Exercises and Training: Virginia Department of Health Emergency Preparedness and Response Programs Lisa G. Kaplowitz, M.D., M.S.H.A. Deputy Commissioner.

Exercises and Training:Exercises and Training:Virginia Department of Virginia Department of Health Emergency Health Emergency Preparedness and Preparedness and Response ProgramsResponse Programs

Lisa G. Kaplowitz, M.D., Lisa G. Kaplowitz, M.D., M.S.H.A.M.S.H.A.

Deputy CommissionerDeputy Commissioner

Unique Aspects of Unique Aspects of VirginiaVirginia Large state: Significant urban, Large state: Significant urban,

suburban and rural populationssuburban and rural populations Large military presence (including Large military presence (including

Pentagon, Langley)Pentagon, Langley) Part of National Capital Region Part of National Capital Region

(Northern Virginia)(Northern Virginia) Rural areas provide unique Rural areas provide unique

challengeschallenges

Unique Aspects of Unique Aspects of Virginia Department of Virginia Department of Health (VDH)Health (VDH) Most of local health districts are Most of local health districts are

part of the state health part of the state health department (32/35)department (32/35)

Very close collaboration between Very close collaboration between health districts and VDH Central health districts and VDH Central Office Office

Created new regional teams to Created new regional teams to coordinate emergency planning coordinate emergency planning and response effortsand response efforts

Regional Approach to Regional Approach to Planning and Planning and ResponseResponse

Northern Region: National Capital Region Northern Region: National Capital Region (with Maryland and Washington DC), (with Maryland and Washington DC), involvement of federal agenciesinvolvement of federal agencies

Eastern Region: Military bases, tourismEastern Region: Military bases, tourism Central Region: State governmentCentral Region: State government Northwest Region: Rural and suburban Northwest Region: Rural and suburban

Washington DCWashington DC Southwest Region: Rural, large geographic Southwest Region: Rural, large geographic

area with geographic barriers; borders area with geographic barriers; borders North Carolina, Tennessee, North Carolina, Tennessee, Kentucky, West Virginia Kentucky, West Virginia

Exercise Design, Exercise Design, Control and EvaluationControl and Evaluation

Phase 1: Exercise pre-planningPhase 1: Exercise pre-planning Phase 2: Exercise planningPhase 2: Exercise planning Phase 3: ControlPhase 3: Control Phase 4: Assessment and Phase 4: Assessment and

evaluationevaluation

Phase I: Exercise Pre-Phase I: Exercise Pre-planningplanning

Develop:Develop:– Plan of Action and Plan of Action and

MilestonesMilestones– Mission Essential Mission Essential

Task ListTask List– Exercise ObjectivesExercise Objectives– Exercise Story LineExercise Story Line– Participant ListParticipant List

In-houseIn-house Partner AgenciesPartner Agencies

Identify:Identify:– Exercise AudienceExercise Audience– Technologies to Technologies to

be Testedbe Tested– Policies, Policies,

Procedures to be Procedures to be ExercisedExercised

– Exercise LocationsExercise Locations– Communications Communications

RequirementsRequirements

Phase II: Exercise Phase II: Exercise PlanningPlanning Coordinate Use MOAs, Partner Agency Coordinate Use MOAs, Partner Agency

Participation & Support RequirementsParticipation & Support Requirements Develop Pre-exercise Training PlanDevelop Pre-exercise Training Plan Arrange Mentor / Facilitator ParticipationArrange Mentor / Facilitator Participation Prepare Exercise Concept PlanPrepare Exercise Concept Plan

– Core ScenarioCore Scenario– Master Events Scenario ListMaster Events Scenario List

Prepare Observation and Assessment PlanPrepare Observation and Assessment Plan– Observer TeamObserver Team– Exercise Control GroupExercise Control Group

Exercise ControlExercise Control ObserversObservers

– Record / review Record / review reaction.reaction.

– Elicit response.Elicit response.– Measure task Measure task

accomplishment.accomplishment.– Collect data & Collect data &

deliverables.deliverables.– Coordinate w/ Umpires.Coordinate w/ Umpires.– Conduct on-the-spot Conduct on-the-spot

training.training.

UmpiresUmpires– Control clock.Control clock.– Ensure timely and timed Ensure timely and timed

responsesresponses– Input items from Master Input items from Master

Events Scenario ListEvents Scenario List– Reconcile issues.Reconcile issues.– Maintain a time log.Maintain a time log.– Keep exercise on Keep exercise on

schedule/participants on schedule/participants on task.task.

