2017 U of A Game Changer Full-Scale Exercise. Player Handbook Southern Arizona Health Care Coalition (SoAZHCC)

Transcription

1 2017 U of A Game Changer Full-Scale Exercise Player Handbook Southern Arizona Health Care Coalition (SoAZHCC) October 11, 2017

2 PREFACE The Southern Arizona Health Care Coalition (SoAZHCC), hereinafter called the Coalition, 2017 U of A Game Changer Full-Scale Exercise Player Handbook gives exercise Players from participating organizations the information necessary to participate in the exercise. All exercise Players may view the Player Handbook. The Player Handbook was produced with the input, advice, and assistance from the Coalition Exercise Planning Team (EPT), which followed the guidance set forth in the Federal Emergency Management Agency (FEMA) Homeland Security Exercise and Evaluation Program (HSEEP). The information in this document is current as of the date of publication and is subject to change as dictated by the Exercise Planning Team (EPT). The (FSE) is an unclassified exercise. The control of information is based more on public sensitivity regarding the nature of the exercise than on the actual exercise content. Players may view other materials as deemed necessary in the performance of their duties. All exercise Players should use appropriate guidelines to ensure the proper control of information within their areas of expertise and to protect this material in accordance with current jurisdictional directives. Public release of exercise materials to third parties is at the discretion of the Coalition Exercise Director and the Exercise Planning Team (EPT). HANDLING INSTRUCTIONS 1. The title of this document is the Players Handbook. 2. The information gathered in this document 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. Reproduction of this document, in whole or in part, without prior approval from the Coalition Exercise Director and the Exercise Planning Team (EPT) is prohibited. 3. At a minimum, the attached materials will be disseminated only on a need-to-know basis and when unattended, will be stored in an area offering sufficient protection against theft, compromise, inadvertent access, and unauthorized disclosure. 4. For more information, please consult the following point of contact: Exercise Director: Dan Stanley, SoAZHCC Coalition Coordinator dan.stanley0258@gmail.com Preface and Handling Instructions ii FOR OFFICIAL USE ONLY

3 CONTENTS PREFACE...ii HANDLING INSTRUCTIONS...ii EXERCISE OVERVIEW...1 General Information...4 Background Information... 4 Participant Roles and Responsibilities... 4 Exercise Assumptions and Artificialities... 5 Exercise Logistics...7 Safety... 7 Fire Safety... 7 Emergency Medical Services... 7 Weapons Policy... 7 Site Access and Security... 8 POST-EXERCISE AND EVALUATION ACTIVITIES...9 Hot Washes... 9 Agency Hot Wash... 9 Player Feedback Forms... 9 Evaluation... 9 Exercise Evaluation Guides... 9 After-Action Report... 9 After-Action Conference Improvement Planning PARTICIPANT INFORMATION AND GUIDANCE Exercise Rules Player Instructions Before the Exercise During the Exercise After the Exercise Simulation Guidelines Player Communications Public Affairs Appendix A: Acronyms...1 Contents iii FOR OFFICIAL USE ONLY

4 EXERCISE OVERVIEW Exercise Name Exercise Dates October 11, 2017 Scope The is a full-scale exercise (FSE) designed to include all City of Tucson healthcare sector and public health partners. This exercise is being conducted to validate the ability of plans, equipment and personnel to respond to an acute medical surge situation and to test public health and healthcare coordination for the Southern Arizona Health Care Coalition (SoAZHCC), hereinafter known as the Coalition. Mission Area(s) Response Public Health Preparedness Program - Emergency Support Function 8: Public Health and Medical Services (ESF-8) Capability 6: Information Sharing Function 3: Exchange information to determine a common operating picture Capability 10: Medical Surge Function 3: Support jurisdictional medical surge operations Reference: Public Health Preparedness Capabilities: National Standards for State and Local Planning, March 2011, Centers for Disease Control and Prevention, Office of Public Health Preparedness and Response Core Capabilities Hospital Preparedness Program: Capability 1: Foundation for Healthcare and Medical Readiness Objective 4: Train and Prepare the Health Care and Medical Workforce Activity 1: Promote Role-Appropriate National Incident Management System Implementation Capability 2: Health Care and Medical Response Coordination Objective 2: Utilize Information Sharing Procedures and Platforms Activity 3. Utilize Communications systems and platforms Objective 3: Coordinate Response Strategy, Resources, and Communications Activity 1. Identify and Coordinate Resource Needs during an Emergency Capability 4: Medical Surge Exercise Overview 1 FOR OFFICIAL USE ONLY

