COTS CHEMPACK

Tabletop Exercise

June 25, 2015

Welcome and Introductions

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Administrivia

• Registration• Exits & Restrooms • Emergency Evacuation• Cell Phones/Pagers• Participant Feedback Forms • Situation Manual (SitMan) Rules • Questions

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Exercise Schedule

• 07:30 a.m. Registration • 08:00 a.m. Welcome• 08:15 a.m. Participant Briefing• 08:20 a.m. Module 1• 09:20 a.m. Break• 09:30 a.m. Module 2• 10:30 a.m. Module 3• 11:30 a.m. Hotwash• 12:00 p.m. End

Exercise Briefing

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Overview

• The COTS CHEMPACK TTX will utilize a facilitated plenary and moderated breakout group format enhanced with multimedia presentations.

• This exercise emphasizes the roles and responsibilities of agencies and organizations responding to a terrorist incident.

• Policies, processes, and decision making are more important than minute details.

Scope

• Participants from 18 organizations.

• 4-hour facilitated plenary and moderated breakout group TTX.

• 3 Modules: – Module 1: Assessing the Need for the CHEMPACK– Module 2: Requesting & Deploying the CHEMPACK– Module 3: Recovery, Accountability, & Information

Scope (continued)

• Each module comprises: – Plenary situation updates– Open and active facilitated discussion – Moderator-led breakout group discussion– Discussion of various issues– Plenary report out by each breakout group

Participants

Players discuss what their responses would be to the situation presented on the basis of expert knowledge of response procedures, current plans and procedures, and insights derived from training.

Observers may support the group in developing responses to the situation, but they are primarily limited to observing the exercise. They are not participants in any facilitated or moderated discussions.

Participants (continued)

Facilitators provide situation updates and moderate discussions. They also provide additional information or resolve questions as required. Key Exercise Planning Team members may assist with facilitation as subject matter experts (SMEs) during the exercise.For purposes of this exercise the Facilitator will guide the overall exercise conduct and flow and will facilitate report out session during which each breakout group shares its conclusions.

Participants (continued)

Breakout group moderators are assigned to guide the discussion at each breakout group and record the responses of the breakout group participants. The Moderator will use the provided questions to ensure that discussion focuses on the exercise objectives. The Moderator will also provide the plenary breakout group report at the end of each module.

Participants (continued)

• Ohio Health Riverside• Ohio Health Dublin• Ohio Health Grant• Ohio Health Doctors• Mount Carmel Health System• Diley Ridge Medical Center• Nationwide Children’s Hospital• The OSU Wexner Medical Center• Franklin County Public Health• Central Ohio Trauma System

Participants (continued)

• Columbus Public Health• Ohio State Highway Patrol• 52nd Civil Support Team• Battelle Institute• Franklin County Emergency Management and Homeland

Security• Ohio Department of Health• Ohio Hospital Association• Ohio Department of Homeland Security??• Columbus Division of Police• Columbus Division of Fire-EMS

Purpose

• To provide hospital, emergency management agency (EMA), public health, emergency medical services (EMS), fire, and law enforcement participants with an opportunity to evaluate current response concepts, plans, and capabilities used to manage an expanding incident that:– Requires justifying the request for the CHEMPACK

assets, and– Following existing plans for requesting and deploying,

the assets located within Franklin County.

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Objectives

The following objectives were selected by the Exercise Planning Team.

1. Chemical agent identification and need for CHEMPACK.

2. CHEMPACK request process for host-hospitals, non-host hospitals, and EMS.

Objectives

3. Deployment of the CHEMPACK asset.

4. Coordination of response activities between EMA, EMS, law enforcement, and host and non-host hospitals.

5. Information sharing.

Preparedness Capabilities

Capabilities are linked to the objectives, which provide the foundation for development of the exercise objectives and scenario. ASPR:

Capability 1 - Healthcare System PreparednessCapability 3 - Emergency Operations CoordinationCapability 6 - Information SharingCapability 10 - Medical SurgeCapability 14 – Responder Safety and Health

Preparedness Capabilities

PHEP:Capability 3 - Emergency Operations CoordinationCapability 6 - Information SharingCapability 9 - Medical Materiel Management and DistributionCapability 10 - Medical Surge

DHS: Capability - Public Health and Medical ServicesCapability - Public and Private Services and ResourcesCapability - Operational CoordinationCapability - Situation Assessment

Exercise Guidelines

• This is an open, low-stress, no-fault environment. Varying viewpoints, and even disagreements, are expected.

