Arizona Public Health and Healthcare Training and Exercise … · 2018. 4. 27. · 2016 Public Health and Medical Executive Summary Training and Exercise Planning Workshop Workshop

This exercise document was supported by the U.S. Department of Health and Human Services (HHS), Office of the Assistant Secretary for Preparedness and Response (ASPR), Office of Preparedness and Emergency Operations (OPEO), Division of National Healthcare Preparedness Programs (NHPP) HPP Cooperative Agreement Catalog of Federal Domestic Assistance (CFDA) number 93.889. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of HHS

Arizona Public Health and Healthcare Training and Exercise Planning Workshop

12/7/2016

Executive Summary Draft Date: 2/1/2017 Final/Approved Date:

Page Intentionally Left Blank

2016 Public Health and Medical Executive Summary Training and Exercise Planning Workshop

Table of Contents i BPHEP ARIZONA DEPARTMENT OF HEALTH SERVICES

Homeland Security Exercise and Evaluation Program (HSEEP)

Table of Contents Workshop Overview ......................................................................................................................................... 1

Workshop Executive Summary ..................................................................................................................... 3

SUMMARY OF CAPABILITIES .................................................................................................................................... 4

Table 1. Summary of Capability Performance and Functions....................................................... 4

PHEP/HPP Capability 1: Community Preparedness/ Healthcare System Preparedness ............... 5

Objective 1: Align regional training and exercise objectives and schedules, and coordinate efforts to validate, assess, and enhance core capabilities. .............................................................. 5

Central Region .......................................................................................................................................... 5

Northern Region ....................................................................................................................................... 6

Southern Region ...................................................................................................................................... 7

Western Region ........................................................................................................................................ 8

Objective 2: Identify scenarios where integrated planning is needed .......................................... 9

Objective 3: Model relationships, functions, and planning sequences to meet identified integrated planning needs ...................................................................................................................... 10

Statewide (All respondents) ................................................................................................................ 10

Central Region ........................................................................................................................................ 12

Northern Region ..................................................................................................................................... 13

Southern Region .................................................................................................................................... 13

Western Region ...................................................................................................................................... 14

Appendix A: Exercise Participants ............................................................................................................. A

Appendix B: Acronyms ................................................................................................................................... B


Workshop Overview 1 BPHEP ARIZONA DEPARTMENT OF HEALTH SERVICES

Homeland Security Exercise and Evaluation Program (HSEEP)

Workshop Overview

Workshop Name 2016 Public Health and Medical Training and Exercise Planning Workshop (TEPW)

Workshop Date 12/7/2016

Scope

The TEPW will review priorities to identify where future training and exercise efforts should be focused, identify training opportunities and exercises that will assist public health and health care partners, and provide an opportunity to coordinate and de-conflict all training and exercise activities.

Mission Area Prevention

Capabilities

NPG: Planning

PHEP/HPP:

Community Preparedness Healthcare System Preparedness

Objectives

Align regional training and exercise objectives and schedules, and coordinate efforts to validate, assess, and enhance core capabilities.

Identify scenarios where integrated planning is needed

Model relationships, functions, and planning sequences to meet identified integrated planning needs

Sponsor Arizona Department of Health Services

Participating Organizations

PHEP and HPP federal, state, tribal, local and non-profit partners. Please see Appendix A: Workshop Participants for the complete list of organizations.


Workshop Overview 2 BPHEP ARIZONA DEPARTMENT OF HEALTH SERVICES Homeland Security Exercise and Evaluation Program (HSEEP)

Points of Contact

Antonio Hernandez Section Chief, Partner Integration Arizona Department of Health Services Bureau of Public Health Emergency Preparedness 150 North 18th Avenue, Suite 150 Phoenix, Arizona 85007-3237 (602) 763-1774 [email protected] Alyssa Van Story Exercise Coordinator Arizona Department of Health Services Bureau of Public Health Emergency Preparedness 150 North 18th Avenue, Suite 150 Phoenix, AZ 85007-3237 (602) 361-1229 [email protected]

mailto:[email protected]


Executive Summary 3 BPHEP ARIZONA DEPARTMENT OF HEALTH SERVICES Homeland Security Exercise and Evaluation Program (HSEEP)

Workshop Executive Summary

The 2016 Public Health and Healthcare Training and Exercise Planning Workshop had over one hundred participants representing federal, tribal, state and county agencies, as well as all four regional coalitions. ADHS served as the main sponsoring agency but received tremendous support from federal, state and local partners. The goal of the workshop is to provide information to help partners gain valuable insight and additional tools to help their agencies prepare for the year’s training and exercise activities. Attendance at the Workshop fulfills a grant deliverable for PHEP and HPP partners in addition to providing the opportunity to collaborate with each other. The upcoming ADHS MYTEP will be projecting out to three years. This year’s workshop also included valuable information the National Disaster Medical System exercise coming up in the next grant cycle, Threat and Hazard Identification and Risk Assessment (THIRA) impact on training and exercise in Arizona, as well as the latest on public health threat assessment. The workshop helped the public health and medical community identify several common threads regarding gaps, areas of improvement as well as strengths where partners can collaborate to assist one another.

