Onx After Action Report Draft ONX System s3

After Action Report / Improvement Plan Treacherous Transport Exercise

Treacherous Transport Exercise

Central Region

June 6, 2012

AFTER ACTION REPORT / IMPROVEMENT PLAN

Utah Department of Health

ADMINISTRATIVE HANDLING INSTRUCTIONS

1. The title of this document is The "Treacherous Transport - A Healthcare Coalition Tabletop Exercise - Central" After Action Report.

2. The information gathered in this AAR/IP is classified as For Official Use Only (FOUO) and should be handled as sensitive information not to be disclosed. This document should be safeguarded, handled, transmitted, and stored in accordance with appropriate security directives.

3. At a minimum, the attached materials will be disseminated only on a need-to-know basis and when unattended, will be stored in a locked container or area offering sufficient protection against theft, compromise, inadvertent access, and unauthorized disclosure.

4. Points of Contact:
Health Department:
Christine Warren
Utah Department of Health
(Office) 801-273-6663
(E-Mail)
Exercise Director:
Ginny Schwartzer
All Clear Emergency Management Group LLC
(Office) 919-323-9995
(E-Mail)

ADMINISTRATIVE HANDLING INSTRUCTIONS 2

CONTENTS 3

EXECUTIVE SUMMARY 4

SECTION 1: EXERCISE OVERVIEW 5

Exercise Details 5

Participant Information 5

SECTION 2: EXERCISE DESIGN SUMMARY 7

Exercise Purpose and Design 7

Exercise Objectives, Capabilities and Activities 7

Scenario Summary 8

SECTION 3: ANALYSIS OF CAPABILITIES 9

SECTION 4: CONCLUSION 20

APPENDIX A: IMPROVEMENT PLAN 22

APPENDIX B: PARTICIPANT FEEDBACK (3 THUMBS UP – 3 THUMBS DOWN) 23

APPENDIX C: ACRONYMS 25

EXECUTIVE SUMMARY

Treacherous Transport - A Healthcare Coalition Tabletop Exercise - Central was designed and facilitated to test hospital evacuation plans, coordination and agreements with outside agencies.

The purpose of this report is to analyze exercise results, identify strengths to be maintained and built upon, identify potential areas for further improvement, and support development of corrective actions.

Incorporated in Section 3: Analysis of Capabilities of this After Action Report is a comprehensive listing of each Target Capability with its associated Major Strengths, Primary Areas for Improvement and Improvement Recommendations

SECTION 1: EXERCISE OVERVIEW

Exercise Details

Exercise Name: / Treacherous Transport - A Healthcare Coalition Tabletop Exercise - Central
Type of Exercise: / Tabletop
Exercise Start Date: / June 6, 2012
Duration: / Two Hours
Location: / Central Region
Sponsor: / Utah Department of Health
Program: To assist hospitals to assess their plans and procedures regarding a hazardous materials incident.
Purpose: The purpose of the exercise was to test hospital evacuation plans, coordination and agreements with outside agencies.
Mission: To provide exercise participants from various agencies the opportunity to work together as a unified team in support of a hospital’s response to a hazardous materials incident.
Scenario Type: Hazardous Materials Incident

Participant Information

Participant / Location
Central Utah Public Health Department
Utah Department of Health
Sevier Valley Medical Center
Millard County Ambulance
Juab County Fire District
Juab County EMS
Central Valley Medical Center
Intermountain Healthcare
Gunnison Valley Hospital
Number of Participants / 20

SECTION 2: EXERCISE DESIGN SUMMARY

Exercise Purpose and Design

The purpose of the exercise was to test hospital evacuation plans, coordination and agreements with outside agencies.

Exercise Objectives, Capabilities and Activities

Capabilities-based planning allows for the exercise planning team to develop exercise objectives and observe exercise outcomes through a framework of specific action items that were derived from the Target Capabilities List (TCL). The capabilities listed below form the foundation for the organization of all objectives and observations in this exercise. Additionally, each capability is linked to several corresponding activities and tasks to provide additional detail.

Based upon the identified exercise objectives below, the exercise planning team decided to demonstrate the following capabilities during this exercise:

Communications
Activity / Target Capability
# 1 / Initial Incident Communication
# 2 / Hospital Command Center Activation and Management
# 3 / Notification and Coordination with Outside Partners
# 4 / Return to Normal Operations
HazMat Response and Decontamination
Activity / Target Capability
# 1 / Limiting Access to Hospital
# 2 / Decontamination
Evacuation and Shelter-In-Place
Activity / Target Capability
# 1 / Evacuate Patients in Affected Area of Facility
# 2 / Continue Patient Care
Memoranda of Understanding and Agreements
Activity / Target Capability
# 1 / Review Current Agreements with Outside Agencies

Scenario Summary

It is a warm summer day in June with low humidity and mild breeze out of the west. At 4:30 PM, as rush hour is beginning, a tanker tractor-trailer carrying hazardous materials was cut off by a mini-van driven by a distracted teenager, who was carrying his three younger siblings.

