Sound Shake 2010, The Aftershock Functional Exercise October 6-7, 2010

Transcription

1 Region 6 Health and Medical Area Command Public Health Seattle & King County King County Healthcare Coalition Sound Shake 2010, The Aftershock Functional Exercise October 6-7, 2010 After Action Report

2 Table of Contents I. Executive Summary 3-4 II. Exercise Overview 5-6 III. Exercise Objectives 7 IV. Exercise Events Synopsis 7 V. Analysis of Mission Outcomes for HMAC 8-9 VI. Analysis of Mission Outcomes for Healthcare 9-11 VII. Improvement Plan 12 2

3 I. Executive Summary On October 7 th and 8 th, 2010 Public Health Seattle & King County, along with healthcare partners, participated in Sound Shake 2010, The Aftershock (Soundshake), a functional exercise based upon a catastrophic earthquake scenario along the Seattle Fault. Public Health s exercise objectives were coordinated with regional partners and consistent with regional exercise objectives. Public Health participated for two 8 hour days. The following Target Capabilities were tested: Emergency Operations Center Management and Emergency Public Information and Warning. Healthcare partners across King County participated in Soundshake the Aftershock on the afternoon of October 6 th, Exercise play lasted 3 to 4 hours and each organization outlined their own internal objectives, using the regional healthcare objectives as a baseline for what they tested. Each organization defined their own level of play, and primarily utilized the opportunity to practice communications with Health and Medical Area Command, as well as with their local emergency management partners. The focus for healthcare partners during this exercise was on continuity of critical healthcare services. The catastrophic earthquake scenario projected over 1,600 deaths and 18,000 injuries, so providers assumed they would need to implement medical surge plans to address these issues. In order to surge they focused on staffing, resource management, security of their facilities, access to work sites, and the ability to continue providing in-home services. Several organizations tested internal security protocols; practiced walking through coordination issues in their emergency operations center, such as communicating with staff and/or loved ones of residents or patients; conducted decontamination drills; and tested communication mechanisms, such as WATrac and internal radios. A number of items were identified as successes within the Health and Medical Area Command Center (HMAC): Improved integration of vulnerable populations monitoring and outreach. Included a Liaison Officer position in the Area Command Center to coordinate with the city and county EOC s. Operations Section worked effectively to close out issues as they came up. Coordination between Section Chiefs in HMAC was efficient Communications Team provided timely messaging out of the regional Joint Information Center. Newly revised EOC Liaison manuals were a useful tool. Teamwork among HMAC staff was observed by the Evaluator, who also noted that meetings were kept on schedule, and injects were responded to in a timely manner. 3

4 A number of improvement planning items were identified including: Staff need to use the same nomenclature. Increase new staff s knowledge of NIMS. Logistics was understaffed. Need assessment of staffing to reassign based on demands of different Sections within the HMAC. More planning is needed for welfare checks for long term care facilities, and individuals receiving in-home care. Need to communicate better with partners about what information to post in WATRAC chat rooms. Need to develop a matrix as a quick reference guide to efficiently direct calls to the appropriate Section within HMAC. The Plans Section was performing operational tasks. Increase training for new staff on functions of each Section within HMAC. Need to develop a Feed Plan for patients in an Alternate Care Facility. Create job cards for Finance and Administration Section. Need better representation of Public Health s Divisions in the HMAC, e.g. Community Health Services and Environmental Health Divisions. Need to communicate ESF-8 HMAC Objectives more clearly to reduce competing interests among response partners. Brief HMAC staff and EOC Liaisons on current operation plans Overall, players noted the value of testing new functions within ESF-8 HMAC to enhance future response efforts. 4

5 II. Exercise Overview Exercise Name: Duration: Sound Shake 2010, The Aftershock 2 Days Exercise Date: October 6-7, 2010 Sponsor: Type of Exercise: Funding Source: Focus: Classification: Scenario: Location: Public Health Seattle & King County Functional Public Health Seattle & King County and ASPR Response Unclassified Earthquake ESF-8 Area Command Center, Seattle, Washington King County Regional Communications and Emergency Coordination Center, Renton, Washington City of Seattle Emergency Operations Center, Seattle, Washington Participants: Participating Healthcare Partners: Public Health Seattle & King County, Preparedness Section Public Health Seattle & King County, EOC Liaison Team King County Healthcare Coalition Auburn Regional Medical Center, Auburn Bastyr Center for Natural Health, Seattle CareAge Home Health, Bellevue CareForce, Seattle Country Doctor Community Health Centers, Seattle Enumclaw Health and Rehab, Enumclaw Evergreen Hospital Medical Center, Kirkland Fairfax Hospital, Kirkland Garden Terrace, Federal Way Group Health Continuing Care, Seattle Group Health Distribution Center, Tukwila Harborview Medical Center, Seattle Highline Medical Center, Burien Horizon House, Seattle International Community Health Services, Seattle Kindred Hospital, Seattle Mirabella, Seattle 5

