TABLETOP EXERCISE. HCA Education and Research WHAT IS A TABLETOP EXERCISE? EXERCISE FORMAT. Supported with Funding from the NYSDOH 1

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TABLETOP EXERCISE Radiological Dispersal Device 1 HCA Education & Research Supported with funding from the New York State Department of Health WHAT IS A TABLETOP EXERCISE?

1 TABLETOP EXERCISE Radiological Dispersal Device 1 HCA Education & Research Supported with funding from the New York State Department of Health WHAT IS A TABLETOP EXERCISE? People come together to review and discuss a hypothetical emergency situation Designed to allow participants to talk through plans and problems NOT designed to measure anyone s performance Serves as a springboard for further planning and more comprehensive exercises 2 EXERCISE FORMAT The scenario has five sections Discussion questions follow each section At the end of the scenario, everyone will participate in a debriefing or hotwash 3 NYSDOH 1

2 EXERCISE ROLES Facilitator Provide instructions, tell the story, introduce the questions, guide the discussion Participants Immerse yourself as if the scenario were truly occurring in your jurisdiction, using resources that are available to you (Emergency Operations Plan, policies, procedures, references) Participate in the group discussions Evaluators Observe the exercise to evaluate the process 4 GROUND RULES Respond as if the scenario is real Play the role of your department, agency or community throughout the exercise Operate within current resource constraints and realities This is a test of your plan, so you must react according to your plan!!! Take notes for discussion and plan evaluation 5 OBJECTIVES By the end of this exercise, you should be able to: Describe your individual and your agency s roles in the response Identify at least one gap in your agency s existing Emergency Operations Plan (EOP) Contact the appropriate partnering agencies during business hours as well as after hours 6 NYSDOH 2

3 Today in Your Area 7 EXPLOSION! 8 On a bright, sunny morning Without warning, a large explosion occurs in downtown Metropolis A plume of smoke rises and disperses over most of the city 9 DAY 1, 10:30 a.m. NYSDOH 3

Destruction and Devastation 20 nearby vehicles are immediately destroyed Eight surrounding

Breaking news Local TV and radio interrupted by news of explosion Eyewitnesses report

4 Destruction and Devastation 20 nearby vehicles are immediately destroyed Eight surrounding buildings suffer significant blast damage Broadway and the interstate ramp suffer extensive damage 10 DAY 1, 10:45 a.m. Breaking news Local TV and radio interrupted by news of explosion Eyewitnesses report seeing rental truck just before the explosion Local officials indicate that terrorism cannot be ruled out 11 DAY 1, 11:00 a.m. Panic People flee the area in every direction Gridlock Public transportation overwhelmed 12 DAY 1, 11:00 a.m. NYSDOH 4

First responders arrive First responders declare a mass casualty incident Rescue operations

immediate hazards to rescue workers 14 DAY 1, 11:15 a.m. Dirty bomb!

5 First responders arrive First responders declare a mass casualty incident Rescue operations impeded by fires and downed power lines Some civilians remain to assist initial search and rescue efforts 13 DAY 1, 11:15 a.m. Rescue efforts hampered Fires blaze at ruptured gas lines Unstable buildings and debris pose immediate hazards to rescue workers 14 DAY 1, 11:15 a.m. Dirty bomb! Using radiation detection equipment, first responders discover the bomb contained radioactive material (Radiological Dispersal Device or RDD) Immediately cordon off the affected area 15 DAY 1, 11:20 a.m. NYSDOH 5

Mass triage and decontamination First responders set up decontamination sites outside hot zone Other first responders begin to triage victims to determine treatment needs 16 DAY 1,

Contamination spreads Hospitals and ED s quickly fill with walking wounded; nearby hospitals taking diverted patients As people evacuate, they spread radioactive dust or groundshine

6 Mass triage and decontamination First responders set up decontamination sites outside hot zone Other first responders begin to triage victims to determine treatment needs 16 DAY 1, 11:20 a.m. Contamination spreads Hospitals and ED s quickly fill with walking wounded; nearby hospitals taking diverted patients As people evacuate, they spread radioactive dust or groundshine 1 7 DAY 1, 11:30 a.m. EOC established Police control the flow of people and materials in and out of the affected area An Emergency Operations Center (EOC) is set up a half-mile upwind from the blast site to coordinate operations and resource management HAZMAT personnel take the lead in response, victim rescue and recovery 18 DAY 1, 11:45 a.m. NYSDOH 6

Mass care efforts fire stations and hospitals set up decontamination facilities Clean clothes and blankets needed as victims shed contaminated belongings Many

19 DAY 1, 12:00 p.m. Radioactive agent identified Radiological experts arrive on the scene Identify the radioactive agent as cesium-137 20 DAY 1, 12:15 p.m. QUESTIONS What is a dirty bomb?

