HSEEP AAR-IP Template s1

[FOUO] Homeland Security Exercise and Evaluation Program (HSEEP) After Action Report/Improvement Plan Improvised Explosive Device Functional Exercise (AAR/IP) November 2010

Statewide Medical/Health:

Improvised Explosive Device Functional Exercise

November 18, 2010

After Action Report/Improvement Plan

December 29 , 2010 [FOUO] Homeland Security Exercise and Evaluation Program (HSEEP) After Action Report/Improvement Plan Improvised Explosive Device Functional Exercise (AAR/IP) November 2010

This page is intentionally blank. [FOUO] Homeland Security Exercise and Evaluation Program (HSEEP) After Action Report/Improvement Plan Improvised Explosive Device Functional Exercise (AAR/IP) November 2010

HANDLING INSTRUCTIONS 1. The title of this document is the Improvised Explosive Device Functional Exercise.

2. The information gathered in this AAR/IP is classified as [For Official Use Only (FOUO)] and 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 Sierra-Sacramento Valley EMS Agency 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 a locked container or area offering sufficient protection against theft, compromise, inadvertent access, and unauthorized disclosure.

4. Points of Contact:

Shawn Joyce Emergency Preparedness Coordinator/PIO Sierra-Sacramento Valley EMS Agency 5995 Pacific Street Rocklin, CA 95677 (916) 625-1702 Fax: (916) 625-1730 [email protected]

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CONTENTS Administrative Handling Instructions...... 1 Contents...... 3 Executive Summary...... 5 Section 1: Exercise Overview...... 7 Exercise Details...... 7 Exercise Planning Team Leadership...... 7 Participating Organizations...... 8 Section 2: Exercise Design Summary...... 9 Exercise Purpose and Design...... 9 Capabilities and Activities Identified for Demonstration...... 9 Scenario Summary...... 19 Section 3: Analysis of Capabilites...... 10 Section 4: Conclusion...... 12 Appendix A: Improvement Plan...... 13

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EXECUTIVE SUMMARY On November 18, 2010, Sierra-Sacramento Valley EMS Agency (S-SV EMS) participated in the 2010 California Statewide Medical and Health Exercise Program. The exercise scenario was an Improvised Explosive Device (IED). The exercise was designed to allow planning and response partners within each Operational Area (OA) to tailor their level of exercise participation and determine local impact from the threat scenario.

The exercise was designed to test the following U.S. Department of Homeland Security Target Capabilities:

• Communications • Intelligence and Information Sharing and Dissemination • Medical Surge

The objectives used to evaluate these capabilities for the EMS Agency were: Target Capability: Communications

A. Assess the LEMSA’s ability to communicate with response partners including local, health care entities B. Establish communications for EMSystem management of response activities.

Target Capability: Intelligence/Information Sharing and Dissemination

A. Test the plans and technology for gathering intelligence and sharing information with external response partners including health care partners and emergency management authorities B. Test the plans and technology for gathering intelligence and sharing information with staff. C. Determine the ability to gather information on available resources and provide situational information to the Medical Health Operational Area Coordinator.

The objectives used to evaluate these capabilities for the hospitals were:

Target Capability: Medical Surge A. Assess bed surge capacity and participate in a statewide Hospital Available Beds for Emergencies and Disasters (HAvBED) drill.

Target Capability: Communications

A. Assess the facility’s ability to communicate with response partners including other health care entities.

Major Strengths

 Most facilities responded in a timely manner.

 EMSystem is an effective tool for communication and resource assessment.

 RDMHS was prompt and responsive throughout the exercise.

Primary Areas for Improvement

 Hospitals split between regions and EMSystem Administration.

 Reporting times for some facilities was delayed.

 HAvBED definition set unclear, regarding staffed and available beds.

 No option for reporting “N/A” when bed type does not exist at a facility.

 Discrepancies between state data set and local data set for compliance.

o Shasta Regional Medical Center did not report any data.

o Butte County shows 3:4 facilities reporting, when 4:4 reported.

 EMSystem Access

o Yolo County Health Department was not able to log into EMSystem to observe the HAvBED exercise in real time during the exercise related to being “in-flux”.

