1. STATEWIDE MEDICAL AND HEALTH EXERCISE PHASE III: TABLETOP EXERCISE [Exercise Name/Exercise Date]

2. WELCOME & INTRODUCTIONS

3. 3 SCHEDULE OVERVIEW 0000 Registration 0000 Welcome and Opening Remarks 0000 Module 1: Communication and Medical Surge 30 Minutes Briefing, Plenary Discussion, and Brief-Back 0000 Break 0000 Module 2: Confirmed Case & Incident Command 30 Minutes Briefing, Plenary Discussion, and Brief-Back 0000 Lunch 0000 Module 3: Security & Fatality Management 30 Minutes Briefing, Plenary Discussion, and Brief-Back 0000 Break 0000 Hot Wash 0000 Closing Comments

4. 4 PRESENTATION GUIDE BACKGROUND AND ADMINISTRATION MODULE 1: COMMUNICATION & MEDICAL SURGE MODULE 2: CONFIRMED CASE & INCIDENT COMMAND MODULE 3: SECURITY & FATALITY MANAGEMENT MODULE 4: DEBRIEF QUESTIONS & PLANNING FOR THE FUNCTIONAL EXERCISE

5. BACKGROUND AND ADMINISTRATION

6. 6 Cell Phones Restrooms Exercise Materials Breakout Discussion Groups Parking validation Mobile phones Evacuation procedures –“This is a real emergency.” ADMINISTRATION

7. 7 Welcome –Name –Position –Agency/Organization –Optional: Icebreaker Logistics –Materials Situation Manual –Follow along! Feedback Form Observer Handout ADMINISTRATION

8. 8 EXERCISE OVERVIEW Name –Statewide Medical & Health Tabletop Exercise Date –[insert date] Scope –4 phases in program Mission Areas –[insert selected] Capabilities –[insert selected]

9. 9 Objectives –[insert selected] Threat/Hazard –Pandemic Influenza Scenario –Novel Strain of H5N1 Sponsor –CDPH, EMSA, [insert your agency/organization] Participating Organizations –[insert] EXERCISE OVERVIEW

10. GENERAL INFORMATION KEY MATERIAL

11. 11 Introduction Objectives & Core Capabilities –[agency/organization objectives & core capability detail] Participant Roles & Responsibilities –Players –Observers –Facilitators –Evaluators –Controllers GENERAL INFORMATION

12. 12 Exercise Structure –Module 1 – Communication and Medical Surge Breakout group discussion and group presentations –Module 2 – Confirmed Case and Incident Command Breakout group discussions and group presentations –Module 3 – Security and Fatality Management Breakout group discussions and group presentations GENERAL INFORMATION

13. 13 Exercise Guidelines –Use current plans/capabilities Exercise Assumptions & Artificialities –Impacts across response community –See Situation Manual (SitMan) for others Exercise Evaluation –Exercise Evaluation Guides (EEG) –Feedback Forms GENERAL INFORMATION

14. 14 National Association of County and City Health Officials (NACCHO)/Centers for Disease Control (CDC) Program Currently in development Major jurisdictions across California have been engaged in initial planning and testing See Appendix in the Situation Manual for more information This program will be addressed in Module 3 RESOURCE: FLU ON CALL™

15. MODULE ONE COMMUNICATION AND MEDICAL SURGE

16. 16 Worldwide influenza pandemics occur when a novel virus emerges to which the population has little immunity The 20 th century saw three such pandemics –Optional Videos: http://www.flu.gov/video/201 0/01/we-heard-the-bells.html http://www.flu.gov/video/201 0/01/we-heard-the-bells.html –http://www.un- influenza.org/?q=content/ho w-virus-changes-worldhttp://www.un- influenza.org/?q=content/ho w-virus-changes-world BACKGROUND INFORMATION

17. 17 Strains of avian influenza interact with human influenza A mutation can occur, creating a virus capable of human-to human transmission, initiating a pandemic 25 to 35% of the population may become ill Nearly 200,000 Californians may die Impact of the pandemic could last for as long as 18 months, with waves of activity BACKGROUND INFORMATION

18. 18 Non-pharmaceutical containment measures are key to controlling the spread of virus –Optional Video: http://www.un- influenza.org/?q=content/ nhs-pandemic-flu- information-health- workers http://www.un- influenza.org/?q=content/ nhs-pandemic-flu- information-health- workers Vaccination and antiviral treatment are anticipated to be the most effective These may be delayed or in limited supply BACKGROUND INFORMATION

19. 19 Real concern for fear and panic among the public as well as the response community Will there be enough: –Staff? –Supplies? –Equipment? –Vaccine? –Medicines? BACKGROUND INFORMATION

20. 20 How will daily functions be impacted (e.g. schools, transportation, adult care, etc.)? Ability of Federal government to support the response in California will be limited at the onset Virus will be widespread and not limited to one jurisdiction, region or state BACKGROUND INFORMATION

21. 21 Five cases of human-to-human transmission in Cambodia Health care providers used stockpiled antiviral medication Many residents disregard isolation instructions MODULE ONE Communication & Medical Surge

22. 22 H5N1 quickly spreads 30% develop symptoms Seasonal vaccine is ineffective Certain antiviral medications have been shown to help alleviate symptoms Sporadic H5N1 cases appear throughout Southeast Asia and Australia MODULE ONE Communication & Medical Surge

23. 23 CDC initiates enhanced surveillance at quarantine stations Viral isolates sent to the CDC/National Institute of Allergy and Infectious Diseases (NIAID) Hospitals and healthcare facilities asked to increase surveillance and reporting Influenza is the lead story for all major news outlets Public fear continues to grow MODULE ONE Communication & Medical Surge

