MASTER SCENARIO EVENTS LIST

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2015

STATEWIDE MEDICAL AND HEALTH EXERCISE

MASTER SCENARIO EVENTS LIST

SHASTA MEDICAL AND HEALTH 2015

PANDEMIC INFLUENZA FUNCTIONAL EXERCISE

NOVEMBER 19, 2015

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PREFACE

The 2015 California Statewide Medical and Health Exercise (SWMHE) is sponsored by the California

Department of Public Health (CDPH) and the Emergency 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 Public Health (CDPH)}

• _{California Emergency Medical Services Authority (EMSA)}

• _{California Hospital Association (CHA)}

• _{California Primary Care Association (CPCA)}

• _{County of San Mateo EMS Agency}

• _{Emergency Medical Services Administrators Association of California (EMSAAC)}

• _{Kaiser Permanente}

• _{Los Angeles County Department of Public Health}

• Orange County Health Care Agency

• _{Riverside County Department of Public Health}

• _{San Joaquin County EMS Agency}

• _{Sharp HealthCare}

• _{Sutter County Public Health}

• _{Watsonville Community Hospital}

This MSEL follows guidelines set forth by the U.S. Federal Emergency 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 2015 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.

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ADMINISTRATIVE HANDLING INSTRUCTIONS

1. 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 Public 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 Public Health

Emergency Preparedness Office

1615 Capitol Avenue MS 7002

Sacramento, CA 95814

Kristy.Perez@cdph.ca.gov

Telephone: 916-650-6443

Michelle Constant

CEO

Constant & Associates

3655 Torrance Blvd., Suite 430

Torrance, CA

support@constantassociates.com

Telephone: 800-745-3057

Shasta County HHSA Public Health Exercise Planners:

Nicole Bonkrude, MPH

Public Health Emergency Preparedness Coordinator

nbonkrude@co.shasta.ca.us

Katrisha Arambul, MATLT

Community Education Specialist II

karambul@co.shasta.ca.us

Heidi Vert

Public Health Program & Policy Analyst / Hospital Preparedness Program Coordinator

hvert@co.shasta.ca.us

Shasta County Health and Human Services Agency, Public Health

2650 Breslauer Way

Redding, CA 96001

(530) 225-5591

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MASTER SCENARIO EVENTS LIST

BACKGROUND EXERCISE SCENARIO

1 _INFORMATION

Worldwide Situation:

In the early summer of 2015, five cases of human-to-human transmission of a novel strain of the influenza virus H5N1 are initially identified in a

small village in Cambodia. In response, surveillance in surrounding areas is strengthened as resources allow, and additional cases of H5N1 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. H5N1 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. H5N1 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. Hospitals 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 H5N1 through the local public health laboratory.

Hospitals 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.” Hospital staff throughout the area say this past season has been one of the worst in years. Reports

from 9-1-1 and other public safety agencies reveal nearly triple the number of calls compared to this same time last year.

1Planners 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.

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Information Sharing Medical Surge

Emergency Operations Coordination Emergency Public Information Warning

Public Health Surveillance and Epidemiological Investigation Medical Materiel Management and Distribution

Inject Inject Time/

Actual Time Core Capability (when applicable) Objective (PH and Hospital Objectives included as example) Joint Comm. # (only for health-care entities) Send From/ Assigned Staff

Send To Description Expected Action

1 Monday November 16th 12:45 pm Emergency Operations Coordination PH Objectives 1 Hospital Objectives 1, 2, 9 TJC EM.03.01.03 EP 7 TJC EM.03.01.03 EP 12 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.

• Hospital workers notify public health

using the appropriate reporting protocols 2 12:50 pm Emergency Operations Coordination PH Objectives 6

SCPH EPU Staff Public Health is notified of a

probable H5N1 threat to California with an evident surge of influenza like

illnesses (ILI)

• Initiate alert/activation checklist and

initiate an ITAM based on scenario provided (EP Checklists).

