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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. Give a brief Overview of the Maryland 2008 Statewide Pan Flu Exercise - PowerPoint PPT Presentation
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Maryland 2008 Statewide Maryland 2008 Statewide Pandemic Influenza Pandemic Influenza Exercise and CRAExercise and CRAAlbert Romanosky MD, PhDAlbert Romanosky MD, PhDOffice of Preparedness and Office of Preparedness and
ResponseResponseMaryland Department of Health Maryland Department of Health
and Mental Hygieneand Mental Hygiene
2CDC PHIN Conference 2008
Presentation ObjectivesPresentation Objectives
Give a brief Overview of the Maryland 2008 Give a brief Overview of the Maryland 2008 Statewide Pan Flu ExerciseStatewide Pan Flu Exercise
Review the Role of Countermeasures Review the Role of Countermeasures Response Administration (CRA) in the Response Administration (CRA) in the ExerciseExercise
Identify the CRA Sustainable/Key Strengths Identify the CRA Sustainable/Key Strengths and Needs Improvement Activitiesand Needs Improvement Activities
3CDC PHIN Conference 2008
2008 Pan Flu Exercise 2008 Pan Flu Exercise OverviewOverview
Modified Functional Exercise:Modified Functional Exercise: Full Scale ComponentsFull Scale Components Three Days (Three Days (June 17-19, 2008)June 17-19, 2008) Compressed Pandemic Wave Weeks 6-12 and Compressed Pandemic Wave Weeks 6-12 and
RecoveryRecovery Designed to Address:Designed to Address:
Corrective actions following previous exercisesCorrective actions following previous exercises Office of Preparedness & Response identified Office of Preparedness & Response identified
statewide pan flu priorities and operational statewide pan flu priorities and operational activitiesactivities
Federal Pan Flu PrioritiesFederal Pan Flu Priorities
4CDC PHIN Conference 2008
Overarching Exercise Overarching Exercise GoalGoal
The overall goal of the exercise was to test The overall goal of the exercise was to test the expertise and capability of several the expertise and capability of several
components of the healthcare system to components of the healthcare system to adequately identify and respond to adequately identify and respond to
unusual work and patient loads during a unusual work and patient loads during a pandemic influenza outbreak. pandemic influenza outbreak.
5CDC PHIN Conference 2008
Specific Exercise Testing Requirements Specific Exercise Testing Requirements and Guidelinesand Guidelines
Homeland Security Exercise and Evaluation Program Homeland Security Exercise and Evaluation Program (HSEEP)(HSEEP)
Assistant Secretary for Preparedness and Response (ASPR) Assistant Secretary for Preparedness and Response (ASPR) Hospital Preparedness Program (HPP) Exercise Standards and Hospital Preparedness Program (HPP) Exercise Standards and RequirementsRequirements
CDC Public Health Emergency Preparedness Cooperative CDC Public Health Emergency Preparedness Cooperative Agreement Guidance and CDC Pan Flu Appendix 12: Agreement Guidance and CDC Pan Flu Appendix 12: Overarching Exercise Objectives by Priority Area: Pandemic Overarching Exercise Objectives by Priority Area: Pandemic Flu Exercise Guidelines for Medical SurgeFlu Exercise Guidelines for Medical Surge
6CDC PHIN Conference 2008
ASPR Hospital Preparedness Program (HPP) ASPR Hospital Preparedness Program (HPP) Exercise Standards and RequirementsExercise Standards and Requirements
Evaluation of medical surge components of the tiered healthcare systemEvaluation of medical surge components of the tiered healthcare system Develop adequate evaluation tools and methodsDevelop adequate evaluation tools and methods Develop an After Action Report (AAR) Develop an After Action Report (AAR)
Specifics:Specifics: Coordination with Public HealthCoordination with Public Health
Risk CommunicationRisk Communication Medication DistributionMedication Distribution SurveillanceSurveillance Laboratory CapacityLaboratory Capacity
Volunteer Activation (ESAR-VHP)Volunteer Activation (ESAR-VHP) Staff SupportStaff Support CommunicationsCommunications Healthcare System Triage and Admission Healthcare System Triage and Admission Incident Command System (Integration and Coordination)Incident Command System (Integration and Coordination)
7CDC PHIN Conference 2008
CDC Cooperative Agreement CDC Cooperative Agreement and Pan Flu Exercise and Pan Flu Exercise
RequirementsRequirements Maryland State Pan Flu Operational PlanMaryland State Pan Flu Operational Plan
Based Upon CDC Based Upon CDC evaluationevaluation Appendix 12: Overarching Exercise Objectives by Priority Appendix 12: Overarching Exercise Objectives by Priority
Area:Area: Mass VaccinationMass Vaccination Continuity of OperationsContinuity of Operations Surveillance/ Lab ExerciseSurveillance/ Lab Exercise Community MitigationCommunity Mitigation CommunicationsCommunications Antiviral DistributionAntiviral Distribution Strategic National Stockpile (SNS) Medical Strategic National Stockpile (SNS) Medical
