Phase III: Tabletop Exercise Guidebook

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Phase III:Tabletop ExerciseGuidebook1

Table of ContentsIOverview of 2010 Statewide Medical and Health Exercise3II2010 Exercise Objectives5A. Discipline-Specific Objectives5IIIB. The Joint Commission: Emergency Management15C. National Incident Management Objectives for Health Care19D. Local Hospital Preparedness Program Entity OperationalObjectives20Conducting the Tabletop Exercise21 Customizing the Exercise to your JurisdictionExercise ParticipantsExercise ArtificialitiesExercise MessagingIVExercise Scenario23VConclusion and Next Steps28VIExercise Evaluation29VIIAcronym Glossary32Attachment A: Exercise Evaluation Guides (EEGs)EEG: Intelligence / Information Sharing and DisseminationEEG: CommunicationsEEG: Medical Surge2010 Statewide Medical and Health Exercise Phase III2

IOverview of 2010 Statewide Medical and Health ExerciseThe scenario for the 2010 Statewide Medical and Health Exercise is anImprovised Explosive Device (IED). The exercise is designed to allowplanning and response partners within each Operational Area (OA) totailor their level of exercise play and determine local impact from thethreat scenario. The exercise is designed to test the followingHomeland Security Target Capabilities:1. Communications2. Intelligence/Information Sharing and Dissemination3. Medical SurgeThe 2010 Statewide Medical and Health Exercise Program is comprisedof the following four phases:Phase I: Multi-Media TrainingThis training focuses on resource requesting and providing strategicknowledge to health care providers and local government partners onhow to request and utilize the resources available in California.Phase II: Organizational Self AssessmentUsing the three target capabilities, a web-based assessment tool hasbeen developed to assist in identifying organizational resources,strengths, barriers, and needed improvement in requesting resourcesduring a medical surge. The assessment allows for response partnersto evaluate their level of planning and response for the identifiedscenario: an IED. In preparation for Phases III and IV, participants arestrongly encouraged to complete the organizational self assessment toidentify any gaps or strengths that can be shared with responsepartners during the exercises.Phase III: Tabletop ExerciseUsing the IED scenario, local health departments (LHDs) and localHospital Preparedness Program (HPP) entities will facilitate a tabletopexercise for partner agencies and organizations. The tabletop exercisewill focus on an increased threat of an IED event; the functionalexercise will focus on the event occurring within one or morejurisdictions. The scenario will exercise the target capabilities as theyrelate to the response to an IED event. Objectives for the tabletopexercise include: Test the ability of the emergency response partners within theOperational Area to share critical information in both planning forand responding to an Improvised Explosive Device (IED);3

Determine the technology and plans for ensuring ongoingcommunications during an IED event; and,Identify the capacity and capability to respond to a mass-casualtyevent with forensic implications and need for sharing of criticalresources, including personnel and equipment, to respond to anevent with blast, trauma, burn and pediatric injuries.LHDs and HPP entities may develop additional objectives for theirjurisdictions.Phase IV - Statewide Medical & Health Functional ExerciseThe Statewide Medical and Health Functional Exercise, scheduled to beconducted on November 18, 2010, will build on the lessons of the MultiMedia Training, Organizational Self Assessment, and TabletopExercise. The IED exercise scenario will test the target capabilitiespreviously noted.The 2010 Statewide Medical and Health Exercise Guidebook (theGuidebook) includes discipline-specific exercise objectives withreference to applicable elements of performance for The JointCommission (TJC) Chapter on Emergency Management as well ascompliance elements for the National Incident Management System(NIMS). For health care providers and LHDs, the operationalcapabilities for drills and exercises outlined in the Local HPP Entity2009-2010 Work Plan will also be reference. Following the guidelineswithin the Homeland Security Exercise and Evaluation Program(HSEEP), the Guidebook will include Exercise Evaluation Guides(EEGs) based on the identified target capabilities.This exercise has been developed by the California Department ofPublic Health (CDPH) in collaboration with the California EmergencyMedical Services Authority (EMSA), the California Hospital Association(CHA), the California Primary Care Association (CPCA), the CaliforniaAssociation of Health Facilities (CAHF), the California EmergencyManagement Agency (Cal EMA) and representatives from LHDs andthe health care, public safety and emergency management disciplines.2010 Statewide Medical and Health Exercise Phase III4

