1. A Report from Vigilant Guard and the Role of NARR in Rad Exercises Bill Stephens NACCHO Tarrant County Public Health

2. Exercise Overview A 4-day, full-scale exercise for a 10KT IND detonated in the center of Phoenix, AZ following a tropical storm flood Over 8,000 participants, 200 local, state and Federal agencies playing including 5 National Guard Civil Support Teams (CSTs) Local and state public health involved, but primarily notional as observed at IC points

3. Public Health Exercise Objectives Objectives consolidated and focused on PHEP Capabilities 5, 6, 7,9,10, 11,13 Fatality Management Information Sharing Mass Care Medical Materiel Management and Distribution Medical Surge Non-pharmaceutical intervention Public Health Surveillance and Epi Investigation

4. Command and Control Arizona Division of Emergency & Military Affairs and State EOC Collated on Papago Military Reservation

5. Key EM Operation Centers 91 st Division of AZ National Guard Joint Operations Center (JOC) State Division of Emergency Management Center Maricopa Integrated Health System (County hospital) Phoenix Fire Training Academy - simulated rubble pile with radiological contamination and manikin victims

6. State DEM EOC  Well located and equipped EOC with redundant comms.  Large staffing with back-up and liaisons with multiple agencies throughout exercise.  Using WebEOC for 3 weeks.  Excellent plume modeling and DOE presence and support.  Primary resource coordination focused on severely injured in the primary blast and fallout zones.

7.  Medium size hospital well connected with HaVABed system, EMSystems, redundant comm. equipment, and numerous other hospitals via voice and data  Have an excellent capability with level 1 trauma and burn center for both adult and pediatric in the same facility.  Burn center is linked to 10+other hospitals via telemedicine systems Maricopa Integrated Health System

8.  Extremely well organized with strong NIMS and ICS.  Advanced life support and stabilization with advanced field OR at base-camp prior to transport  No presence or mention of public health liaisons  PIO in communication with JIC.  Victim sniffing dogs Phoenix Fire Training – “Rubble Pile”

9. Key Public Health Related Gaps Observed Exercise gap – no public health liaisons present (exercise gap); notional only Community reception center (CRC) function missing or notional and CHC’s only playing in sheltering mode (exercise gap) Training on decon at base-camp and hospitals outdated – scrubbing with soap and brushes! Decon on injured patients done before treating trauma - “it’s inevitable that in these [rad] MCI’s some patients will be lost [due to trauma injuries] but it’s to protect other patients and personnel in ER from radiological contamination.”

10. Opportunities for NARR Support Targeted training/exercise for EM and National Guard CSTs in roles and responsibilities of public health – CRCs must be included First receiver medical response – updated training for medical staff on proper protocols for decon/trauma treatment (trauma first!) Decontamination protocols for radiological contamination – REAC/TS training? Altered standards of care for radiological MCIs Psychosocial/behavioral components not evident in protocols Proper briefing and exercise with media First responders and receivers? Table top exercise and seminar support early in cycle Selected tools cross-walked with identified gaps.