AFTER ACTION REPORT/IMPROVEMENT PLAN

Transcription

1 Measure A Spokane Regional Health District H1N1 Response: October 24, 2009 AFTER ACTION REPORT/IMPROVEMENT PLAN April 9, 2010

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3 HANDLING INSTRUCTIONS 1. The title of this document is Spokane Regional Health District: Spokane Veterans Memorial Arena. 2. 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. 3. Points of Contact: Joel McCullough Health Officer Spokane Regional Health District 1101 W. College Avenue Spokane, WA (office) (cell) jmccullough@spokanecounty.org Lyndia Tye Incident Commander Spokane Regional Health District 1101 W. College Avenue Spokane, WA (office) (cell) ltye@spokanecounty.org Susan Sjoberg Emergency Response Coordinator Spokane Regional Health District 1101 W. College Avenue Spokane, WA (office) (cell) ssjoberg@spokanecounty.org Handling Instructions 1 Spokane Regional Health District

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5 CONTENTS Administrative Handling Instructions...1 Contents...3 Executive Summary...5 Section 1: Exercise Overview... [p] Exercise Details... [p] Exercise Planning Team Leadership... [p] Participating Organizations... [p] Section 2: Exercise Design Summary... [p] Exercise Purpose and Design... [p] Capabilities and Activities Identified for Demonstration... [p] Scenario Summary... [p] Planned Simulations... [p] Section 3: Analysis of Capabilites... [p] [Capability 1]... [p] [Capability 2]... [p] [Capability 3]... [p] Section 4: Conclusion... [p] Appendix A: Improvement Plan... [p] Appendix B: Lessons Learned [Optional]... [p] Appendix C: Participant Feedback Summary [Optional]... [p] Appendix D: Exercise Events Summary Table [Optional]... [p] Appendix E: Performance Ratings [Optional]... [p] Appendix F: Acronyms... [p] [If an AAR contains graphics, figures, or tables, they should be numbered and listed in the Contents section (e.g. Figure 1, Table 1, etc.). Contents 3 Spokane Regional Health District

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7 EXECUTIVE SUMMARY Spokane Regional Health District (SRHD) conducted a walk-in community mass vaccination clinic at the on Saturday, October 24, This was a full scale execution of delivery of nasal spray and injectable H1N1 vaccine to high risk people as defined by Centers for Disease Control and Prevention (CDC). The planning team consisted of SRHD staff, community members (Medical Reserve Corp, Washington State University College of Pharmacy, Washington State University College of Nursing, Spokane Community College School of Nursing, Maxim nurses, Spokane Arena event personnel, and other volunteers). This team did pre-event planning and registering of volunteers prior to the event. The planning process took place for the 2 weeks prior to the event however knowledge of vaccine formulation (nasal vs injectable) was not known until days prior to the event. Based on the planning team s deliberations, the following objectives were developed for : Objective 1: Communicate epidemic events and vaccination plans to public Objective 2: Conduct mass dispensing efforts in a timely manner Objective 3: Manage vaccination needs during the event The purpose of this report is to analyze event results, identify strengths to be maintained and built upon, identify potential areas for further improvement, and support development of corrective actions. Major Strengths The major strengths identified during this exercise are as follows: The was a most efficient venue for mass dispensing. Staff and volunteers were well coordinated. Flow at clinic was well designed. Communication to the public and partners was handled very well considering the information changed hourly at times. Executive Summary 5 Spokane Regional Health District

8 Primary Areas for Improvement Throughout the exercise, several opportunities for improvement in Spokane Regional Health District s ability to respond to the incident were identified. The primary areas for improvement, including recommendations, are as follows: Consistent and clear information needs to be given universally (education, screeners, vaccinators, evaluators) Volunteer sign in location and process was confusing Clearer role definition would be beneficial. Increased training time would help volunteers Messaging to public created confusion when public perceived the vaccine to be gone and there was still nasal spray available. This event was very successful as 1,194 doses of nasal spray and 827doses of injectable vaccine were distributed in a very timely manner. The arena provided a terrific venue as crowd control and flow were not problems. Over 2,000 people were vaccinated between the hours of 9 am and 3 pm with most of the vaccine administered before noon. Executive Summary 6 Spokane Regional Health District

9 Event Details SECTION 1: EVENT OVERVIEW Event Name Spokane Regional Health District H1N1 Response: Type of event Full Scale Event Event Start Date October 24, 2009 Event End Date October 24, 2009 Duration 9 am to 3 pm Location, Spokane, WA Sponsor Spokane Regional Health District Program 2009 H1N1 Vaccination Clinic Mission The mission of the mass vaccination clinic was to prevent the spread of H1N1, protect those most vulnerable, and respond to the high levels of illness within the local population. Capabilities Target Capabilities addressed in this event were: Mass Prophylaxis Medical Supplies Management and Distribution Emergency Public Information and Warning Scenario Type This event was a biological pandemic event. Section 1: Exercise Overview 7 Spokane Regional Health District