Countermeasure DistributionCountermeasure Distribution
8CDC PHIN Conference 2008
Maryland Statewide Pan Flu Maryland Statewide Pan Flu Exercise ObjectivesExercise Objectives
DHMH Coordination/Command Center and Continuity of DHMH Coordination/Command Center and Continuity of Operations Plan Operations Plan
Health and Medical Surge (Facilities, Personnel, Equipment Health and Medical Surge (Facilities, Personnel, Equipment and Supplies)and Supplies) Medical Surge – Alternate Care SitesMedical Surge – Alternate Care Sites Strategic National Stockpile / Receipt Staging and Storage Strategic National Stockpile / Receipt Staging and Storage Enhanced SurveillanceEnhanced Surveillance Governor’s WellmobilesGovernor’s Wellmobiles Laboratory SurgeLaboratory Surge Countermeasure Response AdministrationCountermeasure Response Administration EMS – Emergency Medical Dispatch EMS – Emergency Medical Dispatch EMS – Transport Diversion ProtocolEMS – Transport Diversion Protocol EMS On-Scene Triage and Assessment ProtocolEMS On-Scene Triage and Assessment Protocol
9CDC PHIN Conference 2008
Maryland Statewide Pan Flu Maryland Statewide Pan Flu Exercise ObjectivesExercise Objectives
Personal and Community PreparednessPersonal and Community Preparedness Community Emergency Response Teams (CERT) Community Emergency Response Teams (CERT) Critical InfrastructureCritical Infrastructure Internal Countermeasure DistributionInternal Countermeasure Distribution Educational FacilitiesEducational Facilities Volunteer ActivationVolunteer Activation Joint Information Center – Public InformationJoint Information Center – Public Information
Interoperable CommunicationsInteroperable Communications
Mass Fatality ManagementMass Fatality Management
Vulnerable PopulationsVulnerable Populations
10CDC PHIN Conference 2008
Maryland 2008 Statewide Maryland 2008 Statewide Pan Flu Exercise Pan Flu Exercise
ParticipantsParticipantsOpen to all Federal, State and Local Partners:Open to all Federal, State and Local Partners: 56 56 Local Agencies Local Agencies
Emergency Medical ServicesEmergency Medical Services Emergency Management Agencies Emergency Management Agencies Local Health Departments Local Health Departments Law EnforcementLaw Enforcement
25 25 State AgenciesState Agencies 4 4 Federal AgenciesFederal Agencies 50 50 Health Care Systems and OrganizationsHealth Care Systems and Organizations 12 12 State Hospitals / Residential and Day Program State Hospitals / Residential and Day Program
Service Service ProvidersProviders 8 8 Community Based Service ProvidersCommunity Based Service Providers 8 8 Critical Infrastructure/Key Resources/Critical Critical Infrastructure/Key Resources/Critical
ManufacturingManufacturing
11CDC PHIN Conference 2008
Maryland 2008 Statewide Maryland 2008 Statewide Pan Flu Exercise Pan Flu Exercise
ParticipantsParticipants
Total Number of Exercise Personnel:Total Number of Exercise Personnel: PlayersPlayers 4,000+4,000+ Contractor Controller/Evaluators/Observers 50Contractor Controller/Evaluators/Observers 50 Peer Controller/Evaluators/ObserversPeer Controller/Evaluators/Observers 100100 Exercise Design and DevelopmentExercise Design and Development 75-10075-100
DHS Target CapabilitiesDHS Target Capabilities:: 29 of 4529 of 45
12CDC PHIN Conference 2008
CDC CRA CDC CRA ActivitiesActivitiesPre-Exercise:Pre-Exercise: Exercise Planning/DevelopmentExercise Planning/Development CRA Access CRA Access TTraining (open to all)raining (open to all)ExerciseExercise:: Just-In-Time Training Just-In-Time Training SSupport for upport for RReal-time eal-time DData ata EEntryntry Situational Awareness / Data ReportingSituational Awareness / Data Reporting State Level Data Access State Level Data Access Post-Exercise:Post-Exercise: Hotwash and After Action Report Hotwash and After Action Report
13CDC PHIN Conference 2008
Countermeasure Response Countermeasure Response AdministrationAdministration
Exercise ObjectivesExercise Objectives Establish and implement CRA to collect Establish and implement CRA to collect
data:data: Offline stand alone scenarioOffline stand alone scenario Online web interface (Real Time/Delay)Online web interface (Real Time/Delay)
Assess CRA ease of use Assess CRA ease of use Track and report on antivirals dispensed at Track and report on antivirals dispensed at
a public and private agency Points of a public and private agency Points of DispensingDispensing
Track and report on community antiviral Track and report on community antiviral dispensingdispensing
14CDC PHIN Conference 2008
CRA Exercise Specific CRA Exercise Specific ActivitiesActivities
CRA ActivationCRA Activation Data Entry Data Entry
Direct: Web based Direct: Web based Indirect/Off-Line: Delayed UploadIndirect/Off-Line: Delayed Upload
Monitoring and Tracking Monitoring and Tracking Dispensing of Medications Dispensing of Medications Adverse Reactions to Antiviral Adverse Reactions to Antiviral
MedicationsMedications
15CDC PHIN Conference 2008
