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2011 Phase III: 2011 Phase III: Tabletop Exercise Tabletop Exercise

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The 2011 California Statewide Medical and Health Exercise is sponsored by the California Department of Public Health and the California

Emergency Medical Services Authority in collaboration with the California Hospital

Association, California Association of Health Facilities, California Primary Care Association

and the California Emergency Management Agency as well as response partners

representing local health departments, emergency medical services, public safety and

health care facilities.

Welcome and Introductions

Introduction of Exercise Planners and Introduction of Exercise Planners and FacilitatorsFacilitators

Introduction of participants, subject matter Introduction of participants, subject matter experts and department officials and mediaexperts and department officials and media

Housekeeping issuesHousekeeping issues

Review of agendaReview of agenda

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The Tabletop Exercise is a The Tabletop Exercise is a discussion-based exercise, discussion-based exercise, focusing on the planning for focusing on the planning for and response to a disruption and response to a disruption in the public water supply.in the public water supply.

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Tabletop Exercise Objectives

Evaluate plans for emergency response Evaluate plans for emergency response partners within the operational area to partners within the operational area to share critical information in planning for share critical information in planning for and responding to a disruption in the public and responding to a disruption in the public water supply.water supply.

Determine whether technology and plans Determine whether technology and plans for ensuring ongoing communications for ensuring ongoing communications during an emergency event are adequate.during an emergency event are adequate.

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Tabletop Exercise Objectives

Evaluate the current plans and resources Evaluate the current plans and resources for maintaining services and operations in for maintaining services and operations in the event of a disruption in the public water the event of a disruption in the public water supply.supply.

Determine whether plans and procedures Determine whether plans and procedures for resource requesting are consistent with for resource requesting are consistent with the Standardized Emergency Management the Standardized Emergency Management System.System.

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Testing and Evaluating the 2011 Statewide Medical and Health Exercise Target Capabilities

CommunicationsCommunications

Intelligence/Information Sharing and Intelligence/Information Sharing and DisseminationDissemination

Medical SurgeMedical Surge

Emergency Operations Center ManagementEmergency Operations Center Management

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Materials for the 2011 Statewide Medical Materials for the 2011 Statewide Medical and Health Exercise have been and Health Exercise have been developed for the following:developed for the following:

• Acute Care Facilities/HospitalsAcute Care Facilities/Hospitals

• Long Term CareLong Term Care

• ClinicsClinics

• Local Health and Environmental Local Health and Environmental Health DepartmentHealth Department

• Local Emergency Medical Local Emergency Medical Services AgencyServices Agency

• Emergency Medical Service Emergency Medical Service ProvidersProviders

• Law EnforcementLaw Enforcement

• Emergency ManagementEmergency Management

Fire ServiceFire Service

Medical Examiner/CoronerMedical Examiner/Coroner

Community Based OrganizationsCommunity Based Organizations

Regional Emergency Operations Regional Emergency Operations CenterCenter

Joint Emergency Operations Joint Emergency Operations CenterCenter

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Exercise Customization

The Tabletop Exercise may be customized to The Tabletop Exercise may be customized to include operational area and discipline include operational area and discipline specific issues, strengths in preparedness specific issues, strengths in preparedness and gaps in planning that may be discussed and gaps in planning that may be discussed Share policies, procedures and plans with Share policies, procedures and plans with

response partnersresponse partners Identify gaps in planning that may be Identify gaps in planning that may be

addressed in the exerciseaddressed in the exercise

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Exercise Customization

Subject matter experts may be used to provide Subject matter experts may be used to provide response specific information and guidance, response specific information and guidance, including:including: Local and operational area water authoritiesLocal and operational area water authorities Environmental Health response partnersEnvironmental Health response partners Intelligence Fusion Center / Terrorism Liaison Intelligence Fusion Center / Terrorism Liaison

OfficersOfficers Medical and Health Operational Area Medical and Health Operational Area

CoordinatorCoordinator Mutual aid coordinators for law and fire Mutual aid coordinators for law and fire

servicesservices

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Exercise Ground Rules

Do not “fight” the scenarioDo not “fight” the scenario

Assume the scenario is “real” and may Assume the scenario is “real” and may impact the jurisdiction and the participantsimpact the jurisdiction and the participants

Participate in a collegial manner: share Participate in a collegial manner: share polices, plans and practices that may benefit polices, plans and practices that may benefit othersothers

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Exercise Ground Rules

Be respectful: allow others to speak and Be respectful: allow others to speak and finish their statementsfinish their statements

Follow communications etiquette: turn off Follow communications etiquette: turn off cell phones, smart phones, computers, etc.cell phones, smart phones, computers, etc.