II2010 Exercise ObjectivesThe following objectives have been identified for Phase III, TabletopExercise and Phase IV, the 2010 Statewide Medical and HealthFunctional Exercise. Objectives are sectioned by response disciplineand categorized under the applicable Target Capability (as identified onpage 3).A. Objectives by Discipline1. Acute Care Facility/HospitalTarget Capability: CommunicationsA. Assess the facility’s ability to communicate with responsepartners including law enforcement, other health care entities,local health department, fire service, Emergency MedicalServices (EMS) providers, Local EMS Agency (LEMSA),community organizations and emergency managementagencies.B. Test the technology available for gathering intelligence andsharing information with external response partners, such as lawenforcement and emergency management authorities.C. Test the ability of the facility to maintain situationalcommunications when use of two-way devices is suspended.Target Capability: Intelligence/Information Sharing and DisseminationD. Test the plans and technology for gathering intelligence andsharing information with staff, patients and visitors.E. Develop Incident Action Plans within the incident managementstructure of the facility; coordinate with other on-scene responseagencies, including law enforcement and external supportagencies as available.F. Activate information management plans and develop publicinformation messages in coordination with local authorities(Joint Information System) law enforcement and health careproviders in a rapid and timely manner for internal and external(e.g., media, community) dissemination.G. Communicate facility needs to outside sources (e.g., vendors,suppliers, LEMSA, city/Operational Area medical health pointof contact, corporate health care system) for essentialsupplies, services, and equipment to ensure integrity ofresource supply chain. In accordance with the StandardizedEmergency Management System (SEMS), resource requeststhat cannot be obtained through normal mechanisms shouldbe channeled to the Medical Health Operational AreaCoordinator or the OA Emergency Operations Center (EOC)per local procedure.5

H. Provide situational status and projected impact on serviceprovision with response partners, other health care providers,law enforcement and local authorities, per OA standard.I. Identify the Terrorism Liaison Officer (TLO) representing healthcare in the jurisdiction.Target Capability: Medical SurgeJ. Activate the Emergency Operations Plan and applicablehazard specific plans, (e.g., bomb threat/suspicious package,perimeter lockdown) where indicated.K. Assess the need to expand the hospital incident managementteam structure in response to size, scope and impact of theevent on clinical and non-clinical operations.L. Activate and test facility surge plans to expand capacity andmanage a large influx of patients in response to an explosiveevent, including trauma, burns and pediatric patients(including non-specialty care receiving facilities).M. Test the ability to move patients across the continuum ofcare, including government-authorized alternate care sitesand long term care facilities.N. Activate and test plans to respond to a fatality surge,integrating with local resources from the MedicalExaminer/Coroner coordinated through the OA EmergencyOperations Center.O. Expand and augment personnel resources, including the useof volunteers and community resources, in response to aprolonged event.P. Prioritize, manage, and allocate resources, especially scarceresources such as burn and trauma supplies, during anexplosive / trauma event.Q. Test the ability of the facility to gather and maintain evidencein a forensic event, ensuring chain of custody consistent withjurisdictional policy.R. Test the ability of the facility to lock down the building(s)/campus in response to a threat/suspicious device.S. Assess bed surge capacity and participate in a statewideHospital Available Beds for Emergencies and Disasters(HAvBED) drill.2. Local Health DepartmentsTarget Capability: Communications2010 Statewide Medical and Health Exercise Phase III6

