Situation Manual Tabletop Exercise 1 Disaster Resistant Communities Group s1

Situation Manual

Time Allotted 355 Minutes

Situation Manual – Tabletop Exercise 1 Disaster Resistant Communities Group – www.drc-group.com Operation Earthquake Endurance – Start Exercise Exercise Briefing

During the exercise it will be important to remember and comply with the following statements:

 You should only use Internet Explorer as your internet browser for today’s Exercise.  It is important NOT to jump ahead in the exercise scenario. In other words don’t focus on what might happen, focus on the Common Operating Picture that is presented during the exercise to make informed decisions.  In any exercise a number of assumptions and artificialities may be necessary to complete play in the time allotted. During this exercise, the following apply: 1. The scenario is plausible, and events occur as they are presented. 2. There is no “hidden agenda”, nor any trick questions.  Exercise Basics: 1. This exercise contains a total of 22 scenario and inject pages. 2. The exercise is self-paced and it should take approximately three hours to complete. However, based on the time spent on each scenario and inject the exercise may be completed in under three hours or it may take much longer than three hours to complete the exercise. 3. There is a scheduled 15 minute break approximately half way through the exercise. 4. All videos embedded within this exercise can be enlarged to FULL SCREEN by simply clicking on the full screen icon in the lower right hand corner of the video. 5. Thoroughly review all scenario information and injects as they are presented during the exercise.  At the end of the exercise you will need to complete an evaluation (Hotwash) on how your team preformed during the exercise. The Hotwash will consist of your team providing comments on three areas in which it performed well (Strengths) and three areas your team will need to improve upon (Areas for Improvement) to enhance its preparedness, response and recovery capabilities. Found below are Hotwash examples:

Strengths – During the exercise our team consulted our disaster plans and procedures and found them to be complete. Areas for Improvement – During the exercise our team consulted our disaster plans and procedures and found portions of the plans and procedures that need to be revised.

 After the exercise each registered participant who took part in the exercise will receive an e-mail to log into the ONX System to complete their Individual Hotwash to access their Certificate of Participation.

Situation Manual – Tabletop Exercise 2 Disaster Resistant Communities Group – www.drc-group.com  If you need assistance anytime during the exercise please call the Help Desk at: Phone Number – 605-475-4700 Account Number – 1076890# Time Allotted 20 Minutes

Situation Manual – Tabletop Exercise 3 Disaster Resistant Communities Group – www.drc-group.com Operation Earthquake Endurance – Inject – # 001 Image of Family Preparedness

Tuesday Earthquake – Minus 1 Day

Residing in a community that is Disaster Ready is the first step in being able to respond to and recover from any disaster or emergency. Yes No

Is the hospital involved in assisting its employees in preparing themselves, their families and their homes for an earthquake and other disasters or emergencies that may strike the region? If the above answer is yes. – List in detail the various disaster preparedness and / or mitigation activities the hospital undertakes to assist its employees and their families to be prepared for an earthquake.

(Example: Our web site contains an entire section regarding earthquake preparedness and mitigation.)

If the above answer is no. – Briefly explain the reason the hospital is not involved in assisting its employees and their families to prepare for an earthquake or other types of disasters.

(Note: For future reference you may want to access the Just In Time Disaster Training Video Library for additional information on Earthquake Preparedness. These videos are too long to view during today’s exercise. Home Earthquake Mitigation / Family Disaster Planning / Preparing a Disaster Supply Kit) – OPTIONAL Time Allotted 15 Minutes

Situation Manual – Tabletop Exercise 4 Disaster Resistant Communities Group – www.drc-group.com Operation Earthquake Endurance – Scenario – # 002 Image of Normal Hospital Activities

Wednesday 10:11AM

It is Wednesday morning and the region’s weather is normal for this time of year, however the local forecast office of the National Weather Service is predicting an increased chance of severe weather within the next 24 hours. The severe weather has the potential of producing heavy rain which could cause localized flooding.

The hospital is experiencing a normal patient load for a weekday and is staffed accordingly.

The current bed count is 97% of occupancy. Time Allotted 10 Minutes

Situation Manual – Tabletop Exercise 5 Disaster Resistant Communities Group – www.drc-group.com Operation Earthquake Endurance – Scenario – # 003 Image of Supplies Under normal conditions the hospital maintains a four to five day inventory of consumable supplies.

