Maryland 2008 Statewide Pandemic Influenza Exercise and CRA

1. Maryland 2008 Statewide Pandemic Influenza Exercise and CRA Albert Romanosky MD, PhD Office of Preparedness and Response Maryland Department of Health and Mental Hygiene

2. Presentation Objectives • Give a brief Overview of the Maryland 2008 Statewide Pan Flu Exercise • Review the Role of Countermeasures Response Administration (CRA) in the Exercise • Identify the CRA Sustainable/Key Strengths and Needs Improvement Activities CDC PHIN Conference 2008

3. 2008 Pan Flu Exercise Overview • Modified Functional Exercise: • Full Scale Components • Three Days (June 17-19, 2008) • Compressed Pandemic Wave Weeks 6-12 and Recovery • Designed to Address: • Corrective actions following previous exercises • Office of Preparedness & Response identified statewide pan flu priorities and operational activities • Federal Pan Flu Priorities CDC PHIN Conference 2008

4. Overarching Exercise Goal The overall goal of the exercise was to test the expertise and capability of several components of the healthcare system to adequately identify and respond to unusual work and patient loads during a pandemic influenza outbreak. CDC PHIN Conference 2008

5. Specific Exercise Testing Requirements and Guidelines • Homeland Security Exercise and Evaluation Program (HSEEP) • Assistant Secretary for Preparedness and Response (ASPR) Hospital Preparedness Program (HPP) Exercise Standards and Requirements • CDC Public Health Emergency Preparedness Cooperative Agreement Guidance and CDC Pan Flu Appendix 12: Overarching Exercise Objectives by Priority Area: Pandemic Flu Exercise Guidelines for Medical Surge CDC PHIN Conference 2008

6. ASPR Hospital Preparedness Program (HPP) Exercise Standards and Requirements • Evaluation of medical surge components of the tiered healthcare system • Develop adequate evaluation tools and methods • Develop an After Action Report (AAR) • Specifics: • Coordination with Public Health • Risk Communication • Medication Distribution • Surveillance • Laboratory Capacity • Volunteer Activation (ESAR-VHP) • Staff Support • Communications • Healthcare System Triage and Admission • Incident Command System (Integration and Coordination) CDC PHIN Conference 2008

7. CDC Cooperative Agreement and Pan Flu Exercise Requirements • Maryland State Pan Flu Operational Plan • Based Upon CDC evaluation • Appendix 12: Overarching Exercise Objectives by Priority Area: • Mass Vaccination • Continuity of Operations • Surveillance/ Lab Exercise • Community Mitigation • Communications • Antiviral Distribution • Strategic National Stockpile (SNS) Medical Countermeasure Distribution CDC PHIN Conference 2008

8. Maryland Statewide Pan Flu Exercise Objectives • DHMH Coordination/Command Center and Continuity of Operations Plan • Health and Medical Surge (Facilities, Personnel, Equipment and Supplies) • Medical Surge – Alternate Care Sites • Strategic National Stockpile / Receipt Staging and Storage • Enhanced Surveillance • Governor’s Wellmobiles • Laboratory Surge • Countermeasure Response Administration • EMS – Emergency Medical Dispatch • EMS – Transport Diversion Protocol • EMS On-Scene Triage and Assessment Protocol CDC PHIN Conference 2008

9. Maryland Statewide Pan Flu Exercise Objectives • Personal and Community Preparedness • Community Emergency Response Teams (CERT) • Critical Infrastructure • Internal Countermeasure Distribution • Educational Facilities • Volunteer Activation • Joint Information Center – Public Information • Interoperable Communications • Mass Fatality Management • Vulnerable Populations CDC PHIN Conference 2008

10. Maryland 2008 Statewide Pan Flu Exercise Participants Open to all Federal, State and Local Partners: • 56 Local Agencies • Emergency Medical Services • Emergency Management Agencies • Local Health Departments • Law Enforcement • 25 State Agencies • 4 Federal Agencies • 50 Health Care Systems and Organizations • 12 State Hospitals / Residential and Day Program Service Providers • 8 Community Based Service Providers • 8 Critical Infrastructure/Key Resources/Critical Manufacturing CDC PHIN Conference 2008

