Health Care Coalition Insert Airborne Transmissible Special Pathogen Name Tabletop Exercise

Health Care Coalition[Insert airborne transmissible special pathogen name] Tabletop Exercise

Contents

Contents

Exercise Overview

About NETEC

Using This Document

Preface

General Information

Background

Purpose

HPP Measures

Scope

Target Capabilities

Exercise Objectives and Target Capabilities

Participant Roles and Responsibilities

Exercise Structure

Exercise Guidelines

Exercise Assumptions and Artificialities

Exercise 1: Patient Self-Presents at Frontline Hospital

Scenario

Module 1: Emergency Department Arrival of PUI Initial Response: Alert/Notification, Coordination, Risk Communications

Module 2: Ongoing Operations: Coordination, Reporting, Sharing Resources

Scenario

Module 3: Transfer Decision to Regional Ebola and Other Special Pathogen Treatment Center and Transportation Logistics

Scenario

Module 4: Returning to Normalcy: Recovery Operations

Scenario

Conclusion

Exercise 2: Multiple Patients arrive at [insert Assessment Hospital or ETC Name] in your Health care Coalition

Scenario

Module 1: Health care Coalition Coordination and Planning Transportation for Multiple Patients with suspected [insert airborne transmissible special pathogen name] From Private Residence

Module 2: Multiple Patient Transport with suspected [insert airborne transmissible special pathogen name] From Private Residence

Module 3: Health care Coalition Surge Capacity

Scenario

Appendix A: Exercise Schedule

Appendix B: Invited Exercise Participants

Appendix C: Relevant Plans8

Appendix D: After Action Report/Improvement Plan (AAR/IP)...... 29

Appendix E: Participant Feedback Form...... 34

Appendix F: Acronyms and Abbreviations...... 36

Exercise Overview

1. Examinethe Health Care Coalition’s role to its members to prepare for, respond to, and recover from a special pathogen event.
2. Assessthe notification and communication processes among local, state, and federal public health, EMS, and the healthcare delivery system partners, including the Regional Ebola and Other Special Pathogen Treatment Center.
3. Examinethe healthcare coalition’s role to support EMS capabilities, and its role to help determine the most appropriate method for transportation (e.g., air versus ground).
4. If applicable, evaluateEMS ground transportation coordination with air transportation resources.
5. Assessjust-in-time PPE don/doff training resources and PPE availability for EMS, and other involved healthcare delivery system personnel
6. [List any additional exercise objectives]

About NETEC

NETEC is a consortium of Emory University, NYC Health + Hospitals, and the University of Nebraska Medical Center, as equal partners, who support ASPR and the CDC by developing the National Ebola Training and Education Center. All three institutions have safely and successfully cared for patients with Ebola virus disease (EVD) since the beginning of the outbreak in March 2014. The goal of the NETEC, over its five-year funding period, is to increase the competency of health care and public health workers and the capability of health care facilities to deliver safe, efficient, and effective Ebola patient care through the nationwide, regional network for Ebola and other infectious diseases. The objectives are: 1) to develop metrics to measure facility and health care worker readiness (including health care worker training) to care for patients infected with the Ebola virus and other special pathogens (e.g. variola or smallpox, Marburg virus, Yersinia pestis, anthrax, or measles); 2) to conduct assessments, monitoring, recognition reporting, and validation of Regional and State Ebola Treatment Centers and Assessment Hospitals; 3) to create and maintain a comprehensive suite of timely and relevant educational materials related to care of patients with Ebola and other special pathogens; 4) to identify and incorporate best practices regarding how health departments and treatment centers collaborate around the care of patients with Ebola virus infection; 5) to establish a web-based repository to support dissemination of timely and relevant materials; 6) to support the public health departments and health care facilities through training and technical assistance.

Exercise Resource Technical Assistance:

NETEC offers 24/7 Exercise Technical Assistance with subject matter experts who are versed in HSEEP exercise design and development. Exercise Technical Assistance can include onsite exercise assistance (e.g., observer, evaluator), and remote technical assistance (e.g., exercise development).

