Mass Fatality Management Tabletop Exercise

Report
OHIO CENTRAL REGION HOSPITALS
Mass Fatality Management
Tabletop Exercise (TTX)
PRESENTED BY
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BEFORE WE BEGIN
 Restrooms
 Exits
 Drinks
 Materials
 Breaks and Lunch
TODAY’S AGENDA
• Introductions
• Purpose and Scope of Exercise
• Exercise Objectives
• Exercise Participants & Guidelines
• Presentation of the Exercise Scenario
• Hot wash & Close Out
PURPOSE AND SCOPE
 Purpose

To measure response effectiveness against current response
concepts, written plans, procedures and capabilities for
mass fatality management (MFM).
 Scope

This exercise examines Central Region Hospital (CRH)
response to an incident that generates in-hospital deaths
that exceed morgue capacity with limited or no local
decedent management resources.
EXERCISE OBJECTIVES
 Incident Command
 Decedent Management: Identification and Tracking
 Resource Management
 Communications
 Medical Surge
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PARTICIPANTS
 Players
 Evaluators
 Facilitators/Controllers
 Observers
EXERCISE STRUCTURE
 Module 1:
Response and Notifications
 Module 2: Incident Escalation
 Module 3: Reconstitution – Return to Normal
TYPES OF EXERCISE
 Full Scale
 Functional
 Table Top
 THIS IS A TABLE TOP EXERCISE
EXERCISE GUIDELINES
 This is a low-stress, no-fault environment. Varying
viewpoints, even disagreements, are expected.
 Respond based on your knowledge of your hospital’s
current plans and capabilities, (i.e., you may use only
existing assets) and insights derived from training.
 Decisions are not precedent setting and may not
reflect your organization’s final position on a given
issue. This is an opportunity to discuss and present
multiple options and possible solutions.
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ASSUMPTIONS
 The scenario is plausible.
 Events occur as they are presented.
 Everyone gets the same information.
 There are no trick questions.
 There are no hidden agenda.
 There is no one right answer.
Questions before we begin??
MODULE 1
RESPONSE AND NOTIFICATIONS
APRIL 20, 2011
 The hospital has been receiving an influx of patient
presenting with flu-like symptoms.
 Six (6) of these patients have died exhausting morgue
capacity.
 Funeral homes have accepted receipt of these
decedents per typical procedures.
 A hospital staff member
has just been admitted
with flu symptoms.
APRIL 20, 2011
 Labs show this virus to be consistent
with recent CDC notifications regarding an
outbreak of influenza (named H1NA) that
appears to have originated in Mexico City,
Mexico in late January.
 Reports come too late to relocate Super Bowl XLV
and post-event, the virus was quickly found in 10
states.
 Two weeks ago, Ohio joined these ranks with four
(4) H1NA patients, one of which died.
APRIL 20, 2011
 The virus is virulent and is
currently reflecting a 2.5%
mortality rate.
 630 dead in Mexico and 105 in
the United States from H1NA.
 CDC has been able to isolate the virus and a
vaccine is being rapidly produced.
 Healthcare workers will be included in Tier One
distribution which is expected soon.
 The hospital is not seeing a dramatic reduction in
staff from fear/illness, however, they are a bit uneasy.
MODULE 1 DISCUSSION
 Would the Hospital Incident Command System be
activated at this point? If so, what is the activation
process? Which positions would currently be in play?
 Would the hospital’s mass fatality plan be activated at
this point? If so, what MFM HICS positions would be
activated?
 Would you have any security concerns at this point?
 Would you consider selecting alternate morgue space
now? Where?
 What notifications, if any, would you make?
MODULE 1 DISCUSSION
 Would you request additional resources at this point?
If so, what and from whom?
 What other hospital plans, if any, would be activated?
 Would you call in additional staff?
 What other actions would you take at this point?
MODULE 2
EVENT ESCALATION
APRIL 25, 2011
0935 HOURS
 In the last five (5) days, the hospital has seen a
dramatic increase in patients with H1NA.
 Fifteen more H1NA deaths have occurred and more
are inevitable.
 Only two (2) of the decedents were picked up by
funeral homes which are now completely inundated
and are asking hospitals to hold bodies until they can
pick them up.
 Hospital morgue capacity has been exceeded by nine
(9) bodies.
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APRIL 25, 2011
0935 HOURS
 All but one CRH has exceeded their morgue capacity and
staffed bed capacity.
 Newscasters are reporting H1NA
deaths in 2/3 of the country with 5500
deaths in the U.S. to date.
 A Public Health Emergency has been declared by the
Dept. of Health and Human Services Secretary.
 Schools and businesses are closing due to lack of
attendance and clientele.
 Staff numbers are down by 10% and one has died from
HINA
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APRIL 25, 2011
2100 HOURS
 Three more patients have died since this morning, one of
which expired in triage without any identification.
 Funeral homes have still not picked up the nine (9) bodies
and are now reporting that they will be unavailable to
assist the hospital with decedents for the foreseeable
future.
 You now have 4 bodies in the morgue, and 12 bodies in
alternate storage.
 Coroner was contacted for assistance. Answering
machine messages states that they are unable to
accept any bodies at this time. Mailbox was full.
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APRIL 27, 2011
 Four more patients have died from H1NA. Your alternate
morgue space is diminishing.
 No local decedent resources
have as yet come forward to assist
the hospital with decedents.
 Tier One distribution of the vaccine has been dispensed
to hospital staff but not their families. Many hospital
members are choosing to stay at work to avoid bringing the
virus home.
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MODULE 2 DISCUSSION
 Have any additional HICS positions been activated?
 Have any additional fatality management operations
positions been activated that were not initially
activated?
 Have you implemented any additional hospital plans
since the initial response?
 Have you made any additional notifications?
 How will you handle staff housing?
 How are you tracking decedents?
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MODULE 2 DISCUSSION
 Would you request additional resources at this point? If





so, what and from whom?
How is the hospital keeping current with local and
national information?
Have you made any implementations regarding staffing
shortages?
How are you keeping your staff informed of current
information?
What are your priority action items for consideration at
this point in the incident?
Do you have any security issues at this point?
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MODULE 3
RECONSTITUTION –
RETURNING TO NORMAL
OPERATIONS
MAY 1, 2011
 In the last five days, seven (7) more patients have
expired from H1NA. The county opened a community
morgue yesterday and will accept the hospital’s bodies but
has not way to pick them up.
 Tier One vaccine distributed four
(4) days ago has helped staffing
levels. General public began
receiving the vaccine two (2) days
ago.
 Hospital and public moral has shown improvement but
many are suffering from stress-related issues.
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MAY 3, 2011
 Many staff that suffered from illness would like to
come back to work but do not have the stamina to
work a regular shift.
 Patient influx has diminished greatly in the past two
(2) days alone with many alternate care areas of the
hospital being returned to normal use.
 Local and national news is reporting signs of viral
illness diminishing across the country.
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MODULE 3 DISCUSSION
 Does your hospital have a plan to get the bodies to
the community morgue?
 What are your priority action items at this point?
 What hospital recovery plans would be instituted?
 Do you have the resources to provide immediate and
long-term stress management or mental health
services to your personnel? If not, how can those
services be obtained?
 What documentation needs to be initiated for the
incident and future cost reimbursement submission?
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HOT WASH
EVALUATORS
PARTICIPANTS

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