SECTION 1: EXERCISE OVERVIEW

Exercise Details Exercise Name Improvised Explosive Device Functional Exercise Type of Exercise Functional Exercise Exercise Start Date November 18, 2010 Exercise End Date November 18, 2010 Duration 2 hours Program Fiscal Year 2010/11 Mission Prevention (planning) Capabilities Medical Surge, Communications, and Intelligence/Information Sharing & Dissemination Scenario Type Threat/Explosion of Improvised Explosive Device’s

Exercise Planning Team Sierra-Sacramento Valley EMS Agency Colusa County DHHS Shawn Joyce Bonnie Davies Emergency Preparedness Coordinator/PIO Director of Nursing-HPP Coordinator

Disaster Doug Consulting Nevada County Hospitals Douglas E. Buchanan Patti Carter Consultant HPP Coordinator

Placer County Public Health Siskiyou County Lynnette Goldstein Lynn Corliss Health Educator/HRSA Local Coordinator EPC-HPP Coordinator HPP Coordinator

Sutter County Hospital Tehama County Health Services Agency Jeff Kennedy Susan Murphy and Sydnei Wilby HPP Coordinator HPP Coordinators

Yolo Co Public Health Yuba County Hospital Dana Carey John Anderson HPP Coordinator HPP Coordinator

Participating Organizations Sierra-Sacramento Valley EMS Agency

Butte County: Nevada County: Biggs-Gridley Memorial Hospital Tahoe Forest Feather River Hospital Sierra Nevada Memorial Hospital Enloe Medical Center Oroville Hospital

Colusa County: Sutter County: Colusa Regional Medical Center Fremont Medical Center

Placer County: Yuba County: Sutter Roseville Rideout Kaiser Roseville Sutter Auburn Faith

Siskiyou County: Yolo County: Fairchild Medical Center Sutter Davis Mercy Medical Center - Mt. Shasta Woodland Memorial

Tehama County: Shasta County: St. Elizabeth Hospital Mayers Memorial Hospital District Patients’ Hospital of Redding Shasta Community Health Center Mercy Medical Center Redding Northern California Rehab Hospital

SECTION 2: EXERCISE DESIGN SUMMARY

Exercise Purpose and Design

The purpose of the HAvBED exercise is to evaluate a real-time electronic bed tracking/monitoring system that augments a system/region's ability to care for a surge of patients.

Exercise Objectives, Capabilities, and Activities Capabilities-based planning allows for exercise planning teams to develop exercise objectives and observe exercise 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 exercise. Additionally, each capability is linked to several corresponding activities and tasks to provide additional detail.

Based upon the identified exercise objectives below, the exercise planning team has decided to demonstrate the following capabilities during this exercise:

 Objective 1: Assess bed surge capacity and participate in a statewide Hospital Available Beds for Emergencies and Disasters (HAvBED) drill. o Capability: Medical Surge . Activity 1.1: Create Regional HAvBED event in EMSystem. . Activity 1.2: Facilities report status within the 2-hour specified time frame.

 Objective 2: Test the plans and technology for gathering intelligence and sharing information with external response partners including health care partners and emergency management authorities. o Capability: Intelligence/information Sharing and Dissemination . Activity 2.1: Run HAvBED data report and submit to state agencies.

 Objective 3: Test the plans and technology for gathering intelligence and sharing information with staff. o Capability: Communication . Activity 3.1: Ensure MHOAC is notified of the state HAvBED event.

Scenario Summary November 18: In response to a request from CDPH/EMSA for in-patient bed availability, a HAvBED poll was conducted.

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 Improvised Explosive Device Functional Exercise are listed below, followed by corresponding activities. Each activity is followed by related observations, which include references, analysis, and recommendations.

CAPABILITY 1: MEDICAL SURGE

Capability Summary: Medical Surge is the capability to rapidly expand the capacity of the existing healthcare system (long-term care facilities, community health agencies, acute care facilities, alternate care facilities and public health departments) in order to provide triage and subsequent medical care. This includes providing definitive care to individuals at the appropriate clinical level of care, within sufficient time to achieve recovery and minimize medical complications. The capability applies to an event resulting in a number or type of patients that overwhelm the day-to-day acute-care medical capacity. Medical Surge is defined as the rapid expansion of the capacity of the existing healthcare system in response to an event that results in increased need of personnel (clinical and non-clinical), support functions (laboratories and radiological), physical space (beds, alternate care facilities) and logistical support (clinical and non-clinical equipment and supplies).

Activity 1.1: Create Regional HAvBED event in EMSystem.

Observation 1.1.1: All facilities outside of Region IV were left off the HAvBED poll. RDMHS developed a second HAvBED poll to include facilities outside Region IV.

References: No written protocol.

Analysis: RDMHS was originally directed to only poll Region IV Hospitals.

Recommendations: To include all (S-SV EMS) acute care facilities in Regional HAvBED polls, including S-SV EMS Region III facilities which are in the Region IV EMSystem view. S-SV EMS Region III hospitals which are not yet migrated to the Region IV view (Shasta, Siskiyou, and Tehama) will be polled through NorCal EMS electronically and the data will be forwarded to S-SV EMS until they are fully migrated.