• Responses are based on the current plans and capabilities of each agency or organization.

• Decisions are not precedent setting; consider different approaches and suggest improvements.

• Slow-paced problem solving will be used. • Players are encouraged to discuss issues in depth.

Assumptions & Artificialities

• The scenario is plausible, and events occur as they are presented.

• There are no trick questions or hidden agendas.

• All players receive information at the same time.

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StartEX

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Module 1

ASSESSING THE NEED FOR CHEMPACK

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Thursday, June 24, 2015 @ 6:00 a.m.

• Registration for the Olentangy Valley Clinic Marathon and ½ Marathon is underway. Registration and the race starting line are located at the Fred Beekman Park on Lane Ave.

• Approximately 7,000 runners are pre-registered for the race and over 25,000 people are expected to line the race course from the starting line at Fred Beekman Park to the finish line at the Columbus Commons.

• It’s a hot day. The temperature will be in the mid 80s at race time and is expected to climb quickly into the mid 90s by finish time. Wind is out of the west at 0-5mph.

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Thursday, June 24, 2015 @ 7:00 a.m.

• The race began on time with over 7,000 runners in the field. Among them are runners representing all 50 U.S. states and 23 countries from around the world.

• The runners will follow a course that includes Lane Ave., North High St., Broad St., South Gift St., Dodge Park, South Souder Ave, Mound St., Harmon Ave, Greenlawn Ave., and Louis Berliner Park and proceeds north on South High St. to the Columbus Commons finish line.

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Thursday, June 24, 2015 @ 9:00 a.m.

Two Octo-Copter Drones are observed flying over the crowded Columbus Commons finish line area. The area is filled with spectators, runners, and local dignitaries that are supporting the awards ceremony. A rumor begins to flow through the crowd that the drones are spraying something on the people in attendance.

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Thursday, June 24, 2015 @ 9:15 a.m.

• Columbus Emergency Dispatch has become swamped with cell phone calls requesting EMS as people around the finish line become ill. The sick include both racers and spectators.

• Symptoms include: tremors, drooling, watering eyes, urge to urinate, need to defecate, shortness of breath – rapid respiration, runny nose, uncontrolled coughing, blurred vision, confusion, rapid pulse rate, nausea and vomiting and restriction of their pupils.

• People in low lying areas have the most severe symptoms.

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Key Issues

• 7,000+ runners• 25,000+ workers & spectators• 80-85° F• West wind at 0 - 5mph• Each Unmanned Aerial Vehicle (UAV) can carry 5.28 gallons

(20 liters) of liquid• UAV endurance: 20-30 minutes• UAV flights occurred at the finish line area at Columbus

Commons• 2,300 runners and 8,000 spectators are ill and

demonstrating symptoms27

Key Issues (continued)

– Tremors– Drooling– Watering eyes– Urge to urinate– Need to defecate– Shortness of breath –

rapid respiration– Runny nose

– Uncontrolled coughing– Blurred vision– Confusion– Rapid pulse rate– Nausea and upset

stomach– Vomiting– Restriction of the pupil

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Victims are exhibiting the following:

Moderated Group Discussion

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Module 2

REQUESTING AND DEPLOYING THE CHEMPACK

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Thursday, June 24, 2015 @ 9:30 a.m.• An Air Monitoring Team located near the

Columbus Commons finish line has notified the Columbus Division of Police that their monitoring system has registered a positive indication for nerve agents, possibly Sarin.

• Existing supplies of nerve agent antidotes at EMS and fire agencies in Franklin County are not available due to a widespread recall or they have been expended.

• Because there are limited supplies of nerve agent antidote (Atropine and Valium) at non-host hospitals, they are requesting CHEMPACK assets.

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Thursday, June 24, 2015 @ 10:30 a.m.

• The ICP and a Staging Area have been set up at the COSI parking lot on West Broad. Columbus Fire and Police are in a Unified Command. The section of Broad St. and High St. running between COSI and the Columbus Commons has been restricted to responder traffic only.

