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Inject Response Report Utah Department of Health Treacherous Transport Tabletop Exercise

Tri-County Region

June 7, 2012 Treacherous Transport Tabletop Exercise Inject Responses – June 2012

This report contains the inject responses from the Treacherous Transport Tabletop Exercise. These responses are unedited and are directly exported from the information typed into the ONX System during the exercise. The purpose of this report is to provide documentation for your organization’s records of exact responses captured during the exercise. www.drc-group.com – [email protected]

Disaster Resistant Communities Group LLC www.drc-group.com Treacherous Transport Tabletop Exercise Inject Responses – June 2012

Treacherous Transport - TriCounty - # 002

Chris Chestnut - Indian Health Service All of the passengers in the mini-van are injured in the crash, with the tractor trailer driver suffering significant injuries.

Several people have stopped their cars to provide assistance to those injured in the accident. Part 1 As the chemical release continues to grow, all of the people in the immediate vicinity become overwhelmed by the fumes.

Briefly describe what the immediate concerns would be given this scenario. Part 2 Is the chemical going to overwhelm the initial victims and the first responders Based on your agency’s role in responding to this event, what information would Part 3 you want to know? What is the chemical, what is the status of the individuals involved in crash and Part 4 response and have emergency response personnel been notified

Katie Potts - TriCounty Health Department All of the passengers in the mini-van are injured in the crash, with the tractor trailer driver suffering significant injuries.

Several people have stopped their cars to provide assistance to those injured in the accident. Part 1 As the chemical release continues to grow, all of the people in the immediate vicinity become overwhelmed by the fumes.

Briefly describe what the immediate concerns would be given this scenario. Isolate the scene and deny entry.

Part 2 Identify the Hazardous Material.

Concerns: exposures to bystanders, injured and other on-lookers. Based on your agency’s role in responding to this event, what information would Part 3 you want to know? Part 4 Weather

Wind direction

Staging area

Exposures to critical infrastructures

Who is the Incident Commander?

Chris Chestnut - Indian Health Service First responders arrive on scene and identify six patients with various injuries from the crash and additional respiratory problems from breathing in the fumes being released from the damaged tractor-trailer. Part 1 Evacuation is initiated for the area immediately around the scene.

Identify the agencies that would likely be notified for this event. Hospitals, ambulatory care facilities for potential augmentation of staff, Haz mat Part 2 team, police for support in evacuation and scene security, and the ICT will form at this point Part 3 Briefly describe how the first responders will identify the chemical being released. Identify the chemical placards located on the truck and then contacting the Part 4 transport company for a manifest to verify.

Katie Potts - TriCounty Health Department First responders arrive on scene and identify six patients with various injuries from the crash and additional respiratory problems from breathing in the fumes being released from the damaged tractor-trailer. Part 1 Evacuation is initiated for the area immediately around the scene.

Identify the agencies that would likely be notified for this event. Part 2 Health Department - Environmental Health

Ambulance contacts the Hospitals - ER

Search and Rescue

Water and Sewer Department Part 3 Briefly describe how the first responders will identify the chemical being released. Placards

Shipping Papers

Part 4 Driver

Type of tractor trailer

Chris Chestnut - Indian Health Service During the initial response to the accident, a motorist who stopped to help was mildly exposed to the chemical fumes. He immediately left the scene when he realized hazardous materials were involved.

Minutes later he began to experience symptoms including burning in his nose Part 1 and mouth and difficulty breathing.

The motorist arrived at the hospital and reported his symptoms, but did not initially mention the hazardous materials.

At this point in the event, is the hospital likely to know an accident happened? Part 2 No Describe how the hospital will learn of the incident and will prepare for receiving Part 3 contaminated patients. Part 4 The ICT will notify everyone through a pre developed emergency calll list Part 5 Typically, how long after an incident is the hospital notified? Part 6 15 minutes Part 9 Briefly describe the procedures for limiting access the hospital. Part 10 initiating the hospitals ICT that will coordinate with the on scene ict to very

possible needs and at that point determine if limiting access is necessary Part 11 Is there a formal written policy for the above described procedures? Part 12 Yes Identify the individual(s) that determine when the procedures for monitoring the Part 13 ED would be activated. Part 14 the incident commander

Katie Potts - TriCounty Health Department During the initial response to the accident, a motorist who stopped to help was mildly exposed to the chemical fumes. He immediately left the scene when he realized hazardous materials were involved.

Minutes later he began to experience symptoms including burning in his nose Part 1 and mouth and difficulty breathing.

The motorist arrived at the hospital and reported his symptoms, but did not initially mention the hazardous materials.