Supplies are normally ordered throughout the week, however due to above normal consumption of inventoried supplies a large re-supply order was placed on Tuesday with various vendors.

The supplies are scheduled for delivery on Thursday. Time Allotted 10 Minutes

Situation Manual – Tabletop Exercise 6 Disaster Resistant Communities Group – www.drc-group.com Operation Earthquake Endurance – Inject – # 004 Image of Earthquake Striking

Wednesday 5:19PM Day 1 Earthquake Strikes

At 5:19PM residents throughout the area begin to feel the ground roll and shake.

CLICK ON POD CAST TO PLAY

Podcast Library – # 04 – Earthquake

Briefly describe the Protective Actions that hospital staff members, patients, visitors, and others should take as the earthquake strikes.

Initial seismic reports indicate that a 6.1 magnitude earthquake has occurred.

(Note: For future reference you may want to access the Just In Time Disaster Training Video Library for additional information on the Evacuation of Healthcare Facilities. This video is too long to view during today’s exercise. Evacuation of Healthcare Facilities) – OPTIONAL Time Allotted 15 Minutes

Situation Manual – Tabletop Exercise 7 Disaster Resistant Communities Group – www.drc-group.com Operation Earthquake Endurance – Inject – # 005 Image of HICS

Wednesday 5:43PM Day 1

Yes No As the hospital initiates its response to the earthquake will it utilize the Hospital Incident Command System (HICS) to effectively and efficiently manage its response and recovery activities? If the above answer is yes. – Identify the name and job title of the primary, secondary and tertiary individuals that are responsible for making this decision.

Briefly describe the process for notifying and mobilizing the necessary hospital staff members that will be needed to establish HICS.

(Note: By now it is early Wednesday evening and most of the hospital’s management left before the earthquake struck.)

If the above answer is no. – Briefly explain why the hospital will not implement HICS at this time.

(Note: For future reference you may want to access the Just In Time Disaster Training Library for additional information on the Hospital Incident Command System (HICS). These videos are too long to view during today’s exercise. Hospital Incident Command System: An Overview / HICS for Hospital Staff / HICS for Physicians) – OPTIONAL Time Allotted 15 Minutes

Situation Manual – Tabletop Exercise 8 Disaster Resistant Communities Group – www.drc-group.com Operation Earthquake Endurance – Inject – # 006 Image of Hospital Command Center The decision has been made to fully implement the hospital’s Emergency Operations Plan (EOP) and establish HICS. Employees assigned to the various ICS positions have been arriving at the hospital’s Incident Command Center (HCC) for the past 20 minutes.

Identify the individuals that will fulfill the various ICS positions and briefly describe the responsibility for each position.

(Example: Position: Public Information Officer – June Carter – Will serve as the point of contact for all media inquiries, prepare appropriate media advisories and press releases as well as monitor news outlets including Social Media.)

Operation Earthquake Endurance – Inject – # 007 Image of Earthquake Damage Situation Manual – Tabletop Exercise 9 Disaster Resistant Communities Group – www.drc-group.com Wednesday 5:48PM Day 1

Once conditions permit it will be important for the hospital to assess the condition of its facilities.

Identify the name and job title of the primary, secondary and tertiary individuals that will have the responsibility of coordinating the hospital’s Damage Assessment.

Does the hospital have an adequate number of employees trained in how to conduct Damage Yes No Assessment? If the above answer is no. – Prepare a brief training action plan to teach Damage Assessment procedures to hospital employees.

Describe in detail how the hospital will undertake Damage Assessment.

(Note: If Damage Assessment Forms are not currently a part of the hospital’s EOP you may want to access the following examples for possible inclusion into the Hospital’s EOP – Building – Contents.)

Situation Manual – Tabletop Exercise 10 Disaster Resistant Communities Group – www.drc-group.com Operation Earthquake Endurance – Scenario – # 008 Image of Structural Damage Damage Assessment Teams have completed the preliminary damage assessment of the hospital.