Observation 1.1.2: The EMSystem HAvBED data set differed between Region III and Region IV polls.

References: RDMHC Policy 08-001: Regional In-Patient Bed Polling.

Analysis: Appears to be discrepancies between federal, state, and local definitions on the HAvBED set.

Recommendations: Work with RDMHS and CDHP to clarify data set and all systems would use a common data set and definitions.

Activity 1.2: Facilities report status within the 2-hour specified time frame.

Observation 1.2: Some facilities were delayed in response time.

References: RDMHC Policy 08-001: Regional In-Patient Bed Polling.

Analysis: ***Conference Call Feedback***

Recommendations: To review training and protocols to responding to HAvBED events with all facilities.

CAPABILITY 2: INTELLIGENCE/INFORMATION SHARING AND DISSEMINATION

Capability Summary: The Intelligence/Information Sharing and Dissemination capability provides necessary tools to enable efficient prevention, protection, response, and recovery activities. Intelligence/Information Sharing and Dissemination is the multi-jurisdictional, multidisciplinary exchange and dissemination of information and intelligence among federal, state, local, and tribal layers of government, the private sector, and citizens. The goal of sharing and dissemination is to facilitate the distribution of relevant, actionable, timely, and preferably declassified or unclassified information and/or intelligence that is updated frequently to the consumers who need it. More simply, the goal is to get the right information to the right people at the right time. An effective intelligence/information sharing and dissemination system will provide durable, reliable, and effective information exchanges (both horizontally and vertically) between those responsible for gathering information and the analysts and consumers of threat- related information. It will also allow for feedback and other necessary communications in addition to the regular flow of information and intelligence.

Activity 2.1: Run HAvBED data report and submit to state agencies.

Observation 2.1: Data report was run without problems and submitted to CDPH.

Analysis: EMSystem reports directly to CDPH following HAvBED events.

Recommendations: The state to continue to work with EMSystem to automate reporting.

CAPABILITY 3: COMMUNICATIONS

Capability Summary: Communications is the fundamental capability within disciplines and jurisdictions that practitioners need to perform the most routine and basic elements of their job functions. Agencies must be operable, meaning they must have sufficient wireless communications to meet their everyday internal and emergency communication requirements before they place value on being interoperable, i.e., able to work with other agencies.

Communications interoperability is the ability of public safety agencies (police, fire, EMS) and service agencies (public, works, transportation, hospitals, long-term care, etc) to talk within and across agencies and jurisdictions via radio and associated communications systems, exchanging voice, data and/or video with one another on demand, in real time, when needed, and when authorized. It is essential that public safety has the intra-agency operability it needs, and that it builds its systems toward interoperability.

Activity 3.1: Ensure MHOAC is notified regarding state HAvBED event.

Observation 3.1: CAHAN alert was received regarding HAvBED event.

Analysis: No problems.

Recommendations: None.

SECTION 4: CONCLUSION Besides the data and reporting discrepancies, the exercise ran well and most facilities reported within the expected time frame. EMS Agency staff should continue to work with the RDMHC/S program, EMSA, and CDPH to standardize the alerting process, data set, and automation for HAvBED assessments.

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APPENDIX A: IMPROVEMENT PLAN This IP has been developed specifically for the Sierra-Sacramento Valley EMS Agency as a result of the Improvised Explosive Device Functional Exercise conducted on November 18, 2010. These recommendations draw on both the After Action Report and the After Action Conference.

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Table A.1 Improvement Plan Matrix Primary Corrective Action Capability Agency Capability Observation Title Recommendation Responsible Start Date Completion Date Description Element POC Agency Medical Surge Observation 1.1.1: All To include all S- RDMHS agreed facilities outside of SV EMS acute to include all Region IV were left off care facilities in hospitals in the HAvBED poll. Regional S-SV/ future polls. S- Planning 12/29/10 RDMHS developed a HAvBED polls, RDMHC/S SV to contact second HAvBED poll including non RDMHS prior to include facilities Region IV to future drills. outside Region IV. facilities. Medical Surge Observation 1.1.2: The Work with EMSystem HAvBED RDMHS and data set differed CDHP to clarify between Region III and data set and all Region IV polls. systems would use a common data set Work with the 2 Planning 1/31/11 and definitions. RDMHS to clarify Doug 12/29/10 with CDPH/EMSA

Primary Corrective Action Capability Agency Capability Observation Title Recommendation Responsible Start Date Completion Date Description Element POC Agency Medical Surge Continuing monitoring and To review training Observation 1.2: Some provide and protocols to Planning facilities were delayed feedback to responding to & 12/29/10 in response time. hospitals. HAvBED events Page 14 of 14 Training Adhoc exercise with all facilities. to test response times.