At this point in the event, is the hospital likely to know an accident happened? Part 2 Yes Describe how the hospital will learn of the incident and will prepare for receiving Part 3 contaminated patients. EMS Pagers Part 4 Initiate lock-down and redirect patients to the decon tent. ARMC would immediately set up their tents UBMC will await further instructions. Part 5 Typically, how long after an incident is the hospital notified? Part 6 Immediately Part 9 Briefly describe the procedures for limiting access the hospital. ER would contact the Safety Engineer. Funnel patients through a specific Part 10 decon area in the hospitals. Part 11 Is there a formal written policy for the above described procedures? Part 12 Yes Identify the individual(s) that determine when the procedures for monitoring the Part 13 ED would be activated.

ER staff will contact the On-Call Administrator, if they are unavailable the ER Part 14 Physician determines if it is an emergency.

Chris Chestnut - Indian Health Service Briefly describe how decontamination is performed for this type of event. Part 1 (Explain if gross decon is performed in the field with technical decon performed at the hospital or are other methods employed.) depending on the type of chemical a larger area may need to be evacuated at Part 2 which point the haz mat clean-up crew will respond with the appropriate gear to begin decon after all individuals are rescued Does the hospital have adequate training, staff and resources to undertake Part 3 decontamination? Part 4 No Part 5 If the above answer is yes. – List the resources that are available at the hospital. For the IHS facility most of the needed gear for decon is not available. However Part 6 several staff nurses, doctors etc... do have sufficient training to augment personnel and assist in a coordinated response. If the above answer is no. – Briefly describe how the hospital will coordinate Part 7 decon with external resources. Part 8 IHS will coordinate with the emergency response to backfill staff as necessary

Katie Potts - TriCounty Health Department Briefly describe how decontamination is performed for this type of event. Part 1 (Explain if gross decon is performed in the field with technical decon performed at the hospital or are other methods employed.) Part 2 Evacuate within 1000 feet of the established Hot Zone

Set-up the decon in the warm zone

Keep everyone in the cold zone

Transport patients to the most appropriate facility. More severe cases will be

sent to SLC via local helicopter.

IC would establish command channels Does the hospital have adequate training, staff and resources to undertake Part 3 decontamination? Part 4 No Part 5 If the above answer is yes. – List the resources that are available at the hospital. Part 6 If the above answer is no. – Briefly describe how the hospital will coordinate Part 7 decon with external resources. The hospital has enough staff to decon for 1.5 hours. Additional Hazmat resources would be sent via dispatch. Part 8 A total of 50 Volunteer Firefighters are available. Response time is approx. 30- 40 minutes.

Chris Chestnut - Indian Health Service Part 1 How will the hospital know the chemical to which the patients were exposed? The ICT or the first responders will notify them as soon as possible after they Part 2 know. Describe how EMS will ensure their vehicles are not contaminated by the Part 5 chemical. EMS will keep vehicles out of the red zone and in the green zone. In the event the vehicle is in the red zone it will remain there until it is properly Part 6 decontaminated unless it is absolutely necessary to move for use. Then it will be decontaminated for use immediately if possible. The tractor-trailer was carrying two chemicals identified as FE-1A Acidizing Part 7 Composition and VICON NF BREAKER.

Katie Potts - TriCounty Health Department Part 1 How will the hospital know the chemical to which the patients were exposed? Part 2 Through dispatch to hospitals.

Describe how EMS will ensure their vehicles are not contaminated by the Part 5 chemical. Could condomize the vehicles but would use rapid decon. New EMS will need Part 6 additional training. The tractor-trailer was carrying two chemicals identified as FE-1A Acidizing Part 7 Composition and VICON NF BREAKER.

Chris Chestnut - Indian Health Service Additional motorists in the area of the crash begin to self-report to the ED with complaints of burning eyes, nose and mouth. Part 1 The ED begins to reach capacity.

Is the Hospital Command Center (HCC) activated at this point? Part 2 Yes Part 3 Describe how and when the HCC would be activated. When an emergency event that overwhelms or could potentially overwhelm the Part 4 system the HCC is activated Part 7 Are the trigger points defined in a formal plan? Part 8 Yes Briefly describe how the HCC staff will be notified upon the activation of the Part 9 HCC. For IHS an emergency calling tree has been developed that when necessary is Part 10 used to activate the ICT and to notify any individuals required for support of the HCC Briefly describe any changes in the staff notification procedure if the event Part 11 occurred overnight or on a weekend. Part 12 Secondary numbers and standby staff are identified to fill needed positions

Katie Potts - TriCounty Health Department Part 1 Additional motorists in the area of the crash begin to self-report to the ED with complaints of burning eyes, nose and mouth.

