MASTER SCENARIO EVENTS LIST

SHASTA MEDICAL AND HEALTH 205 PANDEMIC INFLUENZA FUNCTIONAL EXERCISE 205 NOVEMBER 9, 205 STATEWIDE MEDICAL AND HEALTH EXERCISE Version 2.0

PREFACE The 205 California Statewide Medical and Health Exercise (SWMHE) is sponsored by the California Department of Health (CDPH) and the Medical Services Authority (EMSA). This Master Scenario Events List (MSEL) was produced with input, advice, and assistance from the SWMHE Planning Team, comprised of representatives from: California Association of Health Facilities (CAHF) California Department of Health (CDPH) California Medical Services Authority (EMSA) California Association (CHA) California Primary Care Association (CPCA) County of San Mateo EMS Agency Medical Services Administrators Association of California (EMSAAC) Kaiser Permanente Los Angeles County Department of Health Orange County Health Care Agency Riverside County Department of Health San Joaquin County EMS Agency Sharp HealthCare Sutter County Health Watsonville Community This MSEL follows guidelines set forth by the U.S. Federal Management Agency (FEMA) Homeland Security Exercise and Evaluation Program (HSEEP). This MSEL is a guidance document that can and should be modified by healthcare entities with the particulars of their exercise. It is a complementary document to other documents developed for this exercise, including the Exercise Plan. It is tangible evidence of Shasta County s commitment to ensure public safety through collaborative partnerships that will prepare them to respond to any emergency. All exercise participants should use appropriate guidelines to ensure proper control of information within their areas of expertise and protect this material in accordance with current jurisdictional directives. This MSEL is a tool for use in preparing for and conducting the 205 SWMHE Program. This MSEL provides staff with all the necessary injects and scenario updates to lead and conduct a full exercise. Only controllers and evaluators should view the MSEL. 2

ADMINISTRATIVE HANDLING INSTRUCTIONS. The title of this document is the California Statewide Medical and Health Exercise (SWMHE) Program Master Scenario Events List (MSEL). 2. The information gathered in this MSEL is designated as For Official Use Only (FOUO) and should be handled as sensitive information that is 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 Shasta County HHSA Health is prohibited. 3. For more information about the exercise, please consult the following points of contact (POCs): State point of contact: Kristy Perez Chief, Planning, Exercises and Training Section California Department of Health Preparedness Office 5 Capitol Avenue MS 7002 Sacramento, CA 9584 Kristy.Perez@cdph.ca.gov Telephone: 9-50-443 Michelle Constant CEO Constant & Associates 355 Torrance Blvd., Suite 430 Torrance, CA support@constantassociates.com Telephone: 800-745-3057 Shasta County HHSA Health Exercise Planners: Nicole Bonkrude, MPH Health Preparedness Coordinator nbonkrude@co.shasta.ca.us Katrisha Arambul, MATLT Community Education Specialist II karambul@co.shasta.ca.us Heidi Vert Health Program & Policy Analyst / Preparedness Program Coordinator hvert@co.shasta.ca.us Shasta County Health and Human Services Agency, Health 250 Breslauer Way Redding, CA 900 (530) 225-559 3

BACKGROUND EXERCISE SCENARIO INFORMATION Worldwide Situation: In the early summer of 205, five cases of human-to-human transmission of a novel strain of the influenza virus H5N are initially identified in a small village in Cambodia. In response, surveillance in surrounding areas is strengthened as resources allow, and additional cases of H5N begin to be identified throughout the country. Once identified, ill persons are either hospitalized or isolated at home. In efforts to contain the outbreak, officials use stockpiled antiviral medication for treatment and for use as prophylaxis against persons coming into contact with ill persons. Local ill Cambodian residents disregard isolation instructions to remain in their villages, and many flee in hopes of obtaining antiviral drugs in more urban areas. H5N quickly spreads throughout Cambodia and soon crosses into other regions of Southeast Asia. In Asia, the World Health Organization (WHO) reports there is sustained human-to-human transmission, with an estimated 30% of those who are exposed, developing symptoms. The seasonal vaccine is ineffective, and all age groups are affected. Certain antiviral medications have been shown to help alleviate symptoms and are in high demand from local health departments, pharmacies, and healthcare providers. H5N cases begin to appear in Australia. WHO declares a pandemic. United States Situation: The U.S. Centers for Disease Control and Prevention (CDC) develops a case definition and initiates enhanced surveillance at quarantine stations and large healthcare facilities at major U.S. ports of entry. Viral isolates are sent to the CDC and the National Institute of Allergy and Infectious Diseases (NIAID) to begin vaccine development. s and healthcare facilities across the country are asked to increase surveillance and reporting. The novel influenza virus begins to make headlines worldwide and becomes the lead story on major news networks. In the U.S., influenza is the lead story for all major newspapers, television networks and cable news broadcasts. Signs of public concern and fear continue to grow. Many health departments and healthcare providers attempt to purchase additional stockpiles of antiviral medications. California Situation: At the same time, California is already experiencing an above-average flu season and many healthcare facilities are inundated with Influenza-like- Illness (ILI) cases. Due to the recent public health alerts, patient workups include testing for H5N through the local public health laboratory. s and healthcare facilities in California are doing all they can to keep up with the local seasonal influenza epidemic. They ve brought in extra doctors to handle the overload, said Dr. Smith of Mercy Medical Center Redding. And even with that, you still end up with patients waiting in the emergency room for 24 hours for a bed. staff throughout the area say this past season has been one of the worst in years. Reports from 9-- and other public safety agencies reveal nearly triple the number of calls compared to this same time last year. Planners are encouraged to focus on the design of a capability and objective-driven exercise. To aid in the testing of capabilities and objectives determined within the abbreviated timeframe of the exercise, some events have been condensed or altered. 4