Hospital partners in each region have identified staff turnover as a challenge that has contributed to their short and long term priorities regarding training.

National Incident Management System (NIMS) and Incident Command System (ICS) training is a necessity for all regions.

Strategic National Stockpile exercises including POD drills will be the focus of almost every region in both the short and long term.

Tribal Communities will be focusing on behavioral health as well as the resource request process throughout the cooperative agreement.


Summary of Capabilities 4 BPHEP ARIZONA DEPARTMENT OF HEALTH SERVICES Homeland Security Exercise and Evaluation Program (HSEEP)

SUMMARY OF CAPABILITIES Table 1. Summary of Capability Performance and Functions

NPG Capability

PHEP/HPP Capability

Objective Function

Planning

HPP Capability 1: Healthcare System Preparedness

PHEP Capability 1: Community Preparedness

1. Align regional training and exercise objectives and schedules, and coordinate efforts to validate, assess, and enhance core capabilities.

PHEP Function 4: Coordinate training or guidance to ensure community engagement in preparedness efforts HPP Function 6: Improve healthcare response capabilities through coordinated exercise and evaluation

2. Identify scenarios where integrated planning is needed

HPP Function 4: Determine gaps in the healthcare preparedness and identify resources for mitigation of these gaps PHEP Function 2: Build community partnerships to support health preparedness

3. Model relationships, functions, and planning sequences to meet identified integrated planning needs

HPP Function 4: Determine gaps in the healthcare preparedness and identify resources for mitigation of these gaps PHEP Function 2: Build community partnerships to support health preparedness

The following sections provide an overview of the performance related to each workshop objective and associated capability.


Capabilities - Region Breakouts 5 BPHEP ARIZONA DEPARTMENT OF HEALTH SERVICES Homeland Security Exercise and Evaluation Program (HSEEP)

PHEP/HPP Capability 1: Community Preparedness/ Healthcare System Preparedness

Objective 1: Align regional training and exercise objectives and schedules, and coordinate efforts to validate, assess, and enhance core capabilities. Central Region

What are the short term training priorities?

Identifying strategies to connect public health and health care with municipal emergency management and emergency services (police, fire, and EMS). They will look into a timeline for development of the plan and how to tie in training within the project.

AZCHER plans to update the EM101 and EM102 programs, changing it to a four hour program using Homeland Security Exercise Evaluation Program (HSEEP) concepts.

Regarding the NDSM exercise planned for 2017, they will seek to identify training opportunities to help build up and support the exercise.

They will apply for training grants to primarily fund National Incident Management System (NIMS)/ Incident Command System (ICS) training with Homeland Security grants (UASI grant) coordinated through DEMA. They are usually looking for additional participants to prevent course cancellations, and will explore ways to fill them with Public Health participants. AzCHER and ADHS can assist in sharing information to partners.

Was a local TEPW conducted? Who participated? What were the strengths and areas of improvement? What were the challenges and barriers?

Maricopa County Public Health held a local TEPW that included: Health care Metropolitan Medical Response System (MMRS) cities Local law enforcement Central region counties Tribal communities Air quality Environmental health Medical examiners

Pinal County Public Health is planning to have one in the near future. Is there a link between areas of improvement and future exercise planning?

AzCHER identified HVA and NDMS based upon improvement planning.



Long Term Care Centers – From gap analysis beginning in 2012 they have been focusing on training to facilities. The Disaster Ready Workshop was a Community wide tabletop exercise for partners based on a gap assessment.

Indian Health Services (IHS) – They used real world scenarios for developing drills. Staff turnover can pose a challenge requiring training. The tabletop exercise seems to be a good format for them however it does not meet Joint Commission standards. They have identified a need for surge planning.

ADHS EDC: The vector control conference with a focus on Zika (a two-day event)

including the Centers for Disease Control (CDC) and the University of Arizona (U of A) with information on Aedes Agepti abatement.