Phase IV: Analysis & Phase IV: Analysis & ReportingReporting

Record reactions to inputs against desired Record reactions to inputs against desired responsesresponses

Evaluate degree to which objectives metEvaluate degree to which objectives met Conduct an immediate “Hot Washup” Conduct an immediate “Hot Washup” Prepare an after-action report within 2 Prepare an after-action report within 2

wks wks Develop a “Lessons Learned” databaseDevelop a “Lessons Learned” database Establish an Implementation PanelEstablish an Implementation Panel

VDH Exercises: 2002-VDH Exercises: 2002-20032003

Multiple local, regional exercises, including Multiple local, regional exercises, including National Capital RegionNational Capital Region

Statewide exercises:Statewide exercises:– Hurricane Isabel in Sept, 2003Hurricane Isabel in Sept, 2003– Statewide bioterrorism exercise in Oct, 2003Statewide bioterrorism exercise in Oct, 2003– Anthrax event in Nov, 2003: VMI and medication Anthrax event in Nov, 2003: VMI and medication

clinicclinic Collaboration with hospitals, laboratories, Collaboration with hospitals, laboratories,

VDEM, MMRS, localities: establishment of VDEM, MMRS, localities: establishment of exercise calendar for all state agenciesexercise calendar for all state agencies

Bioterrorism Exercise: Bioterrorism Exercise: October 2003October 2003 Release of the plague at large alumni eventRelease of the plague at large alumni event Cases of pneumonia present to hospitals Cases of pneumonia present to hospitals

statewidestatewide Involve epidemiology and state laboratory to Involve epidemiology and state laboratory to

identify event and organismidentify event and organism Strategic National Stockpile delivered to Strategic National Stockpile delivered to

state and distributed statewide to 6 regionsstate and distributed statewide to 6 regions 6 mass medication/vaccination clinics 6 mass medication/vaccination clinics

establishedestablished

Bioterrorism Exercise: Bioterrorism Exercise: October 2003October 2003

All District Health Departments participatedAll District Health Departments participated Multiple offices in VDH: EP&R, Epidemiology, Chief Multiple offices in VDH: EP&R, Epidemiology, Chief

Medical ExaminerMedical Examiner CDC CDC 82% of hospitals, state laboratory, state police, 82% of hospitals, state laboratory, state police,

emergency management agencies, UPS, local emergency management agencies, UPS, local governments and volunteers participatedgovernments and volunteers participated

VDH Emergency Coordination Center (ECC) and VDH Emergency Coordination Center (ECC) and state EOC operationalstate EOC operational

Test of communication systems, as well as disease Test of communication systems, as well as disease control and preventioncontrol and prevention

Bioterrorism ExerciseBioterrorism ExerciseObjectives: Days 1-2Objectives: Days 1-2

Identification of pneumonia cases presenting to Identification of pneumonia cases presenting to hospitals throughout Virginia, with deathshospitals throughout Virginia, with deaths

Recognition of outbreak situationRecognition of outbreak situation Recognition that outbreak could be related to Recognition that outbreak could be related to

intentional release of organism (BT event)intentional release of organism (BT event) Request Strategic National Stockpile Push Pack, Request Strategic National Stockpile Push Pack,

prior to identification of organismprior to identification of organism Identification of organism after SNS requestedIdentification of organism after SNS requested Key objectives: CommunicationKey objectives: Communication

and decision makingand decision making

Bioterrorism ExerciseBioterrorism ExerciseObjectives: Day 3Objectives: Day 3 Response to BT event by VDH, other Response to BT event by VDH, other

emergency response emergency response agencies/organizationsagencies/organizations

Confirm identification of organismConfirm identification of organism Identification of event where organism Identification of event where organism

releasedreleased Determination of infection control, Determination of infection control,

treatment and prophylactic response treatment and prophylactic response Key objectives: Communication and Key objectives: Communication and

decision makingdecision making

Objectives: Day 3Objectives: Day 3Tabletop componentTabletop component Opportunity for district health directors Opportunity for district health directors

and their response teams to discuss and and their response teams to discuss and make decisions with their local make decisions with their local emergency manager(s) and their local emergency manager(s) and their local hospital(s)hospital(s)– 79/96 (82%) acute care hospitals 79/96 (82%) acute care hospitals

participatedparticipated Provide a low stress event to clarify roles Provide a low stress event to clarify roles

and responsibilities for the management and responsibilities for the management of a large scale BT eventof a large scale BT event

Objectives: Day 3Objectives: Day 3Tabletop ComponentTabletop Component

Decisions regarding surge capacity Decisions regarding surge capacity – What facilities would be established? What facilities would be established? – Procedures for patient movementProcedures for patient movement

Decisions regarding isolation and quarantineDecisions regarding isolation and quarantine Analysis of impact on daily business (schools, Analysis of impact on daily business (schools,

EMTs, Fire, Law, transportation..)EMTs, Fire, Law, transportation..) A checklist provided to each participating site A checklist provided to each participating site

to assist with work flowto assist with work flow

Bioterrorism ExerciseBioterrorism ExerciseDeliverables: Day 3Deliverables: Day 3

All districts asked to produce and submitAll districts asked to produce and submit– Local press release coordinated with agency PIOLocal press release coordinated with agency PIO– Summary Report documenting communication Summary Report documenting communication

with participating local emergency managerswith participating local emergency managers– Dispensing Site Management Plan that identifies Dispensing Site Management Plan that identifies

2 dispensing sites and outlines the staffing and 2 dispensing sites and outlines the staffing and management plans for each site. management plans for each site.

