Meeting/Conference Name
Pandemic Influenza
Tabletop Exercise
Facilitator’s Manual
Date:
Facilitator:
Location:
TABLE OF CONTENTS
Subject Page
Introduction …………..……………………….………………….……………………..3
Exercise Objectives……………………………….…………………………………....4
Sample Exercise Schedule….…….………………………………...………………...5
Module 1…………………………………………………………………..……………..6
Limited number of H5N1 cases in Asia, no human cases in the United States.
Module 1 NOTES ………………………………………………………...…...... 8
Module 2 …..………………………………………………………………..…………..9
H5N1 human cases on the rise in Asia, few isolated human cases found in
the United States.
Module 2 NOTES…………………………………………………………..………….12
Module 3…………………………………………………………………..……………13
Increased H5N1 human-to-human transmission in the U.S.
Module 3 NOTES……………………………………………………………..……….15
Module 4……………………………………………………………………..…………16
Human H5N1 cases on a steady decline…for now.
Module 4 NOTES…………………………………………………………..………….19
Exercise Debriefing Questions ………………..………………...... 20
Exercise Closing Statement….…………………………………………..…………..21
Appendices
Appendix A………………………………………………………..…………………...23
HHS School District (K-12) Pandemic Influenza Planning Checklist
Appendix B………………………………………………………..…………………....26
CDC Avian Influenza Fact Sheet
Appendix C………………………………………………….………….………………29
Pandemic Influenza Community Mitigation Interim Planning Guide for Elementary and Secondary Schools, Community Strategy for Pandemic Influenza Mitigation
Appendix D……………………………………………………………….…………….35
WHO Pandemic Alert Phases vs. Stages of Federal Government Response
Appendix E ………………………………………………………………………….....37
Pandemic Severity Index (PSI)
Appendix F ……………………………………………………………………………..38
“FDA Approves First U.S. Vaccine for Humans against the Avian Influenza Virus H5N1”
Additional Resources ……………………………………………………………………….....40
Glossary of Terms………………………………………………………………………………44
This Facilitator Manual is designed as guidance for designated exercises controllers to facilitate this pandemic influenza tabletop exercise (TTX). It contains general instructions to the facilitator on the overall exercise process, necessary materials, and discussion questions. Detailed notes for the facilitator’s consideration are shown in bold and italicized font.
Introduction
General Instructions:
This TTX begins with a PowerPoint presentation as it outlines the content of the Participant Manual. The presentation will detail, in the following sequence, the rules, objectives, and scenario included in this TTX. Please note that although the pandemic influenza scenario presented is fictitious, it realistically represents a probable pandemic influenza event affecting the school districts.
Players are strongly encouraged to participate in in-depth discussions as the primary purpose of the exercise is to evaluate and improve skills, knowledge, and emergency response plans for the school district and its partners. It is important for players to keep the exercise objectives in mind as all issues raised by the scenario will be thoroughly discussed.
This pandemic scenario will be presented in four modules. Following each module, players will have a set time period to review the module and discuss the suggested issues. During this exercise, the following rules apply:
§ This TTX is conducted in a “non-attributable” and stress-free environment, in which the goal of the exercise is to examine and resolve issues rather than assess individual performance.
§ The scenario represents a plausible pandemic influenza event.
§ There are no trick questions or “hidden agendas” associated with this TTX.
§ Players have no previous knowledge of the scenario and will receive all information at the same time.
§ Players will respond using existing plans, procedures, and other response resources.
§ Decisions are not precedent setting and may not reflect your organization’s final position on a given issue.
For reference, the Appendices to this Participant Manual contain additional information on the pandemic influenza threat addressed in this exercise.
Note to Lead Facilitator: Before showing the slide on “Exercise Rules”, brief the group on emergency exits, bathroom locations, and other relevant housekeeping items.
Lead Facilitator Instructions: Show “Exercise Objectives” slide. If multimedia presentation capability is not available, read the narrative as written below.
Exercise Objectives
The (school district name), in collaboration with its State and local emergency response partners will conduct a pandemic influenza TTX, using the four phases of emergency management (prevention-mitigation, preparedness, response, and recovery) as a foundation, to:
1. Assess school district hazard prevention measures by addressing infectious threats such as pandemic influenza.
2. Assess school district preparedness, such as maintaining disinfectant supplies and providing training to school faculty and staff in pandemic flu, in anticipation of a mass influenza outbreak.