A mosquito identification and insecticide resistance workshop. They will also hold northern and southern region mosquito

identification training. (March 16 and 17 for Maricopa county) Maricopa County Public Health and Pinal County Public Health have a

requirement to do a Medical Counter Measure (MCM) Full Scale Exercise (FSE) with a March 2018 timeframe. They will also work on resource requesting procedures and data collection (epidemiological data).

Northern Region

What are the short term training priorities?

The Navajo Nation is working on Incident Command System (ICS) training with an emphasis on testing, training, and exercise (TT&E). They plan to provide more training to hospitals and are pushing to implement NIMS.

White Mountain Apache plans to implement crisis training and have stated that staff turnover continues to be a challenge.

Yavapai County is doing multi-position training because they have a small pool of staff to pull from for incidents.

The northern region identified their long term training priorities as:

Ebola training to be conducted in the Spring with additional TBD ICS training to be conducted in the Spring with additional TBD A Strategic National Stockpile (SNS) full scale exercise (FSE) to be conducted in

November with law enforcement and warehouse personnel Epidemiology training that addresses the need for more epidemiologists Public Information Officer (PIO) advanced training


There will be a TEPW held in Window Rock on January 12th to include: County PHEP



FMC Guardian Air The hospitals Behavioral health Red Cross Citizen Corp Council

Southern Region

What are the short term training priorities? Overall there are concerns with incident management due to a “revolving

door” from a lot of turnover and new people who need to be trained. Hospitals need to bring in more Hospital Incident Command System (HICS)

training. Training to address when there are capability “fails” how to make them

operational. Cochise County is developing a multi-hazard team to help in hospital

emergency operations coordination and the public safety group. Pima County priorities:

Communication Surge NIMS Incident Command Leadership

The southern region identified their long term training priorities as:

Medical Countermeasure Bio Surveillance Epidemiology vector borne challenges with staff, space and analyzing the

studies. They are concerned with the ability to establish and meet their responsibilities when funding is no longer available.

What training support or technical assistance is needed?

Tribal communities identify challenges in getting training set-up and trainers out to their areas.

Hospitals need help with justification for budgeting from their administrative funds.

Do you plan to provide training on emergency plans?

Pima County will update on health emergency operations standards to meet requirements.



New plans in development include vector control and Zika to have something operational.

The hospitals will review plans annually.


Pima County will conduct a MYTEP in early November to cover three years. Pima County held a coalition –based TEPW. The challenges included

understanding roles and resources and how to document everything.

Identify gaps/root causes, and determine if the improvements were addressed:

Hospitals report following the computer outage/flood – Incident command was identified but the full after action report is still pending.

Tribal – Conducted a Point of Distribution (POD) drill.

Western Region

What are the short term training priorities (2017 – 2018)?

La Paz County plans a law enforcement and responder isolation and quarantine exercise on January 25th. They will address gaps identified that question who can give orders, triggers, and the role of law enforcement regarding who can issue quarantines and whether it can be enforced.

EOC training in March by TEEX Pediatric disaster training TBD in the first quarter Hazmat training in February and March hosted by Fort Huachuca CASPR training at the end of BP5 Wildland firefighting TBD in Yavapai County

What training support or technical assistance is needed?

A behavioral health focus is needed for each capability area When the new functions and new priorities are released there will be a need

for training specific to those changes and what they mean for planning and exercises.


Emergency management held a TEPW.

Regional Exercises Planned:

A Zika Tabletop exercise at La Paz Public Health Department – TBD



A mass fatality exercise to cover Chemical Biological Radiological Nuclear Explosive (CBRNE), Critical Incident Stress Management (CISM) and behavioral health in general is scheduled for around April or May 2017 by La Paz Emergency Management and Public Health collaboratively.

A Hazmat spill tabletop by Yuma County and Cocopah Tribal Nation in collaboration with Kinder Morgan - TBD

And emergency operations center exercise to cover ICS and NIMS by Yuma County – TBD

An MCM full scale exercise for April 2017 by Yuma County and Cocopah Tribal Nation to cover SNS with closed PODS to be tested.

An MCM functional exercise is planned for September 2017 by Mohave county and Fort Mojave Tribal Nation to cover SNS and specifically regional PODS.

What exercise support or technical assistance is needed?

Cocopah tribe has identified AAR/IP writing and evaluation and just-in-time training for PODS as a technical assistance need. Process flow mapping would also be helpful and useful.

Objective 2: Identify scenarios where integrated planning is needed Central Region

What plans need to be updated/created during 2017-2018?

