1. Healthcare Mass Fatality Management Tabletop Exercise > >

2. Exercise Agenda  Introduction & overview  Scenario and messaging with player response to follow  Break  Debrief

3. What is a Tabletop Exercise?  Informal discussion using a scripted disaster scenario as a catalyst  No time pressures, designed to promote free and open exchange of ideas  Familiarizes players with roles, responsibilities, functions, plans, and procedures  Identifies issues requiring further work

4. Exercise Play  Introductory narrative, followed by “problem statements” and subsequent updates  Put yourself in the position described in the scenario  When asked, describe your actions as if this were “real,” following organizational plans and procedures  There are no “right” or “wrong” answers  Identification of issues, but not necessarily trying to solve them

5. Procedural Notes  Parking Lot: as you come up with things that need further action as an organization, write them on a Post-It sticky note, hand to the facilitator and he/she will place it in the “parking lot”.  Your Specific Department: make notes of things you want to follow up on later with your department leadership and/or colleagues.

6. Exercise Objectives 1. Identify organizational planning gaps relating to mass fatality response 2. Determine > ability to assess and report fatalities 3. Determine > ability to track, move, and store remains and personal effects 4. Determine > ability to respond to family/friend inquiries following a mass fatality event 5. Identify internal training needs to respond to multiple fatalities

7. Assumptions  An increase in demand for > services is predicted during an emergency.  Some key decision makers are inaccessible.  Our community, including law enforcement, medical services, schools, stores, food banks, shelters, vendors, etc., will be impacted in the same ways > is impacted.

8. Scenario  It is a hot summer day in King County, WA. The weather forecast is mostly sunny skies with a high of mid 80s and an overnight low of high 60s  It is currently 5:30pm. 24 hours ago a magnitude 6.7 earthquake shook the Puget Sound Region affecting King, Pierce and Snohomish Counties

9. Situation Update #1.  SR 520, I-90, I-5 and I-405 are heavily damaged and both the I-90 and SR 520 bridges are impassable. The Alaskan Way Viaduct has collapsed.  Electricity is disrupted with only intermittent service throughout the county.  There are reports of numerous fatalities as well as injuries throughout the region.  Most of the hospitals in the region are operational, information gathering from other healthcare sectors is ongoing.  Health and Medical Area Command (HMAC) is activated and is supporting the King County Medical Examiner with response operations.

10. Situation #1: Questions 1. How will > determine the number of fatalities that have occurred within your facility as a result of the earthquake? a. How will > gather information about deceased staff members? 2. How will > organize the information to facilitate reporting to the King County Medical Examiner? a. Has > developed protocols for documenting non-patient deaths that occur at your facility? b. What types of documents will > use to identify and track remains to report to the Medical Examiner? c. How will > incorporate the tracking forms provided in the Fatality Management Plan template?

11. Situation Update #2  It is 3 days later  In King County, there are 1600 reported fatalities  The King County Medical Examiner will be delayed in their response to reported deaths, operations at funeral homes have also been delayed  Organizations and facilities are advised that it may be several days before bodies may be picked up  30 individuals located at your facility have dies

12. Situation #2: Questions 1. How will > surge to accommodate the deceased? a. What space will > use to store the remains? b. Have > developed protocols to address the following considerations with storage? a. Security b. Accessibility c. Temperature Management d. Appropriate Placement e. Privacy f. Ventilation g. Pest Control

13. Situation #2: Questions Cont. 2. What supplies, equipment and resources will > require to store the remains for several days? 3. How will > coordinate the tracking, movement and storage of remains? a. Who will complete the forms related to each decedent and ensure proper tracking of the remains? b. How will > track the personal effects of decedents? 4. How will > manage security issues? a. Security of human remains? b. Security of personal effects?

14. Situation #2: Questions Cont. 5. What infection control planning, if any, needs to be addressed? 6. How will > provide staff to fill the following job functions? a. Morgue Lead b. Personal Affects Management c. Morgue Security d. Storage Facility Maintenance e. Family Liaison 7. How will > provide training or just-in-time training to staff to be able to fill these roles? 8. How will > assess and support the mental health needs of staff involved in managing a mass fatality incident?

15. Situation Update #3  Family/friends are looking for their loved ones in any way possible  Community members have begun to find their family members/friends deceased and are bringing them to your facility/organization.

16. Situation #3: Questions 1. How will > handle family/friends that show up at the facility or inquire about their family members? a. How will > decide what information, if any, you will provide about their deceased family member? b. How will > handle inquiries from families about deceased staff members? 2. How will > respond to inquiries from the media regarding fatalities? 3. What will > do if community members bring their deceased family/friends to the facility?

17. Addition Planning In a non-earthquake scenario there may be other planning areas to consider: 1. What is > protocol for continuity of death certification? a. Has > developed a strategy for managing a surge of natural death certifications?

18. Congratulations! You have successfully participated in a mass fatality exercise

19. Debrief

20. 1. What were some significant issues that came out of exercise? 2. What issues came up that you did not expect? 3. What questions/issues came up that you’ll want to discuss with your employees? 4. What are things you want to follow up on within your department? Revisit post-it notes/”parking lot issues”. 5. What follow up would you like for the agency to do?