The tractor-trailer hit the mini-van and swerved into a ditch, tipping on its side and spilling its contents.

SECTION 3: ANALYSIS OF CAPABILITIES

Communications

Performance / Target Capability
[OVERALL] /

Activity # 1: Initial Incident Communication

Associated Critical Tasks
Task # 1.1: Have understanding of response agency notifications.
Strong / Evaluator # 1
Observations / · Quick response.
· Players were aware of the notification process.
Recommendations / · None
Adequate / Evaluator # 2
Observations / · Communication indicated an understanding of the process of decon at the scene.
Recommendations / · Neither the Fire Department nor EMS was present to confirm other entities assumptions.
Adequate / Evaluator # 3
Observations / · EMS representative was able to provide excellent information on fire / haz-mat response and hazmat regional response team information and how to notify through dispatch.
· Good discussion.
· Hospital representatives were knowledgeable regarding hospital haz-mat response team and notification.
Recommendations / · Contact Utah Central Health District (local health department) and find out their hazardous materials / environmental health resources and guidelines to a hazardous materials leak affecting public health.
Task # 1.2: Communications between the field and the hospital.
Adequate / Evaluator # 1
Observations / · Policy and procedures in place for hospitals no EMS or dispatch personnel present for exercise.
Recommendations / · None
Strong / Evaluator # 2
Observations / · Communication the same as will any emergency.
Recommendations / · None
Strong / Evaluator # 3
Observations / · Monitor radio system.
· Working knowledge of communications with EMS in the field that would provide information on the scene and material information regarding haz-mat from hazmat response personnel. If necessary, hospital ECC would call dispatch to gather further information regarding hazardous materials and critical information.
Recommendations / · Consider what other options and resources you would be able to gather information at the incident if EMS did not respond and dispatch was overwhelmed with call and radio traffic.
Performance / Target Capability
[OVERALL] /

Activity # 2: Hospital Command Center Activation and Management

Associated Critical Tasks
Task # 2.1: Established protocols for activating the Hospital Command Center.
Strong / Evaluator # 1
Observations / · Players know when and how to activate, trigger points quick activation.
Recommendations / · None
Strong / Evaluator # 2
Observations / · Policy in place.
Recommendations / · Coordination / involvement of clinics or urgent care.
Strong / Evaluator # 3
Observations / · Have policy on activating HCC and who would be the response team.
Recommendations / · None
Task # 2.2: Hospital Command Center is adequately staffed.
Adequate / Evaluator # 1
Observations / · Small hospitals, dependent upon time of day and day of the week.
Recommendations / · Difficult to recommend as facilities have a small staff of personnel to begin with.
Weak / Evaluator # 2
Observations / · Hospital reported ability to staff for one shift.
Recommendations / · Coordinate with MRC to staff subsequent shifts.
Adequate / Evaluator # 3
Observations / · None
Recommendations / · Staffing will be one of the major concerns, if key response personnel unavailable.
Task # 2.3: Hospital Command Center is able to receive requests for resources/information and dispatch accordingly.
Adequate / Evaluator # 1
Observations / · Able to communicate within facility and outside for resources, policy and procedures in place.
Recommendations / · None
Adequate / Evaluator # 2
Observations / · None
Recommendations / · None
Strong / Evaluator # 3
Observations / · None
Recommendations / · None
Task # 2.4: Significant events or developments are communicated to the HCC in a timely fashion.
Adequate / Evaluator # 1
Observations / · Able to communicate within facility.
Recommendations / · Only difficulty was no policy in place how to determine if emergency department is contaminated.
Adequate / Evaluator # 2
Observations / · None
Recommendations / · None
Unsure / Evaluator # 3
Observations / · Significant discussion regarding communication to ED Nurse Manager and staff, but not directly to HCC, it seemed that the ED Manager would communicate information to HCC - the HCC would communicate decisions on response to ED Manager.
· They might have it detailed out in their emergency response plan, but unclear if it was specific regarding the communication flow.
Recommendations / · Ensure the communication flow is specified in Emergency Disaster Plan
Performance / Target Capability
[OVERALL] /

Activity # 3: Notification and Coordination with Outside Partners

Associated Critical Tasks
Task # 3.1: Maintain communications with outside partner agencies.
Strong / Evaluator # 1
Observations / · Able to communicate with outside parties via radio or phone.
Recommendations / · None
Adequate / Evaluator # 2
Observations / · None
Recommendations / · None
Strong / Evaluator # 3
Observations / · Again, they were confident in communication with EMS in the field, unsure of other response partners who they would need to communicate with.
· They confirmed they would contact nearest hospitals through landline.
Recommendations / · Research response partners or other resources available for response to determine hospital contamination.
Performance / Target Capability
[OVERALL] /