The ED begins to reach capacity.

Is the Hospital Command Center (HCC) activated at this point? Part 2 Yes Part 3 Describe how and when the HCC would be activated. Would have been activated once the number of victims was identified. HCC Part 4 would expand with the size of the incident. Part 7 Are the trigger points defined in a formal plan? Part 8 Yes Briefly describe how the HCC staff will be notified upon the activation of the Part 9 HCC. Part 10 Set-up the HCC depending on the incident size. Briefly describe any changes in the staff notification procedure if the event Part 11 occurred overnight or on a weekend. Part 12 They would use a calling tree regardless of the time

Chris Chestnut - Indian Health Service List the positions that would be activated within the HCC and identify by name the individual that would be assigned to each position. Part 1 (Example: Logistics Section Chief – John Harper) Delaine Alley CEO - Incident Commander

Chris Chestnut - Safety Officer

Part 2 Johanna Bizcardi - Logistics

Frances Kagevenema - Planning

Joann Perank or Eric Reynolds - PIO

Katie Potts - TriCounty Health Department

List the positions that would be activated within the HCC and identify by name the individual that would be assigned to each position. Part 1 (Example: Logistics Section Chief – John Harper) Part 2 Activate HCC within the IC system

Chris Chestnut - Indian Health Service Hospital security reports to the HCC that members of the public are gathering near the ED entrance and are creating a disturbance.

One man in particular is agitated complaining that is 18-month old daughter was in the car when he drove near the accident scene. While she is not exhibiting any symptoms, he insists she is seen by a doctor immediately. Part 1 Security officers would like to know if additional support can be dispatched to the ED entrance to assist.

Identify and briefly describe what additional resources can be used to help security. The Security Officer has only the BIA police to assist in this type of incident for Part 2 the IHS facility so depending on their involvement in the incident additional staff may need to assist the security officer.

Katie Potts - TriCounty Health Department Hospital security reports to the HCC that members of the public are gathering near the ED entrance and are creating a disturbance.

One man in particular is agitated complaining that is 18-month old daughter was in the car when he drove near the accident scene. While she is not exhibiting any symptoms, he insists she is seen by a doctor immediately. Part 1 Security officers would like to know if additional support can be dispatched to the ED entrance to assist.

Identify and briefly describe what additional resources can be used to help security. Part 2 Dispatch would coordinate the request for Citizen Corps-MRC CERT with the

assistance of Badged officers.

The hospitals actively monitor their radios.

Chris Chestnut - Indian Health Service A nurse within the ED begins to exhibit symptoms similar to those of the patients who were exposed to the chemical on scene. Part 1 Briefly describe the concerns associated with this new development. Part 2 This means that the ED has potentially been contaminated. Briefly describe the actions that will be undertaken to determine if the ED has Part 3 been contaminated. Part 4 haz mat / infection control team will determine

Katie Potts - TriCounty Health Department A nurse within the ED begins to exhibit symptoms similar to those of the patients who were exposed to the chemical on scene. Part 1 Briefly describe the concerns associated with this new development. The ER is potentially contaminated.

Part 2 Decon the nurse.

Attempt to determine the source of contamination. Briefly describe the actions that will be undertaken to determine if the ED has Part 3 been contaminated. Lock down the ER and use a different entrance. Part 4 Hazmat monitoring equipment.

Chris Chestnut - Indian Health Service Part 1 It has been confirmed that the ED is contaminated.

Prepare a list of all external agencies that should be notified about the contamination of the ED. Indian Health Service, Bureau of Indian Affairs, TriCounty Health Department, State Health Department, HHS DSNS, Ute Tribe Emergency Management Part 2 Office, Ashley Valley Regional Hospital, Uintah Duchesne and Dagget County Emergency Management, Briefly describe how communications will occur with the above listed external Part 3 agencies. Though the PIO of the incident command team in coordination with the HCC PIO Part 4 and agency representatives. Briefly explain how the need for partial or full evacuation of the ED will be Part 5 determined. To limit contamination evacuation may not be the best idea, this will be determined by the HCC based upon the exact conditions and extent of Part 6 contamination as the ED is a separate system from the rest of the hospital and air handlers are separate from the main hospital Describe the process for notifying EMS of the need to divert patients to other Part 7 hospitals. Part 8 the PIO will notify dispatch who will coordinate patient transport

Katie Potts - TriCounty Health Department It has been confirmed that the ED is contaminated. Part 1 Prepare a list of all external agencies that should be notified about the contamination of the ED. Contact dispatch to facilitate contacting:

Ambulance to re-route patients

Health Department Part 2 Media

Sewage and Water

Public Works

Briefly describe how communications will occur with the above listed external Part 3 agencies. JIC's Part 4 Telephone and radio communications Briefly explain how the need for partial or full evacuation of the ED will be Part 5 determined. Part 6 Shut down the ER and redirect non-contaminated individuals to a triage area. Describe the process for notifying EMS of the need to divert patients to other Part 7 hospitals. Part 8 Dispatch

Chris Chestnut - Indian Health Service The HCC has determined the best course of action is to evacuate the ED. Part 1 Briefly describe the evacuation plan for the ED. IHS doesn’t have an ED so if our staff were assisting they would follow the Part 2 direction of the HCC as to what actions to take Part 3 Identify the location to which patients and staff will be relocated. other hospitals, ambulatory care centers or possibly to a triage location such as a Part 4 tent outside. Due to contamination of the ED, describe what treatment or decon will the Part 5 patients and staff receive. Part 6 full rinse with water for 15 minutes with all clothing removed (shower decon tent) Describe what external resources, if any, will be needed to assist with decon, Part 7 patient movement, transportation and / or staffing. Part 8 Emergency management teams, nurses, etc. from all of the EM response teams

Katie Potts - TriCounty Health Department The HCC has determined the best course of action is to evacuate the ED. Part 1 Briefly describe the evacuation plan for the ED.

Containing the contaminated patients. Use gurneys to move non-contaminated Part 2 patients to a triage facility. Part 3 Identify the location to which patients and staff will be relocated. Shelter in place the contaminated patients. The LDS church across the street Part 4 has a verbal understanding that their building can be used. Due to contamination of the ED, describe what treatment or decon will the Part 5 patients and staff receive. Part 6 Regular decon procedures. Describe what external resources, if any, will be needed to assist with decon, Part 7 patient movement, transportation and / or staffing. Part 8 Firefighters will assist.

Chris Chestnut - Indian Health Service There are additional patients self-reporting to the hospital complaining of symptoms similar to others exposed to the chemical. Part 1 With the ED closed, how will these patients be received, triaged, treated and / or transported? A triage tent will be placed outside to triage potential patients until the ED is Part 2 decontaminated and possibly throughout the incident.

Katie Potts - TriCounty Health Department There are additional patients self-reporting to the hospital complaining of symptoms similar to others exposed to the chemical. Part 1 With the ED closed, how will these patients be received, triaged, treated and / or transported? Redirected to decon if contaminated. If they are not contaminated they can be Part 2 diverted to the triage tent or additional entrance.

Chris Chestnut - Indian Health Service

911 Dispatch receives a call from an Urgent Care Clinic in the area.

Three people have arrived at the facility with symptoms of respiratory distress. The patients mentioned the accident and the hazardous material spill. Part 1 The Urgent Care Clinic does not have the capability to decon these patients and is looking for support.

Briefly describe the best course of action to care for these patients. Part 2 triage the patients and transport them elsewhere if needed Briefly describe the ongoing communications that occur between healthcare Part 3 agencies during this event. Part 4 constant feedback and reporting from all groups to the ICT and/or HCC

Katie Potts - TriCounty Health Department 911 Dispatch receives a call from an Urgent Care Clinic in the area.

Three people have arrived at the facility with symptoms of respiratory distress. The patients mentioned the accident and the hazardous material spill. Part 1 The Urgent Care Clinic does not have the capability to decon these patients and is looking for support.

Briefly describe the best course of action to care for these patients. Contact dispatch for further instructions. They do not have radios to monitor the situation and would need to be contacted via dispatch at the on-set of this Part 2 accident for lock-down instructions. CodeRed could be utilized to contact the private healthcare facilities if they are registered. Briefly describe the ongoing communications that occur between healthcare Part 3 agencies during this event. Part 4 See above

Chris Chestnut - Indian Health Service Part 1 EMS has a patient to transport from Daggett County.

EMS calls the hospital en route only to find out that the ED is on divert.

The patient has extensive injuries including lacerations and neck pain from falling through a plate glass window.

Briefly describe how this patient will be treated and where he will be transported. The patient will need to be transported to the nearest facility not contaminated Part 2 (Ashley Valley or UBMC) as these injuries could be made worse if contaminated from exposure to the chemicals.

Katie Potts - TriCounty Health Department EMS has a patient to transport from Daggett County.

EMS calls the hospital en route only to find out that the ED is on divert. Part 1 The patient has extensive injuries including lacerations and neck pain from falling through a plate glass window.