A. Assess the ability to communicate with response partnersincluding health care partners, law enforcement, fire, medicalexaminer/coroner, community organizations and emergencymanagement.B. Test the plans and technology for gathering intelligence andsharing information with law enforcement and emergencymanagement authorities.C. Test the ability of the department to maintain situationalcommunications when use of two-way devices is suspended.D. Test the Disaster Health Volunteer (DHV) two-waycommunication alert systems from State to local level.Target Capability: Intelligence/Information Sharing and DisseminationE. Test the plans and technology for gathering intelligence andsharing information with employees.F. Participate in Incident Action Planning coordinated through theOA Emergency Operations Center and/or the DepartmentOperations Center.G. Activate information management plans and develop publicinformation messages in coordination with local authorities(Joint Information System) law enforcement and health careproviders in a rapid and timely manner for internal and external(e.g., media, community) dissemination.H. Provide situational status and projected impact on serviceprovision with health care partners, first responders and localauthorities.I. Provide situational report to Regional Disaster Medical HealthCoordinator according to California Disaster Health OperationsManual (CDHOM) protocol.Target Capability: Medical SurgeJ. Activate the Emergency Operations Plan and applicablehazard specific plans (e.g., bomb threat/suspicious package,perimeter lockdown), where indicated.K. Assess the need to expand the incident management teamstructure in response to size, scope and impact of the eventon clinical and non-clinical operations.L. Activate internal personnel surge plans to deal with increasedneed to respond to public health, laboratory, hazardousmaterials and/or medical guidance issues.M. Request activation of government-authorized alternate caresites as needed.2010 Statewide Medical and Health Exercise Phase III7

3. Community Care Clinic/Medical ClinicTarget Capability: CommunicationsA. Assess the facility’s ability to communicate with responsepartners including law enforcement, other health care entities,local health department, community organizations andemergency management agencies.B. Demonstrate the ability to communicate needs to outsidesources (e.g., vendors, suppliers, Emergency Medical Services(EMS) providers, city/Operational Area stockpiles, corporatehealth care system) for essential supplies, services, andequipment to ensure integrity of resource supply chain.C. Test the ability of the clinic to maintain situationalcommunications when use of two-way devices is suspended.Target Capability: Intelligence/Information Sharing and DisseminationD. Test the plans and technology for gathering intelligence andsharing information with external response partners includinglaw enforcement and emergency management authorities.E. Test the plans and technology for gathering intelligence andsharing information with employees and patients.F. Develop Incident Action Plans within the incident managementstructure of the facility; coordinate with other health care, lawenforcement and emergency management partners.G. Activate information management plans and develop publicinformation messages in coordination with local authorities(Joint Information System) law enforcement and health careproviders in a rapid and timely manner for internal and external(e.g., media, community) dissemination.H. Provide situational status and projected impact on serviceprovision reports to local authorities.Target Capability: Medical SurgeI. Activate the Emergency Operations Plan and hazard specificplan, where indicated.J. Assess the need for and activate expansion of the incidentmanagement team structure due to size, scope and impact ofthe event on clinical and non-clinical operations.K. Assess the ability of the clinic to expand patient capacity byutilizing non-traditional patient care areas within the facility(e.g., office space, conference rooms) for the triage andtreatment of patients and/or acute care hospital transfers.L. Assess the ability to prioritize, manage and allocateresources, especially scarce resources in the response to anexplosive event.2010 Statewide Medical and Health Exercise Phase III8

M. Test the ability of providers to gather and maintain evidencein a forensic event, ensuring chain of custody consistent withjurisdictional policy.N. Determine ability to assist other clinics and health careproviders in the OA with personnel and equipment resources.O. Test the ability of the facility to lock down thebuilding(s)/campus in response to a threat / suspiciousdevice.4. Long Term Care FacilitiesTarget Capability: CommunicationsA. Assess the facility’s ability to communicate with responsepartners including law enforcement, local health departments,other health care entities, community organizations andemergency management agencies.B. Test the ability of the facility to maintain situationalcommunications when use of two-way devices is suspended.Target Capability: Intelligence/Information Sharing and DisseminationC. Test the plans and technology for gathering intelligence andsharing information with external response partners, lawenforcement and emergency management authorities.D. Test the plans and technology for gathering intelligence andsharing information with employees, patients and visitors.E. Develop Incident Action Plans within the incident managementstructure of the facility and in coordination with law enforcementand emergency management partners.F. Activate information management plans and develop publicinformation messages in coordination with local authorities(Joint Information System) law enforcement and health careproviders in a rapid and timely manner for internal and external(e.g., media, community) dissemination.G. Provide situational status and projected impact on serviceprovision with local authorities.Target Capability: Medical SurgeH. Activate the Emergency Operations Plan and hazard specificplan, as applicable.I. Assess the need to expand the incident management teamstructure due to size, scope and impact of the event on clinicaland non-clinical operations.2010 Statewide Medical and Health Exercise Phase III9

