2017 u of a game changer full scale exercise · 2017-09-20 · tohono o’odham, pascua yaqui, and...

2017 U of A Game Changer

Full-Scale Exercise Player Handbook Southern Arizona Health Care Coalition (SoAZHCC)

October 11, 2017

Player Handbook 2017 U of A Game Changer Full-Scale Exercise

Preface and Handling Instructions ii FOR OFFICIAL USE ONLY

PREFACE

The Southern Arizona Health Care Coalition (SoAZHCC), hereinafter called the Coalition, 2017 U of A

Game Changer Full-Scale Exercise Player Handbook gives exercise Players from participating

organizations the information necessary to participate in the exercise. All exercise Players may view

the Player Handbook.

The Player Handbook was produced with the input, advice, and assistance from the Coalition Exercise

Planning Team (EPT), which followed the guidance set forth in the Federal Emergency Management

Agency (FEMA) Homeland Security Exercise and Evaluation Program (HSEEP). The information in this

document is current as of the date of publication and is subject to change as dictated by the Exercise

Planning Team (EPT).

The 2017 U of A Game Changer Full-Scale Exercise (FSE) is an unclassified exercise. The control of

information is based more on public sensitivity regarding the nature of the exercise than on the actual

exercise content. Players may view other materials as deemed necessary in the performance of their

duties.

All exercise Players should use appropriate guidelines to ensure the proper control of information within

their areas of expertise and to protect this material in accordance with current jurisdictional directives.

Public release of exercise materials to third parties is at the discretion of the Coalition Exercise Director

and the Exercise Planning Team (EPT).

HANDLING INSTRUCTIONS 1. The title of this document is the 2017 U of A Game Changer Full-Scale Exercise Players

Handbook.

2. The information gathered in this document should be handled as sensitive information not to be

disclosed. 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 the Coalition Exercise Director and the Exercise Planning Team

(EPT) is prohibited.

3. At a minimum, the attached materials will be disseminated only on a need-to-know basis and

when unattended, will be stored in an area offering sufficient protection against theft,

compromise, inadvertent access, and unauthorized disclosure.

4. For more information, please consult the following point of contact:

Exercise Director:

Dan Stanley, SoAZHCC Coalition Coordinator

520-330-2927

[email protected]


Contents iii FOR OFFICIAL USE ONLY

CONTENTS

PREFACE .................................................................................................................ii

HANDLING INSTRUCTIONS .........................................................................................ii

EXERCISE OVERVIEW ...............................................................................................1

General Information .............................................................................................4

Background Information .............................................................................. 4

Participant Roles and Responsibilities ............................................................ 4

Exercise Assumptions and Artificialities .......................................................... 5

Exercise Logistics ................................................................................................7

Safety ....................................................................................................... 7

Fire Safety ................................................................................................. 7

Emergency Medical Services ......................................................................... 7

Weapons Policy ........................................................................................... 7

Site Access and Security .............................................................................. 8

POST-EXERCISE AND EVALUATION ACTIVITIES ..........................................................9

Hot Washes ................................................................................................ 9

Agency Hot Wash ................................................................................................................... 9

Player Feedback Forms ........................................................................................................... 9

Evaluation .................................................................................................. 9

Exercise Evaluation Guides .................................................................................................... 9

After-Action Report ................................................................................................................ 9

After-Action Conference ...................................................................................................... 10

Improvement Planning .......................................................................................................... 10

PARTICIPANT INFORMATION AND GUIDANCE ........................................................... 11

Exercise Rules .......................................................................................... 11

Player Instructions .................................................................................... 11

Before the Exercise ............................................................................................................... 11

During the Exercise............................................................................................................... 12

After the Exercise ................................................................................................................. 13

Simulation Guidelines ................................................................................ 13

Player Communications ............................................................................. 13

Public Affairs ............................................................................................ 14

Appendix A: Acronyms .......................................................................................1


Exercise Overview 1 FOR OFFICIAL USE ONLY

EXERCISE OVERVIEW

Exercise Name 2017 U of A Game Changer Full-Scale Exercise

Exercise Dates October 11, 2017

Scope

The 2017 U of A Game Changer Full-Scale Exercise is a full-scale exercise (FSE)

designed to include all City of Tucson healthcare sector and public health partners.

