1. Designing, Conducting, and Evaluating Tabletop Exercises for Pandemic Influenza Business Continuity Planning Kristine Moore, MD, MPH Medical Director Jill DeBoer, MPH Associate Director

2. Workshop Outline Overview of Exercises (30 minutes) The Tabletop Exercise Planning Process: From Conception to Action (60 minutes) Facilitating a Tabletop Exercise; Exercise Evaluation and Follow-up (30 minutes)

3. Overview of Exercises

4. Presentation Outline Steps in Business Continuity Planning Purpose and Timing of Exercises Five Major Types of Exercises Unique Features of Pandemic Influenza Exercises Designing Exercises to Meet Your Needs

5. Steps in Business Continuity Planning 1.Conduct a Risk Assessment 2.Conduct a Business Impact Analysis (BIA) 3.Develop a Business Continuity Plan (BCP) 4.Implement the BCP 5.Test, Refine, and Revise the BCP

6. Steps in Business Continuity Planning 1.Conduct a Risk Assessment  Identify internal and external threats, hazards, and vulnerabilities that could impact your company  Hazards may be industry-specific or may be general  Rank hazards by probability and severity  Pandemic influenza is a hazard with a high potential severity and high probability (at some point)

7. Steps in Business Continuity Planning 1.Conduct a Risk Assessment 2.Conduct a Business Impact Analysis (BIA)  Define how different hazards (such as pandemic influenza) could impact your business  Identify critical job functions and operations  Assess assets for response  Consider minimal requirements for continuing operations

8. Steps in Business Continuity Planning 1.Conduct a Risk Assessment 2.Conduct a Business Impact Analysis (BIA) 3.Develop a Business Continuity Plan (BCP)  Utilize an all-hazards approach with annexes for specific issues  Make key decisions (based on the BIA)  Develop policies and procedures as necessary  Define trigger points as needed  For pandemic planning, consider unique stresses ( CIDRAP 10-point framework)

9. Steps in Business Continuity Planning 1.Conduct a Risk Assessment 2.Conduct a Business Impact Analysis (BIA) 3.Develop a Business Continuity Plan (BCP) 4.Implement the BCP  Educate staff and conduct training as needed  Conduct steps necessary to implement policies and procedures

10. Steps in Business Continuity Planning 1.Conduct a Risk Assessment 2.Conduct a Business Impact Analysis (BIA) 3.Develop a Business Continuity Plan (BCP) 4.Implement the BCP 5.Test, refine, and revise the BCP

11. Purpose and Timing of Exercises An exercise is a focused practice activity that places the participants in a simulated situation requiring them to function in the capacity that would be expected of them in a real event. Excerpt from FEMA Emergency Management Institute Independent Study Course, Exercise Design (March, 2003)

12. Why Exercise? Identify successes and strengths to be maintained and built upon Plans, policies, and procedures Resources Reveal areas needing further improvement Plans, policies, and procedures Resources Educate on plans, policies, and procedures Educate on the complexities of a specific emergency scenario

13. Why Exercise? (continued) Improve organizational coordination and communications Train personnel in roles and responsibilities Improve individual performance Satisfy regulatory and/or funding requirements Evaluate response systems

14. When to Exercise According to planned exercise program schedule But also… Revision of Business Continuity Plan Changes in key personnel Shifts in sector/industry trends New regulatory requirements Changes in information technology systems In response to recent past incidents or events In anticipation of upcoming events

15. Exercise Categories Orientation Drill Tabletop Exercise Functional Exercise Full Scale Exercise

16. Orientation Purpose Familiarize staff to organization’s emergency response plan Familiarize current staff to changing information or procedures Bring together various departments for better understanding and coordination Identify planning and response priorities prior to plan development