3 1:00 pm

Information Sharing

PH Objectives 6

EPU Staff ITAM

Participants

Shasta County Public Health has initiated an ITAM at _____ by the direction of

______.

• Respond to no notice CAHAN

notification of the ITAM

• 6.1.2 At the time of an event or incident notify designated incident command staff of public health responsibilities C3/F2/T5 4 ITAM 1:30 pm Emergency Operations Coordination PH Objectives 6 ITAM Participants ITAM Participants

Situation Briefing with

scenario details •

6.1.1 Prior to an event or incident, identify incident command and emergency management functions for which public health is responsible.

C6/F1/T1

• Develop an Incident Action Plan (EP

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Inject Inject Time/ Actual Time Core Capability (when applicable) Objective (PH and Hospital Objectives included as example) Joint Comm. # (only for health-care entities) Send From/ Assigned Staff

5 Emergency Operations Coordination PH Objectives 1 ITAM Participants ITAM Participants

Implement use of ICS forms

to develop the IAP •

Develop the incident response strategy

• 6.2.1 Disseminate Incident Action

Plans (IAPs) to Public Health Response staff C3/F3/T2 6 Public Health Surveillance and Epidemiological Investigation PH Objectives 1 ITAM Participants ITAM Participants

Implement the Epidemiology and Surveillance Position •

3.1.1 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

C13/F1/T1 7 Emergency Public Information and Warning PH Objectives 8 ITAM Participants ITAM Participants

Implement the Public Information Officer position •

8.2.1 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 8 Information Sharing PH Objective 1,6 ITAM Participants ITAM Participants

Activate the DOC • 1.1.1 Identify inter jurisdictional public

health Stakeholders to determine information sharing needs C6/F1/T2

• 1.2.1 Prior to and as necessary during an incident identify routine incident-specific data requirements for each stakeholder. C6/F2/T2

• 6.1.1 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/F1/T2

•6.3.2 Maintain situational awareness using information gathered from medical, public health, and other health stakeholders. C3/F4/T3 Emergency Operations Coordination 9 Thursday November 19th 8:00 am Emergency Operations Coordination

N/A DOC All Exercise

Participants

Communications Check / Player Briefing

• All participants check in all players receive appropriate materials.

• Conduct Conference Call and

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10 9:00 am Information Sharing PH Objective 1 SCPH DOC

CAHAN

Alert

All Players Start Ex • 1.3.1 Send CAHAN alert for START

EX C6/F3/T5 11 Emergency Operations Coordination PH Objectives 6 Hospital Objectives 3, 4, 5, 12 TJC EM.01.01.01 EP 7 TJC EM.02.02.01 EP 6 Changeover Briefing Emergency Preparednes s Unit

DOC Planning meeting - The mother and six year old child who presented at 0805 have

passed.

• Hospitals and healthcare facilities

consult internal plans, local pandemic influenza plans, and California Pandemic Influenza Preparedness and Response Plan.

• 6.2.1 Disseminate Incident Action

Plans (IAPs) to Public Health Response staff C3/F3/T2

• 6.1.2 At the time of the incident, notify designated incident command staff of public health responsibilities C3/F4/T4

• 6.3.1 Coordinate public health and medical emergency management operations for the public health response (e.g., phone calls, meetings, and conference calls). C3/F4/T1

• 6.3.4 Safety briefings will be

conducted in accordance with Incident Command System (ICS) procedures and documented on Safety Message/Plan form ICS 208

12 Emergency Public Information and Warning PH Objectives 8

PIO DOC DOC Briefing • Implement the CERC (Local

Procedures)

• 8.1.1 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

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13 Public Health Surveillance and Epidemiological Investigation PH Objectives 4 Epi/ Surveillance

DOC DOC Briefing • 4.1.2 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. C13/F2/T2

• 4.2.1 Provide information to public

health officials to support them in decision making related to mitigation actions. C13/F3/T2 14 Emergency Public Information and Warning PH Objectives 8 Hospital Objectives 9, 10, 12

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 10 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.

• 8.3.1 Establish mechanisms for public

and media inquiries that can be scalable to meet the needs of the incident. C4/F4/T1 15 Public Health Surveillance and Epidemiological Investigation PH Objective 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.

• 3.1.2 Conduct routine and

incident-specific 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.

