Transcript Maryland 2008 Statewide Pandemic Influenza Exercise and CRA

Maryland 2008 Statewide
Pandemic Influenza
Exercise and CRA
Albert Romanosky MD, PhD
Office of Preparedness and Response
Maryland Department of Health and Mental
Hygiene
Presentation Objectives
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Give a brief Overview of the Maryland 2008
Statewide Pan Flu Exercise
Review the Role of Countermeasures
Response Administration (CRA) in the
Exercise
Identify the CRA Sustainable/Key Strengths
and Needs Improvement Activities
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2008 Pan Flu Exercise Overview
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Modified Functional Exercise:
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Full Scale Components
Three Days (June 17-19, 2008)
Compressed Pandemic Wave Weeks 6-12 and Recovery
Designed to Address:
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Corrective actions following previous exercises
Office of Preparedness & Response identified statewide pan
flu priorities and operational activities
Federal Pan Flu Priorities
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Overarching Exercise Goal
The overall goal of the exercise was to test the
expertise and capability of several components
of the healthcare system to adequately identify
and respond to unusual work and patient loads
during a pandemic influenza outbreak.
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Specific Exercise Testing Requirements
and Guidelines
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Homeland Security Exercise and Evaluation Program
(HSEEP)
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Assistant Secretary for Preparedness and Response (ASPR)
Hospital Preparedness Program (HPP) Exercise Standards and
Requirements
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CDC Public Health Emergency Preparedness Cooperative
Agreement Guidance and CDC Pan Flu Appendix 12:
Overarching Exercise Objectives by Priority Area: Pandemic
Flu Exercise Guidelines for Medical Surge
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ASPR Hospital Preparedness Program (HPP)
Exercise Standards and Requirements
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Evaluation of medical surge components of the tiered healthcare system
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Develop adequate evaluation tools and methods
Develop an After Action Report (AAR)
Specifics:
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Coordination with Public Health
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Risk Communication
Medication Distribution
Surveillance
Laboratory Capacity
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Volunteer Activation (ESAR-VHP)
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Staff Support
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Communications
Healthcare System Triage and Admission
Incident Command System (Integration and Coordination)
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CDC Cooperative Agreement and Pan
Flu Exercise Requirements
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Maryland State Pan Flu Operational Plan
 Based Upon CDC evaluation
Appendix 12: Overarching Exercise Objectives by Priority Area:
 Mass Vaccination
 Continuity of Operations
 Surveillance/ Lab Exercise
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Community Mitigation
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Communications
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Antiviral Distribution
Strategic National Stockpile (SNS) Medical Countermeasure
Distribution
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Maryland Statewide Pan Flu
Exercise Objectives
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DHMH Coordination/Command Center and Continuity of
Operations Plan
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Health and Medical Surge (Facilities, Personnel, Equipment
and Supplies)
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Medical Surge – Alternate Care Sites
Strategic National Stockpile / Receipt Staging and Storage
Enhanced Surveillance
Governor’s Wellmobiles
Laboratory Surge
Countermeasure Response Administration
EMS – Emergency Medical Dispatch
EMS – Transport Diversion Protocol
EMS On-Scene Triage and Assessment Protocol
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Maryland Statewide Pan Flu
Exercise Objectives
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Personal and Community Preparedness
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Community Emergency Response Teams (CERT)
Critical Infrastructure
Internal Countermeasure Distribution
Educational Facilities
Volunteer Activation
Joint Information Center – Public Information
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Interoperable Communications
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Mass Fatality Management
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Vulnerable Populations
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Maryland 2008 Statewide Pan Flu
Exercise Participants
Open to all Federal, State and Local Partners:
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56 Local Agencies
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Emergency Medical Services
Emergency Management Agencies
Local Health Departments
Law Enforcement
25
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50
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State Agencies
Federal Agencies
Health Care Systems and Organizations
