Situation Manual 340 Minutes Situation Manual Tabletop Exercise 1 Disaster Resistant Communities Group www.drc-group.com
Beleaguered Bus Exercise Play During the exercise it will be important to remember and comply with the following statements: The focus of this exercise is your hospital s INITIAL RESPONSE to the potential of Ebola infected patients arriving at your hospital. The exercise time line begins several hours prior to patients arriving at your hospital and concludes several days later. It is important NOT to jump ahead in the exercise scenario. In other words don t focus on what might happen, focus on the Common Operating Picture that is presented during the exercise to make informed decisions. In any exercise a number of assumptions and artificialities may be necessary to complete play in the time allotted. During this exercise, the following apply: 1. The scenario is plausible, and events occur as they are presented. 2. There is no hidden agenda, nor any trick questions. Exercise Basics: 1. This exercise contains a total of 18 scenario and inject pages. 2. The exercise is self-paced and it should take approximately three hours to complete. However, based on the time spent on each scenario and inject the exercise may be completed in under three hours or it may take much longer than three hours to complete the exercise. 3. There is a scheduled 15 minute break approximately half way through the exercise. 4. All videos embedded within this exercise can be enlarged to FULL SCREEN by simply clicking on the full screen icon in the lower right hand corner of the video. 5. Thoroughly review all scenario information and injects as they are presented during the exercise. At the end of the exercise you will need to complete an evaluation (Hotwash) on how your team performed during the exercise. The Hotwash will consist of your team providing comments on three areas in which it performed well (Strengths) and three areas your team will need to improve upon (Areas for Improvement) to enhance its preparedness, response and recovery capabilities. Found below are Hotwash examples: Strengths During the exercise our team consulted our disaster plans and procedures and found them to be complete. Areas for Improvement During the exercise our team consulted our disaster plans and procedures and found portions of the plans and procedures that need to be revised. After the exercise each registered participant who took part in the exercise will receive an e-mail to log into the ONX Situation Manual Tabletop Exercise 2 Disaster Resistant Communities Group www.drc-group.com
System to complete their Individual Hotwash to access their Certificate of Participation. If you need assistance anytime during the exercise please call the Help Desk at: Phone Number 605-475-4700 Account Number 1076890 # 20 Minutes Situation Manual Tabletop Exercise 3 Disaster Resistant Communities Group www.drc-group.com
Beleaguered Bus Scenario # 001 Image of Charter Bus On Sunday afternoon 18 members of the Modern Missionary Movement left for the airport on a charter bus for a six week mission trip to the east African country of Ethiopia. The focus of the trip was to staff a small village health clinic and help construct an addition to the village s school. Aware of the current Ebola outbreak in western Africa the team leader for the missionaries consulted with the Ethiopian Ministry of Health and was told that there was currently not an Ebola problem in Ethiopia. As trained healthcare workers the missionaries took the normal precautions while working in the village s health clinic. Upon returning to the United States the same charter bus picked the missionaries up at the airport and proceeded to drive them to Camp for All Seasons a summer camp attended by young church members from across the state. While at the camp the missionaries met with over 200 campers and staff on the last day of camp as they shared their missionary experiences. Day 1 Wednesday 1:19AM Late in the afternoon the missionaries board the charter bus for the trip home. Several hours into the trip some of the missionaries began to feel ill and run a fever. One of the medically trained missionaries demands that the bus driver stop immediately and call 911. He does! 10 Minutes Situation Manual Tabletop Exercise 4 Disaster Resistant Communities Group www.drc-group.com
Beleaguered Bus Scenario # 002 Image of Emergency Department Day 1 Wednesday 1:43AM It's a peaceful mid-week midnight shift at the hospital. Staffing is normal for this shift and there is little to no activity in the Emergency Department (ED). At 1:43 AM the ED receives a call from an EMT who is on-scene at a local truck stop. The EMT reports responding to a charter bus full of church missionaries recently returned from Ethiopia in East Africa. The EMT provides the following information: Three of the missionaries have become ill enough that travel on the bus is no longer viable. Their symptoms include high fever, nausea and diarrhea. All passengers report compliance with their anti-malarial prescriptions and have stated to their knowledge they have not come into contact with any known contagion while on their missionary trip. The team leader for the missionaries mentioned that all the team members did partake in traditional Ethiopian meals while there, including some bush meat. All reported no symptoms or measureable fever upon arriving at the airport several days ago. For the past two days all of the missionaries have been helping at a youth camp. The three ill patients on the bus report having felt the onset of symptoms prior to leaving the camp. (Note: Access the Centers for Disease Control (CDC) Interim Guidance for Emergency Medical Services (EMS) Systems and 9-1-1 Public Safety Answering Points (PSAPs) for Management of Patients with Known or Suspected Ebola Virus Disease in the United States.) 10 Minutes Situation Manual Tabletop Exercise 5 Disaster Resistant Communities Group www.drc-group.com