10 Event Planning Team Dr. Joel McCullough Health Officer Lyndia Tye Incident Commander Susan Sjoberg Emergency Response Coordinator Julie Graham Information Officer Cindy Jobb Operations Section Chief Patti Richards Planning Section Chief Eric Meyer Logistics Section Chief Kim Kramarz Finance Section Chief Paula Maxwell Medical Records/Documentation Unit Lead Tiffany Reed Clinic Lead Kristi Siahaya Clinic Lead Cindy Thompson Clinic Lead Participating Organizations Spokane Regional Health District staff and volunteers Washington State University College of Nursing Washington State University College of Pharmacy Spokane Community College School of Nursing Medical Reserve Corp of Eastern Washington Maxim American Medical Response Inland Empire Emergency Services Association American Red Cross Spokane Police Department Staff Number of Participants Approximately 150 staff and volunteers participated in the event. Section 1: Exercise Overview 8 Spokane Regional Health District

11 SECTION 2: EVENT DESIGN SUMMARY Event Purpose and Design This event was designed to administer large quantities of vaccine to CDC identified priority populations within Spokane County in a timely manner. Event Objectives, Capabilities, and Activities Capabilities-based planning allows for event planning teams to develop objectives and observe 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 event. Additionally, each capability is linked to several corresponding activities and tasks to provide additional detail. Based upon the identified objectives below, the planning team has decided to document the following capabilities during this event: Objective 1: Communicate epidemic events and vaccination plans to public. Emergency public information and warning: Issue public information, alerts/warnings, and notifications; conduct media relations; and provide public rumor control. Objective 2: Conduct mass dispensing efforts in a timely manner. Mass Prophylaxis: Direct mass prophylaxis dispensing operations; establish points of dispensing; conduct mass dispensing; and conduct medical screening. Objective 3: Manage vaccination and personal protective equipment (PPE) needs during the event Medical supplies management and distribution: Direct medical supplies management and distribution tactical operations; activate medical supplies management and distribution: and repackage and distribute. Section 3: Analysis of Capabilities 9 Spokane Regional Health District SRHD 2009 H1N1 Arena

12 Scenario Summary During the months of September and October of 2009, increased case reports of H1N1 or Flu A in the East Region of Washington created a situation where health information and rumor control were essential. Spokane Regional Health District focused on developing relationships with media so that current and correct information was released on a regular basis. As cases increased, vaccine and nasal spray also became available for priority groups as defined by the Advisory Committee on Immunization Practices (ACIP) and CDC. A Point of Dispensing was planned, originally at the downtown YMCA, to provide vaccine and nasal spray to the public. After further evaluation the YMCA was determined to be too small and had insufficient parking for the numbers expected. The was then booked as a larger venue for the clinic. Community partners were activated and vaccine became available. Section 3: Analysis of Capabilities 10 Spokane Regional Health District SRHD 2009 H1N1 Arena

13 SECTION 3: ANALYSIS OF CAPABILITIES This section of the report reviews the performance of the exercised capabilities, activities, and tasks. In this section, observations are organized by capability and associated activities. The capabilities linked to the exercise objectives of Spokane Regional Health District H1N1 Response: are listed below, followed by corresponding activities. Each activity is followed by related observations, which include references, analysis, and recommendations. CAPABILITY 1: EMERGENCY PUBLIC INFORMATION AND WARNING Capability Summary: Developing, coordinating, and disseminating information to the public, coordinating officials, and incident management and responder across all jurisdictions and disciplines was necessary to reduce panic, inform all personnel involved in the response, and to keep the public informed on activities underway to reduce their risks. Activity 1.1: Issue Public Information, Alerts/Warnings, and Notifications Observation 1.1.1: Strength Good media coverage of available clinics, priority groups, and physician provided vaccine kept the public informed about the qualifying criteria regarding the vaccination or nasal spray. Observation 1.1.2: Strength Education regarding general respiratory hygiene, preventing or avoiding illness were stressed with every media contact. Observation 1.1.3: Weakness During the event, the public received the message that the vaccine had run out when only the injectable was limited. Nasal spray was abundant. Activity 1.2: Conduct Media Relations Observation 1.2.1: Strength - Regular press conferences were scheduled and conducted with pertinent and timely information. News media provided continual coverage of vaccine availability throughout the duration of the clinic hours, encouraging the public to access the arena for vaccination. Observation 1.2.2: Strength The process for managing media on-site was efficient and met the needs of clinic staff and media staff. Activity 1.3 Provide Public Rumor Control Observation 1.3.1: Strength Promotion of who was eligible for vaccine at this clinic was accomplished in multiple ways (srhd website, news press releases, and on-site posters, local Section 3: Analysis of Capabilities 11 Spokane Regional Health District SRHD 2009 H1N1 Arena

