Tornado Tabletop Exercise

Tornado Tabletop ExerciseTornado Tabletop Exercise

Photo courtesy of NOAA Photo Library

Minnesota Emergency Readiness Education and Training Program

(MERET)

MERET worked with partners in Minnesota to adapt curriculum to support the Hospital Incident Command System (HICS) training

MERET is a program designed to educate and train Minnesota’s health care workers in emergency preparedness, tailoring efforts to the unique needs of specific communities as they prepare for a health emergency or bioterrorism event. MERET is funded by the Office of the Assistant Secretary for Preparedness and Response (ASPR) of the U.S. Department of Health and Human Services, and is administered by the University of Minnesota Schools of Nursing and Public Health. Carol O’Boyle, PhD, RN, at the School of Nursing, is the Principal Investigator.

Minnesota Emergency Readiness Education and Training (MERET) is funded under grant #TO1HP06412 from the Office of the Assistant Secretary for Preparedness and Response (ASPR),DHHS, Bioterrorism Training and Curriculum Development Program.

Tabletop ObjectivesTabletop Objectives

Using a tornado scenarioUsing a tornado scenario::●● Demonstrate understanding and skill in opening an Incident Demonstrate understanding and skill in opening an Incident

Command PostCommand Post● ● Activate appropriate modules within the Incident Command Activate appropriate modules within the Incident Command

SystemSystem● ● Demonstrate ability to perform roles and responsibilitiesDemonstrate ability to perform roles and responsibilities● ● Demonstrate ability to locate and implement Job Action Demonstrate ability to locate and implement Job Action

Sheets (JAS)Sheets (JAS)● ● Verbalize understanding of a coordinated emergency Verbalize understanding of a coordinated emergency

response with other community agenciesresponse with other community agencies● ● Assess needs for alternative modes of operation. Assess needs for alternative modes of operation. ● ● Verbalize importance of contributing to team efforts Verbalize importance of contributing to team efforts ● ● Verbalize understanding of continuity of operationsVerbalize understanding of continuity of operations

Background InformationBackground Information

Sunday afternoon NWS Sunday afternoon NWS issues issues Tornado WatchTornado Watch (insert general area e.g. (insert general area e.g. SW and SC) MinnesotaSW and SC) Minnesota

At 4:40 PM National At 4:40 PM National Weather Service issues Weather Service issues Special Weather Special Weather StatementStatement of a line of of a line of severe storms developing severe storms developing over (insert general area over (insert general area e.g. SW and SC) e.g. SW and SC) MinnesotaMinnesota


Are we doing anything with Are we doing anything with this information for the this information for the

organization?organization?

Background InformationBackground Information At 5:45 PM NWS issues At 5:45 PM NWS issues

a a Severe Thunderstorm Severe Thunderstorm WarningWarning for( insert for( insert general area e.g. Brown general area e.g. Brown and Watonwan) and Watonwan) CountiesCounties

NWS radar indicates a NWS radar indicates a line severe line severe thunderstorms between thunderstorms between (insert general (insert general information e.g. Sleepy information e.g. Sleepy Eye and St. James) Eye and St. James) moving eastmoving east

Photographer: D. Burgess. Photo courtesy of NOAA Photo Library

Would we do anything Would we do anything with this new with this new information?information?

Emergencies Present In 2 Emergencies Present In 2 Ways…Ways…

Oklahoma City Bombing

Tornado

Hurricane Katrina

Midwest Floods

Pandemic FluNorthridge Earthquake

The Amount of Time We’re GivenTo Pre-Organize People and Pre-Stage Equipment

Can Drastically Change Our Response Effectiveness

Anticipatedand/or

With Warning

Anticipatedand/or

With Warning

Unanticipatedand/or

Without Warning

Unanticipatedand/or

Without Warning

Illustration courtesy of Pete Brewster – VA Medical System

Incident progressionIncident progression

BOOM!

Reactive PhaseRecognitionNotificationsInitial control and safety actionsEstablish ICP

Primary ToolsSOPsJob Action Sheets

Primary GoalPrevent incident expansionPrevent responder injury

Proactive PhaseSituation assessedObjectives establishedStrategies / tacticsResources requested

Primary ToolsICSIncident Action Planning

Primary GoalManage incident

Slide courtesy of John Hick Hennepin County Medical Center

What are the respective agencies What are the respective agencies doing with this Tornado Warning?doing with this Tornado Warning?