Beleaguered Bus Inject # 003 The EMT is asking how the hospital s infection control officer wants to proceed. Image of PPE Develop a list of immediate actions that will need to be taken by the hospital at this point. With each action list all resources (personnel, equipment, consumable supplies, etc.) that will be needed to complete the action. 20 Minutes Situation Manual Tabletop Exercise 6 Disaster Resistant Communities Group www.drc-group.com
Beleaguered Bus Inject # 004 Image of EMS Day 1 Wednesday 2:01AM Describe in detail the instructions that will be given to EMS personnel and other first responders by the hospital. (Note: Access the CDC - Evaluation of Returning Travelers Guidelines.) Do EMS personnel and other first responders have the required Personal Protection Equipment (PPE) that will be needed to safely undertake and complete the actions identified above? If the above answer is no. Prepare a list of all the equipment, consumable supplies, etc. that is needed to properly protect EMS personnel and other first responders in this situation. Yes No 15 Minutes Situation Manual Tabletop Exercise 7 Disaster Resistant Communities Group www.drc-group.com
Beleaguered Bus Inject # 005 Image of Red Phone Day 1 Wednesday 2:37AM Prepare a comprehensive list of all hospital personnel, by job title that will need to be contacted at this point and list their afterhours contact information. Remember it is currently the midnight shift at the hospital. (Example: Title: Hospital Safety Director / Contact Information: Home Phone 555-555-5555 Cell Phone 444-444-4444) In addition to notifying hospital personnel it will be important that various non-hospital agencies and organizations be contacted as soon as possible. Prepare a list of all non-hospital agencies and organizations that will need to be contacted at this point and list their 24 hour contact information. 15 Minutes Situation Manual Tabletop Exercise 8 Disaster Resistant Communities Group www.drc-group.com
Beleaguered Bus Scenario # 006 Image of Ambulance Day 1 Wednesday 4:37AM EMS personnel along with other first responders have isolated the three sick missionaries and temporarily quarantined all of the other missionaries and the bus driver who had High Risk contact with the sick missionaries. Over the next 45 minutes all of the missionaries and the bus driver (patients) have donned appropriate level PPE. While the three sick missionaries are being transported to the hospital via ambulance the 15 other missionaries and the bus driver are transported to the hospital via the charter bus. (Note: Access the CDC Checklist for Patients Being Evacuated for Ebola in the United States.) 10 Minutes Situation Manual Tabletop Exercise 9 Disaster Resistant Communities Group www.drc-group.com
Beleaguered Bus Inject # 007 Image of HICS Day 1 Wednesday 4:47AM As hospital personnel that were contacted over the past couple of hours begin to arrive will the hospital shift the management of its response to the incident from the ED staff to the Hospital Incident Command System (HICS)? Yes No (Note: For future reference you may want to access the Just In Time Disaster Training Library for additional information on the Hospital Incident Command System. This video is too long to view during today s exercise. Hospital Incident Command System) OPTIONAL If the above answer is yes. Identify the title of the individual that will be responsible for making this decision. Briefly describe the process for establishing HICS and activating the Hospital s Incident Command Center. If the above answer is no. Briefly explain why the hospital will not implement HICS at this time. 20 Minutes Situation Manual Tabletop Exercise 10 Disaster Resistant Communities Group www.drc-group.com
Beleaguered Bus Inject # 008 Image of Emergency Room Day 1 Wednesday 5:12AM EMS personnel have notified the hospital that the first ambulance should arrive within the next 20 minutes. Describe in detail how the ambulance along with the patients will be received once it arrives at the hospital. (Note: Several of the important items to consider are: The staging area for the arriving ambulance; The personnel that will meet the arriving ambulance and the patients; What equipment / consumable supplies will be needed properly manage the arriving patients?) (Note: For future reference you may want to access the Just In Time Disaster Training Library for additional information on the use of Personal Protection Equipment (PPE). These videos are too long to view during today s exercise. Donning / Doffing PPE) OPTIONAL 20 Minutes Situation Manual Tabletop Exercise 11 Disaster Resistant Communities Group www.drc-group.com