The Damage Assessment Report indicates the hospital did not sustain any significant damage that may put employees, patients or visitors in immediate danger or require patient or employee evacuation at this time. Time Allotted 10 Minutes

Situation Manual – Tabletop Exercise 11 Disaster Resistant Communities Group – www.drc-group.com Operation Earthquake Endurance – Inject – # 009 Image of IAP

Based on the hospital’s Emergency Operations Plan (EOP) and current information regarding the earthquake prepare a prioritized checklist known as an Incident Action Plan (IAP) that focuses on the INITIAL RESPONSE activities the hospital will undertake during the next 24 hours.

Ensure that all objectives are completed using Specific, Measurable, Attainable, Relevant and Time-Bound (SMART) methodology.

In preparing the IAP list the objectives; identify all resources that will be needed to accomplish each listed objective; and list the expected timeline to complete each identified objective.

(Note: Access a list of Potential Operation Concerns to be considered in developing this IAP.)

(Example: Objective: Communicate with county Emergency Operations Center (EOC) to determine extent of damage to critical infrastructure and services. / Required Resources: Resource Contact List. / Timeline: 15 Minutes.)

Situation Manual – Tabletop Exercise 12 Disaster Resistant Communities Group – www.drc-group.com Operation Earthquake Endurance – Inject – # 010 Image of Hospital Surge

A surge of people have been arriving at the hospital as a result of the earthquake. These include both injured persons and the worried-well.

In addition to ensuring the hospital has the ability to sustain its normal operations it is now faced with a Medical Surge that may exceed its current capabilities. Does the hospital have a written Medical Surge Plan? Yes No If the above answer is yes. – Identify the trigger point(s) for activations of the hospital’s Medical Surge Plan.

Describe in detail how Medical Surge will be implemented and managed for this event.

If the above answer is no. – Briefly explain why the hospital will not activate its Medical Surge Plan.

List the available locations within the hospital, other than the space within the Emergency Department (ED), which will be made available to support patient treatment as part of the Medical Surge Plan.

(Examples: Exam Rooms, Conference Rooms, etc.)

Situation Manual – Tabletop Exercise 13 Disaster Resistant Communities Group – www.drc-group.com Operation Earthquake Endurance – Inject – # 011 Image of Hospital Bed Will the hospital temporarily suspend non-essential functions (Elective Surgeries, Regular Yes No Doctor Appointments, Clinic Consultations, etc.) based on the current conditions and its EOP? If the above answer is yes. – Prepare a list of non-essential functions that will be temporarily suspended.

Briefly describe how the decision to temporarily suspend certain non-essential functions will be conveyed to patients that are not currently at the hospital. In other words, describe how patients will be notified that certain activities have been temporarily suspended.

(Note: Remember that phone and internet services are probably down due to the earthquake.)

If the above answer is no. – Briefly explain the reason for not temporarily suspending certain non-essential functions.

Situation Manual – Tabletop Exercise 14 Disaster Resistant Communities Group – www.drc-group.com Operation Earthquake Endurance – Inject – # 012 Image of Supplies Based on current conditions, does the hospital believe it has an adequate amount of consumable supplies and essential equipment to handle the patient surge and to remain Yes No operational for at least the next 4 days? If the above answer is no. – Prepare a list of potential resource shortfalls for the hospital.

(Example: Fuel for generator.)

Under current conditions, briefly explain how consumable supplies and / or essential equipment will be obtained.

Situation Manual – Tabletop Exercise 15 Disaster Resistant Communities Group – www.drc-group.com Operation Earthquake Endurance – Inject – # 013 Image of Guidance

Describe in detail what the hospital’s employees, who are not currently working a shift at the hospital, will be told when notified the hospital has activated its Emergency Operations Plan (EOP) and the Hospital Incident Command System (HICS).

Situation Manual – Tabletop Exercise 16 Disaster Resistant Communities Group – www.drc-group.com Operation Earthquake Endurance – Scenario – # 014 Image of Earthquake Damage

Once areas affected by the earthquake become accessible local and regional emergency response personnel initiate life safety operations. From conducting needs assessment to carrying out search and rescue operations law enforcement agencies, fire departments, EMS, emergency management officials and various volunteer organizations are working together to meet the immediate earthquake caused needs of the area’s residents.

In the hours following the earthquake, local television is filled with images of damaged homes, commercial buildings, roads and bridges.

