• Drill
• Tabletop Exercise
• Functional Exercise
• Full Scale Exercise

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Orientation

• Purpose
• Familiarize staff to organizations emergency
  response plan
• Familiarize current staff to changing information
  or procedures
• Bring together various departments for better
  understanding and coordination
• Identify planning and response priorities prior
  to plan development

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Orientation

• Methods
• Talk Through
• Brain Storming
• Case Study
• Training Workshop

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Orientation

• Example
• Cross Border Orientation Exercise

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Scenario 1 Foodborne Botulism Outbreak
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• Suspect Botulism Cases
• Cranial nerve dysfunction
• Bilateral proximal muscle weakness

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Largest Foodborne Botulism Outbreak Reported in
North America 176 cases
 
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Small Group Discussion

• Review Identified Issues
• Prioritize Issues
• Brainstorm Realistic Action Steps

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Orientation

• Good for
• Educating, building awareness
• Gathering new ideas or feedback
• Exercising before a plan is started
• Exercising before a plan is finalized

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Drill

• Purpose
• Instruct thoroughly through repetition and
  practice
• Focus is usually on one aspect of the response
  plan in one organization
• Can be used to test staff training, response
  time, interdepartment cooperation and resources,
  manpower and equipment capabilities
• Can be preceded by orientation

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Drill

• Sometimes referred to as
• Procedure verification exercise
• Validation exercise
• Walk-through exercise

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Drill

• Examples
• After Hours Notification Drill
• Emergency Operations Center Drill
• IT System Recovery Drill
• Mass Dispensing Site Drills

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Tabletop Exercise

• Purpose
• Focus on constructive problem solving as a group
• The success of a tabletop exercise is determined
  by feedback from participants and the impact this
  feedback has on evaluation and revision of
  policies, plans, and procedures

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Tabletop Exercise

• Methods
• A discussion guided by a facilitator based on a
  simulated emergency situation
• Basic Tabletops Participants discuss problems as
  a group leader summarizes conclusions
• Advanced Tabletops Series of messages requiring
  rapid response facilitator guides the discussion

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Tabletop Exercise

• Advantages (FEMA Exercise Design Manual)
• Is a good way to acquaint key personnel with
  emergency responsibilities, procedures, and one
  another
• Is an effective method for reviewing plans,
  procedures, and policies
• Requires only a modest commitment in terms of
  time, cost, and resources

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Tabletop Exercise

• Disadvantages (FEMA Exercise Design Manual)
• Lacks realism and thus does not provide a true
  test of an emergency management systems
  capabilities
• Provides only a superficial exercise of plans,
  procedures, and staff capabilities
• Does not provide a practical way to demonstrate
  system overload

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Functional Exercise

• Purpose
• Fully simulated interactive exercise that tests
  the capability of an organization to respond to a
  simulated event
• Tests multiple functions and coordinated response
  in a time-pressured, realistic simulation
  (without deploying resources)

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Functional Exercise

• Methods
• Participants gather where they would actually
  operate in an emergency (usually an EOC or other
  operating center)
• Participants are briefed immediately prior to the
  start of the exercise as to objectives,
  procedures, time frame and recording requirements
• Simulated information is delivered to players by
  paper, telephone, or radio

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Functional Exercise

• Methods (continued)
• Players respond as they would in a real
  emergency, in real time, making on-the-spot
  decisions and taking on-the-spot actions
• Similar to full-scale exercise without the
  equipment
• Involves controllers, simulators, and evaluators
• May consider no-notice design

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Functional Exercise

• Sometimes referred to as
• Simulation exercise
• Operational exercise

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Functional Exercise

• Examples
• Strategic National Stockpile Exercises
• Nuclear Power Plant Exercises

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Full Scale Exercise

• Purpose
• Tests the comprehensive response capacity of
  multiple organizations by simulating a real event
  as closely as possible

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Full Scale Exercise

• Methods
• Field personnel proceed to the location of a mock
  emergency
• EOC activities are combined with on-scene use of
  simulated victims, equipment, and manpower
  (enactment)
• Activities at the scene serve as input and
  require coordination with the simulation at the
  EOC

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Full Scale Exercises

• Example
• City/County Emergency Management Exercises
• Airport Disaster Exercises

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Exercises are Everywhere

• Military
• Emergency Management
• Hospital Disaster Planning
• Nuclear Power Plants
• Airports
• Businesses
• Public Health

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Unique Features of Pandemic Influenza Exercises

• Rapid decision-making with limited information
• Staged decision-making
• Long term event
• Global event
• Impacts all sector of society
• Exploring relationships with the public health
  system
• Anticipated public panic

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Designing Exercises to Meet Your Needs

• Choose Type of Exercise Carefully
• Based on Exercise Goal and Objectives
• Choose Exercise Format Carefully
• Unlimited possibilities
• Consider the Roles of Internal Teams and External
  Consultants

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Early in the Design Process Visualize
That was a smashing success!
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Three Key Questions
What did the participants learn?
What was documented?
How do the participants feel?