Beleaguered Bus Inject # 009 Image of Isolation Area Day 1 Wednesday 5:34AM As patients are being offloaded from arriving ambulances hospital personnel will need to move each person to an isolation area. Describe in detail how this will be accomplished and identify the route that will be taken from the ambulance staging area to the isolation area. Does this route present any challenges with regards to exposure risks, whether high or low, to hospital personnel or other patients? If the above answer is yes. Briefly explain how the hospital will mitigate any risks. Yes No Will the identified route require environmental clean-up or decontamination afterwards? Yes No If the above answer is yes. Briefly explain how this will be accomplished. 15 Minutes Situation Manual Tabletop Exercise 12 Disaster Resistant Communities Group www.drc-group.com
Beleaguered Bus Inject # 010 Image of Media Day 1 Wednesday 5:47AM Unknown to the EMS personnel at the truck stop several by-standers have contacted the local media. As hospital personnel continue to offload patients a news crew from the local television station arrives at the main entrance to the ED. A reporter has already approached several hospital staff waiting outside the ED asking for confirmation that 19 suspected Ebola patients are arriving at the hospital. The reporter asks for a spokesperson because they are going to go live with CNN in five minutes. Describe in detail how this media inquiry will be handled. Most sound bites for television broadcast last 10 to 20 seconds. Identify three main points the hospital would need to make. (Note: State these points in 30 words or less.) 15 Minutes Situation Manual Tabletop Exercise 13 Disaster Resistant Communities Group www.drc-group.com
Beleaguered Bus Inject # 011 Image of Hospital Command Center As day shift personnel are about to show up for work the decision is made to implement appropriate portions of the hospital s Emergency Operations Plan (EOP) and establish HICS to effectively coordinate, communicate and manage this growing crisis effectively. Personnel that are assigned to the various ICS positions have been arriving at the hospital s Incident Command Center for the past 15 minutes. Identify the individuals that will fulfill the various ICS positions and briefly describe the responsibility of each position. (Example: Public Information Officer: June Carter Will serve as the point of contact for all media inquiries, prepare appropriate media advisories and press releases as well as monitor news outlets including social media.) 20 Minutes Situation Manual Tabletop Exercise 14 Disaster Resistant Communities Group www.drc-group.com
Beleaguered Bus Inject # 012 Image of Incident Action Plan Day 1 Wednesday 9:00AM The majority of the incident command personnel have arrived at the command center. One of the first actions that will need to occur will be to develop an Incident Action Plan (IAP) focusing on the IMMEDIATE RESPONSE issues now confronting the hospital. CLICK ON VIDEO TO PLAY Video Library General # 1 Video # 5 Incident Action Plan Develop an IAP focusing on the actions to be taken over the next 24 hours. In preparing the IAP list the objectives; identify all resources that will be needed to accomplish each listed objective; and list the expected timeline to complete each identified objective. (Example: Action: Assign a Public Health Liaison. / Required Resource: Assigned staff should have a working knowledge of the hospital s EOP along with an understanding of Public Health operations. / Timeline: 1 Hour.) (Note: For future reference you may want to access the Just In Time Disaster Training Library for additional information on Public Health Operations. These videos are too long to view during today s exercise. Public Health Operations) OPTIONAL 30 Minutes Situation Manual Tabletop Exercise 15 Disaster Resistant Communities Group www.drc-group.com
Beleaguered Bus Inject # 013 Image of Medical Testing Day 1 Wednesday 9:27AM All of the patients have been in the hospital s isolation area since their arrival. In consultation with the local public health department and the CDC, the hospital decides that it is imperative to begin testing the patients to determine if any have Ebola. Although the patient's symptoms agree with an Ebola diagnosis, the CDC cautions that Malaria and Lassa fever are also quite common in East Africa and have been mistaken for Ebola without clinical tests. (Note: Access the CDC Interim Guidance for Specimen Collection, Transport, Testing, and Submission for Patients with Suspected Infection with Ebola Virus Disease.) Does the guidance from the CDC require any modification of the hospital s current specimen Yes No collection, transport and testing procedures? If the above answer is yes. Describe in detail the changes that will need to be made to these procedures. Does the hospital have the necessary equipment / consumable supplies to comply with the CDC's requirements for packaging and shipping clinical specimens to the CDC that are suspected of containing Ebola? (Note: Access the US Department of Transportation Guidance for the Transport of Category A Infectious Substances.) Yes No If the above answer is yes. Identify the equipment / consumable supplies available to hospital personnel. If the above answer is no. Prepare a list of any needed equipment / consumable supplies. 15 Minutes Situation Manual Tabletop Exercise 16 Disaster Resistant Communities Group www.drc-group.com
