State and Regional Exercises: Lessons Learned National Governor’s Association Conference Boston Seaport Hotel January 12, 2004 Suzanne Condon, Associate Commissioner Center for Environmental Health and Center for Emergency Preparedness Massachusetts Department of Public Health “Preparation for the likely prepares us for the unlikely”

Introduction 1. Introduction/Exercises 2. Major Issues Involved in Exercises and Planning 3. Collaborative Exercise Program in Massachusetts 4. Summary of Important Lessons

Recent Exercises Operation Yankee, August 2003 Operation Yankee, August 2003 Measured Response to Bioterrorism TTX, October 2003 Measured Response to Bioterrorism TTX, October 2003 Emergency Powers Working Group TTX, December 2003 Emergency Powers Working Group TTX, December 2003 Various SNS Exercises Various SNS Exercises

Key Areas of Lessons Learned Planning Planning All-Hazards Approach All-Hazards Approach Communications Communications Training Training Policy/Decision-Making Policy/Decision-Making Risk Communication Risk Communication Multi-Disciplinary Collaboration Multi-Disciplinary Collaboration

Planning Need to exercise completed written plans Need to exercise completed written plans Take Baby Steps: There is a necessary hierarchy in types of exercises Take Baby Steps: There is a necessary hierarchy in types of exercises Need to have all our ducks in a row Need to have all our ducks in a row Cannot be afraid of the evaluation Cannot be afraid of the evaluation

All-Hazards Approach “Preparation for the likely prepares us for the unlikely” “Preparation for the likely prepares us for the unlikely” Events do not occur in silos Events do not occur in silos Triggering events may vary; initial response mechanisms do not Triggering events may vary; initial response mechanisms do not

Communications Ensure capability across jurisdiction Ensure capability across jurisdiction Interoperability Interoperability Redundant modes needed Redundant modes needed Relationships important; should not be the first time people interact Relationships important; should not be the first time people interact

Training Need for standardized incident command system (NIMS) Need for standardized incident command system (NIMS) Cross-disciplinary Cross-disciplinary  Including forensic epidemiology, chain of custody issues  Awareness of authorities and emergency powers Need to train executives and elected officials on process Need to train executives and elected officials on process

Policy/Decision-Making  Need to keep elected officials apprised of process  SNS – when to request  What constitutes a public health emergency  The bigger the event, the more volatile it may become

Risk Communication How much information do you have? How much information do you have? How do you act on limited information? How do you act on limited information? What to release to the public, and when What to release to the public, and when Issues regarding stockpile requests, mass prophylaxis, evacuation, sheltering Issues regarding stockpile requests, mass prophylaxis, evacuation, sheltering At what point does the scale tip? At what point does the scale tip?

Multi-Disciplinary Collaboration Emergencies are rarely restricted to one community or to one discipline Emergencies are rarely restricted to one community or to one discipline Partners from public safety, public health and other organizations should be involved Partners from public safety, public health and other organizations should be involved Events do not recognize borders or organizational charts Events do not recognize borders or organizational charts Need for mutual aid agreements, regional plans Need for mutual aid agreements, regional plans

MA Statewide Exercise Program DPH and EOPS partnership DPH and EOPS partnership CDC, HRSA and ODP grant funding CDC, HRSA and ODP grant funding Statewide Exercise Advisory Committee Statewide Exercise Advisory Committee RFR to design, implement, and evaluate multi-disciplinary tabletop, functional and full-scale exercises RFR to design, implement, and evaluate multi-disciplinary tabletop, functional and full-scale exercises

Summary Planning is key to preparedness Planning is key to preparedness Planning is crucial to effective exercises Planning is crucial to effective exercises Communication/collaboration is essential Communication/collaboration is essential Developing partnerships at all levels before an event occurs has multiple benefits Developing partnerships at all levels before an event occurs has multiple benefits