Our Experience with HSEEP Exercises

Transcription

1 Our Experience with HSEEP Exercises Rick France, Ph.D. Florida Dept. of Health Dana Johnson, Mississippi State Dept. of Health Theresa Kittle, MPH, Mississippi State Dept. of Health

2 Objectives HSEEP Overview Mississippi s s HSEEP Experience (FSE) Laboratory perspective Epidemiology perspective Florida s s HSEEP Experience (FSE) Building upon the Mississippi FSE Questions and Answers

3 What is HSEEP? Homeland Security Exercise and Evaluation Program A capabilities and performance-based exercise program Provides common exercise policy and program guidance The methodology of HSEEP was based on proven exercise design, development, and evaluation methods from other programs

4 HSEEP Compliance Conduct an annual Training and Exercise Plan Workshop and develop and maintain a Multi-year Training and Exercise Plan Conduct exercises in accordance with the guidelines set forth in HSEEP Develop and submit a properly formatted After- Action Report/Improvement Plan (AAR/IP) Track and implement corrective actions identified in the AAR/IP

5 Why Do Exercises? Federal Funding may be conditional upon HSEEP compliance It s s important to practice It s s the only way you ll know if your preparedness plan will work

6 What s s Involved? HSEEP Documentation (Volume I III) ExPlan Exercise Plan Controllers Handbook MSEL Master Scenario Events List EEG Exercise Evaluation Guide Coordinating Players, Controllers and Evaluators AAR/IP s s (After Action Reports and Improvement Plans)

7 Take Home Message Exercises are conducted not to find fault but to find gaps!

8 What Type of Exercise Tabletop Multiple or single agency Panel Discussion Multiple agencies Drill Proficiency Tests, Packaging and Shipping Functional - Multiple agencies but no boots on the ground Full Scale Multiple agencies, multiple jurisdictions and multiple disciplines

9 Multi-Year Training and Exercise Plan

10 HSEEP Advantages Provides framework for trainings up through exercises Gives starting point Provides templates for documents, presentations Logical process for training, exercising and testing plans Provides a basis to build upon annually Other states are able to build upon existing exercises Reduces redundancy Facilitates networking between states

11 Planning a Full Scale Exercise Planning a Full Scale Exercise After Action Report Improvement Plan Next Years Planning Exercise Day Final Planning Conference MSEL Conference Mid- Term Planning Conference Initial Planning Conference Concepts and Objectives 6/09 8/09 10/09 7/09 9/09 11/09 12/09 2/10 1/10

12 Florida s s HSEEP Experience Drills CDC Proficiency Testing Monthly Intralaboratory P&S Exercises 2008 CT Forum - Tampa Panel Discussion Exercise Functional Exercise

13 FBI LEO EPA EH Poison CDC Labs Hospital Epi PIO DEP Agri

14 Panel Discussion Exercise Scenario Agricultural Contamination Patients arrive to hospital Foodborne Outbreak Symptoms similar to cholinesterase inhibitor Laboratory Testing Strawberries Mevinphos Over 5,000 exposed

15 Panel Discussion Exercise (cont d) After Action Report and Improvement Plan AAR/IP Strengths Stakeholders identified Plans activated Resources coordinated Partnerships enhanced Area for Improvement Disposal of contaminated food PHIN reporting of laboratory results Clarification of JIC

16 Panel Discussion Exercise (cont d) After Action Report and Improvement Plan AAR/IP Strengths Stakeholders identified Plans activated Resources coordinated Partnerships enhanced Area for Improvement Disposal of contaminated food PHIN reporting of laboratory results Clarification of JIC

17 Panel Discussion Exercise (cont d) Lessons Learned Predistribution of information Scout the venue Check microphones Collect Feedback forms

18 Functional Exercise Players FDOH Bureau of Laboratories LRN-C C Laboratories CDC

19 Functional Exercise (cont d) Objectives Coordination with CDC DEOC Directors Emergency Operations Center CERT Chemical Emergency Response Team Packaging and Shipping clinical specimens Analyzing clinical specimens for chemical agents

20 Functional Exercise (cont d) Linked to the Panel Discussion Exercise Same scenario Conference Call Call to the DEOC at CDC in Atlanta 4:10 AM

21 Functional Exercise (cont d) Packaging and Shipping CDC Spiked blood and urine specimens Chemical Terrorism Laboratory Coordinators P&S back to home laboratory CDC pick up specimens for Rapid Toxic Screen

22 Functional Exercise (cont d) Chemical Emergency Response Team (CERT) Photograph by Eric Clark

23 Chemical Emergency Response Team (CERT)

24 Functional Exercise (cont d) Laboratory Testing Analysis for OPNA 10 urine samples each for 9 states Results Reporting Surge Testing by CDC 5,000 samples to 10 Level 1 labs

25 Functional Exercise (cont d) After Action Report and Improvement Plan AAR/IP Strengths Coordination between LRN-C C laboratories and CDC LRN-C C laboratories able to use CDC methodologies Results reporting to CDC Area for Improvement Time involved to package and ship specimens Getting labels to stick to frozen samples

26 Functional Exercise (cont d) Lessons Learned Develop Evaluations First Coach Evaluation Team Collect Feedback Forms Include a Photographer (Videographer)

27 Mississippi s s HSEEP Experience 2008 Statewide CT Full Scale Exercise Collaboration between Public Health Laboratory (clinical and environmental services) and Office of Epidemiology Involved district staff (DHO, on-call, environmental, ERCs,, etc.)