Beleaguered Bus Inject # 014 Image of Hospital Waste Day 1 Wednesday 5:37PM Although the patients have only been in the hospital for half a day, the necessity for medical personnel to change out of PPE and the fact that all consumable supplies that have come into contact with the patients will need to be properly disposed of has already created quite a lot of biohazard waste. Several of the patients have had several bouts of diarrhea (mostly fluid in nature) that require linen and adult diaper changes and periodic environmental cleanup of the isolation area, leading to even more biohazard waste. The CDC has emphasized that the Ebola virus may remain active on contaminated materials / surfaces for as long as six days. The waste has quickly reached a volume where disposal will soon be necessary. (Note: Access the CDC Interim Guidance for Environmental Infection Control in Hospitals for Ebola Virus.) Based on CDC guidance, describe in detail the procedure / processes that will be implemented and maintained to properly dispose of the Ebola contaminated waste. 15 Minutes Situation Manual Tabletop Exercise 17 Disaster Resistant Communities Group www.drc-group.com
Beleaguered Bus Inject # 015 Image of Hospital Room Day 1 Wednesday 8:01PM As news of 19 potentially Ebola infected patients being isolated at the hospital has spread across the country, already admitted hospital patients and their families (whether rationally or not) have expressed grave concerns about even being in the same facility as patients suspected of being infected with Ebola. Some patients and their families are even demanding they be transferred to other medical facilities. An increasing number of emergency cases have refused to be transported to the hospital s ED Additionally, although small in numbers, there are hospital staff members (clinical and non-clinical) that have either called in sick, taken leave or have outright refused to come to work. Those that have refused to work cite fear of exposing either themselves and / or their families should infection control measures prove less than complete. Prepare a list of actions that will be taken to calm / reassure patients already admitted to the hospital. Prepare a list of actions that will be taken to calm / reassure the public. Prepare a list of actions that will be taken to calm / reassure hospital personnel and their families. 20 Minutes Situation Manual Tabletop Exercise 18 Disaster Resistant Communities Group www.drc-group.com
Beleaguered Bus Inject # 016 Image of Warehouse Day 2 Thursday 9:07AM During the morning Hospital Command Center briefing the Operations and Logistics Chiefs convey that several of the hospital s vendors and service providers have refused to make deliveries out of concern for the safety of their employees. Although contractually obligated, no one can force the delivery of supplies or services. This has already had an impact on the hospital s inventories of medical supplies, food stuffs and other necessities. In particular and due to the frequency of PPE changes, the hospital is facing a complete depletion of PPE supplies within the next 24 hours. Prepare and prioritize a list of vendor provided services and supplies "essential" to the hospital s operations. For each of these prioritized "essential" services and supplies, list any backup vendor or alternative methods of obtaining the services and supplies. 20 Minutes Situation Manual Tabletop Exercise 19 Disaster Resistant Communities Group www.drc-group.com
Beleaguered Bus Inject # 017 Image of Incident Action Plan Day 2 Thursday 9:17AM As the Hospital Command Center briefing continues the Planning Chief asks for input on the Incident Action Plan (IAP) for the next operation period. Develop an IAP focusing on the actions to be taken over the next 24 hours. In preparing the IAP list the objectives; identify all resources that will be needed to accomplish each listed objective; and list the expected timeline to complete each identified objective. (Example: Action: Conduct a daily Press Briefing. / Required Resource: Media contact list and a location to establish a Joint Information Center. / Timeline: 3 Hours.) 30 Minutes Situation Manual Tabletop Exercise 20 Disaster Resistant Communities Group www.drc-group.com
Beleaguered Bus Inject # 018 Image of Ebola Day 3 Friday 10:07AM The hospital s worst fears have been confirmed, the CDC laboratory results are back and three of the patients have Ebola. As advised by the local public health department and the CDC, the hospital s personnel have been vigilant in complying with protocols set forth by the CDC in caring for these patients. All three Ebola infected patients have been provided prodigious amounts of intravenous fluids which have somewhat stabilized what was an obvious physical decline in the days since admission. It has taken a monumental effort by a specialized team to provide continuous round the clock care for these patients. Previous patients successfully treated in the United States have taken more than two months of continuous care to recover. Identify the challenges the hospital will have with the prolonged care of the Ebola infected patients and briefly describe how the hospital will meet each of the challenges. 20 Minutes Situation Manual Tabletop Exercise 21 Disaster Resistant Communities Group www.drc-group.com