5 Objective 2: Respond to a Medical Surge Activity 1. Implement Emergency Department and Inpatient Medical Surge Response Activity 2. Implement Out-of-Hospital Medical Surge Response Activity 4. Provide Pediatric Care during a Medical Surge Response Activity 8. Respond to Behavioral Health Needs during a Medical Surge Response Reference: Health Care Preparedness and Response Capabilities, Department of Health and Human Services, Office of the Assistant Secretary for Preparedness and Response, November Objectives Public Health Emergency Preparedness - Emergency Support Function 8: Public Health and Medical Services (ESF-8) 1. Pima County Emergency Support Function 8: Public Health and Medical Services (ESF-8) will notify partners of the emergency incident and provide situational updates via the Arizona Health Alert Network (AzHAN). 2. Demonstrate the ability to exchange information to determine a common operating picture. 3. Demonstrate the ability to support jurisdictional medical surge operations. 4. Utilize the Arizona Health Alert Network (AzHAN) system to notify the Southern Arizona Health Care Coalition (SoAZHCC) and Arizona Pediatric Disaster Coalition (APDC) of situational status. Hospital Preparedness Program 1. Hospitals will practice decompression at 20% of inpatient census. Of the 20% of patients, 50% will be transferred to Long Term Care, 25% will be transferred to home health, and 25% will be discharged home. 2. Hospitals will transfer admitted inpatient pediatric patients to Tucson Medical Center (TMC) and University Medical Center (UMC). TMC and UMC will respond to the surge in pediatric in-patients by transferring them to Honor Health hospitals. 3. Hospitals will track transferred patients using EMTrack, a patient tracking software system. 4. Healthcare facilities will utilize the Healthcare Incident Command System (HICS) or other National Incident Management System (NIMS) aligned incident command system. 5. Local healthcare agencies and facilities will demonstrate their ability to share information with regional medical and healthcare facilities. 6. The Coalition Behavioral Health Sector will test the coordination of all Behavioral Health response teams, service request calls and response agency communication related to this exercise. Exercise Overview 2 FOR OFFICIAL USE ONLY

6 Threats/ Hazards Scenario Sponsor Participating Organizations Explosion at a large university sports stadium followed by medical surge On the evening of October 11, 2017, there are an estimated 60,000 people in attendance at a football game between U of A and ASU. There are several honored guests at the game, including the Governor; the Davis-Monthan Honor Guard; Tohono O Odham, Pascua Yaqui, and other tribal veterans; and various high school marching bands. There is a loud explosion just as the game is about to begin and people stampede to the stadium exits. U of A law enforcement gain control of the scene. There are traffic gridlocks on streets surrounding the stadium. At least 300 people need to be transported by Emergency Medical Services (EMS) to local hospitals. At least 25% of the injured are pediatric patients. Southern Arizona Health Care Coalition (SoAZHCC) Training and Exercise Committee Health Care Coalition member agencies, Pima County Health Department (PCHD), and the Medical Reserve Corps. A complete listing of participants can be found in the SoAZHCC Participant List. Pima County Office of Emergency Management and Homeland Security (PCOEM) will be simulated through the Simulation Cell (SimCell). Point of Contact SoAZHCC: Dan Stanley SoAZHCC Coordinator dan.stanley0258@gmail.com Exercise Overview 3 FOR OFFICIAL USE ONLY