FireFire Law EnforcementLaw Enforcement EMS/AmbulanceEMS/Ambulance Emergency Management Emergency Management HospitalHospital

Establish an Incident Command Establish an Incident Command Center/PostCenter/Post

Where will it be located? Is there a back-Where will it be located? Is there a back-up location in case of destructionup location in case of destruction

Determine positions to be openedDetermine positions to be opened Hand out Job Action Sheets (JAS)Hand out Job Action Sheets (JAS) Put on job vestsPut on job vests Begin FormsBegin Forms

Forms 201 Incident BriefingForms 201 Incident Briefing Forms 202 Incident ObjectivesForms 202 Incident Objectives

Prepare/Practice/AnticipatePrepare/Practice/Anticipate

Scenario DevelopmentScenario Development

At 6:10 PM NWS issues a At 6:10 PM NWS issues a Tornado WarningTornado Warning for for (insert local info e.g.Blue (insert local info e.g.Blue Earth and Nicollet) Earth and Nicollet) Counties until 7:00 PMCounties until 7:00 PM

At 6:15 PM weather At 6:15 PM weather spotter confirms tornado spotter confirms tornado on the ground (insert on the ground (insert local info e.g.NE of Lake local info e.g.NE of Lake Crystal on HWY 60) Crystal on HWY 60) moving NE at 30 MPHmoving NE at 30 MPH


How do we respond to How do we respond to this NWS this NWS Tornado Tornado

Warning?Warning?


At 6:20 PM sheriff deputies At 6:20 PM sheriff deputies report tornado touchdown report tornado touchdown just west of (add local info just west of (add local info e.g.Mankato near e.g.Mankato near Minneopa Park)Minneopa Park)

At 6:30 PM local police At 6:30 PM local police notify dispatch of tornado notify dispatch of tornado on the ground in the cityon the ground in the city

At 6:35 PM power blinks At 6:35 PM power blinks off/on at Hospital facilityoff/on at Hospital facility

At 6:37 PM Tornado hits At 6:37 PM Tornado hits Hospital facilityHospital facility


Job Action Sheets (JAS)Job Action Sheets (JAS)1. Title1. Title2. Purpose2. Purpose3. To3. To whom they whom they reportreport4. Critical action 4. Critical action considerationsconsiderations5. Forms required by 5. Forms required by

the jobthe job6. Broken into 6. Broken into operational periodsoperational periods

JAS JAS “prompts” the team “prompts” the team member to take needed member to take needed actions related to their actions related to their roles and responsibilitiesroles and responsibilities

Courtesy of HICS

HICS 201 Form (Incident HICS 201 Form (Incident Briefing)Briefing)

1. Incident Name,2. Date of Briefing3. Time of Briefing4. Event History 5. Current Actions 6. Summary7. Current Organization8. Notes (Accomplishments, Issues, Directives)9. Name of the individual who prepared the document10. Facility Name

Courtesy of HICS


Tornado hits south and Tornado hits south and west sides of buildingwest sides of building

Roof is off on the 5200 Roof is off on the 5200 and 5400 wingsand 5400 wings

Windows are broken on Windows are broken on the 5200 and 5400 the 5200 and 5400 wings on ALL floorswings on ALL floors

Tornado lasts about 10 Tornado lasts about 10 minutes with severe minutes with severe winds and heavy winds and heavy rainfallrainfall

Photo courtesy Mark Wolfe/FEMA

Tornado ImplicationsTornado Implications

Main power has been Main power has been interrupted – on interrupted – on generatorgenerator

Phone system outside Phone system outside the hospital is disabledthe hospital is disabled

Cell phone towers are Cell phone towers are down down

Major damage reported Major damage reported (via AM radio) (via AM radio) throughout the throughout the City/CountyCity/County

Photo courtesy Marvin Nauman/FEMA

Facility System Status ReportFacility System Status Report

1. Operational Period Date/Time

2. Date Prepared3. Time Prepared4. Building Name5. System Status Checklist

IT system Communication System Infrastructure Patient Care System Security System Utilities, External

System Utilities, Internal

System6. Certifying Officer7. Facility Name

Courtesy of HICS

Scenario DevelopmentScenario Development What are you going to What are you going to

do?do? What are our priorities?What are our priorities? Incident CommandIncident Command

Who is in charge?Who is in charge? What resources do we What resources do we

have?have? How to access more How to access more

resources?resources? Communication?Communication? Infrastructure Infrastructure

assessment?assessment? Evacuation/Off-site Evacuation/Off-site

care?care?

Photo courtesy of Mike Branick

Managing by Objectives Managing by Objectives Incident Action Plan (IAP)Incident Action Plan (IAP)

There is only one Incident Action Plan at an incident There is only one Incident Action Plan at an incident which identifieswhich identifies

WHAT must be done?WHAT must be done? WHO is responsible?WHO is responsible? How information will be COMMUNICATED?How information will be COMMUNICATED? What if a responder is INJURED?What if a responder is INJURED?

