1. Danica Little, MHA Emergency Preparedness Manager UW Medical Center

2. Executive buy-in Renown Regional Medical Center, December 17, 2013 SPU shooting, June 5, 2014 Training Shots Fired Video Staff buy-in Multiple open-house training sessions with Q&A Staff meeting/education day training Messages over intranet and to all staff Preparing for the Exercise

3. Exercise Design Team UWMC Emergency Department UWMC Public Safety UW Police Department UW Office of Emergency Management Hazard Vulnerability Analysis Mass Casualty Incident Close proximity to campus Across the street from Husky Stadium (70,000+ seats) Organizing the Exercise

4. Exercise Goals Test MCI Plan Test Code Silver Response Pre-Exercise Communication Leadership and Management Teams In-patient Nurse Managers Visitors and Outpatients 911 Dispatch, UWPD and SPD News and Community Relations Organizing the Exercise

5. Exercise Control Organizing the Exercise

6. Signage Staging Area for Law Enforcement Creating Patient Profiles Moulage Refreshments Assignments Evaluation Organizing the Exercise

7. Setting the Stage Organizing volunteers and moulage Setting up tables, chairs, and signs Exercise Control Exercise Evaluation Photography Importance of Partners

8. Joint Commission Standard and Exercise Objective Joint Commission Element of Performance CommunicationEM 02.02.01 Determine effectiveness of communication to UWMC staff about event and response measures How staff will be notified that emergency response procedures have been initiated Assess response rate to disaster page to Group 1 Resources and AssetsEM 02.02.03 Evaluate ability to manage resources and assets needed for response The hospital’s arrangements for transporting some or all patients, their medications, supplies, equipment, and staff to an alternative care site when the environment cannot support care, treatment, and services Safety and SecurityEM 02.02.05 Evaluate coordination with UWPD and other law enforcement organizations How the hospital will coordinate security activities with community security agencies Assess implementation of Code Silver responseThe hospital’s arrangement for internal security and safety Staff ResponsibilitiesEM 02.02.07 Evaluate implementation of disaster planHospital trains staff for their assigned emergency response roles Utilities ManagementEM 02.02.09 Identify impact of vacuum disruption in the Emergency Department Hospital identifies alternative means of providing medical gases/vacuum systems Patient and Clinical Support ActivitiesEM 02.02.11 Evaluate effectiveness of early dischargeHow the hospital will manage the activities required as part of patient scheduling, triage, assessment, treatment, admission, transfer, and discharge Exercise Objectives

9. Exercise playbook Timeline of Events Master Scenario Event List Used spectralink phones from Hospital Command Center, to give all controllers and evaluators ability to communicate with each other Made Incident Command a training opportunity, rather than a test Leveraged Emergency Management Committee members to evaluate Code Silver response in their Departments Tiered response for Mass Casualty, to keep scope limited Running the Exercise

10. Scenario Simulated Saturday night Husky football game. Shooter at the game opens fire, causing victims to self-refer across the street to UWMC. After 3 rd wave of victims arrives, UWPD notifies UWMC Public Safety that shooter may have fled with the crowd. They request we search victims for weapons. Shooter is discovered and continues his search for his intended target, shooting staff in the ED and eventually hiding and shooting himself. Exercise Play

11. Response Initial: Mass Casualty response and Code Triage Second: Code Silver Active Shooter Third: Continued Code Triage and Recovery for Code Silver activities Exercise Play

12. Code Silver was called too early Information given was “shooter at the stadium” Could be drill artificiality, could be realistic Triage and MCI response in ED went very well. Physicians were engaged, professional and efficient More training needed with Charge Nurse on importance of Disaster Binder Code Triage response was delayed, but once in play, the floors identified 42 potential early discharge patients Early discharge process was managed extremely well by inpatient units Lessons Learned

13. Situational awareness was poor Information coming to Hospital Command Center was limited Code Silver response delayed responders from coming to Hospital Command Center Need to identify method for leadership to operate virtually for this type of event Lessons Learned

14. Improve coordination with law enforcement Unified Command was not established Law Enforcement did not utilize maps and key cards available at security desk Code Silver response was good, but can improve Units were evaluated and did a good job securing area ED responded to their injured co-worker before all-clear was given Lessons Learned

15. More education needed with staff about what to expect in a Code Silver Overhead announcements Rescuing victims Include anatomic pathology and Code Team in planning Law enforcement cannot declare person deceased Law enforcement does not render aid Lessons Learned

16. Access security video feeds in the Hospital Command Center Allows you to have eyes on what’s happening, while securing your area Good exercise control cannot be stressed enough! Lessons Learned

17. Recovery How to get hospital operations functioning, even at minimal levels, while law enforcement clears the building Next Steps

18. Danica Little, MHA Emergency Preparedness Manager UW Medical Center littleda@uw.edu (206) 598-2837 Questions?