28 Mississippi State Dept of Health Centralized Health Department Nine public health districts District health officers and field staff County health departments All report back to central office in Jackson

29 Participating Agencies Mississippi State Department of Health Mississippi Band of Choctaw Indians Mississippi Department of Environmental Quality Mississippi Hospital Association Mississippi Poison Control Center

30 Participating Healthcare Facilities PHL Tri-Lakes Medical Center North Mississippi Medical Center- Tupelo Greenwood Leflore Hospital North Mississippi Medical Center- Pontotoc Mississippi Baptist Medical Center Jeff Anderson Regional Medical Center Choctaw Health Center King s s Daughters Medical Center- Brookhaven Forrest General Hospital Stone County Hospital

31 Exercise Scope Test emergency response plans during an all-hazards event Involve multiple outside agencies and facilities that would play a key role in detection and response. Utilize Simulation cell Initiate exercise operations MSDH Campus No activation of emergency operations centers (EOCs( EOCs) No law enforcement or Mississippi State Patrol was involved in play

32 HSEEP Objectives SMART concept Simple: an easily understood statement Measurable: can be gauged against a standard Achievable: challenging, but not impossible Realistic: plausible for your area and relevant to what you to accomplish Task-oriented: tied to a task and measures what you want to exercise

33 Public Health Lab Objectives Evaluate MPHL response time during a chemical exposure event according to MPHL procedure Receive Analyze Report clinical sample results to the Office of Epidemiology Evaluate MPHL response time during a chemical exposure event according to EPA methodology Receive Analyze Report environmental sample results to MSDH Dept of Public Water Supply

34 Public Health Lab Objectives Evaluate the ability of the MPHL and the Office of Emergency Planning and Response (OEPR) during a chemical exposure event occurring on nights, weekends or holidays according to the MPHL emergency response plan for the CDC cooperative agreement Effectively communicate proper sample transport procedures to hospital sentinel laboratories

35 Epidemiology SMART Objective Evaluate the capability of the 24/7/365 on-call reporting system during a chemical exposure event to effectively: Receive phone calls Properly disseminate information to essential public health personnel All in accordance with the Office of Epidemiology s procedures

36 Scenario Synopsis Utilize both the environmental and clinical MSDH after-hours response to a chemical exposure event Arsenic contamination of a water supply system Feeds Slippery Slides Water Park Water ingested by a large group of people Approximately 2,500 people visit the water park each season Has a restaurant, snack bar and a golf course

37 Scenario Synopsis Contaminated Water Supply Nine Public Health Districts have exposed people report to local ER Calls from ER to MSDH Epi and MS PCC Clinical samples collected Epi, PCC, Environmental & ERs notified of results Samples analyzed and results correlated Routine system check of grounds ids possible break-in Calls from PWS alerting environmentalist and engineers of break-in Environmental samples collected Samples sent to MSDH PHL for testing

38 ID Planning Assign Team Responsibilities Development Draft Tools objectives Determine Scenario Develop: EXPLAN MSEL EVALPLAN

39 Demographics & Symptoms Patient Card Instructions

40 HSEEP MSEL Builder

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43 Event Date Event Time Assigned To Description of Event MSDH MSEL

44 Coordination Planning Conferences Initial, Mid-Term, Final Correspondence , Phone calls, Feedback Volunteers Delegate responsibilities Sample distribution

45 Initial call into MS Poison Control Center

46 Call Information Action Taken Add l Info Record of Events Log

47 7/18/08 10AM Water Park opens 7/19/08 2:45AM Patients present at ERs 7/19/08 8:25AM MSDH PHL notified 7/19/08 11:14AM Samples arrive at PHL Timeline of Events 7/19/08 4:15PM CDC - arsenic in clinical samples 7/19/08 4:40PM Field and ERs notified of preliminary arsenic results 7/18/08 8PM Water Park closes 7/19/08 7:30AM MSDH & PCC notified 7/19/08 8:50AM ERCs sent to local ERs for sample pick-up 7/19/08 1:05PM Samples sent to CDC for testing 7/19/08 4:25PM Epi notified of results 7/19/08 7PM Play is suspended Scenario Event Player Action Inject

48 Timeline of Events 7/20/08 7AM Play is resumed 7/20/08 11:45AM Results relayed to Epi 7/20/08 12:27PM Real World event- Epi oncall 7/20/08 1:15PM Results are shared w/field and ERs 7/20/08 11:13AM PHL completes testing 7/20/08 12:25PM Env. Chemistry calls Water Supply w/results 7/20/08 1:00PM Districts notified of results 7/20/08 3:00PM Play is ended! Scenario Event Player Action Inject

