Ebola Cherries Tabletop Exercise

Transcription

1 Tabletop Exercise After-Action Report/Improvement Plan December 29, 2014 The After-Action Report/ aligns exercise objectives with preparedness doctrine to include the National Preparedness Goal and related frameworks and guidance, the National Guidance for Healthcare System Preparedness, and the National Standards for State and Local. Exercise information required for preparedness reporting and trend analysis is included. A Maine CDC Partner

2 EXERCISE OVERVIEW Exercise Name Tabletop Exercise (TTX) Exercise Dates December 18, 2014 Scope Mission Area(s) Core Capabilities Objectives Threat or Hazard Scenario This exercise is a tabletop exercise planned for one-half day at the Central Maine Medical Center in Lewiston, Maine. Exercise play is limited to members of the Central Maine Healthcare Coalition. Response Emergency Operations Coordination Information Sharing Medical Surge Responder Safety and Health Discuss how healthcare, Emergency Medical Services (EMS), and public health agencies will coordinate and implement emergency response activities to manage patients diagnosed with Ebola Virus Disease (EVD) in accordance with Emergency Operations Plans (EOPs). Discuss how healthcare, EMS, and public health agencies will coordinate with local and state agencies to share and disseminate EVD incident related information in accordance with EOPs. Discuss how healthcare, EMS, and public health agencies will continue to provide care during an EVD incident that exceeds the limits of the normal medical infrastructure in accordance with EOPs. Discuss how healthcare, EMS, and public health agencies will protect employees while providing treatment and care to patients diagnosed with EVD in accordance with EOPs. Natural Ebola Virus Disease The 2014 Ebola Hemorrhagic Fever outbreak is the largest Ebola outbreak in history and the first in West Africa. A traveler entering the United States does not disclose information when asked about contact with symptomatic Ebola patients and ultimately tests Maine s ability to respond to the challenges associated with the disease. Exercise Overview 1 Central Maine Regional Resource Center

3 Sponsor Participating Organizations Points of Contact Central Maine Regional Resource Center (CMRRC), A Maine Center for Disease Control and Prevention (Maine CDC) Partner Participation will include Central Maine Healthcare Coalition members. Please refer to Appendix B for additional information. Kara Tudman Walker Central Maine Regional Resource Center 300 Main Street Lewiston, Maine [email protected] Kris Gammon Central Maine Regional Resource Center 300 Main Street Lewiston, Maine [email protected] Exercise Overview 2 Central Maine Regional Resource Center

4 ANALYSIS OF CORE CAPABILITIES Aligning exercise objectives and core capabilities provides a consistent taxonomy for evaluation that transcends individual exercises to support preparedness reporting and trend analysis. Table 1 includes the exercise objectives, aligned core capabilities, and performance ratings for each core capability as observed during the exercise and determined by the evaluation team. Table 1. Summary of Core Capability Performance Objective Discuss how healthcare, EMS, and public health agencies will coordinate and implement emergency response activities to manage patients diagnosed with EVD in accordance with EOPs. Discuss how healthcare, EMS, and public health agencies will coordinate with local and state agencies to share and disseminate EVD incident related information in accordance with EOPs. Discuss how healthcare, EMS, and public health agencies will continue to provide care during an EVD incident that exceeds the limits of the normal medical infrastructure in accordance with EOPs. Discuss how healthcare, EMS, and public health agencies will protect employees while providing treatment and care to patients diagnosed with EVD in accordance Capability Emergency Operations Coordination Information Sharing Medical Surge Responder Health and Safety without Challenges (P) with Some Challenges (S) S S S S with Major Challenges (M) Unable to be (U) Analysis of Capabilities 3 Central Maine Regional Resource Center

5 Objective Capability without Challenges (P) with Some Challenges (S) with Major Challenges (M) Unable to be (U) with EOPs. Ratings Definitions: without Challenges (P): The targets and critical tasks associated with the core capability were completed in a manner that achieved the objective(s) and did not negatively impact the performance of other activities. Performance of this activity did not contribute to additional health and/or safety risks for the public or for emergency workers, and it was conducted in accordance with applicable plans, policies, procedures, regulations, and laws. with Some Challenges (S): The targets and critical tasks associated with the core capability were completed in a manner that achieved the objective(s) and did not negatively impact the performance of other activities. Performance of this activity did not contribute to additional health and/or safety risks for the public or for emergency workers, and it was conducted in accordance with applicable plans, policies, procedures, regulations, and laws. However, opportunities to enhance effectiveness and/or efficiency were identified. with Major Challenges (M): The targets and critical tasks associated with the core capability were completed in a manner that achieved the objective(s), but some or all of the following were observed: demonstrated performance had a negative impact on the performance of other activities; contributed to additional health and/or safety risks for the public or for emergency workers; and/or was not conducted in accordance with applicable plans, policies, procedures, regulations, and laws. Unable to be (U): The targets and critical tasks associated with the core capability were not performed in a manner that achieved the objective(s). The following sections provide an overview of the performance related to each exercise objective and associated core capability, highlighting strengths and areas for improvement. Analysis of Capabilities 4 Central Maine Regional Resource Center