3. Coordinate and assess communication plans as an emergency response activity among school districts and emergency response partners during a pandemic influenza event.
4. Coordinate and assess psychological support to students and staff in the event of a mass influenza outbreak.
5. Assess the school district’s ability to recover from a mass influenza outbreak in order to resume normal activities and restore a safe learning environment.
Note to Facilitator: These objectives should be displayed on the screen throughout the duration of the exercise if multimedia presentation capability allows.
Lead Facilitator Instruction: Show “Exercise Schedule” slide. Go over the exercise schedule with participants.
Sample Exercise Schedule (to be modified as appropriate by facilitator)
1:00 P.M. Participant Sign-In
1:30 P.M. Introduction
Discuss general instructions and ground rules of the exercise
1:40 P.M. Exercise Overview
Discuss exercise objectives, and schedule of exercise
2:00 P.M. Read Module 1
Limited number of H5N1 cases in Asia, no human cases in the United States.
2:10 P.M Module 1 Discussion
2:30 P.M. Read Module 2
H5N1 human cases on the rise in Asia, few isolated human cases found in the United States.
2:40 P.M. Module 2 Discussion
3:20 P.M. Break
3:30 P.M. Read Module 3
Increased H5N1 human-to-human transmission in the U.S.
3:40 P.M. Module 3 Discussion
3:50 P.M. Read Module 4
Human H5N1 cases on a steady decline…for now.
4:00 P.M. Module 4 Discussion
4:20 P.M. Debriefing about Lessons Learned
5:00 P.M. End of Exercise
Notes to Lead Facilitator:
1. Provide participants a few minutes and/or review with them the appendices and inform them of the tools they may want to reference during the scenario.
2. Inform audience you will first provide background information avian influenza viruses with a focus on H5N1, its symptoms, and pre-pandemic planning tools. .
3. Show Slides 7-9, and refer participants to Appendix B, “CDC Key Facts about Avian Influenza”.
4. Show Slides 10-12 and refer participants to Appendix D, “Pandemic Influenza Community Mitigation Interim Planning Guide”
Note to Lead Facilitator: Show “Module 1” slide while reading narrative provided below.
MODULE 1 – Limited number of H5N1 cases in Asia, no human cases in the United States.
Time Period: May 2010 – July 2010
In the past year, the number of H5N1 animal cases has been climbing in a number of Asian countries and a limited number of H5N1 human cases were observed. The H5N1 human cases found in Asia were mainly caused by direct contact with diseased animals since the virus has only acquired limited ability for human-to-human transmission. In view of the situation, the World Health Organization (WHO) issued a Phase 3 pandemic alert defining the pandemic threat as “no or limited H5N1 human-to-human transmission.”
Here in the United States, although no H5N1 cases of any kind have been found, the government is taking steps towards better preparing everyone for a potential pandemic influenza outbreak;. The Department of Health and Human Services (HHS) has developed a Pandemic Influenza Plan which provides guidance for Federal, State and local policy makers and health departments in the event of a pandemic influenza outbreak; within HHS, the Centers for Disease Control and Prevention (CDC) has developed detailed guidelines for infection prevention and control measures for the public, school systems, hospitals, etc.; and funding has been allocated for vaccine development and production.
From movies to news, media coverage of H5N1 outbreaks around the world is raising public awareness here in the U.S. concerning the threat of pandemic influenza. At this point, there is still uncertainty regarding when H5N1 will arrive in the U.S. and if the virus will cause a major pandemic. Nonetheless, to enhance preparedness against the threat of pandemic influenza, school districts must take all necessary preventive measures and mitigate the threat even if H5N1 never reaches U.S. shores.
Lead Facilitator Instructions:
1. Ask participants if they have any questions about Module 1 narrative.
2. Show “Module 1 Questions” slide. Announce to participants that they should address the questions that will be presented by the facilitators.
3. Participants should address most of the following questions during the discussions. If time allows, additional questions are provided for each module. Remind participants to take notes on lessons learned for the debriefing meeting at the end of the exercise.
MODULE 1 KEY DISCUSSION QUESTIONS:
1. What kind of educational material is available to faculty, staff, students, and parents about pandemic influenza?
2. Does the plan outline the decision-making process, key personnel, and criteria for cancelling classes or closing schools? For example, are decisions made by the education or health agency? At the State or local level? Or, collaboratively?
3. Has faculty, staff, community and emergency response partners been involved in providing input and feedback for crisis planning for schools?