Information Sharing Medical Surge Information Warning Health Surveillance and Epidemiological Investigation Medical Materiel Management and Distribution Time/ Monday November th 2:45 pm, 2, 9 EP 2 ER Nursing Director SCPH Three patients (mother, children ages six and nine) present at local hospital in our County, displaying ILI symptoms. Mother attended a neighboring County Fair last week, and an event at her children s school three days ago. workers notify public health using the appropriate reporting protocols 2 2:50 pm SCPH EPU Health is notified of a probable H5N threat to California with an evident surge of influenza like illnesses (ILI) Initiate alert/activation checklist and initiate an based on scenario provided (EP Checklists). 3 :00 pm Information Sharing EPU Shasta County Health has initiated an at by the direction of. Respond to no notice CAHAN notification of the..2 At the time of an event or incident notify designated incident command staff of public health responsibilities C3/F2/T5 4 :30 pm Situation Briefing with scenario details.. Prior to an event or incident, identify incident command and emergency management functions for which public health is responsible. C/F/T Develop an Incident Action Plan (EP Checklists) 5

Time/ 5 Implement use of ICS forms to develop the IAP Develop the incident response strategy.2. Disseminate Incident Action Plans (IAPs) to Health Response staff C3/F3/T2 Health Surveillance and Epidemiological Investigation Implement the Epidemiology and Surveillance Position 3.. Engage and retain stakeholders, which are defined by the jurisdiction who can provide health data to support routine surveillance, including daily activities outside of an incident, and to support response to an identified public health threat or incident C3/F/T 7 Information and Warning 8 Implement the Information Officer position 8.2. Based on jurisdictional structure, provide a single release point of information for health and healthcare issues through a pre-identified spokesperson in coordination with the JIC C4/F3/T2 Information Sharing, Activate the DOC.. Identify inter jurisdictional public health Stakeholders to determine information sharing needs C/F/T2 8.2. Prior to and as necessary during an incident identify routine incidentspecific data requirements for each stakeholder. C/F2/T2.. Prior to and incident, identify a primary and alternate physical and/or virtual structure that will be used to support alerting and public information operations C4/F/T2.3.2 Maintain situational awareness using information gathered from medical, public health, and other health stakeholders. C3/F4/T3 9 Thursday November 9 th 8:00 am N/A DOC All Exercise Communications Check / Player Briefing All participants check in all players receive appropriate materials. Conduct Conference Call and Communications checks with partners

Time/ 0 9:00 am Information Sharing SCPH DOC CAHAN Alert All Players Start Ex.3. Send CAHAN alert for START EX C/F3/T5 3, 4, 5, 2 EM.0.0.0 EM.02.02.0 EP Changeover Briefing Preparednes s Unit DOC Planning meeting - The mother and six year old child who presented at 0805 have passed. s and healthcare facilities consult internal plans, local pandemic influenza plans, and California Pandemic Influenza Preparedness and Response Plan..2. Disseminate Incident Action Plans (IAPs) to Health Response staff C3/F3/T2..2 At the time of the incident, notify designated incident command staff of public health responsibilities C3/F4/T4.3. Coordinate public health and medical emergency management operations for the public health response (e.g., phone calls, meetings, and conference calls). C3/F4/T.3.4 Safety briefings will be conducted in accordance with Incident Command System (ICS) procedures and documented on Safety Message/Plan form ICS 208 2 Information and Warning 8 PIO DOC DOC Briefing Implement the CERC (Local Procedures) 8.. Prior to an incident, identify a primary and alternate physical and/or virtual structure that will be used to support alerting and public information operations 7