J. Test the ability to move patients across the continuum of careincluding government-authorized alternate care sites andhomes.K. Test the ability to increase the level of patient care whenmovement to hospitals is delayed.L. Test the ability of the facility to lockdown the building(s)/campusin response to a threat / suspicious device.5. Law EnforcementTarget Capability: CommunicationsA. Test the ability to communicate with response partners includinghealth care partners, EMS Providers, fire department, MedicalExaminer / Coroner and emergency management agencies.B. Test the communication links to the law enforcement mutual aidcoordinator for the Operational Area.C. Test the ability of the department to maintain situationalcommunications when use of two-way devices is suspended.Target Capability: Intelligence/Information Sharing and DisseminationD. Test the plans and technology for gathering intelligence andsharing information with external response partners includinghealth care partners, other first responders and emergencymanagement authorities.E. Test the plans and technology for gathering intelligence andsharing information with employees.F. Develop Incident Action Plans within the incident managementstructure of the agency/department and in coordination withresponse partners and emergency management authorities.G. Provide situational status and projected impact on serviceprovision with local authorities.6. Emergency Medical Services Providers/Ambulance ProvidersTarget Capability: CommunicationsA. Assess the provider’s ability to communicate with responsepartners including law enforcement, other EMS Providers, healthcare entities and emergency management agencies.B. Establish communications with the Operational Area medicaland health point of contact for guidance and protocols onresponse activities, including alterations in patient receivingsites.2010 Statewide Medical and Health Exercise Phase III10

C. Test the ability of the providers to maintain situationalcommunications when use of two-way devices is suspended.Target Capability: Intelligence/Information Sharing and DisseminationD. Test the plans and technology for gathering intelligence andsharing information with external response partners includinglaw enforcement, health care entities and emergencymanagement authorities.E. Test the plans and technology for gathering intelligence andsharing information with employees.F. Participate in the development of Incident Action Plans within theincident management structure; coordinate with lawenforcement, other EMS and health care partners andemergency management partners.G. Determine the ability to share resource capability and resourceneeds with the medical health point of contact.H. Provide situational status and projected impact on serviceprovision with local authorities.Target Capability: Medical SurgeI. Activate the Emergency Operations Plan and hazard specificresponse plan where applicable.J. Assess the ability to respond to multiple or mass casualtiesand mass fatalities from an explosive event.K. Determine the ability to provide personnel and equipment tostaff and support government-authorized alternate care sites.L. Prioritize, manage, and allocate resources, especially scarceresources, such as burn and trauma supplies, during anexplosive / trauma event.M. Test the ability of providers to gather and maintain evidencein a forensic event, ensuring chain of custody consistent withjurisdictional policy.N. Test the ability of the provider to protect resources(transportation, equipment) in response to a threat/suspiciousdevice.7. Local EMS Agency (LEMSA)Target Capability: CommunicationsA. Assess the LEMSA’s ability to communicate with responsepartners including local health departments, Emergency MedicalServices (EMS) providers, health care entities, law enforcement,community organizations and emergency management.2010 Statewide Medical and Health Exercise Phase III11