State Hospitals / Residential and Day Program Service
Providers
8 Community Based Service Providers
8 Critical Infrastructure/Key Resources/Critical
Manufacturing
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Maryland 2008 Statewide Pan Flu
Exercise Participants
Total Number of Exercise Personnel:
Players 4,000+
 Contractor Controller/Evaluators/Observers 50
 Peer Controller/Evaluators/Observers 100
 Exercise Design and Development
75-100
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DHS Target Capabilities:
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29 of 45
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CDC CRA Activities
Pre-Exercise:
 Exercise Planning/Development
 CRA Access
 Training (open to all)
Exercise:
 Just-In-Time Training
 Support for Real-time Data Entry
 Situational Awareness / Data Reporting
 State Level Data Access
Post-Exercise:
 Hotwash and After Action Report
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Countermeasure Response Administration
Exercise Objectives
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Establish and implement CRA to collect data:
Offline stand alone scenario
 Online web interface (Real Time/Delay)
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Assess CRA ease of use
Track and report on antivirals dispensed at a
public and private agency Points of Dispensing
Track and report on community antiviral
dispensing
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CRA Exercise Specific Activities
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CRA Activation
Data Entry
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Direct: Web based
Indirect/Off-Line: Delayed Upload
Monitoring and Tracking
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Dispensing of Medications
Adverse Reactions to Antiviral Medications
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Maryland CRA Participating Sites
Howard County Health Department
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Hammond Middle School POD (Real-time Data Entry)
POD in Howard County dispensing antivirals to head-of-household for
surrounding community
Chateau Lake Ridge Community (Post-dispensing Data Entry)
Community dispensing with limited social distancing
Chester River Hospital (Real-time Data Entry)
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Fixed POD dispensing antivirals to employees
City of Laurel (Real-time Data Entry)
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Community dispensing with voluntary Isolation and Quarantine
Note: Two sites anticipated using CRA
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CRA Data Entry
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128
119
Chester River
Howard Co (Hammond School
POD)
Howard Co (Chateau Lake Ridge)
Laurel City
172
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CRA Evaluation
Overall Exercise:
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CRA data collection and entry
Key Strengths:
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The “just-in-time” training was very successful
and was a key to proficiency;
Data entry into the CRA application flowed
well;
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CRA Evaluation
Key Strengths:
 Within a short amount of time participants were able
to enter information;
 Data entry into CRA described as simple and
‘intuitive’ by participants;
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(Data entry maybe labor intensive)
Users were able to pull data and track progress;
CRA reports were useful in providing data of
antivirals dispensed at the local and state level;
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CRA Evaluation
Areas for Improvement:
 Ability to track individuals that present at a
dispensing site but do not receive
countermeasures;
 Ability to support Head-of-Household data
collection;
 Support interoperability with other systems;
 Not all regions of the state participated in CRA
exercise activities;
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CRA Evaluation
Recommendations:
 Expansion of CRA participation in the
Public and Private Sectors;
 Continue to train hospitals and health
departments on the CRA program;
 Increase recruitment for CRA access;
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Suggested CRA Enhancement
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Pre-population and Uploading of Data
Health Department Personnel (State HAN)
 Private Sector Expanded Data Entry and
Participation:
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Healthcare Systems
 Public-Private Partnership
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Critical Infra-structure/Key Resources/Critical Manufacturing
 Essential Staff and Personnel
Expanded Application
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Fatality Registration
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Maryland Future Activities
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DAX 2008 (Seasonal Influenza Vaccination
Exercise)
Increase CRA Training and Access
 All Maryland Participation
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24 Counties
Combination:
Real-Time and Delayed Data Entry
 On-Line Web Based vs Off-Line Data Entry
 Aggregate vs individual Data Entry
 Regional Clinic Integration and Coordination
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Al Romanosky, MD, PhD
Maryland Department of Health and
Mental Hygiene
Office of Preparedness and Response
410.767.0823
[email protected]
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