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16 Public Health Surveillance and Epidemiological Investigation PH Objective 4 Epi/ Surveillance Public Health Nurses

Initiate case investigation and contact tracing. Complete H5N1 case history

form

• 4.1.1 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.

17 Information Sharing PH Objectives 1 Hospital Objectives 1, 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). C6/F3/T5

18 Medical Materiel Management and Distribution PH Objective 2 Hospital Objectives 7, 9, 10, 12 TJC EM.02.02.01 EP 6

Inject 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.

• 2.2.1 Determine allocation and distribution strategy, including delivery locations routes, and delivery schedule/frequency, based on incident needs. C9/F1/AO

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19 Emergency Public Information and Warning PH Objective 8 Hospital Objectives 1, 2, 12 TJC EM.03.01.03 EP 7 TJC EM.02.02.01 EP 6 Hospital 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 PH Objectives 2 Hospital Objectives 1, 3, 4, 9 TJC EM.01.01.01 EP 7 TJC EM.03.01.03 EP 8 Healthcare Partners Public 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/T1, ORR C9/F2/AO

• Contact State EOC if necessary.

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Medical Surge PH Objective 5 Hospital Objective 6 TJC EM.03.01.03 EP 10 TJC EM.03.01.03 EP 2 TJC EM.03.01.03 EP 12 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.

• 5.1.1 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 pre-existing plans to maximize scarce resources and prepare for any necessary shifts into and out of conventional, contingency, and crisis standards of care. C10/F1/T3

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22 Information Sharing PH Objectives 1, 2, 3, 4 Hospital Objectives 3, 4, 9 TJC EM.01.01.01 EP 7 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). C6/F3/T5

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Medical Surge PH Objectives 5 Hospital Objectives 1, 2, 6, 10 TJC EM.03.01.03 EP 7 TJC EM.03.01.03 EP 2

Inject 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 County2

.

• 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.

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Medical Surge PH Objectives 1, 12, 15

Hospital Objectives 1,

2, 6

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.

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25 11:00 am Medical Materiel Management and Distribution PH Objectives 2 Hospital Objectives 1, 2, 5, 7 TJC EM.03.01.03 EP 7 TJC EM.03.01.03 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.

• 2.1.1 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/T1, ORR C9/F2/AO 26 11:00 am Information Sharing PH Objective 7 Hospital Objective N/A

DOC CDPH The MHOAC Submits

situation report

• Submit a SITREP

• 7.1.1 Prior to and during an incident,

collaborate with and participate in jurisdictional health information exchange 27 Emergency Public Information and Warning PH Objectives 8 Hospital Objectives N/A

JIC DOC PIO The Public 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 1700 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.

• 8.2.1 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

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Medical Surge Public Health Objectives 2, 9, 13, 14 Hospital Objectives 2, 6, 8 TJC EM.03.01.03 EP 7 TJC EM.03.01.03 EP 2 TJC EM.03.01.03 EP 12 Local Hospitals Public Health DOC Planning Section

Regional hospitals are currently at 110% capacity, if

not more. Numerous admissions are pending and,

in most EDs, these admissions are being quartered in the ED, further

crippling ED operations. Public 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.

• Hospitals expand inpatient operations

at other sites on their campuses.

• Hospitals attempt to augment their

staff with non-traditional personnel (recently retired, etc.).

• Hospitals call local public health for assistance finding other personnel.

29 1:00 pm Information Sharing PH Objective 1 Exercise Director

CAHAN

Alert

All Participants

End of Exercise (EndEx) Return to Normal operations •

At the direction of the Exercise Director, all Exercise activities will conclude.

• 1.3.1 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 C6/F3/T5

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30 Immediately after the exercise Emergency Operations Coordination PH Objective 6 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.

• 6.3.3 Conduct shift change briefings

between outgoing and incoming public health staff to communicate priorities, status of tasks, and safety guidance.

C3/F4/T4

• 6.4.1 Contribute to After Action Report

for public health operations to identify improvement areas and promising practices. C3/F5/T3 31 3:00 pm Emergency Operations Coordination PH Objective 6 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.

• 6.4.1 Contribute to After Action Report for public health operations to identify improvement areas and promising practices. C3/F5/T3