May 26th, 2016
Exercise Agenda
Welcome & Introductions
Tabletop Exercise Overview
Ebola Situation Overview
Module 1: Notification and Communication
Module 2: Transportation
Module 3: Hospital Treatment
Module 4: Fatality and Waste Management
Hot Wash/Evaluation
First Some Housekeeping…
 GoTo Webinar platform
 Everyone is on mute
 Either raise hand or type
question in chat box.
WELCOME & INTRODUCTIONS
• Name
• Agency
• Position
Goal of the Tabletop Exercise
 To practice coordination and communication activities using an
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Ebola virus scenario.
Discuss notification procedure and practices.
Discuss patient, staff, and first responder personal safety.
Discuss the management of human remains of Ebola patients.
Identify roles of the various response partners.
Test Regional EVD Plan.
Core Capabilities
 Environmental Health and Medical Services
 Fatality Management Services
 Public Health and Medical Services
 Communication and Notification
Objectives
 Exercise Objective #1: Discuss how healthcare, public health
agencies, and the Shawnee Preparedness and Response
Coalition will coordinate and implement emergency response
activities to manage patients suspected of Ebola Virus Disease
(EVD).
 Exercise Objective #2: Discuss how Ebola Virus Disease (EVD)
incident related information will be shared and disseminated
within the region.
 Exercise Objective #3: Test the regional EVD plan.
Objectives
 Exercise Objective #4: Discuss the post mortem care and
procedures for the remains of a person suspected of EVD.
 Exercise Objective #5: Discuss the transport needs necessary
for safe and timely transport.
Exercise Structure
 This exercise will be a multimedia, facilitated exercise.
Players will participate in group discussion during the
following four modules:
 Module 1: Notification and Communication
 Module 2: Transportation
 Module 3: Hospital Treatment
 Module 4: Fatality and Waste Management
Exercise Guidelines
 This exercise is designed to be held in an open, low-stress, no-
fault environment. Varying viewpoints, even disagreements,
are expected.
 Respond to the scenario using your knowledge of current
plans and capabilities (i.e., you may use only existing assets)
and insights derived from your training.
 Decisions are not precedent setting and may not reflect your
organization’s final position on a given issue. This exercise is
an opportunity to discuss and present multiple options and
possible solutions.
Exercise Guidelines
 Issue identification is not as valuable as suggestions and
recommended actions that could improve facility protection,
information coordination, and response efforts. Problemsolving efforts should be the focus.
 Today’s scenario encompasses multiple complex issues that
may occur during a healthcare crisis, please focus on today’s
questions and don’t get side tracked.
Assumptions and Artificialities
 The exercise is conducted in a no-fault learning environment
wherein capabilities, plans, systems, and processes will be
evaluated.
 The exercise scenario is plausible, and events occur as they are
presented.
 All players receive information at the same time.
Exercise Evaluation
 Evaluation of the exercise is based on the exercise objectives
and aligned capabilities, capability targets, and critical tasks,
which are documented in Exercise Evaluation Guides (EEGs).
 Players will be asked to complete participant feedback forms.
 These documents will be used to evaluate the exercise and
compile the After Action Report (AAR).
History
 The 2014 Ebola outbreak
was one of the largest Ebola
outbreaks in history and the
first in West Africa including:
 Guinea
 Liberia
 Sierra Leone
 Mali
History
United States
 September 30, 2014 – CDC confirmed the first
laboratory-confirmed case of Ebola to be diagnosed in
the United States in a man who had traveled to Dallas,
Texas from Liberia. ◦The man did not have symptoms
when leaving Liberia, but developed symptoms
approximately four days after arriving in the United
States.
◦Local public health officials identified all close
contacts of the index patient for daily
monitoring for 21 days after exposure.
◦The patient passed away on October 8.
History
United States
 October 10, 2014 – A healthcare worker at Texas
Presbyterian Hospital who provided care for the index
patient tested positive for Ebola.
◦The patient has since recovered and was discharged on
October 24.
History
United States
 October 15, 2014 – A second healthcare worker who
provided care for the index patient at Texas Presbyterian
Hospital tested positive for Ebola.
◦The patient has since recovered and was discharged on
October 28.
History
United States
 October 23, 2014 - The New York City Department of Health
and Mental Hygiene reported a case of Ebola in a medical
aid worker who had returned to New York City from
Guinea, where the medical aid worker had served with
Doctors Without Borders.
◦The diagnosis was confirmed by CDC on October 24.
◦The patient has since recovered and was discharged on
November 11.
Today
 The CDC has lifted monitoring of persons
returning from western Africa and no longer
screens at airports.
 Healthcare organizations no longer need to
screen specifically for Ebola but should
continue to obtain travel history in triage so
that infection control precautions and patient
placement can begin promptly when
appropriate.