7 GENERAL INFORMATION Background Information The Southern Arizona Health Care Coalition (SoAZHCC), hereinafter known as the Coalition, is conducting a full-scale exercise, the. Coalition partners from healthcare sectors, including Behavioral Health, Long Term Care/Skilled Nursing, Ambulatory Care, Hospitals, County and Tribal Public Health, Hospice/Home Health and community resource sectors will be participating in the exercise. Pima County Office of Emergency Management (PCOEM) will be simulated by the exercise Simulation Cell (SimCell). The Pima County Health Department (PCHD) serves as Emergency Support Function 8: Public Health and Medical Services (ESF-8), which is activated by Pima County Office of Emergency Management (PCOEM) to support public health and medical services response. Participant Roles and Responsibilities The term participant encompasses many groups of people, not just those playing in the exercise. Groups of participants involved in the exercise, and their respective roles and responsibilities, are as follows: Players. Players are persons who have an active role in performing their regular roles and responsibilities during the exercise. Players initiate actions, tasks or missions in response to the simulated emergency. Controllers. Controllers manage exercise play, set up and operate the exercise site, implement the evaluation process, and work with the assigned safety officer or act as the safety officer to ensure the safety of the Players, Actors, and others participating in the exercise. They issue exercise material to Players as required, monitor the exercise timeline, and supervise the safety of all exercise participants. Evaluators. Evaluators evaluate and provide feedback on a designated functional area of the exercise. Evaluators observe and document performance against established capability targets and critical tasks, in accordance with the Exercise Evaluation Guides (EEGs). This position may also be filled by the Controller, i.e. one person may need to act as Controller and Evaluator. Actors. Actors simulate specific roles during exercise play, typically victims or other bystanders. Observers. Observers visit or view selected segments of the exercise. Observers do not play in the exercise, nor do they perform any control or evaluation functions. Observers General Information 4 FOR OFFICIAL USE ONLY

8 view the exercise from a designated observation area and must remain within the observation area during the exercise. Very Important Persons (VIPs) are also Observers, but may be grouped separately. Media Personnel. Some media personnel may be present as Observers, pending approval by the sponsor organization and the Exercise Planning Team (EPT). Support Staff. The exercise support staff includes individuals are the planners of the exercise who also perform administrative and logistical support tasks during the exercise (e.g., registration, catering). Exercise Assumptions and Artificialities In any exercise, assumptions and artificialities may be necessary to complete play in the time allotted and/or account for logistical limitations. Exercise participants should accept that assumptions and artificialities are inherent in any exercise, and should not allow these considerations to negatively impact their participation. Assumptions Assumptions constitute the implied factual foundation for the exercise and, as such, are assumed present before the exercise starts. The following assumptions apply to the exercise: The exercise is conducted in a no-fault learning environment wherein capabilities, plans, systems, and processes will be evaluated. The exercise scenario should be considered plausible but will have artificialities that are necessary due to time constraints, and events occur as they are presented during exercise play. The scenario is taken from real world incidents. Players will follow appropriate plans, procedures, regulations, and training they have received. Participating agencies may need to balance exercise play with real-world emergencies. Real-world emergencies take priority. Artificialities During this exercise, the following artificialities apply: Although the exercise documents describe a scenario that occurs at a football game at 8:00 pm, the exercise will actually be conducted on October 11, 2017 between 8:00 am and 12:00 pm. Not all resources may be involved in this exercise that normally would respond to these types of incidents. General Information 5 FOR OFFICIAL USE ONLY