14 H1N1 telephone hotline, arena clinic staff providing additional information to people waiting in line). Observation 1.3.1: Weakness When injectable vaccine became very limited, the wording of the announcement to those waiting in line prompted a mass exodus of those who had been waiting because of the misunderstanding that no more vaccine was available. CAPABILITY 2: MASS PROPHYLAXIS Capability Summary: To protect the health of the population through the administration of critical interventions in response to a public health emergency in order to prevent the development of disease among those who are exposed or are potentially exposed to public health threats. Activity 2.1 Direct Mass Prophylaxis Observation 2.1.1: Strength Good media coverage of clinic and priority groups kept the public informed about those who qualified for vaccine at this clinic. Observation 2.1.2: Strength Request for community partners resulted in great volunteer base and SRHD personnel were also quick to respond to the need. Observation 2.1.3: Weakness Large groups of volunteers and staff made it difficult to ensure Just In Time Training (JITT) was properly received. Observation 2.1.4: Weakness Sign in/ sign out for volunteers at entry point was confusing. Observation 2.1.5: Weakness Roles within Operations overlapped at times and needed clarification. Observation 2.1.6: Strength Personnel were appropriately assigned, signage was in the proper places, lines were delineated clearly, and the public went through a well marked and efficient POD for receiving H1N1 vaccine. Approximately 2020 vaccines were delivered to at risk populations in 4 hours. Activity 2.2 Establish Points of Dispensing Observation 2.2.1: Strength Adjustments were made to accommodate anticipated crowd by changing venue to a larger site. Section 3: Analysis of Capabilities 12 Spokane Regional Health District SRHD 2009 H1N1 Arena

15 Observation 2.2.2: Strength MOUs were exercised with Spokane Veterans Memorial Arena and best venue was chosen. Activity 2.3 Conduct Medical Screening Observation 2.3.1: Strength Media coverage and signage were the initial attempts at screening followed by educators, medical personnel at the screening tables, with referral to Medical Evaluators if needed. Vaccinators also conducted follow-up screening prior to vaccine administration. Observation 2.3.2: Weakness Enforcement of vaccine guidelines with large numbers of screeners/evaluators was difficult due to lack of clear, definitive guidelines and specific training. CAPABILITY 3: MEDICAL SUPPLIES MANAGEMENT AND DISTRIBUTION Capability Summary: Procure and maintain pharmaceuticals and medical materials prior to an incident and to transport, distribute, and track these materials during an incident. Activity 3.1: Direct Medical Supplies Management and Distribution Tactical Operations Observation 3.1.1: Strength SRHD personnel were assigned as vaccine coordinators and logistics chief. Distribution of tasks and materials worked very well. Activity 3.2 Activate Medical Supplies Management and Distribution Observation 3.2.1: Strength Federally supplied equipment arrived with vaccine (syringes, alcohol wipes, sharps containers, gloves, etc.) Activity 3.3 Repackage and Distribute Observation 3.3.1: Strength Personnel were hired to fill this need for SRHD. Section 3: Analysis of Capabilities 13 Spokane Regional Health District SRHD 2009 H1N1 Arena

16 Recommendations: 1. Public received the message that the vaccine was out when only the injectable was limited. Nasal spray was abundant. Pilot testing of messages with staff, development with team input necessary. All public announcements must be generated and coordinated through the communications team lead. 2. Large groups of volunteers and staff for JITT made it difficult to ensure training was properly received. Smaller, more confined rooms for JITT may be beneficial, instructions to ask for clarification from volunteers and staff needs to be included. 3. Sign in for volunteers at entry point was confusing. Sign in sheets can be organized by function and alphabetically. 4. Roles within Operations overlapped at times and needed clarification. ICS roles and responsibilities reviewed and formatted with checklists. Review command assignments and adjust as appropriate based on situation. 5. Consistent rules/guidelines were difficult to enforce with large numbers of screeners/evaluators. Establish strict written rules/ guidelines for screening vaccine eligibility, as early as possible (and stick to them without fail). Strict written rules/guidelines for screeners and evaluators can be included with JITT. Section 3: Analysis of Capabilities 14 Spokane Regional Health District SRHD 2009 H1N1 Arena

