Maryland 2008 Statewide Pandemic Influenza Exercise and CRA Albert Romanosky MD, PhD Office of...

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


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


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.


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


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)


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


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


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


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


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


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


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


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


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


CRA Data EntryCRA Data Entry


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;



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;



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;



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;;


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


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


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

Maryland 2008 Statewide Pandemic Influenza Exercise and CRA Albert Romanosky MD, PhD Office of...

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