Contact:

NETEC Exercise Resource Team:

Using This Document

1. As the exercise planner, you are responsible for scheduling the exercise and inviting the appropriate individuals to the exercise. It is best to plan for approximately 30 minutes to 2 hours per module, plus 1+ hours for instructions and hotwash (Appendix A).
2. This template should be customized to meet each end users unique requirements.Insert appropriate selection into highlighted gray areas.
3. You will need to assign someone to facilitate and evaluate the exercise at your site and write the After Action Report and Improvement Plan (Appendix D).
4. To ensure the best possible learning opportunity for your team, it is strongly recommended that you already have a plan in place for the processes that are discussed in this document. The scenarios and injects that comprise this exercise are designed to stimulate thought and discussion about your current plans and how to improve them.
5. On the day of the exercise, your team should gather in a conference or training room to participate in the exercise using a single computer, combination computer/LCD projector and/or handouts.
6. Inviting members of your local Public Health, Fire and Rescue, Law Enforcement, and/or Emergency Medical Services (EMS) teams and all other applicable Health Care Coalition members.
7. Invite your entire Incident ManagementTeam to this Tabletop exercise. If you do not have an Incident Management Team, some suggestions of people to invite would be:

• Health Care Coalition Leaders
• Health Care Coalition Leaders Members
• Senior Administrative Leadership (e.g., CEO, COO, CMO, CNO or CFO)
• Emergency Preparedness Coordinator
• Physicians
• Nurses
• Nursing Assistants
• Facilities Management staff
• Environmental Services staff
• Infection Prevention Leadership
• Respiratory Protection Program/Industrial Hygiene Leadership
• Any other staff members that participate in patient care

1. Have all participants fill out a Sign-in Sheet.
2. It is helpful for each participant to have a handout that includes the scenario and questions for the exercise so they can follow along and reference the scenario as questions arise during the discussion. This document should be developed based on the portion of the exercise that is planned.
3. Have all participants fill out a Participant Feedback form and hand back to you. (Appendix E)
4. To ensure this Tabletop Exercise meets the requirements of Joint Commission, you will need to have additional community members (local Public Health, etc.) in the room for your discussion. (FOR JOINT COMMISSION ACCREDITED FACILITIES ONLY)
5. An After Action Report (AAR) template (Appendix D) is included in this packet. This is a template for you to fill out after the exercise is completed. It will allow you to easily organize your strengths, weaknesses and improvement planning efforts.

Preface

There has been much focus and effort toward preparedness for Ebola. Ebola is transmitted through direct contact with infected blood or body fluids. Health care facilities and coalitions in the United States must also be prepared for diseases that are transmitted through the air such as Middle East Respiratory Syndrome Coronavirus (MERS-CoV), or otherhighly communicable airborne and non-airborne diseases. By building upon the established regional, tiered approach set forth by Health and Human Services (HHS) for Ebola Virus Disease (EVD), health care facilities can support a system of care for special pathogens including highly communicable airborne and non-airborne diseases, all of which pose a significant burden on the healthcare delivery system and require real time access to expertise in infectious disease management; and involve strategies and tactics related to overall preparedness to special pathogens.

Health care facilities and coalitions should outline plans from an ‘all hazards’ view for administrative, environmental, and communication measures that will be required to prevent spread, and manage the impact on patients, the facility, and staff for incidences involving special pathogen diseases.

By exercising plausible scenarios of varying type and magnitude, including highly communicable airborne and non-airborne diseases, health care facilities and coalitions can maintain an appropriate level of readiness to respond effectively to special pathogen diseases. The proposed airborne diseases in Table 1 are not an exhaustive list of highly communicable airborne diseases. Rather, the list is an impetus to serve as a starting point for health care facilities and coalitions to begin planning for other highly communicable diseases.

This exercise template has been developed by the National Ebola Training and Education Center (NETEC) utilizing the Homeland Security Exercise and Evaluation Program (HSEEP), which provided a “set of guiding principles for exercise programs, as well as a common approach to exercise program management, design and development, conduct, evaluation, and improvement planning.” (

This is a facilitated discussion intended to probe and explore the healthcare system’s ability to identify and stabilize a patient potentially infected with anairborne transmitted highly infectious disease; to initiate care and implement special protocols that may be required for the protection of the healthcare facility staff; and to coordinate such care with other Health Care Coalition (HCC) partners, including emergency medical services (EMS), public health and emergency management.