Briefly describe how this patient will be treated and where he will be transported. Part 2 Patients would be transported to Rock Springs via instructions through dispatch.

Chris Chestnut - Indian Health Service As the response wraps up on scene and patients are being treated and sent Part 1 home, what actions should be considered for returning to normal operations? Many of the treated and untreated individuals will need to be monitored by someone for an additional 72hors because of the possibility of delayed onset. Part 2 Additionally a PSA will need to be given to the local news, police and healthcare centers for use. When the ED goes off diversion, how will this information be communicated to Part 3 EMS and other hospitals? Dispatch will be able to notify EMS who are in their vehicles and the logistics Part 4 officer will assist in notifying all of the agencies Briefly describe how hospitals can improve communication between one another Part 5 during an event such as this.

If the logistics and PIO officers are in routine contact all the time it will be easier Part 6 for them to ensure smooth communication during an event Briefly describe the kind of debrief or after action, if any, that would be performed Part 7 by the hospital following an event such as this. Debrief of all involved responders that identifies gaps successes and failures and Part 8 incorporates those into a proposal for action. As well as soliciting public feedback from the community and individuals involved in the incident.

Katie Potts - TriCounty Health Department As the response wraps up on scene and patients are being treated and sent Part 1 home, what actions should be considered for returning to normal operations? Halliburton would be responsible for the clean-up while the Health Department monitors.

Part 2 H.D. would provide speaking points for advising the Public when receiving calls.

MRC can man hotlines to assist with incoming calls if activated. Dispatch can divert calls to these hotlines. When the ED goes off diversion, how will this information be communicated to Part 3 EMS and other hospitals? IC and Hospitals will use their Incident Command Center to contact dispatch. JIC at Uintah EOC will be utilized to send out information. A representative from Part 4 the media and radio should be involved to establish a relationship and collaboration. Briefly describe how hospitals can improve communication between one another Part 5 during an event such as this. Part 6 n/a Briefly describe the kind of debrief or after action, if any, that would be performed Part 7 by the hospital following an event such as this. All agencies involved would need to participate in a debriefing and after action Part 8 review. Dispatch will need to be involved.

Chris Chestnut - Indian Health Service Part 1 Based on the today’s exercise scenario, list all Memoranda of Understanding

(MOUs) or Memoranda of Agreement (MOAs) that the hospital currently has in place. When listing the MOU / MOA identify the:

 Resource.  Agency the MOU / MOA is with.  If the MOU / MOA is a formal written document or informal agreement.  The date the MOU / MOA was last reviewed.

(Example: Wheelchair Accessible Bus – ABC School District – Formal – Reviewed 12/2011) We have a verbal MOU with the Ute Tribe Emergency Management Office to Part 2 assist with personnel during incidents. Identify and describe any gaps in resources that an MOU / MOA may help Part 3 alleviate based on today’s exercise scenario. Personnel, resources are very limited and clearly there is a great possibility we Part 4 could be overwhelmed.

Katie Potts - TriCounty Health Department Based on the today’s exercise scenario, list all Memoranda of Understanding (MOUs) or Memoranda of Agreement (MOAs) that the hospital currently has in place. When listing the MOU / MOA identify the:

 Resource. Part 1  Agency the MOU / MOA is with.  If the MOU / MOA is a formal written document or informal agreement.  The date the MOU / MOA was last reviewed.

(Example: Wheelchair Accessible Bus – ABC School District – Formal – Reviewed 12/2011) Fire has a MOU with the County

Part 2 Hospitals have them through the coalition and with neighboring facilities.

Bluemed in Price, Moab and St. George Identify and describe any gaps in resources that an MOU / MOA may help Part 3 alleviate based on today’s exercise scenario. Part 4 n/a

Chris Chestnut - Indian Health Service Exercise Feedback

This feedback questionnaire is not the same as the Exercise Hotwash. The Part 1 Exercise Hotwash will need to be completed at the end of the exercise.

What did you like about the ONX System? Part 2 It was easy to navigate and the instructions were clear and precise Part 3 What improvements can be made to the ONX System? I would have liked it if the exercise would have had an audio portion or perhaps a Part 4 live facilitator that could review data presented in real time and facilitate movement through the exercise.

Katie Potts - TriCounty Health Department Exercise Feedback

This feedback questionnaire is not the same as the Exercise Hotwash. The Part 1 Exercise Hotwash will need to be completed at the end of the exercise.

What did you like about the ONX System? Part 2 This system is worth using. Part 3 What improvements can be made to the ONX System? Part 4 Redundancy

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