11. Maryland 2008 Statewide Pan Flu Exercise Participants Total Number of Exercise Personnel: • Players 4,000+ • Contractor Controller/Evaluators/Observers 50 • Peer Controller/Evaluators/Observers 100 • Exercise Design and Development 75-100 DHS Target Capabilities: • 29 of 45 CDC PHIN Conference 2008

12. CDC CRA Activities Pre-Exercise: • Exercise Planning/Development • CRA Access • Training (open to all) Exercise: • Just-In-Time Training • Support for Real-time Data Entry • Situational Awareness / Data Reporting • State Level Data Access Post-Exercise: • Hotwash and After Action Report CDC PHIN Conference 2008

13. Countermeasure Response AdministrationExercise Objectives • Establish and implement CRA to collect data: • Offline stand alone scenario • Online web interface (Real Time/Delay) • Assess CRA ease of use • Track and report on antivirals dispensed at a public and private agency Points of Dispensing • Track and report on community antiviral dispensing CDC PHIN Conference 2008

14. CRA Exercise Specific Activities • CRA Activation • Data Entry • Direct: Web based • Indirect/Off-Line: Delayed Upload • Monitoring and Tracking • Dispensing of Medications • Adverse Reactions to Antiviral Medications CDC PHIN Conference 2008

15. Maryland CRA Participating Sites Howard County Health Department Hammond Middle School POD (Real-time Data Entry) • POD in Howard County dispensing antivirals to head-of-household for surrounding community Chateau Lake Ridge Community (Post-dispensing Data Entry) • Community dispensing with limited social distancing Chester River Hospital (Real-time Data Entry) • Fixed POD dispensing antivirals to employees City of Laurel (Real-time Data Entry) • Community dispensing with voluntary Isolation and Quarantine Note: Two sites anticipated using CRA CDC PHIN Conference 2008

16. CRA Data Entry CDC PHIN Conference 2008

17. CRA Evaluation Overall Exercise: • CRA data collection and entry Key Strengths: • The “just-in-time” training was very successful and was a key to proficiency; • Data entry into the CRA application flowed well; CDC PHIN Conference 2008

18. CRA Evaluation Key Strengths: • Within a short amount of time participants were able to enter information; • Data entry into CRA described as simple and ‘intuitive’ by participants; • (Data entry maybe labor intensive) • Users were able to pull data and track progress; • CRA reports were useful in providing data of antivirals dispensed at the local and state level; CDC PHIN Conference 2008

19. CRA Evaluation Areas for Improvement: • Ability to track individuals that present at a dispensing site but do not receive countermeasures; • Ability to support Head-of-Household data collection; • Support interoperability with other systems; • Not all regions of the state participated in CRA exercise activities; CDC PHIN Conference 2008

20. CRA Evaluation Recommendations: • Expansion of CRA participation in the Public and Private Sectors; • Continue to train hospitals and health departments on the CRA program; • Increase recruitment for CRA access; CDC PHIN Conference 2008

21. Suggested CRA Enhancement • Pre-population and Uploading of Data • Health Department Personnel (State HAN) • Private Sector Expanded Data Entry and Participation: • Healthcare Systems • Public-Private Partnership • Critical Infra-structure/Key Resources/Critical Manufacturing • Essential Staff and Personnel • Expanded Application • Fatality Registration CDC PHIN Conference 2008

22. Maryland Future Activities • DAX 2008 (Seasonal Influenza Vaccination Exercise) • Increase CRA Training and Access • All Maryland Participation • 24 Counties • Combination: • Real-Time and Delayed Data Entry • On-Line Web Based vs Off-Line Data Entry • Aggregate vs individual Data Entry • Regional Clinic Integration and Coordination CDC PHIN Conference 2008

23. Al Romanosky, MD, PhDMaryland Department of Health and Mental Hygiene Office of Preparedness and Response410.767.0823aromanosky@dhmh.sate.md.us CDC PHIN Conference 2008