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After Action Report / Improvement Plan Outbreak Anarchy – An EDS Tabletop Exercise After Action Report Hampden County Public Health Emergency Preparedness Coalition

Improvement Plan

Outbreak Anarchy – An Emergency Dispensing Site Tabletop Exercise November 18, 2014

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ADMINISTRATIVE HANDLING INSTRUCTIONS

1. The title of this document is The "Outbreak Anarchy - An Emergency Dispensing Site Tabletop Exercise - Hampden County" After Action Report. 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. 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:

Public Health Coalition:

Erica Johnson Pioneer Valley Planning Commission (Office) 413-781-6045 (E-Mail) [email protected]

Exercise Director:

Chris Floyd Disaster Resistant Communities Group LLC (Office) 850-241-3565 (E-Mail) [email protected]

CONTENTS

ADMINISTRATIVE HANDLING INSTRUCTIONS...... 2 CONTENTS...... 3 EXECUTIVE SUMMARY...... 4 SECTION 1: EXERCISE OVERVIEW...... 5 Exercise Details...... 5 Participant Information...... 5 SECTION 2: EXERCISE DESIGN SUMMARY...... 7 Exercise Purpose and Design...... 7 Exercise Objectives, Capabilities and Activities...... 7 Scenario Summary...... 7 SECTION 3: ANALYSIS OF CAPABILITIES...... 9 SECTION 4: CONCLUSION...... 13 APPENDIX A: IMPROVEMENT PLAN...... 14 APPENDIX B: PARTICIPANT FEEDBACK (Strengths – Areas for Improvement)...... 14 APPENDIX C: ACRONYMS...... 21

EXECUTIVE SUMMARY

Outbreak Anarchy - An Emergency Dispensing Site Tabletop Exercise - Hampden County was designed and facilitated to assess the capabilities of the coalition’s public health agencies to effectively manage Emergency Dispensing Site operations in the event of an influenza pandemic.

The purpose of this report is to analyze exercise results, identify strengths to be maintained and built upon, identify potential areas for further improvement, and support development of corrective actions.

Incorporated in Section 3: Analysis of Capabilities of this After Action Report is a comprehensive listing of each Core Capability with its associated Major Strengths, Primary Areas for Improvement and Improvement Recommendations

SECTION 1: EXERCISE OVERVIEW

Exercise Details

Outbreak Anarchy - An Emergency Dispensing Site Tabletop Exercise Name: Exercise - Hampden County

Type of Exercise: Tabletop

Exercise Start Date: November 18, 2014

Duration: Three Hours

Location: Chicopee Massachusetts

Hampden County Public Health Emergency Preparedness Sponsor: Coalition

Program: The exercise was conducted as part of the coalition’s public health preparedness program.

Purpose: The purpose of the exercise was to assess the capabilities of the coalition’s public health agencies to effectively manage Emergency Dispensing Site operations in the event of an influenza pandemic.

Mission: To provide the staff and management of the coalition’s public health agencies with a stronger understanding of the various roles and responsibilities associated with operating an Emergency Dispensing Site.

Scenario Type: Influenza Pandemic

Participant Information

Participant Agency / Department

Berkshire Regional Planning Commission

Centers for Disease Control and Prevention

City of Chicopee Health Department

City of Springfield Department of Health & Human Services

City of Springfield Office of Emergency Preparedness

City of Westfield Health Department

Franklin Regional Council of Governments

Gateway Regional School District

Hampshire County Medical Reserve Corps

Massachusetts Department of Public Health

Medical Reserve Corps

Springfield Medical Reserve Corps

Springfield Public Schools

Town of Agawam Health Department

Town of East Longmeadow Local Emergency Planning Committee

Town of East Longmeadow Medical Reserve Corps

Town of Hampden Board of Health Hampden

Town of Longmeadow Board of Health

Town of Ludlow Board of Health

Town of Palmer Board of Health

Town of Southampton Emergency Management Department

Town of Southwick Board of Health

Town of West Springfield Health Department

Number of Participants 34

SECTION 2: EXERCISE DESIGN SUMMARY

Exercise Purpose and Design

The purpose of the exercise was to assess the capabilities of the coalition’s public health agencies to effectively manage Emergency Dispensing Site operations in the event of an influenza pandemic.

Exercise Objectives, Capabilities and Activities

Capabilities-based planning allows for the exercise planning team 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 decided to demonstrate the following capabilities during this exercise:

Medical Countermeasure Dispensing

Activity Core Capability

# 1 Activate Dispensing Modalities

# 2 Dispense Medical Countermeasures to Identified Population

# 3 Adverse Events Monitoring

Scenario Summary

An outbreak of an unusually severe respiratory illness has been identified in a small village in southern China. At least 25 cases have occurred affecting all age groups; 20 patients have required hospitalization, five of whom have died.