– Incident Action PlanIncident Action Plan– Surge Capacity PlanSurge Capacity Plan

Bioterrorism Exercise Bioterrorism Exercise Deliverables: Day 3Deliverables: Day 3

Conducted a “Hot-Wash” debrief immediately Conducted a “Hot-Wash” debrief immediately following the end of exercise activity at each following the end of exercise activity at each site site – Top 10 things that went wellTop 10 things that went well– Top 10 areas that need improvementTop 10 areas that need improvement– Brainstorm list of issues/comments, checklist Brainstorm list of issues/comments, checklist

providedprovided Submit an after action reportSubmit an after action report

– Phase 1 – All hot-wash notes (same day)Phase 1 – All hot-wash notes (same day)– Phase 2 – District Director Report with action plan Phase 2 – District Director Report with action plan

to address lessons learned. (within 2 weeks)to address lessons learned. (within 2 weeks)

Bioterrorism Exercise Bioterrorism Exercise SNS Segment: Day 3SNS Segment: Day 3

Push Pack arrived in Virginia in AM, Push Pack arrived in Virginia in AM, transported to RSS facility in Richmond areatransported to RSS facility in Richmond area– Training Education Demonstration (TED) packageTraining Education Demonstration (TED) package

Receive, Stage & Store (RSS) Site Manager Receive, Stage & Store (RSS) Site Manager and State signatory authority at RSS facilityand State signatory authority at RSS facility

Push Pack broken down, inventoried, Push Pack broken down, inventoried, managed and distributed to 6 dispensing managed and distributed to 6 dispensing sites and 6 treatment centers throughout sites and 6 treatment centers throughout Virginia; transport by UPSVirginia; transport by UPS

Bioterrorism Exercise:Bioterrorism Exercise:SNS Segment (cont)SNS Segment (cont)

Materials arrived by UPS at dispensing Materials arrived by UPS at dispensing and hospital sites prior to 6 PM on Day 3and hospital sites prior to 6 PM on Day 3

Materials utilized on Day 4 at dispensing Materials utilized on Day 4 at dispensing sites and treatment centers. sites and treatment centers. – Tracking and control were key issues. Tracking and control were key issues. – Dispensing sites dispensed materials for 2.5 Dispensing sites dispensed materials for 2.5

hours from 9:00-11:30 AM.hours from 9:00-11:30 AM. Materials returned to RSS site and then Materials returned to RSS site and then

to CDC by 7 PM on Day 4to CDC by 7 PM on Day 4

Bioterrorism ExerciseBioterrorism ExerciseObjectives: Day 4Objectives: Day 4

Distribution of SNS to all parts of stateDistribution of SNS to all parts of state Establish 5 dispensing clinics in all parts Establish 5 dispensing clinics in all parts

of the state (6of the state (6thth site in No. VA 3 days site in No. VA 3 days later)later)– Winchester, Norfolk, Richmond, Roanoke, Winchester, Norfolk, Richmond, Roanoke,

AbingdonAbingdon– ““Non designated” districts provided Non designated” districts provided

personnel to assist at dispensing sites. personnel to assist at dispensing sites. – Two sites actually provided influenza vaccineTwo sites actually provided influenza vaccine– Media involvement encouragedMedia involvement encouraged

Evaluation of functioning of mass Evaluation of functioning of mass medication or vaccination clinicsmedication or vaccination clinics

Bioterrorism Exercise:Bioterrorism Exercise:SNS Segment (cont)SNS Segment (cont)

Fairfax County (Northern Virginia) Fairfax County (Northern Virginia) operated a dispensing site on operated a dispensing site on following Saturday following Saturday – Involve volunteersInvolve volunteers– Use schoolsUse schools– County transportation of public to County transportation of public to

dispensing site from distant sitedispensing site from distant site– County law enforcement provide County law enforcement provide

securitysecurity

Hurricane Isabel; Sept, Hurricane Isabel; Sept, 2003: 2003: The “Other” ExerciseThe “Other” Exercise