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Before We Begin

The purpose of this exercise is to provide The purpose of this exercise is to provide participants with an opportunity to evaluate participants with an opportunity to evaluate current response concepts, plans, and current response concepts, plans, and capabilities for a response to a disruption in capabilities for a response to a disruption in the public water system.the public water system.

Questions will be posed to determine the Questions will be posed to determine the level of preparedness and planning, level of preparedness and planning, identifying both strengths and areas for identifying both strengths and areas for improvement.improvement.

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Background

Potential causes of water supply disruptionPotential causes of water supply disruption

• EarthquakesEarthquakes

• FloodingFlooding

• Power FailuresPower Failures

• Infrastructure collapseInfrastructure collapse

• Intentional contamination of wells or ground Intentional contamination of wells or ground waterwater

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Lessons learned from real events

Loma Prieta Earthquake 1989Loma Prieta Earthquake 1989 70 water main breaks and 50 service line breaks in 70 water main breaks and 50 service line breaks in

San Francisco aloneSan Francisco alone

Martins Ferry, Ohio 2009Martins Ferry, Ohio 2009 Water main break; firefighting and hospital operations Water main break; firefighting and hospital operations

required trucking in water required trucking in water

Massachusetts General Hospital 2010Massachusetts General Hospital 2010 Operations maintained for 4 days by use of bottled Operations maintained for 4 days by use of bottled

water for nutrition and boiling water for clinical water for nutrition and boiling water for clinical operationsoperations

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Lessons learned from real events

Barstow, California 2010Barstow, California 2010 Perchlorate in water supply led to a community-wide Perchlorate in water supply led to a community-wide

notice to drink only bottled waternotice to drink only bottled water

Decatur, Al 2011Decatur, Al 2011 New chemical used in water purification closed down New chemical used in water purification closed down

the water treatment plantthe water treatment plant Hospitals became site of refuge as restaurants, Hospitals became site of refuge as restaurants,

business and government agencies closedbusiness and government agencies closed

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Exercise Begins

Exercise consists of 4 modules plus an Exercise consists of 4 modules plus an addendum for planning the November 17, addendum for planning the November 17, 2011 Functional Exercise2011 Functional Exercise

Each module will identify the key issues Each module will identify the key issues followed by questions for discussionfollowed by questions for discussion

Participants are encourage to share their Participants are encourage to share their plans, polices, strengths and gaps as plans, polices, strengths and gaps as identified in the Organizational Self identified in the Organizational Self AssessmentAssessment

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Scenario Background

Homeland Security officials in California Homeland Security officials in California have issued warnings to local health have issued warnings to local health departments and water authorities departments and water authorities concerning a threat to disrupt the public concerning a threat to disrupt the public water system. water system.

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Scenario Background

Through Intelligence Fusion Centers, law Through Intelligence Fusion Centers, law enforcement agencies and the Terrorism enforcement agencies and the Terrorism Liaison Officer network, information is Liaison Officer network, information is disseminated that the intelligence has disseminated that the intelligence has included the following threats: disruption of included the following threats: disruption of the water purification systems, destruction of the water purification systems, destruction of the water distribution systems and/or the water distribution systems and/or contamination of local reservoirs. contamination of local reservoirs.

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Tampering of fire hydrants, vandalism at Tampering of fire hydrants, vandalism at reservoirs and water treatment plants reservoirs and water treatment plants combined with the earlier terrorism threats combined with the earlier terrorism threats has heightened concerns about the safety of has heightened concerns about the safety of the public water system across the State. the public water system across the State.

Yesterday, a storage area within a water Yesterday, a storage area within a water treatment facility in the State was broken treatment facility in the State was broken into, with containers of caustic soda (used in into, with containers of caustic soda (used in water treatment and purification) stolen.water treatment and purification) stolen.

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Module 1: Key Issues

Ability to receive and validate critical Ability to receive and validate critical information.information.

Ability to assess threat through impact Ability to assess threat through impact analysis on daily and emergency operations.analysis on daily and emergency operations.