Time/ 3 Health Surveillance and Epidemiological Investigation 4 Epi/ Surveillance DOC DOC Briefing 4..2 Provide epidemiological and environmental public health consultation, technical assistance, and information to local health departments regarding disease, injury, or exposure and methods of surveillance, investigation, and response. C3/F2/T2 4.2. Provide information to public health officials to support them in decision making related to mitigation actions. C3/F3/T2 4 Information and Warning 8 9, 0, 2 PIO Front Desk Provide talking points to the front desk - The Health Department receives a call from a woman who explains that she and nearly 0 relatives have arrived back in town after being in Cambodia for two weeks for a family wedding. She is wondering if she and her family members have been exposed to the bird flu, and notes that several family members have had a cough and chills while they were in Cambodia. She wants to know if she and her family members can be tested for this. 8.3. Establish mechanisms for public and media inquiries that can be scalable to meet the needs of the incident. C4/F4/T 5 Health Surveillance and Epidemiological Investigation 3 Epi/ Surveillance DOC Create active surveillance template and provide to DOC for send out to hospitals and clinics via CAHAN. Work with CD nurse to gather school absenteeism data from school mother and children attended. 3..2 Conduct routine and incidentspecific morbidity and mortality surveillance as indicated by the situation using inputs such as reportable disease surveillance, vital statistics, syndromic surveillance, hospital discharge abstracts, population-based surveys, disease registries, and active case-finding. 8

Time/ Health Surveillance and Epidemiological Investigation 4 Epi/ Surveillance Health Nurses Initiate case investigation and contact tracing. Complete H5N case history form 4.. Conduct investigations of disease, injury or exposure in response to natural or man-made threats or incidents and ensure coordination of investigation with jurisdictional partner agencies. Partners include law enforcement, environmental health practitioners, public health nurses, maternal and child health, and other regulatory agencies if illegal activity is suspected. 7 Information Sharing, 9 Healthcare Facility DOC Two more fatalities of patients presenting with ILI have been reported in your county. Proper notifications and reporting have been made, reflecting existing plans, policies, and procedures. Prior to and during an incident, collaborate with and participate in jurisdictional health information exchange (e.g., fusion centers, health alert system, or equivalent). C/F3/T5 8 Medical Materiel Management and Distribution 2 7, 9, 0, 2 EM.02.02.0 EP DOC Local media outlets have been calling in attempts to find out when the vaccination clinics will begin. They have aired stories about vaccination clinics in other cities, and are wondering what the local County will be doing to prevent the long lines and fights that seem to occur in other areas. Include information on medical countermeasures in all joint public information releases. 2.2. Determine allocation and distribution strategy, including delivery locations routes, and delivery schedule/frequency, based on incident needs. C9/F/AO 9

Time/ 9 Information and Warning 8, 2, 2 EM.02.02.0 EP PIO DOC PIO A local hospital is reporting numerous emergency room visits from individuals concerned they have the bird flu. The hospital would like to put the public at ease with social media posts. A decision is made regarding the review of materials. Send Press release 8.3.2 If health department websites exist, post incident-related information on health department website as a means of informing and connecting with the public. C4/F4/T2 8.4.2 Test sending public health alerts and information using CAHAN and redundant communication methods including e-mail, fax, satellite phone, AT&T conference line and HAM radio 20 Medical Materiel Management and Distribution 2, 3, 4, 9 EM.0.0.0 EP 8 Healthcare Partners Health DOC Logistics Section Several local clinics and hospitals are calling to find out about supplies. They are requesting assistance with logistical needs. Assess current and projected logistical needs. Request and accept medical materiel from jurisdictional, private, regional, or federal partners in alignment with National Incident management System standards and incident needs. C9/F2/T, ORR C9/F2/AO Contact State EOC if necessary. 2 Medical Surge 5 EP 0 EP 2 EP 2 Healthcare Facilities DOC The local healthcare facilities are experiencing a surge of patients with ILI symptoms. Current operations are overwhelmed with the influx of patients Surge plans are activated and carried out. 5.. At the time of an incident, provide health-related data to healthcare organizations or healthcare coalitions that will assist the healthcare organizations or healthcare coalitions in activating their preexisting plans to maximize scarce resources and prepare for any necessary shifts into and out of conventional, contingency, and crisis standards of care. C0/F/T3 0