9 Emergency Support Function 8: Public Health and Medical Services (ESF-8) will operate out of an alternate site during this exercise. Another exercise, the Sierra Vista White Powder Exercise will be simulated as occurring at the same time as the explosion incident in this exercise scenario. Exercise participants should consider that both simulated incidents were caused by terrorists and that the entire region is impacted at the same time. Law Enforcement and Emergency Medical Services (EMS) agencies are not participating in this exercise. However, exercise participants should recognize that an incident as significant as the one described in the scenario would normally impact every element of Emergency Medical Services (EMS) and Law Enforcement (LE) agencies in the Tucson area and larger areas of the region. General Information 6 FOR OFFICIAL USE ONLY

10 EXERCISE LOGISTICS Safety Exercise participant safety takes priority over exercise events. The following general requirements apply to the exercise: A Safety Controller at each participating facility/agency site is responsible for participant safety; any safety concerns must be immediately reported to the Safety Controller. The Safety Controllers and Exercise Director will determine if a real-world emergency warrants a pause in exercise play and when exercise play can be resumed. For an emergency that requires assistance, use the phrase real-world emergency. The following procedures should be used in case of a real-world emergency during the exercise: o Anyone who observes a participant who is seriously ill or injured will immediately notify emergency services and the closest facility/agency Controller, and, within reason and training, render aid. o Any facility/agency Controller made aware of a real emergency will internally initiate real-world emergency facility procedures and notify the Exercise Director with the location and description of the emergency. o The Exercise Director will notify all participating facilities or agencies if there is a community-wide real-world emergency and the exercise needs to be stopped. A realworld community-wide emergency may require that all facilities or agencies participate in the response. Fire Safety Standard fire and safety regulations relevant to the jurisdiction or venue will be followed during the exercise. Emergency Medical Services The jurisdiction or venue will coordinate with local Emergency Medical Services in the event of a realworld emergency. Weapons Policy Players, Observers, Controllers, Evaluators, Actors, exercise planning staff, volunteers, or any other persons participating in this exercise must observe a strict no weapons policy. No law enforcement agencies or staff are involved in this exercise. Exercise participants MAY NOT, under any conditions, be in possession of a weapon during the exercise. Exercise Logistics 7 FOR OFFICIAL USE ONLY

11 Site Access and Security All persons attending the exercise in any capacity will register at a Check-In Station located in an area designated by your exercise site. Upon completion of the exercise, all persons should also check-out at the same location. If entry control is required for the exercise venue(s), the sponsor organization is responsible for arranging appropriate security measures. To prevent interruption of the exercise, access to exercise venue will be limited to exercise Players and guests with prior awareness. Players should advise Controllers or Evaluators of any unauthorized persons. Exercise Logistics 8 FOR OFFICIAL USE ONLY

12 POST-EXERCISE AND EVALUATION ACTIVITIES Hot Washes Post-exercise Hot Washes (sometimes called debriefings) aim to collect sufficient relevant data to support effective evaluation and improvement planning. Agency Hot Wash Facility/Agency Hot Washes must be conducted immediately with all exercise Players following the end of the exercise at 11:30 am on October 11, At the conclusion of exercise play, site Controllers will facilitate a Hot Wash to allow Players to discuss strengths and areas for improvement during the exercise. Evaluators will seek clarification with regard to Player actions and decision-making processes. Players are encouraged to participate; however, Observers should not engage in the Hot Wash. Player Feedback Forms Player Feedback Forms will be provided by site Controllers to each facility/agency for Players and Actors (if applicable) to complete. This will provide the Exercise Planning Team (EPT) with information about exercise activities and exercise design. Player Feedback Forms should be distributed and collected within each facility/agency and returned to the site Controller at the conclusion of the exercise. Evaluation Exercise Evaluation Guides Exercise Evaluation Guides (EEGs) assist Evaluators in collecting relevant exercise observations. Individual Players are not identified in the Exercise Evaluation Guides (EEGs). Instead, the Exercise Evaluation Guides (EEGs) document exercise objectives and aligned core capabilities, capability targets, and critical tasks. The Exercise Evaluation Guides (EEGs), coupled with Player Feedback Forms and Agency Hot Wash Forms, are used to evaluate the exercise and compile the After-Action Report (AAR). After-Action Report Following the exercise, an After-Action Report (AAR) is developed to summarize key information related to exercise evaluation. The After-Action Report (AAR) focuses on the overall analysis of core capabilities, including capability performance, strengths, and areas for improvement, rather than individual facility or agency performance. After-Action Reports (AARs) also include basic exercise information, including the exercise name, type of exercise, dates, location, participating organizations, capability areas, specific threat or hazard, a brief scenario description, and the name of the exercise sponsor and Point of Contact (POC). Post Exercise and Evaluation Activities 9 FOR OFFICIAL USE ONLY