This exercise is being conducted to validate the ability of plans, equipment and

personnel to respond to an acute medical surge situation and to test public health

and healthcare coordination for the Southern Arizona Health Care Coalition

(SoAZHCC), hereinafter known as the Coalition.

Mission Area(s) Response

Core

Capabilities

Public Health Preparedness Program - Emergency Support Function 8: Public

Health and Medical Services (ESF-8)

Capability 6: Information Sharing

Function 3: Exchange information to determine a common operating

picture

Capability 10: Medical Surge

Function 3: Support jurisdictional medical surge operations

Reference: Public Health Preparedness Capabilities: National Standards for State

and Local Planning, March 2011, Centers for Disease Control and Prevention,

Office of Public Health Preparedness and Response

Hospital Preparedness Program:

Capability 1: Foundation for Healthcare and Medical Readiness

Objective 4: Train and Prepare the Health Care and Medical Workforce

Activity 1: Promote Role-Appropriate National Incident Management

System Implementation

Capability 2: Health Care and Medical Response Coordination

Objective 2: Utilize Information Sharing Procedures and Platforms

Activity 3. Utilize Communications systems and platforms

Objective 3: Coordinate Response Strategy, Resources, and

Communications

Activity 1. Identify and Coordinate Resource Needs during an

Emergency

Capability 4: Medical Surge



Objective 2: Respond to a Medical Surge

Activity 1. Implement Emergency Department and Inpatient Medical

Surge Response

Activity 2. Implement Out-of-Hospital Medical Surge Response

Activity 4. Provide Pediatric Care during a Medical Surge Response

Activity 8. Respond to Behavioral Health Needs during a Medical

Surge Response

Reference: 2017-2022 Health Care Preparedness and Response Capabilities,

Department of Health and Human Services, Office of the Assistant Secretary for

Preparedness and Response, November 2016.

Objectives

Public Health Emergency Preparedness - Emergency Support Function 8: Public

Health and Medical Services (ESF-8)

1. Pima County Emergency Support Function 8: Public Health and Medical

Services (ESF-8) will notify partners of the emergency incident and provide

situational updates via the Arizona Health Alert Network (AzHAN).

2. Demonstrate the ability to exchange information to determine a common

operating picture.

3. Demonstrate the ability to support jurisdictional medical surge operations.

4. Utilize the Arizona Health Alert Network (AzHAN) system to notify the

Southern Arizona Health Care Coalition (SoAZHCC) and Arizona Pediatric

Disaster Coalition (APDC) of situational status.

Hospital Preparedness Program

1. Hospitals will practice decompression at 20% of inpatient census. Of the

20% of patients, 50% will be transferred to Long Term Care, 25% will be

transferred to home health, and 25% will be discharged home.

2. Hospitals will transfer admitted inpatient pediatric patients to Tucson

Medical Center (TMC) and University Medical Center (UMC). TMC and

UMC will respond to the surge in pediatric in-patients by transferring them

to Honor Health hospitals.

3. Hospitals will track transferred patients using EMTrack, a patient tracking

software system.

4. Healthcare facilities will utilize the Healthcare Incident Command System

(HICS) or other National Incident Management System (NIMS) aligned

incident command system.

5. Local healthcare agencies and facilities will demonstrate their ability to

share information with regional medical and healthcare facilities.

6. The Coalition Behavioral Health Sector will test the coordination of all

Behavioral Health response teams, service request calls and response

agency communication related to this exercise.



Threats/

Hazards Explosion at a large university sports stadium followed by medical surge

Scenario

On the evening of October 11, 2017, there are an estimated 60,000 people in

attendance at a football game between U of A and ASU. There are several honored

guests at the game, including the Governor; the Davis-Monthan Honor Guard;

Tohono O’Odham, Pascua Yaqui, and other tribal veterans; and various high school

marching bands. There is a loud explosion just as the game is about to begin and

people stampede to the stadium exits. U of A law enforcement gain control of the

scene. There are traffic gridlocks on streets surrounding the stadium. At least 300

people need to be transported by Emergency Medical Services (EMS) to local

hospitals. At least 25% of the injured are pediatric patients.