6 Objective 1 Discuss how healthcare, EMS, and public health agencies will coordinate and implement emergency response activities to manage patients diagnosed with EVD in accordance with EOPs. Capability Emergency Operations Coordination Strengths Strength 1: Excellent teamwork throughout the discussion. Strength 2: Willingness of group to help each other. Strength 3: Recognition that there are considerable resources in the area to pull from. Strength 4: Although the TTX was specific to Ebola response and planning, efforts to date can be broadened to other infectious diseases. Strength 5: Great understanding of roles and responsibilities among local facilities, regional, state agencies. Areas for Improvement The following areas require improvement: Area for Improvement 1: Organizations did not know how to access the law enforcement Ebola regional response team. Area for Improvement 2: Organizations are unclear when a CDC Rapid Ebola Preparedness (REP) team would be dispatched and under what conditions. Area for Improvement 3: Not enough EMS representation at the exercise. Area for Improvement 4: There is no electronic forum for coalition members to collaborate between coalition meetings/exercises. Area for Improvement 5: No standardized way to request regional and Maine CDC resources. Area for Improvement 6: Members need a better understanding of the State of Maine Regional Ebola, Assessment, Care and Transport (REACT) Plan. Many coalition members plan to use CAH, local EMS etc. Area for Improvement 7: EMS procedures still fluid and based on agency vs. uniform response. Not at the same level. Area for Improvement 8: Receiving procedures for each hospital in patient hand off is different. Analysis of Capabilities 5 Central Maine Regional Resource Center

7 References: State of Maine Regional Ebola, Assessment, Care and Transport Plan; U.S. CDC Ambulatory Care Evaluation and Emergency Department Evaluation Guidance; U.S. CDC Epidemiological Risk Factor Guidance Analysis: Although the REACT Plan provides some guidance regarding how to respond to an EVD situation, further information and plans are needed in order to coordinate a regional response. Objective 2 Discuss how healthcare, EMS, and public health agencies will coordinate with local and state agencies to share and disseminate EVD incident related information in accordance with EOPs. Capability Information Sharing Strengths Strength 1: The coalition provides for a good hub for communications. Strength 2: The participants had a very good working knowledge of EVD. Strength 3: Coalition members have complete or near complete plans and they are fairly similar. Strength 4: Good collaboration among participants that resulted in shared plans, resources and information. Strength 5: Use of local healthcare facility Public Information Officers (PIO) to disseminate information via established local networks in order to share incident information with the public. The lead PIO would be the facility experiencing the incident. Areas for Improvement The following areas require improvement: Area for Improvement 1: Unsure if Maine CDC s PIO, John Martins, has contact information and relationship with regional hospital s PIOs. Area for Improvement 2: No conference line is available to coordinate information sharing between coalition members. References: State of Maine Regional Ebola, Assessment, Care and Transport Plan Analysis: Coalition communications regarding event response has not been detailed in a plan regarding information sharing and coordination of messaging. Analysis of Capabilities 6 Central Maine Regional Resource Center

8 Objective 3 Discuss how healthcare, EMS, and public health agencies will continue to provide care during an EVD incident that exceeds the limits of the normal medical infrastructure in accordance with EOPs. Capability Medical Surge Strengths Strength 1: Coalition members discussed plans in place for transfer of patients if needed. Strength 2: Positive atmosphere, no politics just everyone working on our shared mission Areas for Improvement The following areas require improvement: Area for Improvement 1: Potential for waste issues if there is a medical surge. Reference: U.S. CDC Ebola-Associated Waste Management Guidance Analysis: Waste management has not been addressed at a regional level in the event that there are multiple EVD patients generating waste. Objective 4 Discuss how healthcare, EMS, and public health agencies will protect employees while providing treatment and care to patients diagnosed with EVD in accordance with EOPs. Capability Responder Health and Safety Strengths Strength 1: A significant amount of planning has taken place already. Strength 2: Coalition members have specific plans to address Responder Health and Safety. Areas for Improvement The following areas require improvement: Area for Improvement 1: Resources for decontamination of a non-regional EMS ambulance are unclear. Establish Memorandums of Understanding (MOUs) with other larger communities. Analysis of Capabilities 7 Central Maine Regional Resource Center