AzCHER identified mass casualty and information gathering as well as updating their by-laws and memorandums of understanding (MOUs)

Coyote Crisis Collaborative identified their Mental Health Disaster Plan. It is in review and the “input” process. They hope to develop a joint disaster plan for RHBA and TRHBA, and a school reunification plan with school districts and the consortium.

The Department of Economic Security identified the state disaster plan for child care.

Which plans will be tested during 2017-2018?

Palo Verde Nuclear Generating Station Emergency Response Plan IHS - Infectious Influx plan

Western Region Identify gaps/root causes, and determine if the improvements were addressed:


Strategic Goals and Priorities 10 BPHEP ARIZONA DEPARTMENT OF HEALTH SERVICES Homeland Security Exercise and Evaluation Program (HSEEP)

Tribal areas/concerns: lands span counties and states causing among other things, mosquito

control challenges - multi-state vector control program Tribes should consider a tribal crisis management team to respond to

tribes all over the state - working with the RHBA’s and TRBHA’s to try and develop something similar to a “hot shot” tribal team.

Should the tribes reach out to coyote crisis in as well? Where the funding for something like this come from?

Fort Mojave had a 7,000 acre fire that was a disaster due to the small size of the community which caused a great deal of damage and had a very negative affect on the community.

Regional case studies for tribal needs Fort Mojave – open regional PODS, in 2009 H1N1 provided the venue to

exercise with La Paz and Yavapai county to simulate mass vaccinations Mountain West PERL – proposal to provide additional training and

looking for additional funding.

What is the status of improvement plan completion?

Several have already been completed meaning that they were “followed through and fulfilled.”

Objective 3: Model relationships, functions, and planning sequences to meet identified integrated planning needs

Strategic Goals and Priorities

Statewide (All respondents) There were multiple disciplines represented in this year’s TEPW. Those disciplines included:

Public Health – 44% Health Care System – 23% Emergency Management – 21% Community/ Volunteer Organization – 6% Other – 6%

The attendees predicted that over the next three years overall preparedness should see the greatest increase in Community Resilience capabilities. They ranked Incident Management as the domain of greatest importance. And determined that the category, “Implement Best, Promising, & Evidence-Based Practices” is the most important strategic goal for the upcoming cooperative agreement period.



Domain Priorities:

Strategic Goals

0%

5%

10%

15%

20%

25%

Implement Best,Promising and

EBP

Improvement inPH Infrastructure

Promote andSupport PH and

Safety

Align Resources Sync.Collaboration and

Coordination

28%

21% 21%

17%

13%

PHEP/HPP Ranked Strategic Goals

0%

5%

10%

15%

20%

25%

IncidentManagement

Informationmanagement

SurgeManagement

CommunityResilience

Countermeasures& Mitigation

Bio Surveillance

22%

18%17%

16%

14%13%

2017- 2018 Domain Priorities



Capability Assessment by Priority

The following section utilizes data captured at the MYTEP workshop with participants answering via the audience response system. Data sets represent the percentage of those in attendance who responded to each question. And respondents were divided into their respective regions.

Central Region The Central region prioritized their capabilities for the upcoming fiscal year ranking Information Sharing as the highest priority and Public Health Surveillance and Epidemiological Investigation as the fifth most important area of focus.

They also predicted that the region would have the greatest increase in Surge Management capabilities over the next three years.

Central Region BP1

Northern Region The Northern region prioritized their capabilities for the upcoming fiscal year ranking Public Health Surveillance and Epidemiological Investigation as the highest priority and Emergency Operations Coordination as the fifth most important area of focus.

They also predicted that the region would have the greatest increase in Information Management capabilities over the next three years.

0%

5%

10%

15%

20%

25%

30%

InformationSharing

Community/Healthcare

Preparedness

ResponderSafety and

Health

PHSurveillance

and EpiInvestigation

MedicalSurge

EmergencyOperations

Coordination

29% 28%

25% 24% 24% 24%

BP1 Capabilities by Priority



Northern Region BP1

Southern Region The Southern region prioritized their capabilities for the upcoming fiscal year ranking Public Health Surveillance and Epidemiological Investigation as the highest priority and multiple capabilities ranking at 23% as important areas of focus.

They also predicted that the region would have the greatest increase in Incident Management capabilities over the next three years.

Chart 3: Southern Region

0%

5%

10%

15%

20%

25%

30%

PH Surveillance&Epi

Investigation


Preparedness

EmergencyOperations

Coordination

MedicalCountermeasure

Dispensing

Mass Care

31% 30%

24%26% 26%


0%

5%

10%

15%

20%

25%

30%

ResponderSaftey and

Health

PHSurveillance

&EpiInvestigation

InformationSharing

EmergencyOperations

Coordination


Preparedness

26% 26%23% 23% 23%




Western Region The Western region prioritized their capabilities for the upcoming fiscal year ranking Responder Safety and Health as the highest priority and Emergency Operations Coordination as the fifth most important area of focus.