Day 11

Surveillance in surrounding areas has been increased resulting in new cases being identified throughout the province. Viral cultures collected from several of the initial patients are positive for type A influenza virus.

Samples of the virus have been sent to the World Health Organization (WHO) and the Centers for Disease Control and Prevention (CDC) for further characterization. Upon analysis the CDC determines that the samples are a novel strain of influenza A, H7N3, a subtype never before found in humans.

Day 29

The findings from the CDC have been transmitted back to the Ministry of Health in China and throughout the WHO network. The CDC, in collaboration with the WHO, has dispatched a team of epidemiologists and laboratory personnel to further evaluate the outbreak in China.

The CDC also disseminates a Health Alert Network (HAN) advisory notifying clinicians and health departments in the United States to be on the alert for patients with severe respiratory illness that have a history of travel to the region of Asia where human cases have occurred.

In addition, the Massachusetts Department of Public Health (DPH) uses the Health and Homeland Alert Network (HHAN) to provide a summary of the CDC HAN to all local health departments, health agents, clinicians and emergency management directors.

Samples of the H7N3 influenza virus are sent to the United States Food and Drug Administration (FDA), Novartis, Sanofi Pasteur, MedImmune and GlaskoSmithKline so that work can begin on developing a vaccine.

SECTION 3: ANALYSIS OF CAPABILITIES

Performance Core Capability

Adequate Activity # 1: Activate Dispensing Modalities

Associated Critical Tasks

Task # 1.1: Activate dispensing strategies, dispensing sites, dispensing modalities and other approaches, as necessary, to achieve dispensing goals commensurate with the targeted population.

Adequate Evaluator # 1

 Exercise participants seemed to understand the necessary Observations approaches, sites, and strategies required.

Recommendation  Conduct a SNS workshop for involved partner agencies to ensure s their knowledge about the process.

Task # 1.2: Activate staff that will support the dispensing modality in numbers necessary to achieve dispensing goals commensurate with the targeted population.

Needs Evaluator # 1 Improvement

 It was observed in multiple groups that contact information for needed stakeholders for EDS activation was not readily available.  Multiple individuals commented that they need their plans to be able to operationalize the concepts within them. Observations  The comment that "the numbers don't work" was provided during the exercise, indicating that the number of staff required would not be available during an emergency.  The Pioneer Valley has plans in place for volunteer staffing, but almost all participants were unaware of them.

Recommendation  Ensure that key personnel responsible for the activation of the s EDS plan have the necessary contact information pre- programmed into cell phones or readily available on computers.  Facilitate regular planning meetings with all involved plan stakeholders to ensure that they know their roles and responsibilities, if the plan is activated.

 Conduct future exercises to ensure that all involved parties understand their roles related EDS operations.  Conduct a workshop to introduce Pioneer Valley Staffing Plans to stakeholders.  Consider regionalization of EDS sites between contiguous municipalities.

Task # 1.3: If indicated by the incident, implement mechanisms for providing medical countermeasures for public health responders, critical infrastructure personnel, and their families, if applicable.

Observations  Was discussed by all work groups.

Recommendation  None s

Task # 1.4: Inform public of dispensing operations including locations, time period of availability, and method of delivery.

 Confusion was observed as it related to the opening and closing Observations times of EDS sites in this scenario.

Recommendation  Work with state planners to ensure that plans consider realistic s and coordinated operating times.

Activity # 2: Dispense Medical Countermeasures to Identified Adequate Population

Task # 2.1: Maintain dispensing site inventory management system to track quantity and type of medical countermeasures present at the dispensing site.

Observations  Discussions appeared to consider the necessary elements.

Task # 2.2: Distribute pre-printed drug / vaccine information sheets that include instructions on how to report adverse events.

 All groups discussed the various information sheets that will need Observations to be distributed at the EDS.

Task # 2.3: Document doses of medical countermeasures dispensed, including but not limited to: product name and lot number, date of dispensing and location of dispensing (e.g., address and zip code).

Observations  None

Task # 2.4: Determine the disposition of unused medical countermeasures within the jurisdictional health system according to jurisdictional policies.

Observations  Existing protocols would be utilized in coordination with the state.

Adequate Activity # 3: Adverse Events Monitoring

Task # 3.1: Activate mechanism(s) for individuals and healthcare providers to notify health departments about adverse events.

Observations  Existing state protocols would be utilized.

Task # 3.2: Report adverse event data to jurisdictional and federal entities according to jurisdictional protocols.

Observations  Existing protocols would be utilized.