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Questions for Discussion

1.1. How would your organization/jurisdiction How would your organization/jurisdiction receive this threat intelligence? What is the receive this threat intelligence? What is the source of information validation and source of information validation and dissemination within the jurisdiction?dissemination within the jurisdiction?

2.2. Is there a policy and/or procedure in place Is there a policy and/or procedure in place to receive and disseminate this information to receive and disseminate this information internally and externally?internally and externally?

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Questions for Discussion

3.3. What mechanisms and/or technology are in What mechanisms and/or technology are in place to receive and disseminate place to receive and disseminate information internally and externally?information internally and externally?

4.4. How would your organization evaluate the How would your organization evaluate the impact of this threat?impact of this threat?

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Questions for Discussion

5.5. Does your operational area have a Does your operational area have a standardized process to develop a standardized process to develop a communications plan for all affected communications plan for all affected stakeholders (health care facilities, local stakeholders (health care facilities, local emergency medical service authorities, emergency medical service authorities, local health departments, environmental local health departments, environmental health departments, fire service, and law health departments, fire service, and law enforcement)?enforcement)?

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Module 2: INCIDENT RESPONSEResource Assessment

Key IssuesKey Issues

Ability to assess impact of water service Ability to assess impact of water service disruption on the organization’s ability to disruption on the organization’s ability to maintain operations.maintain operations.

Adequate supplies of potable and non-potable Adequate supplies of potable and non-potable water are available on site or may be rapidly water are available on site or may be rapidly accessed.accessed.

Project the impact of water service disruption on Project the impact of water service disruption on response partners.response partners.

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Questions for Discussion

1.1. Has your organization/jurisdiction planned for Has your organization/jurisdiction planned for an interruption in water service or a complete an interruption in water service or a complete loss of water?loss of water?

2.2. Has your organization/jurisdiction evaluated its Has your organization/jurisdiction evaluated its need for potable water for 24, 48, 72 and 96 need for potable water for 24, 48, 72 and 96 hours? Does the planning address seasonal hours? Does the planning address seasonal changes (i.e., increased consumption of water changes (i.e., increased consumption of water in summer months) in water needs and use? in summer months) in water needs and use? What services require potable water for your What services require potable water for your agency/organization? Does this address agency/organization? Does this address current operations as well as a surge in service current operations as well as a surge in service demands that the incident might cause?demands that the incident might cause?

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Questions for Discussion

3.3. Does your organization/jurisdiction have a cache of Does your organization/jurisdiction have a cache of potable water to support services to staff, clients, potable water to support services to staff, clients, patients and visitors? Is the cache secure? Does patients and visitors? Is the cache secure? Does access to the cache address water rationing?access to the cache address water rationing?

4.4. Do you have multiple sources to access additional Do you have multiple sources to access additional water, including vendor agreements, access to water, including vendor agreements, access to local businesses and distributors or retail outlets, local businesses and distributors or retail outlets, etc.?etc.?

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Facilitated Discussion

• Discuss the impact of a disruption in the public water Discuss the impact of a disruption in the public water system to your organization/facility/agency and to system to your organization/facility/agency and to the community.the community.

• Determine all possible uses of water and the impact Determine all possible uses of water and the impact on the provision of daily operations if there is a water on the provision of daily operations if there is a water failure. failure.

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Facilitated Discussion

Review how the disruption of the public water Review how the disruption of the public water system on your facility/agency/organization will system on your facility/agency/organization will impact your response partners.impact your response partners.

Consider the multiple sites that provide services (fire Consider the multiple sites that provide services (fire stations, hospitals, clinics, police stations, stations, hospitals, clinics, police stations, community organizations, etc.).community organizations, etc.).

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Facilitated Discussion

Identify both gaps in planning and strong practices Identify both gaps in planning and strong practices that can be shared among the response partners.that can be shared among the response partners. Plans for water conservation and water rationingPlans for water conservation and water rationing Memoranda of Understanding with vendors or partner Memoranda of Understanding with vendors or partner

organizationsorganizations Alternate means of housekeeping and hygiene, etc.Alternate means of housekeeping and hygiene, etc. Best practices identified from actual experience with a Best practices identified from actual experience with a

disruption in the public water system.disruption in the public water system.