Module 1
Notification and Communication
Exercise Scenario
Six patients arrive at your emergency department
independent from one another:
 At 1040 a 21 y/o female with fever,
sweating, nausea, and general
malaise.
 At 1100 a 54 y/o male is
brought to ED by EMS with c/c
of weakness, fever, severe
headache, and genera malaise.
 At 1120 a 28 y/o male is dropped
off at the ED by his friend. C/c of
“not feeling well,” fever, achy
muscles, and occasional vomiting.
 Two minutes later, EMS brings
in a 37 y/o female and her two
children ages 3 and 6 years old
all complaining of fever and
dehydration.
Module 1 Questions:
 What information
should be obtained in
triage?
 What information would
you share within the
hospital and what
information would you
share outside the
hospital and with whom
would you share it.
Shawnee Preparedness and
Response Coalition
Take 7 minutes to discuss
within your group.
Ebola Plan Tabletop Exercise
Information Obtained During Triage
 The 21 y/o female says she
recently came home from
college in Southern Missouri
and denies being out of the
country.
 The 28 y/o male is a local
bartender who started
feeling sick two days ago. He
has never been anywhere
outside of S. Illinois.
 The 54 y/o male patient is an
OB doctor that returned from
Liberia about three weeks
ago. He was on a missionary
medical relief trip where he
cared for high risk OB
patients.
 The mother with two young
children returned from
Guinea 27 days ago. States
she was in Africa to attend
her father’s funeral
Module 1 Questions:
 Where would you place
these patients?
 Who would you notify?
 What information would
you share?
 How does this
information change
what treatment you
anticipate for each
Take 7 minutes to discuss
within your group.
patient?
Shawnee Preparedness and
Response Coalition
Ebola Plan Tabletop Exercise
More Information
 The mother with two
young children who
returned from Guinea 27
days ago actually had
attended her father’s
funeral in Ethiopia and on
the return flight her plane
made an emergency
landing in Guinea where
she reports that they
never left the airport.
Module 1 Questions:
 Does this information
change your response?
If so, how?
Take 5 minutes to discuss
within your group.
Shawnee Preparedness and
Response Coalition
Ebola Plan Tabletop Exercise
Module 2
Hospital Treatment
 It is determined that the
54 y/o OB doctor should
be admitted and tested
for Ebola Virus Disease
and remain in isolation
until EVD testing is
negative x 2.
Module 2 Questions
 What questions would
be asked at your facility?
 What other procedures
do you have in place to
limit potential
Take 5 minutes to discuss
these questions in your
group.
exposures?
Shawnee Preparedness and
Response Coalition
Ebola Plan Tabletop Exercise
Module 2 Additional Information
The identified EAH cannot accept any of the
patients as they are already caring for a person
under investigation.
Module 2 Follow-up Questions
 Does this new
information change your
response? If so, How?
 Who would you
contact?
Take 5 minutes to discuss
these questions in your
group.
 What would you do?
Shawnee Preparedness and
Response Coalition
Ebola Plan Tabletop Exercise
Module 2 Questions
 What is your treatment
protocol?
 How will you isolate and
care for this patient?
 What other options do
you have?
Take 25 minutes to discuss
these questions in your
group.
Shawnee Preparedness and
Response Coalition
 Does the local hospital
have laboratory
capabilities to collect,
package, and ship a
possible EVD blood
specimen? Who will
transport the samples?
 How will the local
hospital dispose of
medical waste? Do you
have this in place now?
Ebola Plan Tabletop Exercise
Module 3
Transportation
Module 3 Questions
 What transportation options
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are available?
What factors go into
determining which EAH the
person will go to?
Who makes that decision?
What communication is
needed prior to the patient
going to the identified
hospital?
If transporting somewhere,
what arrangements do you
have? Is Local EMS able to
safely transport?
Shawnee Preparedness and
Response Coalition
 Hospitals - Does your facility
have transfer agreements for
EVD? Who would be your
transportation provider to take
a patient to an ETC in Chicago?
 Who would the nurse and
physician report to at the EAH
Hospital? Who else would be
notified?
Take 15 minutes to discuss these
questions in your group.
Ebola Plan Tabletop Exercise
Module 4
Fatality Management
Module 4 Information
While awaiting transport to the EAH, the patient
suddenly goes into cardiac arrest and dies.
Module 4 Questions
 How would you handle
the remains?
 Who would you
contact?
 What equipment and
Take 10 minutes to discuss
these questions in your
group.
procedures are in place
to safely deal with a
highly infectious
deceased person?
Shawnee Preparedness and
Response Coalition
Ebola Plan Tabletop Exercise
Thank You For Participating