Regional Transport Plan -[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: Regional Transport Plan Activation, Coordination and Transport of [Stable Patient or Critical Patient] with [suspected or confirmed][insert airborne transmissible disease name]

Module 1: Plan Activation and Coordination following Notification of [Stable or Critical] Patient with [suspected or confirmed][insert airborne transmissible disease name]

Module 2: Ground Patient Transport

Special Consideration: Patient Decompensation en route to Receiving Hospital

Special Consideration: Pediatric Patient Transfer

Special Consideration: Multiple Patient Transfer

Module 3: Air Patient Transport

Module 4: Decontamination after Patient Transport

Appendix A: Exercise Schedule

Appendix B: Invited Exercise Participants

Appendix C: Relevant Plans

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

Exercise Overview

Analysis of Target Capabilities

Improvement Plan

Appendix E: Participant Feedback Form

Appendix F: Acronyms and Abbreviations

Exercise Overview

Exercise Name / [Insert the formal name of exercise, which should match the name in the document header]
Exercise Date / [Month/Day, Year]
Scope / This exercise is a [exercise type], planned for [exercise duration] at [exercise location]. Exercise play is limited to [exercise parameters].
Mission Area(s) / [Prevention, Protection, Mitigation, Response, and/or Recovery]
Target Capabilities / Foundation for Health Care and Medical Readiness, Health Care and Medical Response Coordination, Continuity of Health Care Service Delivery, and Medical Surge. [List any other applicable target capabilities being exercised]
Objectives /
  1. Assess the abilityto safely and effectively coordinate transportation arrangements of a patient with [suspected or confirmed][insert airborne transmissible disease name]for evaluation, treatment and admission within an appropriate time frame.
  2. Examinethe decision making process and notification and communication processes between multiple jurisdictions including local, state, and federal public health, EMS, and other healthcare delivery system partners, sending facility and the Regional Ebola and Other Special Pathogen Treatment Center, as well as media management.
  3. EvaluateEMS capabilities, and determine the most appropriate method for transportation (e.g., air versus ground or both) and clinical resources (staff and equipment) required for transportation:
  4. Management of [stable or critical] patient or PUI transported by ground EMS personnel
  5. Management of patient undergoing air transportation and coordination with ground EMS personnel for [stable or critical] patient or PUI
  6. Evaluatejust-in-time PPE don / doff training resources and PPE availability for EMS, and healthcare delivery system personnel.
  7. Assessthe transport of special populations (e.g., pediatric patients).
  8. Evaluatethe management of a patient who decompensates en route from receiving facility to the Regional Ebola and Other Special Pathogen Treatment Center.
  9. Evaluatethe management of decontaminating ambulance or aircraft after transport by EMS personnel.
  10. [List any additional exercise objectives]

Hazard / Special Pathogen
Scenario / [Insert a brief overview of the exercise scenario, including scenario impacts (2-3 sentences)]
Sponsor(s) / [Insert the name of the sponsor organization, as well as any grant programs being utilized, if applicable]
Participating Organizations / [Agency/Department]
[Agency/Department]
Point of Contact / [Agency/Department]
Name
Title
Email
Phone
[Agency/Department]
Name
Title
Email
Phone

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:

Name / Institution / Title
Elizabeth L. Beam, PhD, RN / University of Nebraska Medical Center, Nebraska Biocontainment Unit / Project Coordinator and Assistant Professor
Nicholas V. Cagliuso, Sr., PhD, MPH / NYC Health + Hospitals / Assistant Vice President, Emergency Management
Shawn G. Gibbs, PhD, MBA, CIH / Indiana University, School of Public Health-Bloomington / Executive Associate Dean and Professor
Syra S. Madad, DHSc, MSc, MCP / NYC Health + Hospitals / Director, System-wide Special Pathogens Program
Kristine Sanger, BS, MT(ASCP) / University of Nebraska Medical Center, Center for Preparedness Education / Director of Hospital Training and Exercise Programs
Sam Shartar, RN, CEN / Emory University Office of Critical Event Preparedness and Response CEPAR / Senior Administrator

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. This Regional Transport Plan template can used to activate, coordinate and transport a patient from any transfer facility (i.e., Frontline or Assessment Hospital) to a receiving facility (i.e., Assessment Hospital, ETC or RESPTC).
  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. Invite your entire Regional Transport PlanTeam to this Tabletop exercise. Suggestions of people to invite would be:
  7. Participating health care facilities (e.g., Frontline Hospitals, Assessment Hospitals, State-Designated ETCs, your HHS designated Regional Ebola and Special Pathogen Treatment Center)
  8. Members of your local Public Health, Fire and Rescue, Law Enforcement, and/or Emergency Medical Services (EMS) teams
  9. Any member/agency/facility involved in coordination, transfer and care of a PUI within your region
  10. Have all participants fill out a Sign-in Sheet.
  11. 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.
  12. Have all participants fill out a Participant Feedback form and hand back to you. (Appendix E)
  13. 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 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 and coalitions 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.