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Module 2: INCIDENT RESPONSEEMERGENCY OPERATIONS

CENTER MANAGEMENTKey IssuesKey Issues

Response is coordinated through the use of the Response is coordinated through the use of the Incident Command System and command centers.Incident Command System and command centers.

Incident action plans are developed to guide and Incident action plans are developed to guide and document the response and recovery phases.document the response and recovery phases.

Resource requesting processes are established and Resource requesting processes are established and tested in compliance with the Standardized tested in compliance with the Standardized Emergency Management System.Emergency Management System.

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Questions for Discussion

1.1. Does your organization/jurisdiction use the Does your organization/jurisdiction use the Incident Command System to organize and Incident Command System to organize and guide response and recovery operations in guide response and recovery operations in an emergency? Does the use of the an emergency? Does the use of the Incident Command System address, when Incident Command System address, when necessary, the application of unified necessary, the application of unified command?command?

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Questions for Discussion

2.2. Does your organization/jurisdiction have a Does your organization/jurisdiction have a command/operations center (e.g., Hospital command/operations center (e.g., Hospital Command Center, Nursing Home Command Center, Nursing Home Command Center, Department Operations Command Center, Department Operations Center) to support Incident Command Center) to support Incident Command System operations?System operations?

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Questions for Discussion

3.3. Does your organization/jurisdiction have a Does your organization/jurisdiction have a policy and procedure to communicate and policy and procedure to communicate and share information and intelligence with share information and intelligence with other members of the incident management other members of the incident management team or command center personnel? How team or command center personnel? How is information transfer validated? If is information transfer validated? If procedures are in place, is the process procedures are in place, is the process regularly tested? If not, how can command regularly tested? If not, how can command center communication be establish or center communication be establish or improved?improved?

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Questions for Discussion

4.4. Does your organization/jurisdiction Does your organization/jurisdiction have resource requesting policy and have resource requesting policy and procedure to request or share procedure to request or share resources within the operational area resources within the operational area and beyond to the region or the and beyond to the region or the State? If so, is this process regularly State? If so, is this process regularly tested? How is this process tested? How is this process coordinated with the incident coordinated with the incident command structure for your command structure for your agency/department/facility?agency/department/facility?

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Module 3: ONGOING OPERATIONSRISK COMMUNICATIONS

Key IssuesKey Issues

Risk communication messaging is Risk communication messaging is developed within the operational area Joint developed within the operational area Joint Information System.Information System.

Policy and procedure for dissemination of Policy and procedure for dissemination of key messages is established within the key messages is established within the facility/agency/department.facility/agency/department.

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Questions for Discussion

1.1. Does your organization/jurisdiction Does your organization/jurisdiction participate in a Joint Information System?participate in a Joint Information System?

2.2. How is information communicated from the How is information communicated from the Joint Information System to the Joint Information System to the organization?organization?

3.3. How would you share your organization’s How would you share your organization’s information with the Joint Information information with the Joint Information System? Who approves information to be System? Who approves information to be shared?shared?

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Questions for Discussion

4.4. How would messages be coordinated and How would messages be coordinated and disseminated? (For example, direction on disseminated? (For example, direction on boil water orders, where to go for more boil water orders, where to go for more information, etc.)information, etc.)

5.5. Who would provide guidance to the Who would provide guidance to the community on the response actions to take community on the response actions to take for a water system disruption? Who has the for a water system disruption? Who has the final authority on messages released to the final authority on messages released to the public?public?

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Questions for Discussion

6.6. Do you have a plan to notify staff, patients, Do you have a plan to notify staff, patients, clients, and/or stakeholders of an alteration clients, and/or stakeholders of an alteration in service due to water disruption? What in service due to water disruption? What individuals or groups require notification? individuals or groups require notification? What are the communication methods to What are the communication methods to disseminate this information and the safety disseminate this information and the safety measures to be taken due to a loss of measures to be taken due to a loss of water event?water event?

