Ambulatory Tabletop Exercise October 25, 2011

Exercise Scenario A powerful earthquake has hit Southern California, measuring 7.8 on the Richter Scale, centered on the southern end of the San Andreas fault in Imperial County, CA. The earthquake resulted in nearly 3 minutes of severe ground shaking along a 200 mile stretch of the fault heading northwesterly through the center of the state. San Bernardino and Riverside Counties have sustained substantial property damage and casualties. Although ground shaking on the West side of Los Angeles County was significantly less than areas farther east, the earthquake was intense for about 1 minute, causing any unsecure items to fall over and onto the floor. Buildings comprising the UCLA Health System have sustained some damages, but are structurally intact.

Scenario Widespread power outage except for areas with red outlets and emergency lighting. Water pressure is very low due to broken pipes throughout the water distribution system. Telephones are not operational (landline or cellular). IT systems can be accessed via computers on backup power. Fallen ceiling tiles and other unsecured items litter the floor. Several staff members and patients have sustained minor injuries from falling items.

Departmental Response Administration has activated a Code Triage External – Level III across the Health System What are your initial departmental priorities?

Initial Department Assessment Remove patients and staff from immediate danger Visual inspection of facility and equipment Request assistance for life threatening concerns UDAR submission Internal casualties should be assessed, serious injuries should be sent to the Emergency room for triage and treatment. Equipment should be prepared for use, do not move equipment unless directed to do by the command center If indicated staff should be assigned to clear the department of current patients, and then present to the Labor Pool at the medical center

Ambulatory Department Response Matrix Ambulatory Clinics / FPG Locations Level I –Maintain situational awareness and report issues to the Hospital Command Center Level II – Inventory staff and supplies, send additional staff to the labor pool Level III – Clear department of current patients; prepare to activate Alternate Care Site Plan Additional Operating Room Facilities (ASC, JSEI) Level I – Maintain situational awareness and report issues to the Hospital Command Center Level II – Same as Level I Level III - Clear department of current patients; prepare to activate Alternate Care Site Plan

Scenario The eastern side of Los Angeles County and the counties to the east of us have sustained massive damage. All major highways leading to and from the Inland Empire are impassable. Traffic around UCLA is gridlocked due to everyone trying to leave the area through debris-cluttered streets with non-functioning traffic signals.

Scenario Ronald Reagan Medical Center is preparing to receive an influx of transfer patients from other facilities more seriously damaged by the earthquake. The Hospital Command Center is doing everything possible to create surge capacity to accept the most critically ill and injured patients from throughout the region. The Emergency Department is experiencing a steady influx of minor to moderate injuries from the local community, and occasional trauma patients by air and ground EMS.

Alternate Care Site Activation The Hospital Command Center has decided to activate the Alternate Care Site Plan to utilize Medical Plaza to treat minor injuries. The Command Center has also decided to move stable surgical recovery patients from RRMC to the Ambulatory Surgery Center and Medical Procedures Unit to free PACU beds for ICU overflow. There is no emergency evacuation required from the Medical Center at this time.

N Gayley Ave Charles E. Young Drive 200 Med Plaza Westwood Blvd Evacuation Assembly Location Triage Area Minor Gayley Ave Immediate Delayed Discharge Minor Triage Area 200 Med Plaza Charles E. Young Drive Minor Trauma Minor Medical Immediate Delayed 300 Med Plaza Discharge Ronald Reagan UCLA N Westwood Blvd

Access Points Minor Trauma Minor Medical Patient Waiting Triage/ Registration Access Points Minor Trauma Minor Medical Patient Waiting

Mission Continuity Planning 2 2

Initial Response The First Few Hours Ensure Patient, Visitor, Staff, Faculty, and Volunteer safety Provide care for current patient population Develop ability to accept surge of patient care volume from the community What are the mission critical functions at the department level that must be maintained or can be deferred for an established period of time? Let’s Take the Earthquake scenario that is more likely in So. California but we could apply this to a pandemic influenza which affects our workforce, or a wildfire which prevents or supply chain from reaching us. So far we have planned around the first few hours (review main objectives above) The next step is to start planning for the ability to overcome the challenges created by the hazard or interruption and return to normal. This is the concept of Business Continuity Planning. 3 3

Response to Recovery The Few Days After Acclimate to changes in space, human resources, information systems, equipment, and supplies What mechanisms will be used to monitor long-term recovery staffing needs? How do we account for resource needs if there are supply chain disruptions with our primary vendors?

Getting Back to Normal Recovery: Resume Full Normal Operations Full Recovery Getting Back to Normal Recovery: Resume Full Normal Operations Once the alternate care site has been demobilized, what is the recovery time objective for restoration of normal business functions within our ambulatory care departments? What are the upstream and downstream critical support dependencies that need to be in place to support restoration of normal operations (e.g. pharmacy, blood bank, etc)? Has each ambulatory department engaged in mission continuity planning to address these identified operational resiliency needs?

The Disaster Lifecycle: Preventative Reactive Corrective Before During After TIME Emergency Management Response Mitigation Preparedness Recovery Normal Operations Minimal Tolerable Level of Function Disaster Planning + Business Continuity Planning Business Continuity Zero Hour Begins Restoration Ends Phases Incident Occurs Proactive BCP Activities Prevention and Preparedness Reactive BCP Activities Response, Recovery & Restoration 10 10

So, if you don’t want to be in this position… 19

Next Steps: Designate a plan writing team with your department or unit manager (usually 2-3 staff) Contact the Office of Emergency Preparedness to schedule a UC Ready plan building session During the session your team will receive supportive materials and 1:1 guidance on how to develop your business continuity plan 20

Questions or Comments Office of Emergency Preparedness Website: http://disaster.mednet.ucla.edu/ (310) 267-7107 oep@mednet.ucla.edu