VDH Emergency Coordination Center establishedVDH Emergency Coordination Center established Staffed ESF 8 at state EOC for 10 daysStaffed ESF 8 at state EOC for 10 days Water and power issues for hospitals, nursing Water and power issues for hospitals, nursing

homes, health departments, homeboundhomes, health departments, homebound Impact on hospital, institutional, home healthcareImpact on hospital, institutional, home healthcare Public health and public information issuesPublic health and public information issues

– Water safety: boil water alertsWater safety: boil water alerts– Hurricane related injury, disease and deathsHurricane related injury, disease and deaths– Restaurant inspections, food safetyRestaurant inspections, food safety– Mosquito controlMosquito control

Anthrax Scare, Nov 7 Anthrax Scare, Nov 7 ’03’03

Positive anthrax test at postal facilityPositive anthrax test at postal facility PartnersPartners

– Arlington HDArlington HD– DHS, HHS, CDC, USPSDHS, HHS, CDC, USPS– VA Office of Commonwealth PreparednessVA Office of Commonwealth Preparedness

Antibiotics from VMI delivered, Arlington HDAntibiotics from VMI delivered, Arlington HD– Dispensing clinic staffed/operational within 4 hrsDispensing clinic staffed/operational within 4 hrs

Confirmatory test negative; no Confirmatory test negative; no antibiotics givenantibiotics given

Assessment and Assessment and EvaluationEvaluation

Lessons Learned combined for exercise, Lessons Learned combined for exercise, hurricane and anthrax event: one hurricane and anthrax event: one documentdocument

Lessons Learned Implementation Panel Lessons Learned Implementation Panel established established – Recommend changes in VDH and state Recommend changes in VDH and state

emergency operations plans emergency operations plans – Institutionalize all lessons learned Institutionalize all lessons learned – Report due by June, 2004Report due by June, 2004– Revise VDH emergency operations Revise VDH emergency operations

plan prior to DP ‘04 plan prior to DP ‘04

Determine Promise ‘04Determine Promise ‘04

Department of Defense exercise, August 2004Department of Defense exercise, August 2004 Major components of exercise in Eastern and Major components of exercise in Eastern and

Central Virginia: chemical and explosive Central Virginia: chemical and explosive events, biologic threatsevents, biologic threats

VDH major participantVDH major participant Test revised VDH emergency operations planTest revised VDH emergency operations plan

– Response to chemical, explosive events and bio Response to chemical, explosive events and bio threatthreat

– Test surge planTest surge plan– Bring in VDH personnel from other parts of the Bring in VDH personnel from other parts of the

state as local resources become overwhelmedstate as local resources become overwhelmed

Education and TrainingEducation and Training Ensure the development and delivery of Ensure the development and delivery of

appropriate education and training to:appropriate education and training to:– Public Health ProfessionalsPublic Health Professionals– PhysiciansPhysicians– Emergency Response PersonnelEmergency Response Personnel– Other Healthcare ProvidersOther Healthcare Providers

Collaboration with academic health Collaboration with academic health centers, poison control centerscenters, poison control centers

Education and TrainingEducation and Training

Training needs assessment doneTraining needs assessment done– Public Health personnelPublic Health personnel– Hospital personnel: ER physicians and nurses, Hospital personnel: ER physicians and nurses,

security officerssecurity officers– Infection control practitionersInfection control practitioners

Focus training efforts on greatest identified Focus training efforts on greatest identified needsneeds– Chemical agents and exposuresChemical agents and exposures– Incident commandIncident command– CommunicationsCommunications

Education and TrainingEducation and Training

Link directly to exercises and programmatic Link directly to exercises and programmatic initiativesinitiatives– Conduct and evaluation of exercisesConduct and evaluation of exercises– Incident command and emergency managementIncident command and emergency management– Mental health responseMental health response– Special needs populationsSpecial needs populations

Collaborate with all emergency management Collaborate with all emergency management agencies and organizations, avoid agencies and organizations, avoid duplication of effortsduplication of efforts

Education and TrainingEducation and Training

Use of new technologies to increase Use of new technologies to increase access to training programsaccess to training programs– Videoconferencing, DVD/CDVideoconferencing, DVD/CD– Webcasting, internet based trainingWebcasting, internet based training

TRAIN Learning Management System: TRAIN Learning Management System: http:/va.train.orghttp:/va.train.org– Portal for EP&R health trainingPortal for EP&R health training– Search for coursesSearch for courses– Register online: tracks individual learning Register online: tracks individual learning

recordsrecords

Other Training Other Training ResourcesResources Available through VDH web site: Available through VDH web site:

www.vdh.virginia.govwww.vdh.virginia.gov Information on biologic and Information on biologic and

chemical agentschemical agents Links to other resources, including Links to other resources, including

CDCCDC Recent VDH news and informationRecent VDH news and information