24. 24 Health departments try to purchase additional stockpiles of antiviral medications California already experiencing an above- average flu season Patient workups include testing for H5N1 MODULE ONE Communication & Medical Surge

25. 25 "They've brought in extra doctors to handle the overload," said Dr. [insert name] of [insert local hospital name]. "And even with that, you still end up with patients waiting in the emergency room for 24 hours for a bed." 9-1-1 had triple the number of calls compared to this same time last year MODULE ONE Communication & Medical Surge

26. 26 Elect a group spokesperson Use the Situation Manual and exercise materials to take notes Focus on –Strengths –Areas for improvement As it pertains to: –Doctrine –Organization –Personnel –Training –Equipment –Support DISCUSSION FORMAT

27. CONFIRMED CASE & INCIDENT COMMAND MODULE TWO

28. 28 On Monday, a 33-year old woman in a neighboring county becomes the first confirmed H5N1 case in California While ill, she attended a large fair with over 5,000 attendees in the neighboring county last week Hospitals in the neighboring county experience a wave of ILI cases, many who attended the same fair MODULE TWO Confirmed Case & Incident Command

29. 29 Monday - 12:30 PM: First confirmed H5N1 fatality in CA in a neighboring county Tuesday –The [insert your jurisdiction] public health department operations center (DOC) is activated –Strategic National Stockpile (SNS) assets are requested Wednesday –SNS assets are available for distribution MODULE TWO Confirmed Case & Incident Command

30. 30 Extra security requested for: –Healthcare facilities –Government buildings –Point of Dispensing (POD) Sites Local public health –Distribute vaccines to hospitals and local health departments –Activate a select number of PODs At least 80 suspect H5N1 cases in the neighboring county MODULE TWO Confirmed Case & Incident Command

31. 31 9:00 AM on Thursday: three patients, a mother with two children ages six and nine, present at a local hospital They attended the fair with several members of their church last week Also, the mother attended an event at her children’s school three days ago MODULE TWO Confirmed Case & Incident Command

32. 32 Healthcare facilities experience a surge of ILI cases, many of whom had contact with the confirmed H5N1 cases Several individuals calling in with questions about their symptoms Many confirm they were at the county fair or school event three days ago The mother and the youngest of her two children become the first confirmed local H5N1 fatalities MODULE TWO Confirmed Case & Incident Command

33. 33 The Local Health Officer is faced with an onslaught of crucial decisions to make: –Ongoing risk communications strategies –DOC/EOC coordination –Disease investigation/surveillance and coordination with authorities The Governor declares a state of emergency MODULE TWO Confirmed Case & Incident Command

34. 34 Elect a group spokesperson Use the Situation Manual and exercise materials to take notes Focus on –Strengths –Areas for improvement As it pertains to: –Doctrine –Organization –Personnel –Training –Equipment –Support DISCUSSION FORMAT

35. SECURITY & FATALITY MANAGEMENT MODULE THREE

36. 36 In the following days: –Healthcare facilities continue to experience a surge –Concerned citizens present at healthcare facilities asking for antiviral medications and vaccines –News crews camp out in front of hospitals, public health departments, and City Hall seeking more information MODULE THREE Security & Fatality Management

37. 37 Local public health begins a contact tracing campaign Officials asked to publish guidance on: –appropriate diagnosis and treatment –public information for proper hygiene, hand washing, and contact with others 15 additional cases present MODULE THREE Security & Fatality Management

38. 38 State and local agencies again asked to intensify influenza surveillance and communications CDPH considers special programs Asymptomatic citizens begin to: –Seek medical attention –Demand prophylactic treatment –Buy out over-the-counter medications MODULE THREE Security & Fatality Management

39. 39 News commentators criticize government officials Local hospitals reporting staff absenteeism Law enforcement agencies respond to civil unrest calls Dispatcher reports an increase in the number of calls Of the confirmed H5N1 cases, roughly 25% have been fatal MODULE THREE Security & Fatality Management

40. 40 Local Department of the Medical Examiner/Coroner’s Office: –activates their DOC –contacts EOC for mutual-aid assistance Hospitals implement mass fatality management plans PODs are activated Hospitals experience their most significant medical surge yet MODULE THREE Security & Fatality Management

41. 41 Medical personnel are at the breaking point in dealing with: –fears of the worried well –surge in decedents Personnel in key positions are absent due to: –Illness/exhaustion/burn out –fear of illness –caring for ill family members MODULE THREE Security & Fatality Management

42. 42 Elect a group spokesperson Use the Situation Manual and exercise materials to take notes Focus on –Strengths –Areas for improvement As it pertains to: –Doctrine –Organization –Personnel –Training –Equipment –Support DISCUSSION FORMAT

43. 43 CONCLUSION OF THE DISCUSSION-BASED TABLETOP

44. DEBRIEF QUESTIONS & FUNCTIONAL EXERCISE PLANNING MODULE FOUR

45. 45 Debrief questions Exercise levels –Level of play –DOC/EOC activation Exercise duration Scenario development Participation Testing of plans & procedures Role of State agencies MODULE FOUR

46. 46 Please complete your Participant Feedback Form or Evaluation Notes/EEGs and return them to an Exercise Facilitator at Registration Please clean up your area and take all your materials with you Additional materials can be found at the Statewide Medical and Health Exercise Program website: www.californiamedicalhealthexercise.com CONCLUSION

47. STATEWIDE MEDICAL AND HEALTH EXERCISE PHASE III: TABLETOP EXERCISE [Exercise Name/Exercise Date]