After Action Report

FOR OFFICIAL USE ONLY

Homeland Security Exercise and Evaluation Program (HSEEP) After Action Report/Improvement Plan Formidable Footprints W/S #1 Version 1.0 02/04/09

FORMIDABLE FOOTPRINTS FLORIDA/GEORGIA WORKSHOP #1

JANUARY 28, 2009

FOR OFFICIAL USE ONLY

FOR OFFICIAL USE ONLY

Homeland Security Exercise and Evaluation Program (HSEEP) After Action Report/Improvement Plan

Formidable Footprints W/S #1

After Action Report/Improvement Plan February 4, 2009

This page is intentionally blank.

2

FOR OFFICIAL USE ONLY

FOR OFFICIAL USE ONLY

Homeland Security Exercise and Evaluation Program (HSEEP) After Action Report/Improvement Plan

Formidable Footprints W/S #1

HANDLING INSTRUCTIONS 1. The title of this document is Formidable Footprints Workshop #1 After Action Report/Improvement Plan (AAP/IR). 2. The information gathered in this AAR/IP is classified as “For Official Use Only.” It should be handled as sensitive information not to be disclosed to the public [119.071 (3)(a) F.S.]. This document should be safeguarded, handled, transmitted, and stored in accordance with appropriate security directives. Reproduction of this document, in whole or in part, without prior approval from Florida Department of Health is prohibited. 3. At a minimum, the attached materials will be disseminated only on a needto-know basis and when unattended, will be stored in a locked container or area offering sufficient protection against theft, compromise, inadvertent access, and unauthorized disclosure. 4. Point of Contact: Jack Pittman, Exercise Manager Florida Department of Health Office of Public Health Preparedness 4052 Bald Cypress Way Bin A-23 Tallahassee, Florida 32399-1720 850.245.4444 ext. 3725 [email protected]

Kelly Nelson, Asst. Exercise Manager Florida Department of Health Office of Public Health Preparedness 4052 Bald Cypress Way Bin A-23 Tallahassee, Florida 32399-1720 850.245.4089 [email protected]

FF W/S #1

3 FOR OFFICAL USE ONLY

Florida Department of Health

FOR OFFICIAL USE ONLY

Homeland Security Exercise and Evaluation Program (HSEEP) After Action Report/Improvement Plan

Formidable Footprints W/S #1

CONTENTS Administrative Handling Instructions........................3 Contents..................................................................4 Executive Summary..................................................5 Section 1: Formidable Footprints Overview...............6 Section 2: Workshop Discussion................................7 Section 3: Analysis of Workshop Discussion..............7 Major Strengths ..................................................7 Areas for Improvement ........................................7 Analysis ..............................................................8 Recommendations ...............................................8 Section 4: Conclusion...............................................8

FF W/S #1

4 FOR OFFICAL USE ONLY

Florida Department of Health

FOR OFFICIAL USE ONLY

Homeland Security Exercise and Evaluation Program (HSEEP) After Action Report/Improvement Plan

Formidable Footprints W/S #1

EXECUTIVE SUMMARY Florida, Alabama, and Georgia have responded to a wide variety of emergency and disaster events -- hurricanes, wild fires, tornados, floods, toxic chemical spills, and biological terrorism scares. Typically, events that require emergency response are managed at the local level with local resources. Some major events such as hurricanes, wild fires, tornados, and floods cross county lines and overwhelm local resources and require state response often with assistance of federal partners. Some events occur in rapid succession or for a long period of time. During the 2004 hurricane season, for example, 50 Florida counties reported damage by powerful storms hitting the state in rapid succession. During the peak period, the State Emergency Response Team (SERT) reported up to 800 assistance requests per day. Coordination of response across so many counties, proved difficult for a fatigued SERT as well as operational staffs in affected county emergency operations centers. A pandemic event could result in an unprecedented, catastrophic disaster affecting all communities, counties, and states over a period six months or more. Furthermore, we can assume that most or all of the other states will be affected by the pandemic thus severely limiting outside and federal assistance. This workshop series focuses on the sudden introduction of a new influenza virus in a multi-county area that, in at least two workshops, crosses state borders. The basic workshop scenario premise is that a medical and health care corridor or footprint will form along the major interstate highways. Citizens will cross state line to find better or different care than what is available in their area. Each workshop scenario begins with rapid initial case containment and then strong community containment measures to prevent or at least reduce potential pandemic spread. Hospitals, the medical and public health communities will need consistent and measured risk communication. The challenge is to quickly get control of the situation, requesting resources, managing outcomes over both the short and long term event. The workshop will seek to evaluate existing county, district, regional and state-level planning where they exist while creating a nexus for future multicounty and state pandemic planning. FF W/S #1

5 FOR OFFICAL USE ONLY

Florida Department of Health

FOR OFFICIAL USE ONLY

Homeland Security Exercise and Evaluation Program (HSEEP) After Action Report/Improvement Plan