Time/ 22 Information Sharing, 2, 3, 4 3, 4, 9 EM.0.0.0 HCC Planning Section Chief HCC Management Local Situation reports are submitted by phone fax and e-mail to the DOC Prior to and during an incident, collaborate with and participate in jurisdictional health information exchange (e.g., fusion centers, health alert system, or equivalent). C/F3/T5 23 Medical Surge 5, 2,, 0 EP 2 DOC CNN is reporting that an unspecified number of health care providers at a hospital in the neighboring county have been hospitalized with a severe respiratory illness. The hospital has a significant lack of personnel and is asking for help. The hospital is requesting that many of its patients be transferred to a hospital in your County 2. Ensure local healthcare entities are in contact with neighboring jurisdictions as necessary. Develop guidelines and precautions for healthcare workers treating ILI patients. Coordinate patient transport procedures while monitoring local healthcare facilities for bed availability and patient tracking. 24 Medical Surge, 2, 5, 2, EMS DOC A local private ambulance provider has called EMS to ask about decreasing elective ambulance use and establishing new treat and triage guidelines for their paramedic staff. Many of their staff are new and unaware of current surge protocols for a pandemic. Implement Altered Standards of Care 2 This inject has been included to test the medical surge and patient transport coordination abilities of EMS agencies and public health departments. Your hospital may or may not choose to accept patients, according to your current protocols.

Time/ 25 :00 am Medical Materiel Management and Distribution 2, 2, 5, 7 EP 8 Healthcare Facilities DOC Logistics Branch Healthcare facilities are requesting gloves, face masks, sanitizer, and disposable linens. Initiate resource request process for needed items. 2.. Request and accept medical materiel from jurisdictional, private, regional, or federal partners in alignment with National Incident management System standards and incident needs. C9/F2/T, ORR C9/F2/AO 2 :00 am Information Sharing 7 N/A DOC CDPH The MHOAC Submits situation report Submit a SITREP 7.. Prior to and during an incident, collaborate with and participate in jurisdictional health information exchange 27 Information and Warning 8 N/A JIC DOC PIO The Health Director has requested a press release. He requests that the press release include details on local, regional, and state initiatives for the pandemic influenza. The press conference will be held at 700 hours this afternoon. Verify who will speak at the press conference, how long they will be speaking, and whether they will be taking questions from the media. Develop detailed press briefing that will dispel some of the fears and rumors in the community. Develop an organization chart for the public showing the major players roles and responsibilities. 8.2. Based on jurisdictional structure, provide a single release point of information for health and healthcare issues through a pre-identified spokesperson in coordination with the JIC. C4/F3/T2 2

Time/ 28 Medical Surge Health 2, 9, 3, 4 2,, 8 EP 2 EP 2 Local s Health DOC Planning Section Regional hospitals are currently at 0% capacity, if not more. Numerous admissions are pending and, in most EDs, these admissions are being quartered in the ED, further crippling ED operations. Health has identified and activated three alternative care sites. Many healthcare facilities and first responders are still unaware of the availability of these alternative care sites. s expand inpatient operations at other sites on their campuses. s attempt to augment their staff with non-traditional personnel (recently retired, etc.). s call local public health for assistance finding other personnel. 29 :00 pm Information Sharing Exercise Director CAHAN Alert All End of Exercise (EndEx) Return to Normal operations At the direction of the Exercise Director, all Exercise activities will conclude..3. Prior to and during an incident if necessitated by the situation, acknowledge receipt of information or public health alert. Receive the CAHAN STARTEX and ENDEX messages C/F3/T5 Initiate Demobilization Actions 3

Time/ 30 Immediately after the exercise All participating agency Controllers and Evaluators Exercise players at each facility C/E Debriefing A C/E Debrief will be conducted for all exercise Controllers and Evaluators to capture observations and feedback. Collect all feedback, paperwork, and any equipment that must be returned. Adjourn and thank you..3.3 Conduct shift change briefings between outgoing and incoming public health staff to communicate priorities, status of tasks, and safety guidance. C3/F4/T4.4. Contribute to After Action Report for public health operations to identify improvement areas and promising practices. C3/F5/T3 3 3:00 pm Exercise Director/ HPP Coordinators All HPP Exercise Partner Controllers and Evaluators A Hot Wash Conference Call will be conducted for all exercise participating agencies. Controllers will ensure direction is provided. Hot Wash will capture brief, high-level feedback on the exercise and agency performances. Collect all feedback, paperwork, and any equipment that must be returned. Adjourn and thank you..4. Contribute to After Action Report for public health operations to identify improvement areas and promising practices. C3/F5/T3 4