7 Mass care efforts fire stations and hospitals set up decontamination facilities Clean clothes and blankets needed as victims shed contaminated belongings Many people resist giving up personal items 19 DAY 1, 12:00 p.m. Radioactive agent identified Radiological experts arrive on the scene Identify the radioactive agent as cesium DAY 1, 12:15 p.m. QUESTIONS What is a dirty bomb? What is the FIRST rule regarding exposure to a radio active substance? What should your first response be when you hear of this event? What will your agency be doing at this point and what is your role? What is your agency s plan for a radioactive event? 21 NYSDOH 7

8 QUESTIONS What type of injuries typically result from an explosion? According to your plan, what education will you need to give staff? Discuss ground shine. How much do you need to know about it? If patients call and ask if their nurse or aide will be able to come today, who takes the call and what should they be told/asked? 15 minutes to discuss 22 Communication 23 Breaking news! Officials publicly confirm that explosive was a radiological dispersal device (RDD), a.k.a. a dirty bomb Hundreds killed or severely injured Thousands may be contaminated Many TV channels are explaining potential effects of dirty bomb, providing instructions and urging the public to remain calm 2 DAY 1, 12:30 p.m. 4 NYSDOH 8

9 Due to nonstop news coverage Large numbers of worried well concerned about contamination They overwhelm hospitals that are already full of patients A mother brings in her two young children: We don t live near the explosion area but my children need to be checked for contamination! 25 DAY 1, 2:00 p.m. Help arrives State radiation monitoring team arrives along with additional responders from: Fire and rescue Emergency Medical Services (EMS) State Police arrive to provide security Additional state and federal authorities contacted for assistance Authorities debate evacuation versus sheltering in place 2 DAY 1, 3:00 p.m. 6 QUESTIONS Your agency s disaster response plan will be activated. Who does this, and what is the chain of command? What will be the extent and type of injuries resulting from a RDD? What will be the difference in your agency s response depending on whether the County & City recommend evacuation or sheltering in place? 10 minutes for discussion 27 NYSDOH 9

10 CRISIS 28 The crisis intensifies Roads are closed Intense security surrounds the city, air ways around the city are closed, airports and trains are shut down 29 DAY 1, 3:45 p.m. Search for the missing Rescue and recovery efforts at the blast site continue 3 0 DAY 2, 8:00 a.m. NYSDOH 10

Assisting the local response 9:15 a.m. State radiation monitoring team begins an environmental assessment of the area 10:30 a.m. National Guard troops arrive to relieve local law enforcement securing the blast area 11:15 a.

11 Assisting the local response 9:15 a.m. State radiation monitoring team begins an environmental assessment of the area 10:30 a.m. National Guard troops arrive to relieve local law enforcement securing the blast area 11:15 a.m. Federal response teams and Strategic National Stockpile (SNS) material 3 arrive 1 DAY 2 Situation update The mayor and police chief hold a press conference Emergency rescue officials indicate 180 known fatalities Hospitals have treated 270 individuals directly injured by the blast; hundreds more are not injured by have high rates of contamination from being directly downwind of the event City asks citizens to remain at home (SIP) and issues a hotline number for citizens who need aid DAY 2, 12:00 p.m. 32 QUESTIONS Is it safe to be outside yet? How do you know? What is the primary result of a RDD? How will you locate patients and track staff and patients who have been exposed? What do they need to know? Who should be called in? Hospice? Mental Health? 10 minutes for discussion 33 NYSDOH 11

Shelter Challenges Emergency shelters are overflowing Mental health workers

12 INVESTIGATION 34 Looking for leads Law enforcement officials pursue intense investigation FBI establishes hotline for tips and leads 3 5 DAY 2, 1:00 p.m. Shelter Challenges Emergency shelters are overflowing Mental health workers called in to care for people traumatized by the event 36 DAY 2, 1:15 p.m. NYSDOH 12

Environmental assessment results State radiation monitoring team reports preliminary results: Winds spread contamination unevenly, creating hot spots of radioactivity Radiation has entered air

and your role or participation. Who will be in charge of providing shelter? Who would you contact to locate patients?

13 Environmental assessment results State radiation monitoring team reports preliminary results: Winds spread contamination unevenly, creating hot spots of radioactivity Radiation has entered air intakes and contaminated interiors of several large downtown buildings Main sewage treatment plant contaminated River concerns 37 DAY 7 QUESTIONS Discuss your agency s EOC, contact information and your role or participation. Who will be in charge of providing shelter? Who would you contact to locate patients? If area hospitals need to do a surge discharge, how do you determine how many additional patients you can admit? Who do you need to be able to contact? 38 INJECT BTW How is your family? What plans do you have as a family? How much does everyone know about radiation? 39 NYSDOH 13

14 QUESTIONS What are the long term affects of exposure? Should Potassium Iodide (KI) be recommended to staff and patients? What messages should you be giving to your patients? 10 minutes for discussion 40 Resolution 41 Over the next six months Many businesses closed while being decontaminated Demolition and rebuilding, along with streetscape reconstruction, make parts of downtown inaccessible and hinder economic recovery 42 NYSDOH 14

15 QUESTIONS What might be the negative economic impacts on the community and home care patients? Is your mental health support plan adequate for this situation? How will you monitor long-term health effects from the exposure to radioactivity in your patient population? How do you establish environmental surety of the agency offices, your and your patient homes? minutes for discussion End of RDD Scenario 44 NEXT STEPS Where is your knowledge lacking? What do you need to do? Agency wise, does your COOP cover this kind of event? What work do you need to do? Overall, how do you think you responded? 45 NYSDOH 15

16 CONTACT INFORMATION Alexis Silver Vice President for Clinical Policy HCA Education and Research, Inc. (518) NYSDOH 16

Chemical, Biological, Radiological, Nuclear, and Explosives (CBRNE) TERRORISM RESPONSE ANNEX

Chemical, Biological, Radiological, Nuclear, and Explosives (CBRNE) TERRORISM RESPONSE ANNEX DISTRICT BOARD OF HEALTH MAHONING COUNTY YOUNGSTOWN CITY HEALTH DISTRICT 1 MAHONING COUNTY PUBLIC HEALTH CBRNE