Maryland CRA Participating SitesMaryland CRA Participating Sites
Howard County Health DepartmentHoward County Health DepartmentHammond Middle School POD (Real-time Data Entry)Hammond Middle School POD (Real-time Data Entry)
POD in Howard County dispensing antivirals to head-of-household for POD in Howard County dispensing antivirals to head-of-household for surrounding communitysurrounding communityChateau Lake Ridge Community (Post-dispensing Data Entry)Chateau Lake Ridge Community (Post-dispensing Data Entry)
Community dispensing with limited social distancingCommunity dispensing with limited social distancing
Chester River Hospital (Real-time Data Entry)Chester River Hospital (Real-time Data Entry) Fixed POD dispensing antivirals to employeesFixed POD dispensing antivirals to employees
City of Laurel (Real-time Data Entry)City of Laurel (Real-time Data Entry) Community dispensing with voluntary Isolation and QuarantineCommunity dispensing with voluntary Isolation and Quarantine
Note: Two sites anticipated using CRANote: Two sites anticipated using CRA
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CRA Data EntryCRA Data Entry
17CDC PHIN Conference 2008
CRA EvaluationCRA Evaluation
Overall Exercise:Overall Exercise: CRA data collection and entryCRA data collection and entry
Key Strengths:Key Strengths: The “just-in-time” training was very The “just-in-time” training was very
successful and was a key to proficiency;successful and was a key to proficiency; Data entry into the CRA application flowed Data entry into the CRA application flowed
well;well;
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CRA EvaluationCRA Evaluation
Key Strengths:Key Strengths: Within a short amount of time participants were able Within a short amount of time participants were able
to enter information; to enter information; Data entry into CRA described as simple and Data entry into CRA described as simple and
‘intuitive’ by participants;‘intuitive’ by participants; (Data entry maybe labor intensive)(Data entry maybe labor intensive)
Users were able to pull data and track progress;Users were able to pull data and track progress; CRA reports were useful in providing data of CRA reports were useful in providing data of
antivirals dispensed at the local and state level;antivirals dispensed at the local and state level;
19CDC PHIN Conference 2008
CRA EvaluationCRA Evaluation
Areas for Improvement:Areas for Improvement: Ability to track individuals that present at a Ability to track individuals that present at a
dispensing site but do not receive dispensing site but do not receive countermeasures;countermeasures;
Ability to support Head-of-Household data Ability to support Head-of-Household data collection;collection;
Support interoperability with other systems;Support interoperability with other systems; Not all regions of the state participated in CRA Not all regions of the state participated in CRA
exercise activities;exercise activities;
20CDC PHIN Conference 2008
CRA EvaluationCRA Evaluation
Recommendations:Recommendations: Expansion of CRA participation in the Expansion of CRA participation in the
Public and Private Sectors;Public and Private Sectors; Continue to train hospitals and health Continue to train hospitals and health
departments on the CRA program;departments on the CRA program; Increase recruitment for CRA accessIncrease recruitment for CRA access;;
21CDC PHIN Conference 2008
Suggested CRA Suggested CRA EnhancementEnhancement
Pre-population and Uploading of DataPre-population and Uploading of Data Health Department Personnel (State HAN)Health Department Personnel (State HAN) Private Sector Expanded Data Entry and Private Sector Expanded Data Entry and
Participation:Participation: Healthcare SystemsHealthcare Systems Public-Private Partnership Public-Private Partnership
Critical Infra-structure/Key Resources/Critical Critical Infra-structure/Key Resources/Critical ManufacturingManufacturing
Essential Staff and PersonnelEssential Staff and Personnel
Expanded ApplicationExpanded Application Fatality RegistrationFatality Registration
22CDC PHIN Conference 2008
Maryland Future Maryland Future ActivitiesActivities
DAX 2008 (Seasonal Influenza DAX 2008 (Seasonal Influenza Vaccination Exercise)Vaccination Exercise) Increase CRA Training and AccessIncrease CRA Training and Access All Maryland ParticipationAll Maryland Participation
24 Counties24 Counties Combination:Combination:
Real-Time and Delayed Data EntryReal-Time and Delayed Data Entry On-Line Web Based vs Off-Line Data EntryOn-Line Web Based vs Off-Line Data Entry Aggregate vs individual Data EntryAggregate vs individual Data Entry Regional Clinic Integration and CoordinationRegional Clinic Integration and Coordination
23CDC PHIN Conference 2008
Al Romanosky, MD, PhDAl Romanosky, MD, PhD
Maryland Department of Health Maryland Department of Health and Mental Hygiene and Mental Hygiene
Office of Preparedness and Office of Preparedness and ResponseResponse
410.767.0823410.767.0823
[email protected]@dhmh.sate.md.us