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Scenario Update / Issues

The threat of contamination or the disruption of The threat of contamination or the disruption of the public water system will cause widespread the public water system will cause widespread implications in the community and the health implications in the community and the health care system. Hospitals, clinics, long term care care system. Hospitals, clinics, long term care facilities and private medical providers may be facilities and private medical providers may be required to alter their services based on the required to alter their services based on the disruption of the public water system. For disruption of the public water system. For example, medical procedures, housekeeping example, medical procedures, housekeeping services and personal hygiene, as well as services and personal hygiene, as well as maintenance of the infrastructure will all be maintenance of the infrastructure will all be impactedimpacted

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Scenario Update / Issues

If the water system is contaminated, or if If the water system is contaminated, or if there is a threat of contamination, persons there is a threat of contamination, persons living in the community may be exposed or living in the community may be exposed or be fearful of exposure, resulting in large be fearful of exposure, resulting in large numbers of patients presenting to hospitals numbers of patients presenting to hospitals and clinics for evaluation.and clinics for evaluation.

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Module 3: ONGOING OPERATIONS

MEDICAL SURGEKey IssuesKey Issues

Continuity of operations has been Continuity of operations has been addressed within the addressed within the organization/jurisdiction.organization/jurisdiction.

Plans to surge services are developed in Plans to surge services are developed in conjunction and coordination with response conjunction and coordination with response partners.partners.

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Questions for Discussion

1. Does your organization/jurisdiction have a plan to 1. Does your organization/jurisdiction have a plan to alter services if there is a disruption in the water alter services if there is a disruption in the water supply? What types of services can be altered or supply? What types of services can be altered or postponed within your agency/organization?postponed within your agency/organization?

2. Do you have a water rationing or water conservation 2. Do you have a water rationing or water conservation plan? Who has authority to activate these hazard plan? Who has authority to activate these hazard specific plans?specific plans?

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Questions for Discussion

33. Do you have a surge plan to address increased . Do you have a surge plan to address increased persons presenting to your health care facility persons presenting to your health care facility with symptoms or concerns about water with symptoms or concerns about water contamination? How do you receive the case contamination? How do you receive the case definition for persons exposed to a water definition for persons exposed to a water contaminant? How is the case definition shared contaminant? How is the case definition shared with staff?with staff?

4. Are there partner organizations that can assist 4. Are there partner organizations that can assist in providing services that you must alter or in providing services that you must alter or suspend due to a water disruption? Do you suspend due to a water disruption? Do you have memoranda of understanding signed with have memoranda of understanding signed with these partner organizations? these partner organizations?

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Questions for Discussion

5. Who are the local/operational area 5. Who are the local/operational area authorities who would provide direction on authorities who would provide direction on water use and water safety? Do you have water use and water safety? Do you have 24/7 contact information for these 24/7 contact information for these authorities?authorities?

6. What are your plans, equipment and 6. What are your plans, equipment and priorities for distribution of water throughout priorities for distribution of water throughout the facility? Who has the authority for the facility? Who has the authority for prioritization of distribution?prioritization of distribution?

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Questions for Discussion

7.7. Do you have a plan to control or limit Do you have a plan to control or limit access to your organization/jurisdiction access to your organization/jurisdiction during an emergency or disaster? Would during an emergency or disaster? Would you require the assistance of law you require the assistance of law enforcement in maintaining the safety and enforcement in maintaining the safety and security of your facility?security of your facility?

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Conclusion of Conclusion of Discussion-Based Discussion-Based

TabletopTabletop

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Planning for the November 17 Functional Exercise

Using the information identified earlier by the Using the information identified earlier by the local water authorities along with the local water authorities along with the discipline identified impacts and resources discipline identified impacts and resources related to water disruption, this module will related to water disruption, this module will be used to begin the development of a be used to begin the development of a customized scenario for the functional customized scenario for the functional exercise.exercise.

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Issues for Discussion

Exercise LevelsExercise Levels

What level of exercise play do the organizations What level of exercise play do the organizations represented today anticipate for the November represented today anticipate for the November 17, 2011 exercise? Examples include 17, 2011 exercise? Examples include communications drill, functional and full scale communications drill, functional and full scale exercises; level of play may include use of exercises; level of play may include use of simulated patients, movement of patients to simulated patients, movement of patients to health care facilities, perimeter lockdown, health care facilities, perimeter lockdown, activation of the joint information center, etc.activation of the joint information center, etc.

Will Will your agency/department activate its your agency/department activate its command/operations center?command/operations center?

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Issues for Discussion

Exercise Times/DurationExercise Times/Duration

Exercise play is being developed to Exercise play is being developed to include a message released from several include a message released from several State agencies confirming a threat or State agencies confirming a threat or attack on the public water system. attack on the public water system. Participants may begin exercise play at Participants may begin exercise play at their discretion but are strongly their discretion but are strongly encouraged to collaborate with encouraged to collaborate with local/operational area partners. local/operational area partners.

