1. Healthy NH Shelters October 29, 2014

2. Acknowledgements  Shelter Surveillance Work Group and Exercise Planning Team  Participants – that’s you!  Funding

3. Thank you!  Manchester Health Department for letting us use their space  American Red Cross for providing refreshments

4. Healthy NH Shelters  Exercise Briefing  October 29, 2014  Manchester Health Department  Exercise Scope: tabletop; 2 hours  Mission area: Response

5. Objectives and Public Health Preparedness Capabilities Exercise ObjectiveCore Capability Identify the roles and responsibilities of the participating agencies during health surveillance in mass care shelters. PHP Capability 1: Community Preparedness; HP Capability 1: Healthcare System Preparedness Identify all existing laws, plans, policies and procedures related to health surveillance in shelters and how they can be coordinated for a more efficient response. PHP Capability 7: Mass Care

6. Exercise ObjectiveCore Capability Evaluate the guidance, policies, and protocols to implement health surveillance in mass care shelters. PHP Capability 7: Mass Care; PHP Capability 13: Public Health Surveillance and Epidemiological Investigation Evaluate communication flow and information sharing between the shelters, the SEOC and the NH DHHS ICC/DPHS. PHP Capability 3: Emergency Operations Coordination; PHP Capability 6: Information Sharing Assist the shelter with identifying and implementing infection prevention and control measures for the shelter. PHP Capability 13: Public Health Surveillance and Epidemiological Investigation

7. Participant Roles and Responsibilities  Players: Respond to situation presented based on current plans, policies, and procedures  Observers: Support players in developing responses, but do not participate in moderated discussion  Facilitators: Provide situation updates and moderate discussions  Evaluators: Observe and document player discussions

8. Exercise Structure  2 modules  Break  Hotwash & Evaluation Forms

9. Exercise Guidelines  This is an open, low-stress, no-fault environment. Varying viewpoints, even disagreements, are expected.  Base your responses on the current plans and capabilities of your organization.  Decisions are not precedent setting; consider different approaches and suggest improvements.  Issue identification is not as valuable as suggestions and recommended actions that could improve efforts; problem-solving efforts should be the focus.

10. Assumptions and Artificialities  The exercise is conducted in a no-fault learning environment wherein capabilities, plans, systems, and processes will be evaluated  The exercise scenario is plausible, and events occur as they are presented  All players receive information at the same time

11. Module 1: Storm Headless Horseman

12. Module 1 Objectives (30 mins)  Identify the roles and responsibilities of the participating agencies during health surveillance in mass care shelters.  Identify all existing laws, plans, policies and procedures related to health surveillance in shelters and how they can be coordinated for a more efficient response.

13. 10/22/14 In the news……  ISIS Using Chemical Weapons?  Ebola Quarantine Rules  Will Hawaii’s Volcanic Menace Stop?

14. 10/22/14 – Weather Forecast  A major storm with torrential downpours and heavy winds is expected to hit NH  Worry about power outages and flooding  With Halloween around the corner the storm was nicknamed the Headless Horseman

15. Discussion  What is your agencies role pre- event when bad weather is coming?  Is there anything being done to pre-designate or set-up shelters?

16. 10/23/14 – Storm Headless Horseman hits NH  Heavy rains  High winds  Saturated ground

17. 10/23/14  Flash Flood Watch in effect for entire state of NH

18. 10/23/14  Multiple vehicle accidents across state  1 fatality; 5 sent to the hospital  One person sent to the hospital after trying to clear a fallen tree from his driveway

19. 10/24/14 – after the storm  DPW starts to clear the damage  Flash flood warning goes into effect  Power is out to 300,000 people across NH

24. 10/24/2014 – Shelter  Granite State High School opens a shelter for residents, pets and individuals with functional needs  It is run by the municipality with help from the Public Health Region

25. 10/24/14 – ARC Shelter  American Red Cross sets up a shelter in the neighboring region

26. Discussion  What is your agencies role in setting up, running or assisting shelters during emergencies?  How can your agency help with surveillance in shelters?

27. Discussion  Are there existing laws, plans, policies or procedures that can assist with conducting surveillance in shelters?

28. Surveillance in Shelters  When does the surveillance process start for shelters?  Should any of the surveillance forms be started prior to opening a shelter?

29. Module 2: Granite State High School Shelter

30. Module 2 Objectives (70 mins) Evaluate the guidance, policies, and protocols to implement health surveillance in mass care shelters. Evaluate communication flow and information sharing between the shelters, the SEOC and the NH DHHS ICC/DPHS. Assist the shelter with identifying and implementing infection prevention and control measures for the shelter.

31. 10/25/14  Power outages expected to be out for approximately 7-10 days  Flooding severe in some places and people can’t return home

32. 10/25/14  Both shelters are filling up quickly  Granite State High School shelter  120 residents  30 volunteers/staff during the day  15 volunteers/staff at night  1-2 medical staff available each shift

33. Granite State High School Number Category Number Category 68Females52Males 35 Families w/o children 14Families w/children 1Service Dogs10 People with durable medical equipment 2 Group Home adult residents 2Group Home staff 30 Shelter staff – day shift 15 Shelter staff – night shift

34. Discussion  Who oversees surveillance and infection control in shelters?  Who would be tasked to contact the state to report outbreaks or communicable diseases?  Who is responsible for triage at the shelter?

35. Discussion  What communication pathways exist between shelters (including ARC shelters) and the state?

36. 10/25/14  Granite State High School is working with the municipality and giving updates on shelter counts and issues to the LEOC  Shelter mentions that they may need help with medical supplies for some of the residents from the group home  The residents from the group home brought some yummy delicious Halloween cupcakes they made before the storm hit and shares them with everyone….they are so nice!

38. SEOC to GSHS  The SEOC ESF-8 reaches out to the GSHS to check-in and asks if they have started to conduct surveillance using the forms  GSHS didn’t know they were supposed to fill out forms

39. Discussion  How can the GSHS access the forms?  What can the SEOC do to assist the shelter?  How can the shelter get the forms to the SEOC daily?

40. Discussion  Who keeps track of the summary forms and monitors for trends?  If a possible outbreak is identified, who assists?

41. 10/26/14 – 10/28/14  GSHS has been filling out the summary form and sending it to the NH DHHS ICC email address daily

42. 10/28/14 – Concord, we have a problem

43. Discussion  What is the problem?  Who gets notified?  Who takes control of the outbreak investigation?

44. Discussion  What additional information is needed from the shelter?  What measures are given to the shelter to try to stop the outbreak?  What actions should have been taken before this started to prevent it?

45. Back to the cupcakes…  Two of the ill residents are from the group home and one of the ill residents is a staff person from the group home.  Investigation reveals that all the ill residents ate the cupcakes  One resident is transported to the hospital for dehydration and test results point to norovirus

46. American Red Cross Shelter  If this same situation happened at an ARC shelter:  Who is notified?  Who is in charge of notifying the state of an outbreak situation?  What ARC resources are available to help mitigate the situation?

47. Remaining Thoughts?

48. Hotwash  Strengths  Areas for Improvement

49. Thank you for coming!  Please fill out your evaluation form before you leave!