Overall Priorities Overall Priorities Life SavingLife Saving Incident stabilizationIncident stabilization Property PreservationProperty Preservation

Establish Incident Action Plan objectives, strategies, Establish Incident Action Plan objectives, strategies, tacticstactics

Slide courtesy of FEMA

Establishment of Incident Establishment of Incident Objectives and StrategyObjectives and Strategy

What are the Strategic Goals?What are the Strategic Goals?

What are the immediate Tactical What are the immediate Tactical Objectives?Objectives?

Remember – Documentation!Remember – Documentation!

HICS 202 Form (Incident HICS 202 Form (Incident Objectives)Objectives)

1. Incident name

2. Date prepared

3. Time prepared

4. Operational period ( date & time)

5. General command & control objectives for the incident (including alternatives)

6. Weather/environmental implications during the period (forecast, wind speed/direction, daylight)

7. General safety/staff messages to be given

8. Attachments (ex. medical plan, facility system status)

9. Name of the individual who prepared the document

10. Approval of the Incident Commander

11. Facility nameCourtesy of HICS

Incident Action Plan Establishes Incident Action Plan Establishes Objectives, Strategies, and TacticsObjectives, Strategies, and Tactics

State what will be accomplished (agency exec and State what will be accomplished (agency exec and IC)IC)

Establish the general plan or Establish the general plan or direction for accomplishing the direction for accomplishing the incident objectives (IC)incident objectives (IC)

Tactics Specify how the strategies will Specify how the strategies will

be executed. (be executed. (OperationsOperations))

Incident Objectives

Strategies


Incident Command StaffIncident Command Staff How much of the ICS is How much of the ICS is

implemented?implemented? Staff in the ICS organizational Staff in the ICS organizational

structure are appointed as the structure are appointed as the incident complexity expandsincident complexity expands

SafetyOfficerSafetyOfficer

LiaisonOfficerLiaisonOfficer

Public InformationOfficer

Public InformationOfficer

Command Staff

IncidentCommander

IncidentCommander

OperationsSection

OperationsSection

PlanningSection

PlanningSection

LogisticsSection

LogisticsSection

Finance/AdminSection

Finance/AdminSection

General Staff


Sample “Build Outs”: Sample “Build Outs”: ImmediateImmediate

Incident Commander

PlanningSection Chief

LogisticsSection Chief

Operations Section Chief

Finance/Administration Section Chief

LiaisonOfficer

Medical/Technical Specialist

SafetyOfficer

Public Information

Officer

ProcurementUnit Leader

Compensation/Claims

Unit Leader

TimeUnit Leader

CostUnit Leader

ServiceBranch Director

SupportBranch Director

ResourcesUnit Leader

SituationUnit Leader

Documentation Unit Leader

Demobilization Unit Leader

Staging Manager

Medical Care Branch Director

Infrastructure Branch Director

HazMatBranch Director

SecurityBranch Director

Business Continuity

Branch Director

Power/Lighting UnitWater/Sewer UnitHVAC UnitBuilding/Grounds Damage UnitMedical Gases UnitMedical Devices UnitEnvironmental Services UnitFood Services Unit

Inpatient UnitOutpatient UnitCasualty Care UnitMental Health UnitClinical Support Services UnitPatient Registration Unit

Detection and Monitoring UnitSpill Response UnitVictim Decontamination UnitFacility/Equipment Decontamination Unit

Access Control UnitCrowd Control UnitTraffic Control UnitSearch UnitLaw Enforcement Interface Unit

Information Technology UnitService Continuity UnitRecords Preservation UnitBusiness Function Relocation Unit

PersonnelVehicleEquipment/SupplyMedication Personnel Tracking

Materiel Tracking

Patient TrackingBed Tracking

Communications UnitIT/IS UnitStaff Food & Water Unit

Employee Health & Well-Being UnitFamily Care UnitSupply UnitFacilities UnitTransportation UnitLabor Pool & Credentialing Unit

Biological/Infectious DiseaseChemicalRadiologicalClinic AdministrationHospital AdministrationLegal AffairsRisk ManagementMedical StaffPediatric CareMedical Ethicist

Legend

Activated Position



Compensation/Claims

Unit Leader

TimeUnit Leader

CostUnit Leader




CommunicationsCommunications What do you communicate to the community?What do you communicate to the community? Who is the spokesperson?Who is the spokesperson? What is the plan for news media?What is the plan for news media? Who will be the Public Information Officer?Who will be the Public Information Officer? Is there a Joint Public Information Center?Is there a Joint Public Information Center? Will a press conference be scheduled?Will a press conference be scheduled? What are the key messages?What are the key messages? When/How will updates be When/How will updates be

done?done?