Preliminary Damage Assessment – Essential Services

 Utility providers are reporting that 75% of their customers are currently without electrical power.  The hospital is operating on generator power.  The natural gas and sewer lines serving the hospital have been damaged.  Mobile phone service has been disrupted and is not reliable in many areas.  Most of the roads and streets surrounding the hospital are accessible.  Telecommunication providers are reporting that 70% of landline phone service is down.  The water tower providing drinking water to the hospital has been damaged and the water pressure has been steadily falling for the past several hours.

Preliminary Damage Assessment – Residences

Found below are the Initial estimates of damage to homes:

Level of Damage Percentage of Homes Damaged Minor 27% Major 8% Destroyed 3%

Situation Manual – Tabletop Exercise 17 Disaster Resistant Communities Group – www.drc-group.com Time Allotted 10 Minutes

Situation Manual – Tabletop Exercise 18 Disaster Resistant Communities Group – www.drc-group.com Operation Earthquake Endurance – Inject – # 015 Image of Staff Sheltering

Yes No Does the hospital have a Staff / Family Sheltering Plan for its employees and their family members to stay at the hospital to ensure the hospital is adequately staffed? If the above answer is yes. – Briefly describe the plan and how it will be implemented and managed.

Prepare a list of consumable supplies and equipment that will be needed for the hospital to set-up such a shelter.

(Example: Equipment: Cots / Quantity: 100)

If the above answer is no. – Briefly explain why the hospital will not provide shelter for employees and their families following an earthquake.

(Note: Found below are plans, procedures, forms, guidelines, etc. that could be useful in establishing, managing and demobilizing the hospital’s Staff / Family Shelter. These resources may be useful in developing or revamping a Staff / Family Sheltering Plan.)

Shelter Guidelines Shelter Registration Form PDF Shelter Fundamentals Checklist PDF Sheltering Handbook PDF

(Note: For future reference you may want to access the Just In Time Disaster Training Library for additional information on Shelter Operations. These videos are too long to view during today’s exercise. Shelter Operations) – OPTIONAL Time Allotted 15 Minutes

Situation Manual – Tabletop Exercise 19 Disaster Resistant Communities Group – www.drc-group.com Operation Earthquake Endurance – Inject – # 016 Image of Patients Describe how communications will be established and maintained with the families of patients that were in the hospital at the time of the earthquake.

(Note: Remember that phone and internet services have been disrupted due to the earthquake.)

Situation Manual – Tabletop Exercise 20 Disaster Resistant Communities Group – www.drc-group.com Operation Earthquake Endurance – Inject – # 017 Image of Money

Thursday 8:03AM Day 2

The hospital’s Incident Management Team (IMT) is currently conducting the morning Incident Briefing.

As part of the briefing the Incident Commander introduces the Finance / Administration Section Chief. This individual is responsible for tracking and documenting all expenses (Overtime Pay, Consumable Supplies, Equipment, etc.) that will be incurred by the hospital during its response to and recovery from the earthquake.

Describe in detail the process the hospital will use to track and document these expenses.

Situation Manual – Tabletop Exercise 21 Disaster Resistant Communities Group – www.drc-group.com Operation Earthquake Endurance – Inject – # 018 Image of Social Media A new inexperienced hospital employee who believes there will not be enough workers to properly staff the hospital sends the following Tweet.

“Due to the #earthquake the #hospital will possibly need #volunteers to help meet the needs of our #patients. If you would like to #volunteer please call or come by the hospital. #NursesNeeded #NeedHelp #AssistanceNeeded #RedCross”

Moments later the message has gone viral as numerous individuals have Retweeted the message. Does the hospital have a policy regarding the use of Social Media by its employees? Yes No If the above answer is yes. – Briefly describe the hospital’s Social Media policy.

Briefly explain how the hospital will mitigate such a Tweet.

(Note: For future reference you may want to access the Just In Time Disaster Training Library for additional information on How People Use Social Media During Disasters. This video is too long to view during today’s exercise. How People Use Social Media During Disasters) – OPTIONAL Time Allotted 15 Minutes

Situation Manual – Tabletop Exercise 22 Disaster Resistant Communities Group – www.drc-group.com Operation Earthquake Endurance – Inject – # 019 Image of CBS News

Thursday 11:19AM Day 2

Robert Geha with ABC is on the phone asking a number of questions:  Will the hospital be able to keep its doors open?  Will the hospital be able to maintain all of its services or will it need to scale back?  If the hospital has to scale back what services will be suspended?  If a local resident wants to volunteer to help at the hospital who should they contact? Describe in detail how the hospital will manage inquiries from the media.