B. Establish communications for EMS system management ofresponse activities.C. Test the Disaster Health Volunteer (DHV) two-waycommunication alert systems from the State to the local level.Target Capability: Intelligence/Information Sharing and DisseminationD. Test the plans and technology for gathering intelligence andsharing information with external response partners includinghealth care partners and emergency management authoritiesE. Test the plans and technology for gathering intelligence andsharing information with staff.F. Participate in the development of Incident Action Plans within theincident management structure; coordinate with other healthcare and emergency management partners.G. Determine the ability to gather information on availableresources and provide situational information to the MedicalHealth Operational Area Coordinator.H. Provide situational status and projected impact on serviceprovision with local authorities.I. Provide situational report to Regional Disaster Medical HealthCoordinator according to CDHOM protocol.Target Capability: Medical SurgeJ. Activate the Emergency Operations Plan and hazard specificresponse plan (e.g., bomb threat/suspicious package) whereapplicable.K. Test the ability to manage transportation of increasednumbers of pre-hospital transports to health care facilities,first aid sites, and government authorized alternate sites ofcare.L. Assess the ability to sustain, maximize, and augmentEmergency Medical Services staffing during a surge event.M. Determine the ability to provide personnel and equipment tostaff and support government-authorized alternate care sites.8. Medical Examiner/CoronerTarget Capability: CommunicationsA. Assess the ability to communicate with response partnersincluding local health departments, health care entities,Emergency Medical Services (EMS) providers, law enforcement,and emergency management as well as private sector mortuaryservices.2010 Statewide Medical and Health Exercise Phase III12

B. Establish communications with the Operational Area medicaland health point of contact and OA law enforcement mutual aidcoordinator.C. Test the ability of the response staff to maintain situationalcommunications when use of two-way devices is suspended.Target Capability: Intelligence/Information Sharing and DisseminationD. Test the plans and technology for gathering intelligence andsharing information with external response partners includinglaw enforcement, health care and emergency managementauthorities.E. Test the plans and technology for gathering intelligence andsharing information with staff.F. Develop Incident Action Plans within the incident managementstructure; coordinate with law enforcement, health care andemergency management partners.G. Provide situational status and projected impact on serviceprovision with local authorities.Additional ObjectivesH. Activate the Emergency Operations Plan and hazard specificresponse plan (e.g., bomb threat/suspicious package) whereindicated.I. Activate the mass fatality plan to respond to a surge infatalities from an explosive event.9. Community Based OrganizationsTarget Capability: CommunicationsA. Assess the organization’s ability to communicate with responsepartners including Local Health Departments, health careentities, law enforcement, other community organizations andemergency management agencies.B. Test the ability of the agency to maintain situationalcommunications when use of two-way devices is suspended.Target Capability: Intelligence/Information Sharing and DisseminationC. Test the plans and technology for gathering intelligence andsharing information with external response partners includinglaw enforcement and emergency management authorities.D. Test the plans and technology for gathering intelligence andsharing information with staff and clients.2010 Statewide Medical and Health Exercise Phase III13

E. Provide situational status and projected impact on serviceprovision with local authorities.Additional ObjectivesF. Activate the Emergency Operations Plan and hazard specificresponse plan where applicable.G. Identify those services provided by the organization whichcan be postponed, consolidated or reassigned to partnerorganizations due to resources shortages or interruptions inservice (including organization and volunteer personnel).H. Test the ability of the facility to lockdown thebuilding(s)/campus in response to a threat/suspicious device.10. Emergency ManagementTarget Capability: CommunicationsA. Test the plans and technology for gathering intelligence andsharing information with external response partners, such aslocal health departments and emergency managementauthorities.B. Initiate Joint Information System plans and procedures andtechnology for development and dissemination of coordinatedmessages to the media and public.C. Test the ability of the agency to maintain situationalcommunications when use of two-way devices is suspended.Target Capability: Intelligence/Information Sharing and DisseminationD. Assess the need to expand the incident management structurebased on situation assessment, projected impact andanticipated length of activation.E. Initiate ongoing incident action planning with response partners,utilizing situational assessment and projected impact.F. Activate information gathering for entry into ResponseInformation Management System (RIMS) and informationsharing with Regional Emergency Operations Center (REOC).Additional ObjectivesG. Activate the Emergency Operations Plan and hazard specificresponse plans (e.g., bomb threat/suspicious package) whereapplicable.H. Assist in the procurement and allocation of scarce resourcesin compliance with the Standardized EmergencyManagement System.2010 Statewide Medical and Health Exercise Phase III14