They also predicted that the region would have the greatest increase in Community Resilience capabilities over the next three years.

Chart 4: Western Region

0%

5%

10%

15%

20%

25%

30%

ResponderSafety and

Health

VolunteerManagement


Preparedness

MedicalCountermeasure

Dispensing

EmergencyOperations

Coordination

31% 30%

24% 24%23%



Appendix A – Exercise Participants A BPHEP ARIZONA DEPARTMENT OF HEALTH SERVICES Homeland Security Exercise and Evaluation Program (HSEEP)

Appendix A: Exercise Participants Participating Organizations

Federal

IHS - Phoenix

Veterans Affairs

State

Arizona Department of Education

Arizona Department of Emergency and Military Affairs

Arizona Department of Health Services

Tribal

Cocopah Indian Tribe

Colorado River Indian Tribes

Fort Mojave Indian Tribe

Gila River Indian Community

Hopi Tribe

Pascua Yaqui Tribe of Arizona

Tohono O’odham Nation

White Mountain Apache Tribe

Local

Cochise County

Coconino County

Graham County Health Department

Greenlee County Health

La Paz Health Department

Maricopa County

Mojave County Department of Public Health

Navajo County

Santa Cruz County Health Services

Yavapai County Community Health Service




Yuma County Public Health Service District

Hospitals/Clinics

Adelante Healthcare

Arizona Spine and Joint

Arrowhead Hospital

Banner Casa Grande

Banner Desert Medical Center

Banner Thunderbird and Del Webb

Banner University Medicine Tucson/South

Canyonlands Health Care

Carondelet Health Network Western Arizona Regional Medical Center

Chiricahua Community Health Centers

Cobra Valley Regional Medical Center

Copper Queen Community Hospital

Dignity Health

El Rio Community Health Center

Flagstaff Medical Center Sage Memorial Hospital

Gila River Health Care

Havasu Regional Medical Center

Honor Health

Hopi Health Care Center

Kingman Regional Medical Center

Marana Health Center

Maricopa Integrated Health System

Maryvale Hospital

Mayo Clinic

Mercy Maricopa Hospital

Mountain Vita Medical Center

Mt. Graham Regional Medical Center




Northern Cochise Community Hospital

Northwest Medical Center

Phoenix Baptist Hospital

Sells Indian Hospital

St. Luke’s Medical Center

Sun Life Family Health Center

Tuba City Regional Health Care Corporation

Tucson Medical Center

Valley View Medical Center

Verde Valley Medical Center

West Valley Hospital

Wickenburg Community Hospital

Winslow Indian Health Care Center

Yavapai Regional Medical Center

Yuma Regional Medical Center

Health Care Coalitions

Arizona Health Care Association

AzCHER - Central

Arizona Alliance for Community Health Centers

Coyote Crisis Collaborative

Appendix A – Exercise Participants B BPHEP ARIZONA DEPARTMENT OF HEALTH SERVICES Homeland Security Exercise and Evaluation Program (HSEEP)

Appendix B: Acronyms

Acronym Term

ADHS Arizona Department of Health Services

AFN Access and Functional Need

AHCA Arizona Health Care Association

AZTEC Arizona Tribal Executive Committee

BP4 Budget Period 4

CDC Centers for Disease Control and Prevention

CPG Capability Planning Guide

DEMA Division of Emergency and Military Affairs

DOD Department of Defense

DPS Department of Public Safety

EM Emergency Management

EMS Emergency Medical Services

EOC Emergency Operations Center

ESF Emergency Support Function

FEMA Federal Emergency Management Agency

HPP Hospital Preparedness Program

HHS Health and Human Services

ICS Incident Command System

JIC Joint Information Center

LTC Long Term Care

MCM Medical Countermeasures

NDMS National Disaster Medical System

PAHPA Pandemic and All Hazards Preparedness Act

PHEP Public Health Emergency Preparedness

PIO Public Information Officer

RBHA Regional Behavioral Health Authority

SAC Senior Advisory Council

SERRP State Emergency Response and Recovery Plan

SNS Strategic National Stockpile

VA Department of Veterans’ Affairs

Documents

Arizona Public Health and Healthcare Training and Exercise … · 2018. 4. 27. · 2016 Public Health and Medical Executive Summary Training and Exercise Planning Workshop Workshop