Activity # 4: Return to Normal Operations

Associated Critical Tasks
Task # 4.1: Communicate return of normal operations to all parties involved.
Adequate / Evaluator # 1
Observations / · Dependent upon the situation.
Recommendations / · No written plan at this time.
Strong / Evaluator # 2
Observations / · Carry through to financial responsibility through proper documentation.
Recommendations / · Release public service announcement.
Adequate / Evaluator # 3
Observations / · None
Recommendations / · Need to find the resources that would be able to determine the contamination was eliminated to return to normal operations.
Evaluator Number / Evaluator Name
# 1 / Ronald Steege
# 2 / Deidre Hyde
# 3 / Christine Warren

HazMat Response and Decontamination

Performance / Target Capability
[OVERALL] /

Activity # 1: Limiting Access to Hospital

Associated Critical Tasks
Task # 1.1: Hospital understands and has ability to implement a limited access.
Strong / Evaluator # 1
Observations / · Policy and procedure for limiting access to facility when notified of an event.
Recommendations / · None
Strong / Evaluator # 2
Observations / · None
Recommendations / · None
Strong / Evaluator # 3
Observations / · Excellent response and understanding of the emergency disaster plan.
Recommendations / · None
Performance / Target Capability
[OVERALL] /

Activity # 2: Decontamination

Associated Critical Tasks
Task # 2.1: Understanding of capabilities to decon patients during a hazardous materials incident.
Strong / Evaluator # 1
Observations / · Facilities have decontamination equipment available personnel going through training.
Recommendations / · None
Strong / Evaluator # 2
Observations / · None
Recommendations / · None
Strong / Evaluator # 3
Observations / · Working understanding and knowledge of hospitals capabilities in decon patients.
Recommendations / · None
Task # 2.2: Determine appropriate decon procedures based on chemical identified.
Strong / Evaluator # 1
Observations / · Facilities able to use appropriate procedures based on type of agent.
Recommendations / · None
Strong / Evaluator # 2
Observations / · None
Recommendations / · None
Adequate / Evaluator # 3
Observations / · They do not have immediate knowledge of appropriate decontamination procedures by chemical, but there was significant discussion on how to find the information through web and ERG.
Recommendations / · Have resources as annex in emergency disaster plan.
Evaluator Number / Evaluator Name
# 1 / Ronald Steege
# 2 / Deidre Hyde
# 3 / Christine Warren

Evacuation and Shelter-In-Place

Performance / Target Capability
[OVERALL] /

Activity # 1: Evacuate Patients in Affected Area of Facility

Associated Critical Tasks
Task # 1.1: Review established evacuation plan.
Strong / Evaluator # 1
Observations / · None
Recommendations / · None
Adequate / Evaluator # 2
Observations / · They briefly discussed evacuation, because in this scenario they would lock-down and shelter in place all contaminated areas and patients.
· There was discussion discuss if they would not move patients into area without first decon then move to clean area.
Recommendations / · None
Task # 1.2: Determine need for outside assistance in evacuation.
Strong / Evaluator # 1
Observations / · None
Recommendations / · None
Strong / Evaluator # 2
Observations / · Discussion on their MOU business and had an entire book on business they have established partnership and MOUs with if the need for assistance in evacuation was required. This is with their emergency response plan.
Recommendations / · None
Performance / Target Capability
[OVERALL] /

Activity # 2: Continue Patient Care

Associated Critical Tasks
Task # 2.1: Procedures are established for alternative care for patients arriving at the ED.
Weak / Evaluator # 1
Observations / · Not sure if new patients will be triaged in parking lot and then referred on or just post closed sign on door.
Recommendations / · Policy anticipating ED contamination and response.
Strong / Evaluator # 2
Observations / · The discussion involved setting decon and triage patients outside of hospital to determine patient care needs.
· Limitations on enough staff to fulfill positions in decon, triage and patient care in and out of hospital.
Recommendations / · Research possibly of where you could draw staffing from outside of hospital to assist. Haz-mat / fire agencies resources throughout Utah and Millard Counties for volunteers and where you would be able to utilize.
· Medical Reserve Corp (MRC) – Need to learn more regarding MRC qualifications and how the Utah Responds System works. Contact health department who oversees the MRCs within Central Health District.
Task # 2.2: Hospital directs patients seeking care to adequate community resources or alternatives.
Weak / Evaluator # 1
Observations / · None
Recommendations / · None
Adequate / Evaluator # 2
Observations / · The discussion was focused more on decon patients on-site and then treat within hospital.
· There was some discussion they would contact Payson Hospital North and Fillmore / Delta Hospital South for staffing support and accepting evacuating patients.
· There was discussion of MOUs with all three hospitals.
Recommendations / · Ensure MOUs are in place for Payson, Fillmore and Delta hospitals
Evaluator Number / Evaluator Name
# 1 / Deidre Hyde
# 2 / Christine Warren

Memoranda of Understanding and Agreements