13 After-Action Conference An After-Action Conference will be held on November 2, After completion of the draft After-Action Report (AAR), Controllers, Evaluators, decision- and policymakers, and other members of the Exercise Planning Team (EPT) will conduct an After-Action Conference (AAC) to present, discuss, and refine the draft After-Action Report (AAR), and to develop an Improvement Plan (IP). This conference is a chance to present the draft After-Action Report (AAR) to participating facilities/agencies in order to solicit feedback and make necessary changes. Improvement Planning Improvement planning is the process by which the observations recorded in the After-Action Report (AAR) are resolved through development of corrective actions, which are prioritized and tracked as a part of a continuous Corrective Action Program (CAP). The Improvement Plan (IP) identifies specific corrective actions, assigns them to responsible parties, and establishes target dates for their completion. It is created by officials from the organizations participating in the exercise, and discussed and validated during the After-Action Conference (AAC). Post Exercise and Evaluation Activities 10 FOR OFFICIAL USE ONLY

14 PARTICIPANT INFORMATION AND GUIDANCE Exercise Rules The following general rules govern exercise play: Real-world emergency actions take priority over exercise actions. Exercise Players will comply with real-world emergency procedures, unless otherwise directed by the control staff. All communications (including written, radio, telephone, electronic, and ) during the exercise will begin and end with the statement This is an exercise. Media personnel and Observers are not to interfere with the Players as they are working to complete their assignments. Player Instructions Players should follow certain guidelines before, during, and after the exercise to ensure a safe and effective exercise. Before the Exercise Review appropriate organizational plans, procedures, and exercise support documents. For those Players who will be reporting to the site prior to the start of the exercise: Be at the appropriate site at least 30 minutes before the exercise starts. Wear the appropriate uniform and/or identification item(s). Sign in when you arrive. If you gain knowledge of the scenario before the exercise, do not communicate that information with other exercise participants. Participant Information and Guidance 11 FOR OFFICAL USE ONLY

15 During the Exercise Respond to exercise events and information as if the emergency were real, unless otherwise directed by an exercise Controller. Controllers will only provide information to encourage missions and/or tasks to be completed. Players are expected to obtain necessary information by utilizing existing emergency information channels unless told differently. Do not engage in personal conversations with Players, Controllers, Evaluators, Observers, or media personnel. If you are asked an exercise-related question, give a short, concise answer. If you are busy and cannot immediately respond, indicate that, but report back with an answer as soon as possible. If you do not understand the scope of the exercise, or if you are uncertain about an organization s participation in an exercise, ask a Controller or the Site Lead. Parts of the scenario may seem implausible. Recognize that the exercise has objectives to satisfy and may require incorporation of unrealistic aspects. Every effort has been made by the exercise s trusted agents to balance realism with safety and to create an effective learning and evaluation environment. All exercise communications will begin and end with the statement This is an exercise. This precaution is taken so that anyone who overhears the conversation will not mistake exercise play for a real-world emergency. For an emergency that requires assistance, use the phrase I have a real-world emergency. The following procedures should be used in case of a real-world emergency during the exercise: o o Anyone who observes a participant who is seriously ill or injured should immediately notify emergency services and the closest member of the planning staff, and, within reason and training, render aid. When a Controller, Evaluator or Planning Staff Member becomes aware of a real emergency, stoppage of the exercise at the emergency location will be initiated, appropriate resources for the emergency will be obtained, and the Exercise Director will be provided with the location of the emergency and resources needed, if any. Maintain a log of your activities. Many times, this log may include documentation of activities that may have not been recorded by the Controller or Evaluator. Participant Information and Guidance 12 FOR OFFICAL USE ONLY

