From Drill to Reality: Lessons for Future Preparedness Quan Le Louisiana Immunization Registry Manager March 8, 2006

Agenda Introduction Drill Experience Comparison of drill characteristics to the Katrina response Lessons learned

LINKS Field Staff

Drill versus an actual event Pre-event & Post-event Preparations & Activity Prior to Katrina Jan 2003 – Smallpox Campaign LINKS module created to collect professional and responder data, Bio-Prepared Response Professional PVS compatible Over 1,400 First Responders inoculated

Drill versus an actual event Pre-event & Post-event Preparations & Activity Prior to Katrina, cont. July 2003 – Bio-Terrorism Drill Combination of BT Response Capacity Drill & live immunization clinic Targeted all seven focus areas of LA’s BT grant Target a cohort to raise immunization rates

Drill versus an actual event Pre-event & Post-event Preparations & Activity Prior to Katrina, cont. March 2004 – Strategic National Stockpile (SNS) Drill Scenario Based (Plague) One Region in LA (Region 7 – Shreveport) Planning Period was five months

A Levee Breach

Devastation of the Ninth Ward

Drill versus an actual event Planning Drill Reality Months of planning, coordination and partnering among multiple organizations Less than one week for mobilization and deployment

Drill versus an actual event Patient Flow Drill Reality “In-the-front-door” and “out-the-back-door” workflow Had to work within the “pool” of patients – unplanned workflow

Drill versus an actual event Patient Volume Drill Reality Prepared responders/healthcare personnel to process large numbers of patients in multiple PODs Required the management of large groups in a clinic/living setting

Drill versus an actual event Post-event Response Drill Reality SNS drill targeted a single threat – plague. No need to review vacc. histories – just track antibiotics dispensed Vaccination for multiple communicable diseases - HepA/B, Tetanus, flu – needed to review vaccination histories

Drill versus an actual event Responder Issues Drill Reality Food, shelter & transportation was controllable & not an issue Major issue – responders themselves became residents of the shelters

Drill versus an actual event Electronic Tracking Drill Reality Able to use streamlined system interface (Mass immunization Module) to record meds dispensed Had to review vaccination histories – required use of LINKS

Drill versus an actual event Electronic Tracking, cont. Drill Reality Access to WAN/Internet not an issue. No WAN/Internet access from the PODs. Required new processes to meet objectives for inventory tracking.

Drill versus an actual event Vaccine Supply & Distribution Drill Reality For BT Drill, supply line was well established Vaccine distribution center in New Orleans was lost

Drill versus an actual event Facilities & Human Resources Drill Reality Carefully planned and controlled Facilities & other resources severely impacted – - Loss of 11 hospitals - Many responders were themselves victims

Drill versus an actual event Duration Drill Reality Limited in the BT drill to 3 days and ½ day in the SNS/Plague drill Not clear at the outset

Lessons Learned Drills are scripted & controlled Drills can’t account for all possibilities Actual events are chaotic Use the “big picture” gained from drills in preparation Plan for threat possibilities specific to your region New York City will be different from the Gulf States