• The Incident Command Planning Section Situation Unit indicates that there are potentially 10,700 people exhibiting Sarin exposure symptoms near the Columbus Commons finish line, and in area hospitals. Of that numbers, 400 are public safety officials, 2,300 are racers and 8,000 are spectators.

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Thursday, June 24, 2015 @ 10:30 a.m.

• The City of Columbus Emergency Operations Center (EOC), Franklin County EOC, and the State EOC are all activated at various levels.

• The Incident Command Post, the Strategic Analysis and Information Center (SAIC), the City of Columbus Counter Terrorism Unit, the Ohio State Highway Patrol HUB, the Franklin County Emergency Management and Homeland Security (FCEM&HS) Agency, Ohio EMA, Ohio Department of Health (ODH) and senior officials are all seeking information from area hospitals and EMS providers. 33

Thursday, June 24, 2015 @ 11:00 a.m.

• As a result of an organized search, two Octo-Copter Drone Sprayers were recovered near East Cherry St. and Zettler St. The tanks of the Octo-Copters were empty. They tested positive for presence of Sarin. (See Sarin-Octo-Copter Fact Sheet.)

• A known terrorist organization calling itself the

“Peoples Supreme Independence Front” has taken responsibility for the attack by posting on the social media sites of numerous news outlets in the city and state.

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Key Issues

• Temperature is in the mid 80s with wind out of the west at 0-5mph.

• Air monitoring team registered a positive indication for Sarin.

• Existing supplies of nerve agent antidote through EMS, law enforcement, fire and hospitals have been expended or are not available. Only the CHEMPACK is available.

• Nine area hospitals and one EMS agency have requested CHEMPACK assets.

• Incident Command and staging is set up in the COSI parking lot.

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Key Issues (continued)

• Roadways between COSI and the Columbus Commons are open only to responders.

• The Situation Unit confirms that 400 public safety officials, 2,300 racers, and 8,000 spectators are showing symptoms of exposure.

• City of Columbus EOC, Franklin County EOC, and the State EOC are all activated at various levels.

• Local, County, State and Federal partners are gathering information from hospitals and EMS.

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Moderated Group Discussion

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Module 3RECOVERY, ACCOUNTABILITY, AND

INFORMATION

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Thursday, June 29, 2015 @ 9:00 a.m.

• The June 24 estimates of the numbers of persons exposed to Sarin were fairly accurate. As of June 29, a total of 5,000 people have died from the Sarin attack and 10,800 persons were believed to be exposed to the nerve agent Sarin.

• Approximately 5,000 patients required admission to a hospital.

• EMS and hospitals implemented decontamination measures to lessen the persistence and spread of the Sarin nerve agent.

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Thursday, June 29, 2015

• As the incident response moves into the investigation and recovery phase, the Unified Command has grown to include the CPD, CFD, FBI, Ohio CST, Ohio EPA, Ohio Department of Homeland Security (DHS), and the U.S. EPA.

• ODH has requested a situational update, records of expended CHEMPACK antidotes, inventories of remaining antidotes, and a plan for the return of unused doses.

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Key Issues

• It is four days after the Sarin attack.• 10,800 persons were believed to be exposed to the

nerve agent Sarin.• All hospitals in Franklin County, Ohio received

patients that were exposed to Sarin.• Hospitals and EMS implemented decontamination

measures to lesson exposure.• Approximately 5,000 victims required

hospitalizations. • 5,000 people died from the Sarin exposure.

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Key Issues (continued)

• Unified Command includes; CPD, CFD,FBI, Ohio CST, Ohio EPA, Ohio DHS, U.S. EPA and ODH.

• Unified Command priorities include: (1) Investigation, (2) Decontamination and Recovery, (3) Protection from secondary incidents, (4) Responder Safety and Health, (5) Emergency Public Information, and (6) Reconstitution of CHEMPACK assets.

• Demand for information from response and recovery partners and the public is extremely high.

• Accountability for use of CHEMPACK assets is required by the CDC.

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Moderated Group Discussion

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Hotwash

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Next Steps

• Develop a draft after action report (AAR).

• Conduct an After Action Meeting to validate strengths, areas for improvement, recommendations, and corrective actions.

• Finalize AAR and distribute to exercise participants and stakeholders.

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Closing Remarks

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THANK YOU

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