49 Exercise Evaluation Participant Feedback forms Record of Events log Hot Wash Debriefing of participants Exercise Evaluation Guides (EEG)

50 Exercise Evaluation Gathered feedback forms and Events log from participants immediately following exercise Asked forms and logs to be faxed if in the field Hot Wash Addressed Expectations, Issues and Outcomes All participants Healthcare facilities Called and debriefed them

51 After-Action Action Conference Invited all participants and administration to After-Action Action Conference Pre-distributed documents to all attendees After-Action Action Report (draft) Improvement Plan Matrix Utilized video- & teleconference equipment Broke into groups to discuss issues and suggestions for improvement

52 Improvement Plan Matrix

53 Key Strengths and Accomplishments Useful learning/training experience Beneficial preparation for real-life life event Identification of weak areas Fostered relationships and encouraged communication with staff in healthcare facilities Helped identify roles of MSDH staff and the parts they can play Briefings of staff to update of developing situation Redundant communication noted

54 Key Areas for Improvement Chain of Custody (COC) forms Not all involved were familiar with COC forms and were unsure how to fill out Communication Lapse in response of returning calls promptly Cell phones worked intermittently and had bad connections Limited access to after-hours contact numbers Roles of employees Confusion as to who does what

55 Key Successes The ability of multiple agencies and facilities to work together to plan, develop and execute a large-scale exercise Hospitals used FSE to meet certification requirements

56 Key Challenge Learning to navigate and use the HSEEP toolkit and the required documentation that is needed in developing a full-scale exercise

57 Lessons Learned Set firm invitation and acceptance deadlines for all participants and agencies involved Have hospitals on planning team Delegate tasks to team members Obtain contacts agencies/facilities involved

58 Lessons Learned Know how many agency calendars exist Ensure the exercise and related meetings/conferences are listed on all calendars Make scenario as realistic as possible Use toolkit as a guide Modify tools to suit exercise needs Ensure players understand their roles and time commitment Brief staff to update on developing situation

59 HSEEP Advantages Provides framework for trainings up through exercises Gives starting point Provides templates for documents and presentations 2008 FSE 2009 Drill 2009 Training

60 HSEEP Advantages Logical process for training, exercising and testing plans Provides a basis to build upon annually

61 HSEEP Advantages Other states are able to build upon existing exercises Reduces redundancy Facilitates networking between states

62 Florida s s Full Scale Exercise March 17-19, 19, 2009 Followed Mississippi s s Scenario Emphasis Communication Laboratory Capability Locations Scenario Central Florida Players - Statewide SIMCELL - Jacksonville

63 Tier Review and Approval by State Office of Public Health Preparedness Submit Documentation Tier Review Form ExPlan Tier Review Level 1 Level 2

64 What s s the Big Picture? The Role of the LRN-C C in Public Health Preparedness

65 Who all is involved in a chemical exposure incident? Poison Information Center Medical Providers Epidemiology Law Enforcement Laboratory Testing Other Public Health Agencies Public (Health) Information Officer

66 Florida s s FSE Agencies Bureau of Epidemiology Bureau of Laboratories CDC Department of Agriculture and Consumer Services Department of Emergency Medical Operations Department of Environmental Protection Division of Environmental Health FBI PIO - Office of Communications Poison Information Center Regional Emergency Response Advisors

67 Exercise March 17-19, 19, 2009 Disgruntled worker contaminates water park with herbicide containing arsenic Emphasis Communication Laboratory Capability Working with other agencies Locations Scenario Central Florida Players - Statewide SIMCELL - Jacksonville

68 CDC Director s s Emergency Operations Center (DEOC) Conference Call All involved agencies were able to listen in and ask questions Described how the state of Florida would formally ask CDC for assistance

69 Getting the Specimens to the Lab Law Enforcement? Hospitals? CT Coordinators? Regional Emergency Response Advisors

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71 Results Reporting Poison Control Medical Providers Epidemiology Environmental Protection State LRN-C Level 1 Lab Public Information Officer CDC Environmental Health FBI Agricultural Lab

72 How do you Report Results to Public Health Partners? Phone? PHIN? ?

73 How do you explain the results? Laboratory-ese PPB μg/l Mean ± % STD Quality Control/Assurance 4 QC-High reported above 3 sigma Clear, concise, understandable in their language Patient X is above Normal Human Levels the reference limits Levels of arsenic in unexposed individuals < 1 μg/l in blood < 100 μg/l in urine 1 ppm in nails 1 ppm in hair ATSDR

74 After Action Report Improvement Plan Strengths Working as a team Laboratory capability CT Lab analysis Other agencies were able to spin off their own mini-exercises

75 After Action Report Improvement Plan (cont d) Areas for Improvement Communication Packaging and Shipping Chain of Custody Patient Specimen database

76 Lessons Learned Many local, state and federal agencies are involved with a chemical exposure response. Laboratory testing is only one of many aspects of response. Cross training and teamwork is a must. It s s all about planning, planning and planning Then Exercise.

77 Questions?

78 Thank You! Richard France Florida Department of Health Dana Johnson Mississippi State Department of Health Theresa Kittle Mississippi State Department of Health