17 Section 3: Analysis of Capabilities 15 Spokane Regional Health District SRHD 2009 H1N1 Arena

18 SECTION 4: CONCLUSION Spokane Regional Health District (SRHD) conducted a walk-in community mass vaccination clinic at the on Saturday, October 24, This was a full scale event with delivery of nasal spray and injectable H1N1 vaccine to high risk people as defined by Centers for Disease Control and Prevention (CDC). The planning team consisted of SRHD staff, community members (Medical Reserve Corp, Washington State University College of Pharmacy, Washington State University College of Nursing, Spokane Community College School of Nursing, Maxim nurses, Spokane Arena event personnel, and other volunteers). This team did pre-event planning and registering of volunteers prior to the event. The planning process took place for the 2 weeks prior to the event, however knowledge of vaccine formulation (nasal vs injectable) was not known until days prior to the event. Based on the planning team s deliberations, the following objectives were developed for : Objective 1: Communicate epidemic events and vaccination plans to public Objective 2: Conduct mass dispensing efforts in a timely manner Objective 3: Manage vaccination needs during the event Massive media coverage was available with terrific cooperation between local media and the Health District Information Office. Priority groups, clinic times and dates, etc were well publicized prior to the event. The served as a terrific venue for this clinic with ample parking, room for lines of participants, and good flow for the clinic. More than 150 volunteers gave their time to assist with the operations of the clinic. Set up was accomplished the night prior to the event so that Just In Time Training could take place in the morning prior to opening to the public. Upon arrival at the arena the morning of the event, the public was lined up around the parking lot with approximately 1,500 people in line; some having camped out the previous night. More than 2,000 people were vaccinated in a short time span with the capabilities of vaccinating thousands more if injectable vaccine had been available. Inventory and staff needs were well accommodated throughout this event. Vaccine was provided to the public without incident and the entire event was considered a great success. Section 4: Conclusion 16 Spokane Regional Health District [Protective Marking]

19 APPENDIX A: IMPROVEMENT PLAN This IP has been developed specifically for Spokane Regional Health District as a result of conducted on October 24, These recommendations draw on both the After Action Report and the After Action survey. Capability Observation Title Recommendation Capability 1: Emergency Public Information and Warning - Developing, coordinating, and disseminating information to the public, coordinating officials, and incident management and responder across all jurisdictions and disciplines was necessary to reduce panic, inform all personnel involved in the response, and to keep the public informed on activities underway to reduce their risks. Capability 2: Mass Prophylaxis - To protect the health of the population through the administration of critical interventions in response to a public health emergency in order to prevent the development of disease among those who are exposed or are potentially exposed to public health threats. 1. Observation: Public received the message that the vaccine was out when only the injectable was limited. Nasal spray was abundant. 1.Observation: Large groups of volunteers and staff made it difficult to ensure JITT was properly received. 2. Observation: Sign in for volunteers at entry point was confusing. 3. Roles within Operations overlapped at times and 1. Messages developed during an event prior to use during the event. Information to be released will have final approval with the clinic manager and the IC. This protocol will be added into the current Communication Plan. 1. Smaller, more confined rooms for JITT will be sought out. Instructions to volunteers and staff to ask for clarification will be included on JAS. 2. Sign in sheets will be organized by function and alphabetically. This information will be included in the checklist for mass treatment set up. 3. ICS roles and responsibilities will be reviewed and formatted Appendix A: Improvement Plan 17 Spokane Regional Health District [Protective Marking] Agency POC PIO Jill Johnson PHEPR Team Cindy, Tiffany, Patti PHEPR Team Cindy, Tiffany, Patti PHEPR Team Completion Date March 1, 2010 April 15, 2010 April 15, 2010 April 15, 2010

20 needed clarification. with checklists. Command assignments will be reviewed and adjusted as appropriate. Cindy, Tiffany, Patti Capability 3: Medical Supplies, Management, and Distribution - Procure and maintain pharmaceuticals and medical materials prior to an incident and to transport, distribute, and track these materials during an incident. 4. Consistent rules/ guidelines were difficult to enforce with large numbers of screeners/evaluators. N/A 4. Strict written rules/guidelines for screeners and evaluators can be included with JITT. They must be developed as early in the event as possible for clarity and consistency. Table A.1 Improvement Plan Matrix PHEPR Team Cindy, Tiffany, Patti April 15, 2010 Appendix A: Improvement Plan 18 Spokane Regional Health District [Protective Marking]

21 [Protective Marking] [Full Exercise Name] [Exercise Name Continued] Appendix F: Acronyms 19 [Jurisdiction] [Protective Marking]