6 New Care Concepts, Seattle North Creek Health and Rehab, Bothell Northwest Hospital, Seattle Overlake Hospital Medical Center, Bellevue Pacific Medical Centers, Seattle Puget Sound Blood Center, Seattle Providence Mt St Vincent, West Seattle Richmond Beach Rehab, Seattle Saint Anne Nursing and Rehab Center, Seattle Saint Francis Hospital, Federal Way Seattle Cancer Care Alliance, Seattle Seattle Medical Rehabilitation Center, Seattle Talbot Rehab, Renton The Polyclinic, Seattle The Washington Poison Center, Seattle Exercise Evaluation: Homeland Security Exercise Evaluation Program (HSEEP) Exercise Evaluation Guide Post Exercise Participant Evaluation 6

7 III. Exercise Objectives 1. Evaluate information sharing procedures between EOC Liaisons at Seattle and King County EOC s and HMAC. (Target Capability tested: Emergency Operations Center Management) 2. Assess usability of EOC Liaison tools to fulfill their role. (Target Capability tested: Emergency Operations Center Management) 3. Evaluate HMAC ability to maintain situational awareness, and share information with partners (Target Capabilities tested: Emergency Operations Center Management, Emergency Public Information and Warning) 4. Coordinate public information through a Joint Information Center (Target Capability tested: Emergency Public Information and Warning) The regional objectives outlined for healthcare were: 1. Evaluate flow of information between healthcare organizations, HMAC, and Local Emergency Management (Target Capability tested: Communications) 2. Determine effectiveness of communication systems to facilitate exchange of information from healthcare organizations to HMAC (Target Capability tested: Communications) 3. Assess resource request process from healthcare organizations to local emergency management and HMAC. (Target Capability tested: Medical Supplies Management and Distribution) 4. Determine need to implement lockdown and visitation policies to protect critical resources and mitigate community sheltering in the healthcare institution (Target Capability tested: Emergency Public Safety and Security Response) 5. Implement ICS and assess available labor pool resources (Target Capability tested: Medical Surge) 6. Identify impact of utility failure to essential services (Target Capability tested: Restoration of Lifelines) 7. Assess census and outline resource or additional capacity needed to maintain patient/client services (Target Capability tested: Medical Surge) IV. Exercise Events Synopsis The exercise scenario began on Day One at 24 hours after a 6.7 magnitude earthquake along the Seattle Fault. Day Two of the exercise began 48 hours after the earthquake. Play lasted 8 hours each day. 7

8 V. Analysis of Discussion Outcomes Based on Health and Medical Area Command Objectives 1. Evaluate information sharing procedures between EOC Liaisons at Seattle and King County EOC s and ESF-8 HMAC. Adding a Liaison Officer position in the HMAC provided better coordination between partner EOC s. Need to communicate ESF-8 HMAC Objectives more clearly to reduce competing interests among response partners. 2. Assess usability of EOC Liaison tools to fulfill their role. EOC Liaisons received training and updated procedure manuals prior to exercise, which increased their ability to perform response duties. Increase the number of trained PHSKC staff to serve as EOC Liaisons. Request King County RCECC training to ensure EOC Liaisons are familiar with their roles within the facility. 3. Evaluate ESF-8 HMAC ability to maintain situational awareness, and share information with partners. HMAC Section Chief briefings were kept on schedule and efficient. Improved integration of vulnerable populations monitoring and outreach. Strengthen welfare checks planning for home health agencies and long term care facilities. Need to communicate better with partners about what information to post in WATRAC chat rooms. The Plans Section was performing operational tasks. Increase training for new staff on functions of each Section within HMAC. Need to develop a Feed Plan for patients in an Alternate Care Facility. Create job cards for Finance and Administration Section. 8