NOTE: The purpose of this template is to give end-users an option when designing, conducting, and evaluating special pathogen exercises and to choose a single airborne-transmissible pathogen and expeditiously proceed.

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 thetransportation of a patient with suspected and/or confirmed airborne transmitted highly infectious from a Transferring Facility (e.g., Frontline, Assessment Hospital or State-Designated Ebola Treatment Center) to a Receiving Facility (e.g., Assessment Hospital, State Designated Ebola Treatment Center or Regional Ebola and Special Pathogen Treatment Center (RESPTC). The series of questions included in this document are intended to initiate discussion and description of how the Regional Transport Plan would be activated to 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 Regional Transport setting. Please utilize these questions to explore the many complexities involved in the transport of EVDpatients, whether it be done in one session, or divided up over a number of sessions in which specific topics (planning and coordination of EMS transport, inter-facility transport capabilities, risk/benefit analysis of ground vs. air transport, implementation of Regional Transport Plan, duration of transport, special considerations for pediatric patients, decontamination, 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 the regional network that received funding through the HPP Ebola Preparedness and Response Activities funding opportunity announcement.

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 healthcare 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 healthcare coalitions to prepare Frontline Facilities, Emergency Medical Services (EMS) and the overall healthcare system in Ebola/Special Pathogen preparedness activities. The development of a regional Ebola treatment strategy, and Ebola 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.For the purpose of these exercises, these metrics have been modified by NETEC and approved by ASPR to also serve Special Pathogen Preparedness and Response.

Regional Transport Plans serve to support Regional jurisdictions for EMS, public health, and healthcare facilities to coordinate safe and effective transfer of patient to a receiving facility, including Assessment Hospital, State-Designated Ebola Treatment Center or Regional Ebola and Other Special Pathogen Treatment Center (RESPTC).

Purpose

The purpose of the facilitated discussion exercise is to evaluate, review, and measure the response elements related to theRegional Transport Plan, in which it must: 1) Support planning for the development of a Regional Transport Plan for transfer of a patient with suspected or confirmed special pathogen, 2) Demonstrate notification and information sharing with all involved stakeholders, 3) Demonstrate activation process, and 3) Coordinate movement of patient. The results of this exercise may be used to support fulfill the Concept of Operations (CONOPS) 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 (Healthcare Coalitions as it relates to Frontline Facilities):

Required HPP Measures*
1 A.A. / Time, in minutes, it takes from an assessment hospital’s notification to the health department of the need for an inter-facility transfer of a patient with confirmed Ebola to the arrival of a staffed and equipped EMS/inter-facility transport unit, as evidenced by a no-notice exercise (Goal: Within 240 minutes or 4 hours).
19 B.A. / Time from confirmation of Ebola/Special Pathogen patient at assessment hospital or ETC to notification by the health department and/or transferring hospital (assessment hospital or ETC) to the health department in the state/jurisdiction where the regional Ebola and other special pathogen treatment center is located about the need for patient transfer (Goal: Within 30 minutes).
20 B.A. / Proportion of member states/jurisdictions in the region that have participated in the development of the regional CONOPS (Goal: 100%).
21 B.A. / Proportion of states/jurisdictions in the HHS region for which a current written and signed agreement is in place to transfer patients from assessment hospitals or ETCs to the regional Ebola and other special pathogen treatment center (Goal: 100%).
22 B.A. / Proportion of states/jurisdictions in the HHS region that have demonstrated the ability to move a patient across jurisdictions by ground or air to a regional Ebola and other special pathogen treatment center, as evidenced by a real-world event or participation in a multi-jurisdiction exercise (Goal: 100%).

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 metrics for special pathogens]

+[These measures have been pulled from select Assessment Hospital HPP measures that can be used as a guide for Frontline Facilities to increase preparedness and planning]

Scope

Transport Plan: The exercise will focus on the Regional Transport Plan and the ability of its users to effectively activate and coordinate safe transfer of patient with[insert airborne transmissible special pathogen name].Furthermore, it will explore the coordination and interplay between the multiple agencies and jurisdictions and emergency response disciplines that comprise the HHS Region.

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.

The NETEC Exercise Design Team, ASPR and CDC have determined the capabilities listed below from the priority capabilities identified in the 2017 – 2022 Health Care Preparedness and Response Capabilitiesand exercise requirements. These capabilities provide the foundation for development of exercise objectives and scenario, as the purpose of this exercise is to measure and validate performance of these capabilities and their associated critical tasks:Foundation for Health Care and Medical Readiness, Health Care and Medical Response Coordination, Continuity of Health Care Service Delivery, and Medical Surge.