Photo courtesy of FEMA Photographer Mike Howard

Scenario MessagesScenario Messages

Incident CommandIncident Command Public Information Public Information

Officer (PIO)Officer (PIO) OperationsOperations Emergency Emergency

DepartmentDepartment SafetySafety

LogisticsLogistics PlanningPlanning FinanceFinance Medical Medical

Director/PhysicianDirector/Physician NursingNursing Infection ControlInfection Control

How much of HEICS is How much of HEICS is implemented…implemented…

OPERATIONS PLANNING

LOGISTICS FINANCE

COMMAND

Images courtesy of USA.gov

Future Objectives & StrategiesFuture Objectives & Strategies

Where might we relocate Where might we relocate other essential functions?other essential functions?

How do you sustain How do you sustain prolonged incident like prolonged incident like this while your facility is this while your facility is stabilized to resume care stabilized to resume care and treatment for your and treatment for your community (5-7 days)community (5-7 days)

What do you What do you communicate to the communicate to the community?community?

Sample “Build Outs”: Sample “Build Outs”: ExtendedExtendedIncident Commander





LiaisonOfficer


SafetyOfficer

Public Information

Officer


Compensation/Claims

Unit Leader

TimeUnit Leader

CostUnit Leader







Staging Manager





Business Continuity

Branch Director







Materiel Tracking





Legend

Activated Position



Compensation/Claims

Unit Leader

TimeUnit Leader

CostUnit Leader




Schedule for Operations briefingSchedule for Operations briefing

Planning Section ChiefPlanning Section Chief reviews agenda and facilitates reviews agenda and facilitates

▼▼ IC presents objectives (sometimes defers to Planning Chief to present)IC presents objectives (sometimes defers to Planning Chief to present)

▼▼ Off-going Operations Section Chief – provides current assessment and Off-going Operations Section Chief – provides current assessment and

accomplishments during last ops periodaccomplishments during last ops period▼▼

Oncoming Operations Section Chief – covers work assignments and Oncoming Operations Section Chief – covers work assignments and staffingstaffing▼▼

Technical Specialist -Safety Officer – Special Operations –present updatesTechnical Specialist -Safety Officer – Special Operations –present updates▼▼

May have specific Unit Leaders present informationMay have specific Unit Leaders present information▼▼

Final IC commentsFinal IC comments▼▼

Planning Section Chief announces next briefing time/location, adjournPlanning Section Chief announces next briefing time/location, adjourn


PlanningMeetingDevelop

strategies &tactics to

Accomplishobjectives

ImplementAction Plan

Assess progressusing measuresof effectiveness

ManagementMeeting

Evaluates& revisesincident

objectives

OperationsBriefingBriefs the

operationalleaders on the

Action Plan

Action Planpreparation& approval

Incident ManagerSets overall

incident objectives& priorities

On-goingsituation

assessment& information

processing

Incident isrecognized

Notifications,assessment,Immediate

needsare

addressed

United States Coast Guard

Next Steps/Follow-UpNext Steps/Follow-Up

Are their any large gaps that are Are their any large gaps that are identified?identified?

What can be done to close those gaps?What can be done to close those gaps? Who is responsible?Who is responsible? What is the timeline?What is the timeline?

Sample “Build Outs”Sample “Build Outs”Incident Commander





LiaisonOfficer


SafetyOfficer

Public Information

Officer


Compensation/Claims

Unit Leader

TimeUnit Leader

CostUnit Leader







Staging Manager





Business Continuity

Branch Director







Materiel Tracking





Legend

Activated Position



Compensation/Claims

Unit Leader

TimeUnit Leader

CostUnit Leader



Incident Commander





LiaisonOfficer


SafetyOfficer

Public Information

Officer


Compensation/Claims

Unit Leader

TimeUnit Leader

CostUnit Leader







Staging Manager





Business Continuity

Branch Director







Materiel Tracking





Legend

Activated Position



Compensation/Claims

Unit Leader

TimeUnit Leader

CostUnit Leader



Immediate Extended


THE END!THE END!

Thanks for ParticipatingThanks for Participating

MERET Acknowledges its Partners:

1. Healthcare System Preparedness Program Partnersa. Minnesota Department of Health–Office of Emergency

Preparednessb. MDH Metropolitan Hospital Compactc. Regional Hospital Resource Center Focus Group:

• Michelle Allen, Northwest• Clyde Annala, Northeast• Jill Burmeister, South Central• Chuck Hartsfield, Central• Marla Kendig, Southeast• Emily Parsons, MDH-OEP• Justin Taves, West Central• Eric Weller, South Central

2. FEMA Independent Study Program

Documents

Tornado Tabletop Exercise