9 4. Coordinate public information through a Joint Information Center. Communications Team provided timely messaging out of the regional Joint Information Center. none documented VI. Analysis of Outcomes Based on Region 6 Healthcare Objectives 1. Evaluate flow of information between healthcare organizations, HMAC, and Local Emergency Management. Healthcare partners felt the snapshot reports and situation reports coming out of HMAC were valuable tools. Conference call with healthcare was confusing. Background noise created distraction from the information provided and information was lacking. Holding a conference call jointly for all healthcare partners was a drill artificiality. Future events should include separate calls for healthcare sectors as appropriate and sector specific information. Regional snapshot information, such as shelters, utility impacts and roads will be needed from KCECC and was captured in their after action review as an area for improvement. 2. Determine effectiveness of communication systems to facilitate exchange of information from healthcare organizations to HMAC. WATrac Command Center rooms are the preferred primary method of communication for hospitals, while ambulatory care and other healthcare sectors prefer as the primary method of communication. Communication via phone with HMAC proved more effective for organizations that did not feel proficient in WATrac. Recommend exercises or training modules to help familiarize staff with WATrac functions on a regular basis. 9

10 Conference call procedures from HMAC staff needs evaluation. Partners reported too many acronyms were used and information was delivered too quickly to capture. Recommend providing information solely using WATrac or other mechanisms 3. Assess resource request process from healthcare organizations to local emergency management and HMAC. Healthcare partners simulated shortage of supplies and staff. Reported positive learning s in taking time to evaluate medical supplies and assess vendor availability. none documented 4. Determine need to implement lockdown and visitation policies to protect critical resources and mitigate community sheltering in the healthcare institution. Organizations that tested this objective reported a positive interaction and support from their local police department for security assistance with lockdown. Clinics had difficulty testing this element during business hours, but did identify a need for better planning in this area. Evergreen hospital had a very positive experience coordinating with the City of Kirkland for law enforcement resources and support. 5. Implement ICS and assess available labor pool resources. All organizations reported success with this task. Several reported the need for more training for leadership and staff. 6. Identify impact of utility failure to essential services. Not tested by all. Some reported positive education opportunity with City EOC regarding critical hospital services dependant on water. none documented 10

11 7. Assess census and outline resource or additional capacity needed to maintain patient/client services. Home health organizations implemented zip coding to determine which staff would make specific client visits. These organizations have mapped their staff by zip code to best match clients with staff in the same geographic area in times of emergency. Most healthcare partners simulated medical surge and tested this capability by evaluating medical staff resource availability. Further surge planning is needed in ambulatory care and pharmacy sectors. Summary of Lessons Learned from Region 6 Healthcare Partners 34% (11/32) of healthcare players returned their evaluation forms. Most objectives were met, however all organizations did not necessarily test every regional objective. In summary, all participants felt well supported by HMAC. Challenges with WATrac occurred due to lack of training and a need for clear delineation of Command Center rooms which room is for which healthcare sector and a description of the purpose of the room, i.e. information sharing/gathering, etc. Otherwise the exercise was highly successful and very well received by healthcare partners. Several organizations captured lessons learned regarding updating capabilities within their emergency operations centers and with their communication plans. The healthcare conference call was found to be a challenge due to the following factors: the staff conducting the call from HMAC were new to the role of running the call; callers did not abide by conference call etiquette which caused significant background noise and distraction; and regional information on impacts of the event was limited due to slow reports from the King County Emergency Coordination Center. All of these lessons will help improve future responses, and will be outlined in regional and organizational improvement plans as appropriate. 11

12 VII. Improvement Plan Action Update HMAC Plans Section Job Action Sheets for Healthcare Situation Status to include reminders in notes for conference calls to establish etiquette ground rules at onset of call and eliminate use of acronyms Responsible Party HMAC Plans Section Estimated Completion Date May 2011 Status Notes Provide training and drill opportunities for WATrac on regular basis to keep users familiar with system Update HMAC Job Action Sheets for Healthcare Situation Status to include sector specific Command Center rooms for WATrac Ensure new staff are trained on ICS positions Create Job Cards for Admin/Finance Section WATrac Staff February 2011 WATrac Exercise Toolkit currently under HMAC Plans Section Preparedness Managers Finance Chief May 2011 development Develop Feed Plan for patients in ACF Logistics Chief Increase EOC Liaison team members, and identify training needs Brief Preparedness Staff and EOC Liaisons on operational plans. Strengthen planning for long term care and in home care agency s welfare checks protocol, and communicate to HMAC staff and partners Exercise and Training Manager Exercise and Training Manager; Preparedness Managers Healthcare Coalition Manager 12