SECTION 4: CONCLUSION

Exercises such as this one allow personnel to validate training and practice strategic and tactical prevention, protection, response and recovery capabilities in a risk-reduced environment. Exercises are the primary tool for assessing preparedness and identifying areas for improvement, while demonstrating community resolve to prepare for major incidents.

Exercises aim to help entities within the community gain objective assessments of their capabilities so that gaps, deficiencies, and vulnerabilities are addressed prior to a real incident.

Exercises are the most effective (and safer) means to:

 Assess and validate policies, plans, procedures, training, equipment, assumptions, and interagency agreements;  Clarify roles and responsibilities;  Improve interagency coordination and communications;  Identify gaps in resources;  Measure performance; and  Identify opportunities for improvement.

This exercise succeeded in addressing all of the above as it provided examples of good to excellent participant knowledge, teamwork, communication and use of plans and procedures while pointing out areas in need of improvement and clarification.

Listed below is a summary of the level of performance the Target Capabilities and Tasks evaluated during the exercise. This summary outlines the areas in which coalition’s public health agencies are strong as well as identifying areas that the departments should invest future planning, training and exercise funds on.

Activity Core Capability Performance

# 1 Activate Dispensing Modalities Adequate

# 2 Dispense Medical Countermeasures to Identified Population Adequate

# 3 Adverse Events Monitoring Adequate

APPENDIX A: IMPROVEMENT PLAN

This Improvement Plan has been developed specifically for Hampden County Public Health Emergency Preparedness Coalition based on the results of Outbreak Anarchy - An Emergency Dispensing Site Tabletop Exercise - Hampden County conducted on November 18, 2014. These recommendations draw on both the After Action Report and the After Action Conference.

Responsible Completion Capability Observation Recommendation Agency Date

Activate Multiple individuals commented Conduct an EDS workshop / Pioneer Valley Dispensing their plans need to be able to webinar for stakeholder agencies Planning May 1, 2015 Modalities operationalize the concepts and organizations to ensure they Commission contained within them. fully understand the EDS process.

Facilitate two planning meetings with all stakeholder agencies and organizations to ensure that each Each September 1, knows their roles and Municipality 2015 responsibilities when the plan is activated.

Their currently exists a plan to Conduct a workshop / exercise on Pioneer Valley July 1, 2015 coordinate volunteers to help staff how to use the plan to recruit, Planning an EDS. However most exercise assign and manage un-affiliated Commission participants were unaware of the spontaneous volunteers. plan.

Current contact information for Ensure that key personnel stakeholder agencies and responsible for the activation of the organizations was not easily EDS plan have the necessary Each February 1, accessible or available. contact information pre- Municipality 2015 programmed into cell phones or readily available on computers. Review and update all contact Each September 1, information in the EDS plans. Municipality 2015

Confusion was observed as it Conduct a workshop / webinar to related to the opening and closing enhance the understanding and Pioneer Valley times of EDS sites in this coordination of EDS opening, Planning April 1, 2015 scenario. operating and closing times among Commission municipalities.

The comment that "the numbers Conduct a volunteer recruitment Pioneer Valley don't work" was stated during the event in coordination with local Planning exercise, indicating that the MRC Units. Commission and May 1, 2015 number of staff required would not Medical Reserve be available during an Corps Units emergency. Establish written agreements with local community and faith based Each September 1, organizations to help provide Municipality 2015 volunteer staffing support to EDS sites.

Dispense Medical The comment that "the numbers Conduct a workshop / webinar to Pioneer Valley May 1, 2015

don't work" was stated during the review potential regionalization of Countermeasures exercise, indicating that the EDS sites. Planning to Identified number of staff required would not Commission Population be available during an emergency.

APPENDIX B: PARTICIPANT FEEDBACK (Strengths – Areas for Improvement)

Strengths

Mixing of towns at each table gave people a chance to learn from each other.

Using the computer interface allowed each table to go through the exercise at its own pace.

Forcing people to make actual phone calls to partners pointed out a) that they didn't know their partners' phone numbers and b) that they didn't know what they were asking them to do.

Having experienced opening up an EDS our group was able to complete tasks.

The group showed an extensive knowledge of the ICS structure.

The group showed an aggressive assertiveness in tackling the various scenarios sometimes to the point where we were running out of time.

The exercise was well thought out.

Good IT support for attendees.

I almost didn't go solo, but I liked comparing details from other towns' ideas, concepts and plans.

I thought the steps and online aspects of this training were really well designed and logical.

Getting to know other people doing the same work in neighboring communities.

The group that was assembled did work well together and were very open with its communications.

I thought the subject matter was relevant to current events and was excited with the use of a modern practical application for recording data.