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Issues for Discussion

Exercise Times/DurationExercise Times/Duration

• Can participants estimate their hours of Can participants estimate their hours of exercise play at this time? exercise play at this time?

Exercise planners should lead a discussion Exercise planners should lead a discussion on exercise start and end times, as well as on exercise start and end times, as well as duration of exercise play.duration of exercise play.

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Issues for Discussion

Scenario DevelopmentScenario Development

The functional exercise should be customized by The functional exercise should be customized by planners with participants and local water authorities to planners with participants and local water authorities to customize the scenario of the disruption to the public customize the scenario of the disruption to the public water system. water system.

Representatives from the local water authorities to Representatives from the local water authorities to provide a brief overview of the operational area water provide a brief overview of the operational area water system, including sources of water for the area, types of system, including sources of water for the area, types of delivery systems, etc. Discussion should include the delivery systems, etc. Discussion should include the various levels of water notices that may be issued: “Boil various levels of water notices that may be issued: “Boil Water,” “Do Not Drink”, or “Do Not Use”, as well as Water,” “Do Not Drink”, or “Do Not Use”, as well as authorities for issuing such notices within the operational authorities for issuing such notices within the operational area and the State. area and the State.

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Issues for Discussion

Scenario DevelopmentScenario Development

Discussion may also include what events may cause Discussion may also include what events may cause a disruption to the public water system such as a disruption to the public water system such as contamination, earthquake, flooding, power failure, contamination, earthquake, flooding, power failure, etc.etc.

The following slide identifies options that may be The following slide identifies options that may be used as the local scenario or may be used in the used as the local scenario or may be used in the development of a scenario customized for the development of a scenario customized for the organization/jurisdiction.organization/jurisdiction.

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Scenario Option 1

This option is for communities that are located in This option is for communities that are located in hilly areas where the local water system has higher hilly areas where the local water system has higher elevation storage reservoirs to provide pressure as elevation storage reservoirs to provide pressure as well as system storage. well as system storage.

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Scenario Option 1

Scenario: On November 16, a break is discovered Scenario: On November 16, a break is discovered at the storage reservoir that serves the pressure at the storage reservoir that serves the pressure zone serving the community. The locks on the hatch zone serving the community. The locks on the hatch directly leading into the reservoir have been cut and directly leading into the reservoir have been cut and several containers were left that had a slight residue. several containers were left that had a slight residue. The local Hazmat Team was called and chemical The local Hazmat Team was called and chemical field tests were inconclusivefield tests were inconclusive

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Scenario Option 1 continues

Two firefighters displayed symptoms of respiratory Two firefighters displayed symptoms of respiratory distress and have been transported to a local distress and have been transported to a local hospital. The water system has just issued a “Do Not hospital. The water system has just issued a “Do Not Use” notice. Local law enforcement is notified who Use” notice. Local law enforcement is notified who in turn contact the Joint Terrorism Task Force.in turn contact the Joint Terrorism Task Force.

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Scenario Option 1 continues

This option uses the introduction of Ricin into the This option uses the introduction of Ricin into the water system as an act of terrorism. water system as an act of terrorism. Ricin is a protein that is extracted from the castor Ricin is a protein that is extracted from the castor

bean (Ricinus communis). Ricin may cause allergic bean (Ricinus communis). Ricin may cause allergic reactions, and is toxic, though the severity depends on reactions, and is toxic, though the severity depends on the route of exposure. Ricin is poisonous if inhaled, the route of exposure. Ricin is poisonous if inhaled, injected or ingested, acting as a toxin by the inhibition injected or ingested, acting as a toxin by the inhibition of protein synthesis. of protein synthesis.

If Ricin is suspected or detected in the water system, a If Ricin is suspected or detected in the water system, a “Do Not Use” notice would be issued.“Do Not Use” notice would be issued.

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Scenario Option 2

This option is for communities that are in a valley This option is for communities that are in a valley where the water system does not rely on higher where the water system does not rely on higher elevation storage reservoirs to provide the pressure, elevation storage reservoirs to provide the pressure, rather water pressure is provided by a network of rather water pressure is provided by a network of pumps throughout the system. These systems are pumps throughout the system. These systems are usually supplied by numerous well sources. usually supplied by numerous well sources.