I. Activate government-authorized alternate care sitesaccording to the policy and plans of the OA.J. Activate mutual aid systems and resource requesting tosupport government authorities alternate care sites within theOA.K. Test the ability of the agency to lockdown thebuilding(s)/campus in response to a threat/suspicious device.L. Track and record all costs and expenditures related to theevent, and project ongoing costs for the next 48, 72 and 96hours.11. Fire ServiceTarget Capability: CommunicationsA. Assess the ability to communicate with response partnersincluding health care partners, EMS Providers, law enforcement,Medical Examiner/Coroner and emergency managementagencies.B. Test the communication links to the fire service mutual aidcoordinator for the Operational Area.C. Test the ability of the department to maintain situationalcommunications when use of two-way devices is suspended.Target Capability: Intelligence/Information Sharing and DisseminationD. Test the plans and technology for gathering intelligence andsharing information with external response partners includinghealth care partners, other first responders and emergencymanagement authorities.E. Test the plans and technology for gathering intelligence andsharing information with employees.F. Develop Incident Action Plans within the incident managementstructure of the department and in coordination with responsepartners and emergency management authorities.G. Provide situational status and projected impact on serviceprovision with local authorities.B. The Joint Commission Chapter on Emergency ManagementElements of performance under The Joint Commission Chapter onEmergency Management may be demonstrated during either thetabletop or functional exercise, dependent on level of exercise play. Apartial list of EM Standards is listed below. Hospital planners should2010 Statewide Medical and Health Exercise Phase III15

review the entire Emergency Management Chapter for opportunities todemonstrate additional performance elements.Standard EM 02.02.01As part of its Emergency Operations Plan, the organization/hospitalprepared for how it will communicate during emergencies.Elements of Performance for EM.02.02.01.The Emergency Operations Plan describes the following:EP1: How staff will be notified that emergency responseprocedures have been initiated.EP2: How the hospital will communicate information andinstructions to its staff and Licensed Independent Practitionersduring an emergency.EP3: How the hospital will notify external authorities thatemergency response measures have been initiated.EP4: How the hospital will communicate with external authoritiesduring an emergency.EP5: How the hospital will communicate with patients and theirfamilies, including how it will notify families when patients arerelocated to alternate care sites.EP6: How the hospital will communicate with the community orthe media during an emergency.EP7: How the hospital will communicate with purveyors ofessential supplies, services, and equipment during anemergency.EP8: How the hospital will communicate with other healthcareorganizations in its contiguous geographic area regarding theessential elements of their respective command structures.EP9: How the hospital will communicate with other healthcareorganizations in its contiguous geographic area regarding theessential elements of their respective command centers.EP10: How the hospital will communicate with other healthcareorganization in its contiguous geographic area regarding theresources and assets that can be shared in an emergencyresponse.EP14: The hospital establishes backup systems andtechnologies for the communication activities identified in EM02.02.01, EPs 1-9.Standard EM.02.02.03As part of its Emergency Operations Plan, the organization/hospitalprepares for how it will manage resources and assets during anemergency.2010 Statewide Medical and Health Exercise Phase III16

Elements of Performance for EM.02.02.03.The Emergency Operations Plan describes the following:EP2: How the hospital will obtain and replenish medical suppliesthat will be required throughout the response and recoveryphases of an emergency, including personal protectiveequipment where required.EP3: How the hospital will obtain and replenish non-medicalsupplies that will be required throughout the response andrecovery phases of an emergency.EP4: How the hospital will share resources and assets with otherhealthcare organization within the community if necessary.EP5: How the hospital will share resources and assets with otherhealthcare organizations outside the community, if necessary, inthe event of a regional or prolonged disaster.EP6: How the hospital will monitor quantities of its resources andassets during an emergency.Standard EM.02.02.05As part of its Emergency Operations Plan, the organizatio

Phase III: Tabletop Exercise Using the IED scenario, local health departments (LHDs) and local Hospital Preparedness Program (HPP) entities will facilitate a tabletop exercise for partner agencies and organizations. The tabletop exercise will foc

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