Greene County Ebola Threat 2014 TTX

W . S E A N H O L L A N D

P u b l i c H e a l t h E m e r g e n c y

P r e p a r e d n e s s C o o r d i n a t o r

G r e e n e C o u n t y P u b l i c H e a l t h D e p a r t m e n t

Ebola Threat 2014 Tabletop Exercise (TTX)

Introductions

Name, Agency, Position

Current Ebola-related activities

What you hope to learn from TTX?

Exercise Overview

Exercise Scope:

This is a Tabletop Exercise, planned for approximately 2 hours at Greene County Emergency Services & Training Center. Exercise play is limited to discussion.

Mission Area(s):

Prevention, Response

Objective and Core Capabilities

Determine current resource and system/process gaps within Greene County’s ability to prevent and respond to Ebola Virus Disease.

Core Capabilities (Appendix D):

Operational Coordination

Environmental Response/Health and Safety

Public Health and Medical Services

Participant Roles and Responsibilities

Players: Respond to situation presented based on current plans, policies, and procedures

Observers: Support players in developing responses, but do not participate in moderated discussion

Facilitator: Provide situation updates and moderate discussions

Evaluators: Observe and document player discussions

Exercise Structure

This exercise will be a multimedia, facilitated exercise by a facilitator.

Players will participate in the following three modules:

Module 1: Person Under Investigation

Module 2: Confirmed Case

Module 3: Exposed Family Members

Exercise Structure

Each module begins with the facilitator presenting a multimedia update (Powerpoint) that summarizes key events occurring within that time period. After the updates, participants review the situation and engage in functional group discussions of appropriate issues for pre-event and incident.

After these functional group discussions, participants will engage in a moderated plenary discussion in which a spokesperson from each group will present a synopsis of the group’s actions, based on the scenario.

Exercise Guidelines

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

Base your responses on the current plans and capabilities of your organization

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

Issue identification is not as valuable as suggestions and recommended actions that could improve response efforts; problem-solving efforts should be the focus

Assumptions and Artificialities

The exercise is conducted in a no-fault learning environment wherein capabilities, plans, systems, and processes will be evaluated

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

All players receive information at the same time

Agenda (Appendix A)

Time:

0940 Background Information

0950 Module 1: Person Under Investigation

1010 Break

1020 Module 2: Confirmed Case

1040 Module 3: Exposed Family Members

1100 Break

1110 Hot Wash

1120 Closing Comments

Background Info on Ebola

Ebola virus disease (EVD)

First identified 1976; 1,716 Total Cases 1976-2013 (WHO)

Symptoms include: fever, headaches, muscle pain, weakness, diarrhea, vomiting, abdominal pain, and unexplained hemorrhage (late sign)

Symptoms on average develop between 8 to 10 days after exposure (can range between 2-21 days)


Key Points:

Persons traveling are not considered at risk unless they visit one of the affected countries

Virus spread through DIRECT CONTACT with blood or bodily fluids of a patient with Ebola

A person infected with Ebola is not contagious until symptoms appear


Primarily reported in Liberia, Guinea, and Sierra Leone

5 additional countries have reported cases

14,413 cases / 5,177 deaths as of 11 November 2014 (CDC)

New York State Actions

Commissioner’s Order 10/17/2014

Hospitals, Health Departments, Clinics, EMS Agencies

Commissioner’s Order 10/27/2014

Local Health Departments – Quarantine Orders

Screening at JFK International Airport

Reporting to LHDs of ALL individuals with a recent (21 days) travel history to affected nations

NYSDOH Risk Categories (Appendix C)

* If entering through JFK, LHD notified if Quarantine Order issued upon entry

Module 1: Person Under Investigation

November 20, 2014; 09:00

An individual returned to Greene County from missionary work in Liberia. (Departed Liberia on November 18, 2014)

Screening at JFK International determines no active symptoms.

NYSDOH determined this person to be High Risk and issued a Quarantine Order in NYC. NYSDOH has provided transport to residence in Greene County with notification to GCPHD.

Key Issues

This individual meets the criteria to be considered a Person Under Investigation (High Risk)

If they were to develop Ebola Virus Disease, they would likely be contagious to others.

Source: Bloomberg.com


How will public health share necessary information regarding a PUI in Greene County to other agencies?

Will quarantine be required and what would be the process for initiating an Order?

What notification(s) will occur, when and to whom?


What actions must be taken to serve an Order for quarantine?

What systems/processes are in place at 911 Center or law enforcement agencies to facilitate this?

What resources might be necessary to enforce the Order?

What notification(s) will occur, when and to whom?


November 21, 2014; 08:00

Public Health has issued a Quarantine Order effective November 20, 2014. Active monitoring has shown NO SYMPTOMS.

Source: NYTimes.com


November 22, 2014; 09:00

Person has developed a fever and diarrhea this morning. They dial 911 and request emergency medical services.

Patient is transported to appropriate hospital facility for evaluation/treatment.

The patient isolated at a local hospital facility and laboratory testing has returned a positive result for Ebola Virus Disease.

Key Issues

The patient definitely has Ebola Virus Disease, which presents a threat to all healthcare workers involved in their care.

Source: WindsorStar.com


Will the emergency medical service providers require a quarantine order or active monitoring?

What epidemiological investigations will be necessary and how will they be performed?

What resources and systems/processes are in place for emergency medical services?


What coordination needs exist between various departments/agencies?

What will the messaging be to the public and how will it be delivered?

What resources and systems/processes are in place for the receiving hospital?

Module 3: Exposed Family Members

November 22, 2014; 17:00

The patient who has laboratory confirmed Ebola Virus Disease has a spouse and two children at home. They have no symptoms at this time but the spouse is concerned regarding their health and welfare.

Key Issues

The patient may have shed virus in the home and the family members may have been exposed.

Various services may need to be provided to these family members.

Source: BangorDailyNews.com


What epidemiological investigations will be necessary and how will they be performed?

Will the family members require a quarantine order; what is their risk level?

How will the family members be provided food and other essentials?


What will the messaging be to the public and how will it be delivered?

Will there be a need for law enforcement to enforce the quarantine order or restrict access of others to the residence? How would this be coordinated?

In the event that the family needs to be relocated, how will this coordination occur and who would be the likely lead agency?

Hot Wash

Strengths

Areas for Improvement

Please complete Participant Feedback Forms

Closing Comments

Did we meet our objective and will participation in this TTX assist you with your agency goals?

Thank you for attending!

After-Action Report will be sent to all participants.

Government & Nonprofit

Greene County Ebola Threat 2014 TTX