Does the hospital plan to utilize Social Media Networks such as Facebook or Twitter to help Yes No manage the flow of information to the public? If the above answer is yes. – Describe in detail the hospital’s plan for utilizing Social Media.

(Note: For future reference you may want to access the Just In Time Disaster Training Library for additional information on Dealing with the Media During Disasters. This video is too long to view during today’s exercise. Dealing with the Media During Disasters) – OPTIONAL Time Allotted 15 Minutes

Situation Manual – Tabletop Exercise 23 Disaster Resistant Communities Group – www.drc-group.com Operation Earthquake Endurance – Inject – # 020 Image of Support Agencies Will local and / or state outside agencies and / or organizations be notified of the current Yes No conditions at the hospital? If the above answer is yes. – Identify the agencies and / or organizations that will need to be notified.

If the above answer is no. – Briefly explain why contact with outside agencies and / or organizations will not be made.

Using the phone contact one of the agencies and / or organizations identified above.

Begin the conversation with “THIS IS AN EXERCISE” and end the conversation with “THIS IS AN EXERCISE”.

Upon contacting the agency or organization ask what resources could be made available to the hospital based on current conditions. Time Allotted 15 Minutes

Situation Manual – Tabletop Exercise 24 Disaster Resistant Communities Group – www.drc-group.com Operation Earthquake Endurance – Inject – # 021 Image of Communications

Thursday 2:47PM Day 2

Telecommunications (Phone, Cable, etc.) providers are reporting that various communications systems, including access to the internet, will be disrupted for at least the next week to ten days.

In addition the antennas supporting the hospital’s radios have been badly damaged severely limiting emergency radio communications. Describe in detail how communications will be maintained with:

 Emergency Responders (EMS, Fire Department, Police Department, etc.)  Other healthcare providers (Hospitals, Public Health, Clinics, etc.)  Vendors

Situation Manual – Tabletop Exercise 25 Disaster Resistant Communities Group – www.drc-group.com Operation Earthquake Endurance – Inject – # 022 Image of Debriefing

Friday 5:47PM Day 3

By the end of day 3 many of the hospital’s staff members have been working non-stop since the earthquake and are beginning to show signs of fatigue and stress. In addition staff members have been unable to communicate with family members due to the Yes No telecommunications failure. These staff members are worried about family members, pets and the condition of their homes.

Will the hospital provide Critical Incident Stress Management (CISM) Debriefings for its employees? If the above answer is yes. – Briefly explain how the debriefings will be provided to hospital employees.

If the above answer is no. – Explain why the hospital will not provide this service.

(Note: For future reference you may want to access the Just In Time Disaster Training Library for additional information on Behavioral Health Care Operations. These videos are too long to view during today’s exercise. Behavioral Health Care Operations) – OPTIONAL Time Allotted 15 Minutes

Situation Manual – Tabletop Exercise 26 Disaster Resistant Communities Group – www.drc-group.com Operation Earthquake Endurance – Inject – # 023 Image of Downsizing

Monday 8:07AM Day 6

During this morning’s Incident Briefing the Incident Commander reports that conditions throughout the community have continued to improve over the weekend. Damage to homes has not been as extensive as first reported and much of the electrical systems have come back on-line.

However the hospital is still dealing with current and new challenges as it continues working through the recovery process. Based on current known conditions and the hospital’s EOP develop an Incident Action Plan (IAP) that focuses on activities associated with RETURNING TO NORMAL OPERATIONS.

In preparing the IAP list the objectives; identify all resources that will be needed to accomplish each listed objective; and list the expected timeline to complete each identified objective.

(Example: Objective: Review the list of non-essential functions that were suspended to determine which ones can be brought back on-line. / Required Resources: List of available staff and resources that will be needed to re-establish each suspended functions. / Timeline: 3 Hours.)

Situation Manual – Tabletop Exercise 27 Disaster Resistant Communities Group – www.drc-group.com