The technology was helpful which keep us on track and moving along with the process and an occasional nudge from the instructors was helpful.

Group setting.

Collaborative group.

Working together as a team.

Decision making process.

Able to immediately contact key players for drill to begin preparing for a possible EDS.

Able to run through steps with Incident Command leading up to activation of EDS.

Networking provided new ideas for resources.

We were able to identify key community players.

We on a local level are well organized

Excellent materials. Well-conceived progress through logical steps of action for the incident.

Good mix of people at each table: experienced / inexperienced; large city / small town, culturally mixed group, etc. The exercise gave us food for thought on how other municipalities set up their EDS.

Brainstorming on how to improve our EDS.

Good communication between diverse agencies.

Productive discussions regarding implementation of existing EDS Plan.

Adding a player that was not from my city and from emergency management from a larger city was definitely a plus.

The exercise was very detailed so it made us go through major steps in our plan

The breaking off in groups and letting each group self-pace was a good idea.

Ability to utilize our EOP.

Ability to contact actual individuals listed in plan to verify they understood the role they play.

Ability to contrast the differences in how a large city would operate under its EDS as opposed to a surrounding town.

The department has a strong background in dealing with this type of event having participated in actual mass immunization clinics.

There is good cooperation between the various city departments that would be participating in such an event. Many of the responders to such an event would be paid staff.

The department is well aware of ICS and how to apply it to such an event.

Plans and organizations available to help.

Helpful to work with people from other communities in teams, good learning experience

Good Networking.

Areas for Improvement

Many participants a) didn't know their partners' phone numbers and b) didn't know what they were asking them to do.

Knowledge of ICS and planning for those with functional and access needs at my table was quite low.

More staff will definitely be needed to complete more than two, three or four shifts.

Would like to see more staff at attendance.

How to communicate to staff, MRC's, push pull partners the importance of responding to the Call Down Drills.

We need to look at different EDS models, for example; our site-based vaccination system was not a good model for this situation. A head of household distribution would have been better and we realized that partway into the exercise.

Plans need to be updated around a few key issues.

While we weren't a town, our ICS structure kind of fell apart at times, with a non-Incident Commander wrestling for control frequently!

Additional disciplines i.e., EMS, Fire and Police around the table for input into the learning and sharing experience.

A greater involvement of the Public Health perspective at the local level in conjunction with Emergency Management.

It was such a wonderful learning experience that I cannot think of anything else that did not go well.

Plan currently not in place for different scenarios required for EDS other than vaccination such as providing antivirals.

Need to identify a volunteer coordinator.

Need staff for mental health services that are trained in disaster type scenarios.

Need to connect with a translation service.

Increase MRC volunteer numbers.

Recruitment and just-in-time training of volunteers.

Timing of when to activate volunteers: have volunteers help with unloading and set-up not just dispensing.

How to plan orderly dispensing to the population or should we count on a rush all at one time. Will the public buy into concept of dispensing by precinct. Importance of security at the EDS.

Update EDS Plan.

Gather contact information for involved agencies.

Modify EDS Plan to be more flexible relative to scenario.

My department needs to update some of the contacts in our EDS Plan.

We realized that we were missing specific groups in our community.

We now know we also need to recruit more volunteers and work on volunteer liability issues.

Increasing the number of individuals involved in actually executing the plan.

Ability to manage spontaneous volunteers not totally ironed out. A combination of just- in-time training, verification of / making copy of license and certifications, and assigning them to duties not involving contact with minors and assigning a mentor from the MRC were discussed.

Notification of volunteers. Usage of city phone trees, personal contact, ham radios discussed. Also discussed putting volunteers on standby before activation, and having a designated meeting place in advance for any unforeseen emergency.

It would have been helpful to have more city departments attend this training.

Having more volunteer resources would reduce the cost of paid staff.

Having city leaders attend such a training such as the mayor and city councilmen.

Numbers never work, don’t have enough staff or volunteers.

Understanding and access to Pioneer Valley Volunteer Plans.

APPENDIX C: ACRONYMS

Acronym Meaning

CDC Centers for Disease Control

COMM Communications

CONOPS Concept of Operations

EDS Emergency Dispensing Site

EOC Emergency Operations Center

ESF Emergency Support Function

IAP Incident Action Plan

IC Incident Command

ICS Incident Command System

IMT Incident Management Team

JIC Joint Information Center

LOFR Liaison Officer

MOA Memorandum of Agreement

MOU Memorandum of Understanding

MRC Medical Reserve Corps

NIMS National Incident Management System

OPS Operations

PIO Public Information Officer

SitRep Situation Report

SOG Standard Operating Guideline

SOP Standard Operating Procedure

UC Unified Command

WHO World Health Organization

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