17. Orientation Methods Talk Through Brain Storming Case Study Training Workshop

18. Orientation Example Cross Border Orientation Exercise

20. Scenario 1: Foodborne Botulism Outbreak

21. Suspect Botulism Cases Cranial nerve dysfunction Bilateral proximal muscle weakness

22. Largest Foodborne Botulism Outbreak Reported in North America 176 cases

24. Small Group Discussion Review Identified Issues Prioritize Issues Brainstorm Realistic Action Steps

25. Orientation Good for: Educating, building awareness Gathering new ideas or feedback Exercising before a plan is started Exercising before a plan is finalized

26. Drill Purpose Instruct thoroughly through repetition and practice Focus is usually on one aspect of the response plan in one organization Can be used to test staff training, response time, interdepartment cooperation and resources, manpower and equipment capabilities Can be preceded by orientation

27. Drill Sometimes referred to as: Procedure verification exercise Validation exercise Walk-through exercise

28. Drill Examples After Hours Notification Drill Emergency Operations Center Drill IT System Recovery Drill Mass Dispensing Site Drills

29. Tabletop Exercise Purpose Focus on constructive problem solving as a group The success of a tabletop exercise is determined by feedback from participants and the impact this feedback has on evaluation and revision of policies, plans, and procedures

30. Tabletop Exercise Methods A discussion guided by a facilitator based on a simulated emergency situation Basic Tabletops: Participants discuss problems as a group; leader summarizes conclusions Advanced Tabletops: Series of messages requiring rapid response; facilitator guides the discussion

31. Tabletop Exercise Advantages (FEMA Exercise Design Manual) Is a good way to acquaint key personnel with emergency responsibilities, procedures, and one another Is an effective method for reviewing plans, procedures, and policies Requires only a modest commitment in terms of time, cost, and resources

32. Tabletop Exercise Disadvantages (FEMA Exercise Design Manual) Lacks realism and thus does not provide a true test of an emergency management system’s capabilities Provides only a superficial exercise of plans, procedures, and staff capabilities Does not provide a practical way to demonstrate system overload

33. Functional Exercise Purpose Fully simulated interactive exercise that tests the capability of an organization to respond to a simulated event Tests multiple functions and coordinated response in a time-pressured, realistic simulation (without deploying resources)

34. Functional Exercise Methods Participants gather where they would actually operate in an emergency (usually an EOC or other operating center) Participants are briefed immediately prior to the start of the exercise as to objectives, procedures, time frame and recording requirements Simulated information is delivered to players by paper, telephone, or radio

35. Functional Exercise Methods (continued) Players respond as they would in a real emergency, in real time, making on-the-spot decisions and taking on-the-spot actions Similar to full-scale exercise without the equipment Involves controllers, simulators, and evaluators May consider “no-notice” design

36. Functional Exercise Sometimes referred to as: Simulation exercise Operational exercise

37. Functional Exercise Examples Strategic National Stockpile Exercises Nuclear Power Plant Exercises

38. Full Scale Exercise Purpose Tests the comprehensive response capacity of multiple organizations by simulating a real event as closely as possible

39. Full Scale Exercise Methods Field personnel proceed to the location of a mock emergency EOC activities are combined with on-scene use of simulated victims, equipment, and manpower (enactment) Activities at the scene serve as input and require coordination with the simulation at the EOC

40. Full Scale Exercises Example City/County Emergency Management Exercises Airport Disaster Exercises

41. Exercises are Everywhere Military Emergency Management Hospital Disaster Planning Nuclear Power Plants Airports Businesses Public Health

43. Unique Features of Pandemic Influenza Exercises Rapid decision-making with limited information Staged decision-making Long term event Global event Impacts all sector of society Exploring relationships with the public health system Anticipated public panic

44. Designing Exercises to Meet Your Needs Choose Type of Exercise Carefully –Based on Exercise Goal and Objectives Choose Exercise Format Carefully –Unlimited possibilities Consider the Roles of Internal Teams and External Consultants

45. Early in the Design Process: Visualize “That was a smashing success!”

46. Three Key Questions: What did the participants learn? What was documented? How do the participants feel?