The introduction of a contaminant into the water The introduction of a contaminant into the water distribution system can be accomplished through a distribution system can be accomplished through a cross connection to the system (i.e. tapping into a cross connection to the system (i.e. tapping into a fire hydrant). Discovery of this activity would lead to fire hydrant). Discovery of this activity would lead to a “Do Not Use” notice being issued. a “Do Not Use” notice being issued.

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Scenario Option 2 continues

On November 16, 2011 the local water system On November 16, 2011 the local water system contacts law enforcement after finding a truck contacts law enforcement after finding a truck illegally connected to one of its fire hydrants with a illegally connected to one of its fire hydrants with a pump found to be positioned to pump into the pump found to be positioned to pump into the hydrant. This hydrant is just around the corner from hydrant. This hydrant is just around the corner from a municipal water source. The water system has a municipal water source. The water system has sampled the water, but results will not be available sampled the water, but results will not be available for 6 to 12 hours. As a precaution, the water system for 6 to 12 hours. As a precaution, the water system has issued a “Do Not Use” notice.has issued a “Do Not Use” notice.

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Scenario Option 3

This option is for a water system with a central water This option is for a water system with a central water treatment plant that serves the entire city. treatment plant that serves the entire city.

On November 16, a water treatment facility was On November 16, a water treatment facility was broken into during the night when the plant is broken into during the night when the plant is unmanned and under automatic operation. During unmanned and under automatic operation. During this break-in the alarms were disabled. The terrorist this break-in the alarms were disabled. The terrorist tampered with the caustic soda metering pump and tampered with the caustic soda metering pump and caused an excessive amount to enter the distribution caused an excessive amount to enter the distribution system.system.

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Scenario Option 3

An excessive amount of Sodium Hydroxide entering An excessive amount of Sodium Hydroxide entering the distribution system would result in the water the distribution system would result in the water system issuing a “Do Not Use” notice. system issuing a “Do Not Use” notice.

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Issues for Discussion Continues

ParticipationParticipation

Review the various organizations in attendance Review the various organizations in attendance today. In the event of a disruption of the public water today. In the event of a disruption of the public water system, are there additional organizations that would system, are there additional organizations that would be impacted who are not in attendance today? be impacted who are not in attendance today?

Are there additional organizations/agencies that Are there additional organizations/agencies that would be impacted by the water disruption to would be impacted by the water disruption to your your facility?facility?

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Issues for Discussion Continues

Testing of Plans and ProceduresTesting of Plans and Procedures

Are there any plans, policies or procedures which Are there any plans, policies or procedures which individual departments or agencies would like to individual departments or agencies would like to test? Examples include: patient surge, fatality test? Examples include: patient surge, fatality response, water rationing plans, continuity of response, water rationing plans, continuity of operations plans, etc.operations plans, etc.

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Role of State Agencies

The California Department of Public Health and the The California Department of Public Health and the California Emergency Medical Services Authority will California Emergency Medical Services Authority will open the Joint Emergency Operations Center. In addition, open the Joint Emergency Operations Center. In addition, the California Emergency Management Agency is the California Emergency Management Agency is anticipated to participate by opening the State anticipated to participate by opening the State Operations Center and the three Regional Emergency Operations Center and the three Regional Emergency Operations Centers to support local and regional Operations Centers to support local and regional exercise play. This will provide the opportunity for local exercise play. This will provide the opportunity for local participants to request additional resources, submit and participants to request additional resources, submit and receive situation status reports and respond to California receive situation status reports and respond to California Health Alert Network (or other notification systems) Health Alert Network (or other notification systems) messages and further direction.messages and further direction.

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Action Items and Next Steps

Review projected levels of play, hours of Review projected levels of play, hours of exercise conduct, participants.exercise conduct, participants.

Identify agencies and individuals to review Identify agencies and individuals to review exercise materials and customize to the exercise materials and customize to the organization/jurisdiction.organization/jurisdiction.

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Action Items and Next Steps

Identify which scenario will be used in the Identify which scenario will be used in the exercise.exercise.

Set meeting times for exercise development.Set meeting times for exercise development.

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Thank you for your Thank you for your participationparticipation

Exercise materials may be found on the Exercise materials may be found on the exercise program website:exercise program website:

www.californiamedicalhealthexercise.com

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