SPARC Ebola Tabletop (TTX) Exercise May 26th, 2016

Exercise Agenda Welcome & Introductions Tabletop Exercise Overview Ebola Situation Overview Module 1: Notification and Communication Module 2: Transportation Module 3: Hospital Treatment Module 4: Fatality and Waste Management Hot Wash/Evaluation Startex at 0845

First Some Housekeeping… GoTo Webinar platform Everyone is on mute Either raise hand or type question in chat box.

WELCOME & INTRODUCTIONS Name Agency Position

Goal of the Tabletop Exercise To practice coordination and communication activities using an Ebola virus scenario. Discuss notification procedure and practices. Discuss patient, staff, and first responder personal safety. Discuss the management of human remains of Ebola patients. Identify roles of the various response partners. Test Regional EVD Plan.

Core Capabilities Environmental Health and Medical Services Fatality Management Services Public Health and Medical Services Communication and Notification

Objectives Exercise Objective #1: Discuss how healthcare, public health agencies, and the Shawnee Preparedness and Response Coalition will coordinate and implement emergency response activities to manage patients suspected of Ebola Virus Disease (EVD). Exercise Objective #2: Discuss how Ebola Virus Disease (EVD) incident related information will be shared and disseminated within the region. Exercise Objective #3: Test the regional EVD plan.

Objectives Exercise Objective #4: Discuss the post mortem care and procedures for the remains of a person suspected of EVD. Exercise Objective #5: Discuss the transport needs necessary for safe and timely transport.

Exercise Structure This exercise will be a multimedia, facilitated exercise. Players will participate in group discussion during the following four modules: Module 1: Notification and Communication Module 2: Transportation Module 3: Hospital Treatment Module 4: Fatality and Waste Management Each module begins with a multimedia update that summarizes key events occurring within that time period. After the updates, participants review the situation and engage in functional group discussions of appropriate issues. For this exercise, the functional groups are as follows: After these functional group discussions, participants will engage in a moderated plenary discussion in which a spokesperson from each group will present a synopsis of the group’s actions, based on the scenario.

Exercise Guidelines This exercise is designed to be held in an open, low-stress, no-fault environment. Varying viewpoints, even disagreements, are expected. Respond to the scenario using your knowledge of current plans and capabilities (i.e., you may use only existing assets) and insights derived from your training. Decisions are not precedent setting and may not reflect your organization’s final position on a given issue. This exercise is an opportunity to discuss and present multiple options and possible solutions.

Exercise Guidelines Issue identification is not as valuable as suggestions and recommended actions that could improve facility protection, information coordination, and response efforts. Problem-solving efforts should be the focus. Today’s scenario encompasses multiple complex issues that may occur during a healthcare crisis, please focus on today’s questions and don’t get side tracked.

Assumptions and Artificialities The exercise is conducted in a no-fault learning environment wherein capabilities, plans, systems, and processes will be evaluated. The exercise scenario is plausible, and events occur as they are presented. All players receive information at the same time.

Exercise Evaluation Evaluation of the exercise is based on the exercise objectives and aligned capabilities, capability targets, and critical tasks, which are documented in Exercise Evaluation Guides (EEGs). Players will be asked to complete participant feedback forms. These documents will be used to evaluate the exercise and compile the After Action Report (AAR).

History The 2014 Ebola outbreak was one of the largest Ebola outbreaks in history and the first in West Africa including: Guinea Liberia Sierra Leone Mali The 2014 Ebola epidemic is the largest in history, affecting multiple countries(http://www.cdc.gov/vhf/ebola/outbreaks/2014-west-africa/distribution-map.html#areas) in West Africa. There were a small number of cases reported in Nigeria and a single case reported in Senegal; however, these cases are considered to be contained, with no further spread in these countries. Two imported cases, including one death, and two locally acquired cases in healthcare workers have been reported in the United States(http://www.cdc.gov/vhf/ebola/outbreaks/2014-west-africa/united-states-imported-case.html). CDC and partners are taking precautions to prevent the further spread of Ebola within the United States. CDC is working with other U.S. government agencies, the World Health Organization (WHO), and other domestic and international partners and has activated its Emergency Operations Center to help coordinate technical assistance and control activities with partners. CDC has also deployed teams of public health experts to West Africa and will continue to send experts to the affected countries.

History United States September 30, 2014 – CDC confirmed the first laboratory-confirmed case of Ebola to be diagnosed in the United States in a man who had traveled to Dallas, Texas from Liberia. ◦The man did not have symptoms when leaving Liberia, but developed symptoms approximately four days after arriving in the United States. ◦Local public health officials identified all close contacts of the index patient for daily monitoring for 21 days after exposure. ◦The patient passed away on October 8.

History United States October 10, 2014 – A healthcare worker at Texas Presbyterian Hospital who provided care for the index patient tested positive for Ebola. ◦The patient has since recovered and was discharged on October 24.