9 Reference: Guidance on Personal Protective Equipment To Be Used by Healthcare Workers During Management of Patients with Ebola Virus Disease in U.S. Hospitals, Including Procedures for Putting On (Donning) and Removing (Doffing) Analysis: Although the REACT Plan provides some guidance regarding how to respond to an EVD situation, further information and plans are needed in order to coordinate with local EMS. Analysis of Capabilities 8 Central Maine Regional Resource Center

10 APPENDIX A: IMPROVEMENT PLAN This IP has been developed specifically for the Central Maine Healthcare Coalition as a result of the Tabletop Exercise conducted on December 18, Capability Issue/Area for Improvement Corrective Action Capability Element Primary Responsible Organization Organization POC Start Date Completion Date Organizations did not know how to access the law enforcement Ebola regional response team. Ensure there is law enforcement contact information in state and regional plans. Maine CDC/CMRRC Jane Coolidge/Kara Walker November 2014 Emergency Operations Coordination Organizations are unclear when a CDC Rapid Ebola Preparedness (REP) team would be dispatched and under what conditions Not enough EMS representation at the exercise. Contact US CDC and determine details regarding support team to incorporate into plan Pursue additional EMS providers to participate Organization Maine CDC CMRRC Mary McElman Kara Walker/Kris Gammon February February There is no electronic forum for coalition members to collaborate between coalition meetings/exercises. Investigate the feasibility of the creation of an open forum on web-site for members to ask questions of one another. CMRRC Kara Walker/Kris Gammon February Appendix A: Improvement Plan A-1 Central Maine Regional Resource Center

11 No standardized way to request regional and Maine CDC resources. The development of a standardized resource request form. Maine CDC/CMRRC Joe Legee/Kara Walker March Emergency Operations Coordination Members need a better understanding of the State of Maine Regional Ebola, Assessment, Care and Transport (REACT) Plan. EMS procedures still fluid and based on agency vs. uniform response. Not at the same level. Invite CDC and EMS to discuss REACT plan. Tabletop of REACT Plan. Regional response plan that has been discussed needs to be completed. Complete statewide EMS response plan/training. Training/Exercise /Training CMRRC CMRRC Kara Walker/Kris Gammon Kara Walker/Kris Gammon January January Receiving procedures for each hospital in patient hand off is different. To reduce confusion should uniform process be developed? SMRMC Mike Hatch February Information Sharing Unsure if Maine CDC s PIO, John Martins, has contact information and relationship with regional hospital s PIOs. Contact John Martins to determine relationship with regional hospital PIOs. Organization Maine CDC Nate Riethmann January Appendix A: Improvement Plan A-2 Central Maine Regional Resource Center

12 Information Sharing No conference line is available to coordinate information sharing between coalition members. Establish a static conference call line for coalition information sharing. CMRRC Kara Walker/Kris Gammon January April Medical Surge Potential for waste issues if there is a medical surge. Determine waste management constraints with waste removal contractor and include in plan. SMRMC/CMRRC/Maine CDC Kevin Oliveira/Kara Walker/Joe Legee February Responder Health and Safety Resources for decontamination of a non-regional EMS ambulance are unclear. Explore having MOUs with other larger communities. Explore the ability to remotely decontaminate ambulances CMRRC Kara Walker March August Appendix A: Improvement Plan A-3 Central Maine Regional Resource Center

13 APPENDIX B: EXERCISE PARTICIPANTS Participating Organizations Central Maine Healthcare Coalition Androscoggin Home Care and Health Bridgton Hospital Central Maine Medical Center Central Maine Regional Resource Center Clover Health Care Franklin Memorial Hospital Maine Center for Disease Control and Prevention Maine Primary Care Association Riverview Psychiatric Center Rumford Community Home St. Mary s Regional Medical Center Stephens Memorial Togus VA Medical Center United Ambulance Appendix B: Exercise Participants B-1 Central Maine Regional Resource Center