The series of questions included in this document are intended to initiate discussion and descriptions of how the HCC would respond to such an event. It is not anticipated that every question will be answered in every session, or that every question is relevant to every HCC setting. Please utilize these questions to explore the many complexities involved in the management of an airborne transmitted highly infectious disease patient(s), whether it is conducted in one session, or divided up over a number of sessions in which specific topics (i.e. coordination of EMS transport, implementation of patient care protocols, development of joint messaging, etc.) are discussed in greater detail.

Please note that there are five (5) specific measures (framed as specific questions in the body of this document) that are REQUIRED to be asked and answered by coalitions that received funding through the HPP Ebola Preparedness and Response Activities funding opportunity announcement.Four (4) other HPP measures are also included to probe Health Care Coalition's ability to prepare for and respond to a special pathogen case(s) within their coalition.

General Information

Background

The Hospital Preparedness Program (HPP) Ebola Preparedness and Response Activities funding opportunity announcement (FOA) provided awardees with the funds to support a regional, tiered approach for the management of Ebola and other special pathogens. At the state or jurisdictional level, awardees are supporting health care facilities that are capable of serving as State-Designated Ebola Treatment Centers (ETC) and Assessment Hospitals for their state(s) or jurisdictions, as well as supporting health care coalitions to prepare Frontline Facilities, emergency medical services (EMS) and the overall healthcare system in Ebola preparedness activities. The development of a regional Ebola/Special Pathogens treatment strategy, and Ebola/Special Pathogen healthcare system preparedness and response, are being supported by ASPR through HPP. HPP has created specific metrics to assess progress in meeting the goals of the HPP Ebola Preparedness and Response Activities FOA.

Purpose

The purpose of this exercise is to evaluate, review, and measure the regional response elements related to the health care coalition, in which the health care coalition must: 1) Ensure that the EMS system is capable of safely transporting patients with a highly infectious, airborne disease, 2) Enhance the competency of health care workers, including EMS personnel in the coalition, and clinical laboratories, and, by supporting annual training and exercises, 3) Rapidly communicate the presence of a PUI across the health care coalition, including health departments, and 3) Assess and report on PPE supplies from/for their members. The results of this exercise may be used to support fulfill the coalition-related HPP measures.

HPP Measures

Conduct of the facilitated discussion should allow sufficient flexibility for exercise participants to initiate the collection of required information in the context of the exercise. It is anticipated that the results of these measures will be reported to the exercise leader in the allotted timeframe, but likely after the conclusion of the “discussion” portion of the exercise.

REQUIRED HPP Measures (Assessment Hospital or Health Care Coalition):

OTHERHPP Measures (Coalition):

OTHER HPP Measures (supporting regionalnetwork measures that may be tested during this exercise that may support a coalition’s preparedness and response):

Hospital Preparedness Program (HPP) Measure Manual: Implementation Guidance for Ebola Preparedness Measures. July 2015 Version 7.0

*[This document has been modified and approved by ASPR to include Measures for special pathogens]

+[These measures have been pulled from select regional network HPP measures that can be used as a guide for HCC's to increase preparedness and planning]

Scope

Health Care coalition: The exercise will focus on emergency operations, coordination and information sharing aspects of the response to a PUI or a patient with confirmed [insert airborne transmissible special pathogen name]. Furthermore, it will explore the coordination and interplay between the multiple agencies and emergency response disciplines that comprise the HCC.

Target Capabilities

The Hospital Preparedness Program (HPP) Ebola Preparedness and Response Activities (CFDA #93.817) Funding Opportunity Announcement (FOA) and the NETEC are utilizing a capabilities-based planning approach as directed by National Preparedness Priorities. Capabilities-based planning focuses on planning under uncertainty, since the next emergence of a highly infectious disease in the United States can never be forecast with complete accuracy. Therefore, capabilities-based planning takes an approach to planning and preparation which builds capabilities that can be applied to a wide variety of special pathogens.