History United States October 15, 2014 – A second healthcare worker who provided care for the index patient at Texas Presbyterian Hospital tested positive for Ebola. ◦The patient has since recovered and was discharged on October 28.

History United States October 23, 2014 - The New York City Department of Health and Mental Hygiene reported a case of Ebola in a medical aid worker who had returned to New York City from Guinea, where the medical aid worker had served with Doctors Without Borders. ◦The diagnosis was confirmed by CDC on October 24. ◦The patient has since recovered and was discharged on November 11. Talk about 5 airports monitoring and home monitoring done by LHDs

Today The CDC has lifted monitoring of persons returning from western Africa and no longer screens at airports. Healthcare organizations no longer need to screen specifically for Ebola but should continue to obtain travel history in triage so that infection control precautions and patient placement can begin promptly when appropriate.

Notification and Communication Module 1 Notification and Communication 0920-0955

Exercise Scenario Six patients arrive at your emergency department independent from one another:

At 1040 a 21 y/o female with fever, sweating, nausea, and general malaise.

At 1100 a 54 y/o male is brought to ED by EMS with c/c of weakness, fever, severe headache, and genera malaise.

At 1120 a 28 y/o male is dropped off at the ED by his friend At 1120 a 28 y/o male is dropped off at the ED by his friend. C/c of “not feeling well,” fever, achy muscles, and occasional vomiting.

Two minutes later, EMS brings in a 37 y/o female and her two children ages 3 and 6 years old all complaining of fever and dehydration.

Take 7 minutes to discuss within your group. Module 1 Questions: What information should be obtained in triage? What information would you share within the hospital and what information would you share outside the hospital and with whom would you share it. Take 7 minutes to discuss within your group.

Information Obtained During Triage

The 21 y/o female says she recently came home from college in Southern Missouri and denies being out of the country.

The 28 y/o male is a local bartender who started feeling sick two days ago. He has never been anywhere outside of S. Illinois.

The 54 y/o male patient is an OB doctor that returned from Liberia about three weeks ago. He was on a missionary medical relief trip where he cared for high risk OB patients.

The mother with two young children returned from Guinea 27 days ago The mother with two young children returned from Guinea 27 days ago. States she was in Africa to attend her father’s funeral

Take 7 minutes to discuss within your group. Module 1 Questions: Where would you place these patients? Who would you notify? What information would you share? How does this information change what treatment you anticipate for each patient? Take 7 minutes to discuss within your group.

More Information The mother with two young children who returned from Guinea 27 days ago actually had attended her father’s funeral in Ethiopia and on the return flight her plane made an emergency landing in Guinea where she reports that they never left the airport.

Take 5 minutes to discuss within your group. Module 1 Questions: Does this information change your response? If so, how? Take 5 minutes to discuss within your group.

15 minutes. Select a couple groups to report out if it will take too long to let everyone.

Module 2 Hospital Treatment 1035-1125

It is determined that the 54 y/o OB doctor should be admitted and tested for Ebola Virus Disease and remain in isolation until EVD testing is negative x 2.

Module 2 Questions What questions would be asked at your facility? What other procedures do you have in place to limit potential exposures? Take 5 minutes to discuss these questions in your group.

Module 2 Additional Information The identified EAH cannot accept any of the patients as they are already caring for a person under investigation.

Module 2 Follow-up Questions Does this new information change your response? If so, How? Who would you contact? What would you do? Take 5 minutes to discuss these questions in your group.

Module 2 Questions What is your treatment protocol? How will you isolate and care for this patient? What other options do you have? Does the local hospital have laboratory capabilities to collect, package, and ship a possible EVD blood specimen? Who will transport the samples? How will the local hospital dispose of medical waste? Do you have this in place now? Evaluator – Check in with EMS, Do they have equipment (i.e. PPE). What is their plan? What issues would be anticipated if asked to transport a patient: From home to an EAH in an adjacent county. From home to nearest ED. From local ED to an EAH or ETC. Take 25 minutes to discuss these questions in your group.

15 Minutes

Module 3 Transportation 1005-1035

Module 3 Questions What transportation options are available? What factors go into determining which EAH the person will go to? Who makes that decision? What communication is needed prior to the patient going to the identified hospital? If transporting somewhere, what arrangements do you have? Is Local EMS able to safely transport? Hospitals - Does your facility have transfer agreements for EVD? Who would be your transportation provider to take a patient to an ETC in Chicago? Who would the nurse and physician report to at the EAH Hospital? Who else would be notified? Take 15 minutes to discuss these questions in your group.

15 Minutes.

Module 4 Fatality Management 1125-1140

Module 4 Information While awaiting transport to the EAH, the patient suddenly goes into cardiac arrest and dies.

Module 4 Questions How would you handle the remains? Who would you contact? What equipment and procedures are in place to safely deal with a highly infectious deceased person? Take 10 minutes to discuss these questions in your group.

5 Minutes.

Thank You For Participating 1140-1200