16 After the Exercise As a Player, participate in the Hot Wash at your venue with Controllers and Evaluators. Complete the Player Feedback Form. This form allows you to comment candidly on emergency response activities and exercise effectiveness. Provide the completed form to an Evaluator. Provide any notes or materials generated from the exercise to your Evaluator for review and inclusion in the After-Action Report (AAR) Simulation Guidelines Because the exercise is of limited duration and scope, certain details will be simulated. The Simulation Cell (SimCell) will simulate the roles and interactions of nonparticipating organizations or individuals. The physical description of what would fully occur at the incident sites and surrounding areas will be relayed to Players site leads or Controllers. Player Communications Exercise communications do not interfere with real-world emergency communications. Players should use routine organization communications systems. These notification methods include: MedsComm Ringdown MedsComm (the medical communications system for 911 Emergency Medical Services) will have an event opened on EMResource for this exercise. AzHAN The Arizona Health Alert Network - A mass notification software program that will be utilized by Emergency Support Function 8: Public Health and Medical Services (ESF-8) and the Exercise Director. EMTrack A web-based patient tracking system used to track patients throughout an event. It can also be utilized to reunify patients and families. Agencies without access to EMTrack receiving Actors from the scene will be using a furnished a paper tracking form. EMResources The bed poll is conducted and posted daily by 8:00 am statewide. Survey Monkey Messages requesting information for situational awareness and resource coordination may be done by phone, , or Survey Monkey. Additional communication assets may be made available as the exercise progresses. Each site or organization coordinates its internal communication networks and channels. All participating organizations are included in the Players Communications Directory. Participant Information and Guidance 13 FOR OFFICAL USE ONLY

17 Public Affairs Agencies participating in this exercise should contact Emergency Support Function 8: Public Health and Medical Services (ESF-8) to coordinate public information messaging prior to disseminating public information directly to the media. The sponsor organization and participating organizations are responsible for coordinating and disseminating public information before the exercise. Each venue should follow internal procedures. Participant Information and Guidance 14 FOR OFFICAL USE ONLY

18 APPENDIX A: ACRONYMS Acronym AAC AAR CAP C/E EEG EMS EOC EPT ESF-8 ExPlan FEMA FOUO FSE HICS HPP HSEEP ICP ICS IED IP JIC JIS LE MCI MOU NIMS OEM PCHD PCOEM PHEP PIO Term After Action Conference After Action Report Corrective Action Program Controller/Evaluator Exercise Evaluation Guide Emergency Medical Services Emergency Operations Center Exercise Planning Team Emergency Support Function 8: Public Health and Medical Services Exercise Plan Federal Emergency Management Agency For Official Use Only Full Scale Exercise Healthcare Incident Command System Healthcare Preparedness Program Homeland Security Exercise and Evaluation Program Incident Command Post Incident Command System Improvised Explosive Device Improvement Plan Joint Information Center Joint Information System Law Enforcement Mass Casualty Incident Memorandum of Understanding National Incident Management System Office of Emergency Management Pima County Health Department Pima County Office of Emergency Management Public Health Emergency Preparedness Public Information Officer Appendix A: Acronyms A-1 FOR OFFICIAL USE ONLY

19 Acronym POC SimCell SME SoAZHCC TMC UMC VIP Term Point of Contact Simulation Cell Subject Matter Expert Southern Arizona Health Care Coalition Tucson Medical Center University Medical Center Very Important Person Appendix A: Acronyms A-2 FOR OFFICIAL USE ONLY