Formidable Footprints W/S #1

On January 28, 2009, 21 health and medical professionals from north central Florida met with 21 health and medical professionals from south central Georgia in a workshop to discuss cross-border issues and coordination in a pandemic influenza scenario. Four modules were presents in an escalating pandemic scenario. The written facts presented in each module were punctuated by "Breaking News" videos which added realism and emphasis to the need for consistent risk communications across both sides of the state border. Hospitals provided excellent discussion of logistics issues affecting their operations as the pandemic worsened -- just-in-time inventories and the realization that hospitals on both sides of the border used the same vendors and suppliers. Topics related to off-site triage-sites, alternative standards of care, and roles for faith-based and neighborhood organizations and volunteers, also provided spirited discussion

This workshop series design contains elements from the US Department of Homeland Security Target Capabilities List (TCL) under the Response Mission Area, TCL Common Capability Planning: • Emergency Triage and Prehospital Treatment • Medical Surge, • Medical Supplies Management and Distribution • Emergency Public Information and Warning regarding hospital altered standards of care • Mass Prophylaxis for hospital staff • Emergency Public Safety and Security Response These comply with the Homeland Security Exercise and Evaluation Program (HSEEP) terminology and guidelines for the conduct of a workshop.

FF W/S #1

6 FOR OFFICAL USE ONLY

Florida Department of Health

FOR OFFICIAL USE ONLY

Homeland Security Exercise and Evaluation Program (HSEEP) After Action Report/Improvement Plan

Formidable Footprints W/S #1

Section 2: Workshop Discussion The following comments were derived from a summary of group breakout discussions following  each module presented in the workshop scenario. The items of discussion were key messages for  public education, recommendations for security, medical surge and mass care, medical  equipment/supply vendor issues, cross county collaboration, isolation/quarantine/containment,  conclusions, and recommendation and considerations for future planning. 

Salient Discussion Points: 1.Voluntary vs. mandated quarantine and support for quarantined individuals 2.Area/regional cross-state command center 3.Stress personal protection strategies/ social distancing, school closings 4.Open joint info center 5.Practice good health practices/stay home if sick 6.Devise good case definitions 10.Stress social distancing 11.Setup AMTS to relieve hospitals 12.Mutual Aid – PH no- others maybe 13.Question: What is Hospital System Communication? System? Some unsure. 14.Same PR message from CDC to State to County 15.PIO has to have credibility and be well known to community 16.Need to establish a cross state Hot-Line Number 17.Need unified communication 18.Need more drills 19.Risk Communication messages with addition of social distancing/self isolation 20.Activate Joint Information Center to send one message and coordinate with state 21.Reduced staff is an issue that will need to be addressed 22.Communication – (coordinated) is the most important public health response 23.Schools could be used as alternative treatment sites to relieve load on hospitals

Conclusions: FF W/S #1

7 FOR OFFICAL USE ONLY

Florida Department of Health

FOR OFFICIAL USE ONLY

Homeland Security Exercise and Evaluation Program (HSEEP) After Action Report/Improvement Plan

1. 2. 3. 4. 5. 6. 7.

Formidable Footprints W/S #1

Much planning has been done but more is needed FL/GA would work together very well Flood P.I. to Public to help calm fears Mutual Aid- iffy for some disciplines Every county is at different levels of the event We need more preparation and communication. Tough-tough discussions

Recommendations for Future Planning: 1.Establish cross-state command center 2.Create a checklist of actions and coordination 3.Key players need to be identified prior to an actual event 4.Keep conducting cross state events to encourage continued communication 5.Strengthen communication between hospitals, Public Health, and the community 6.Have Pandemic Phase’s available for participant to understand roles/responsibilities 7.Local health departments need to determine priority groups 8.More planning needs to be done between public health and school systems

Section 3: Analysis of Workshop Discussion Major Strengths • • • •

Interacting with different agencies from different states. Learning how agencies in Florida/Georgia are preparing The scenario’s were well written and well presented on dvd Very thought provoking discussion

Primary Areas for Improvement • • •

Need to establish coordinated educational materials up front for public Need to establish clear chain of command WHO/CDC/State/County Review area that need extensive planning and coordination (school closing, volunteer, risk communications, technical communication)

Analysis and Recommendations The workshop was a very good start toward building the lines of FF W/S #1

8 FOR OFFICAL USE ONLY

Florida Department of Health

FOR OFFICIAL USE ONLY

Homeland Security Exercise and Evaluation Program (HSEEP) After Action Report/Improvement Plan

Formidable Footprints W/S #1

communication between partners in bordering states/counties. The workshop concluded with a strong recommendation to continue the conversation across the FL-GA border and to expand across a variety of health and medical topics.

Section 4: Conclusions A blog has been established to invite attendees to keep lines of communications open across county and/or state borders. This blog will also be used as a learning tool between public health preparedness partners.

FF W/S #1

9 FOR OFFICAL USE ONLY

Florida Department of Health