4. Will faculty and staff play a role in the incident command structure once the Incident Command System (ICS) is activated during an emergency? If so, what is the role?
5. Does the school have plans to acquire and maintain essential supplies, such as disinfectants, face masks, gloves, in the event of a pandemic influenza outbreak?
MODULE 1 ADDITIONAL DISCUSSION QUESTIONS (as time allows):
1. Is the school district’s current emergency response plan suited for a pandemic influenza outbreak?
2. Has the State legislature drafted policy providing considerations and accommodations to local school districts in the event of a pandemic flu (i.e., reducing the number of required school days and allowing for additional leave for staff).
3. Is there a communication plan for keeping the district and schools informed of decisions regarding school scheduling and closures?
Lead Facilitator Instructions: Ask participants if they have any questions about Module 2 narrative.
MODULE 1 NOTES:
Lead Facilitator Instructions: Show “Module 2” slide while reading narrative provided below.
MODULE 2 – H5N1 human cases on the rise in Asia, few isolated human cases found in the United States.
Time Period: July 2010 – September 2010
In July 2010, WHO laboratory confirmed a surge of human H5N1 cases in many Asian countries including China, Indonesia, India, and Vietnam. Data shows a surge in morbidity and mortality in areas of high population density, such as hospitals, high-rise residential buildings, and schools; many of the infected died from the rapidly emerging disease. In response, the WHO raised its pandemic alert to Phase 6, indicating evidence of efficient and sustained human-to-human transmission.
Experts believe that the sick individuals brought the cases back to the U.S. after recent travels to diseased regions and then became infected at home as well as infecting close contacts. Given the highly infectious nature of the H5N1 virus and the escalating situation in Asia, the Pandemic Severity Index (PSI) is activated, prompting a move from alert to standby mode. Alert status notifies key personnel of their impending activation while standby requires mobilization of resources. CDC has alerted hospitals, physicians, and other healthcare and public health entities to prepare for a potential pandemic influenza outbreak in the United States.
Over the next two months, August and September 2010, the number of human cases increased as more cases appeared in various areas of United States. Patient tracking in hospitals reveals that the virus is starting to be spread via human-to-human contact transmission between previously hospitalized patients and those who had close contact with these individuals. In fact, a significant portion of the most severe cases was seen in children and young adults. Therefore, there is serious concern for schools since they are a point of close contact among students and are now back in session.
On September 20, 2010, CDC confirmed several local media reports that the most recent human H5N1 outbreak occurred inside a high-rise apartment building in (City / District). Additionally, the local hospital is seeing an increase in the number of patients being treated for the H5N1 virus. Most of these patients are children and young adults. Although there are still a fairly low percentage of cases in the community, all schools in the district close on September 26, 2010. The district prepares for long-term school closure (up to 12 weeks).
Lead Facilitator Instructions: Show “Module 2 Questions” slide. Announce to participants that they should address the questions that will be presented by the facilitators.
Note to Facilitator: Participants should address most of the following questions during the discussions. Remind participants to take notes on lessons learned for the debriefing meeting at the end of the exercise.
MODULE 2 KEY DISCUSSION QUESTIONS:
1. Does the school system have a surveillance system for absences? If so, is this system linked to the local health department or other health-related entity?
2. Does the school plan to maintain educational operations in the case of pandemic? If so, what plan is in place for maintaining continuity of instruction (tele-schooling, individual/group mentoring) for students?
3. What is the school procedure for school closure when a public health emergency has been declared?
MODULE 2 ADDITIONAL DISCUSSION QUESTIONS (as time allows):
1. To address the fear of a pandemic influenza outbreak, does the school district have the capabilities to provide psychological support for student and faculty/staff when needed?
2. Does the school have established communication protocols with community and emergency response partners, such as local health departments and media, before and during a public health emergency?
3. What is the school’s plan to communicate with media for latest information dissemination?
4. What is the school’s plan to communicate with emergency response partners (e.g., public health) during pandemic influenza outbreak during a public health emergency?
MODULE 2 NOTES:
Lead Facilitator Instructions: Show “Module 3” slide while reading narrative provided below.
MODULE 3 - Increased H5N1 human-to-human transmission in the U.S.
Time Period: October 2010 –December 2010
It is now early October, since the hospital outbreaks in September, media coverage has surged. Hospital emergency rooms and other healthcare facilities around the country are reporting increasing numbers of influenza-like-illness patients seeking care; samples from the most severe cases are sent confirmation of the H5N1 virus.