Sponsor Southern Arizona Health Care Coalition (SoAZHCC) Training and Exercise

Committee

Participating

Organizations

Health Care Coalition member agencies, Pima County Health Department (PCHD),

and the Medical Reserve Corps. A complete listing of participants can be found in

the SoAZHCC 2017 U of A Game Changer Full-Scale Exercise Participant List. Pima

County Office of Emergency Management and Homeland Security (PCOEM) will be

simulated through the Simulation Cell (SimCell).

Point of Contact

SoAZHCC:

Dan Stanley

SoAZHCC Coordinator

520-330-2927

[email protected]


General Information 4 FOR OFFICIAL USE ONLY

GENERAL INFORMATION

Background Information

The Southern Arizona Health Care Coalition (SoAZHCC), hereinafter known as the Coalition, is

conducting a full-scale exercise, the 2017 U of A Game Changer Full-Scale Exercise. Coalition partners

from healthcare sectors, including Behavioral Health, Long Term Care/Skilled Nursing, Ambulatory Care,

Hospitals, County and Tribal Public Health, Hospice/Home Health and community resource sectors will

be participating in the exercise.

Pima County Office of Emergency Management (PCOEM) will be simulated by the exercise Simulation

Cell (SimCell). The Pima County Health Department (PCHD) serves as Emergency Support Function 8:

Public Health and Medical Services (ESF-8), which is activated by Pima County Office of Emergency

Management (PCOEM) to support public health and medical services response.

Participant Roles and Responsibilities

The term participant encompasses many groups of people, not just those playing in the exercise.

Groups of participants involved in the exercise, and their respective roles and responsibilities, are as

follows:

Players. Players are persons who have an active role in performing their regular roles and

responsibilities during the exercise. Players initiate actions, tasks or missions in response to

the simulated emergency.

Controllers. Controllers manage exercise play, set up and operate the exercise site,

implement the evaluation process, and work with the assigned safety officer or act as the

safety officer to ensure the safety of the Players, Actors, and others participating in the

exercise. They issue exercise material to Players as required, monitor the exercise timeline,

and supervise the safety of all exercise participants.

Evaluators. Evaluators evaluate and provide feedback on a designated functional area of

the exercise. Evaluators observe and document performance against established capability

targets and critical tasks, in accordance with the Exercise Evaluation Guides (EEGs). This

position may also be filled by the Controller, i.e. one person may need to act as Controller

and Evaluator.

Actors. Actors simulate specific roles during exercise play, typically victims or other

bystanders.

Observers. Observers visit or view selected segments of the exercise. Observers do not

play in the exercise, nor do they perform any control or evaluation functions. Observers



view the exercise from a designated observation area and must remain within the

observation area during the exercise. Very Important Persons (VIPs) are also Observers, but

may be grouped separately.

Media Personnel. Some media personnel may be present as Observers, pending approval

by the sponsor organization and the Exercise Planning Team (EPT).

Support Staff. The exercise support staff includes individuals are the planners of the

exercise who also perform administrative and logistical support tasks during the exercise

(e.g., registration, catering).

Exercise Assumptions and Artificialities

In any exercise, assumptions and artificialities may be necessary to complete play in the time allotted

and/or account for logistical limitations. Exercise participants should accept that assumptions and

artificialities are inherent in any exercise, and should not allow these considerations to negatively

impact their participation.

Assumptions Assumptions constitute the implied factual foundation for the exercise and, as such, are assumed

present before the exercise starts. The following assumptions apply to the exercise:

The exercise is conducted in a no-fault learning environment wherein capabilities, plans,

systems, and processes will be evaluated.

The exercise scenario should be considered plausible but will have artificialities that are

necessary due to time constraints, and events occur as they are presented during exercise

play. The scenario is taken from real world incidents.

Players will follow appropriate plans, procedures, regulations, and training they have

received.

Participating agencies may need to balance exercise play with real-world emergencies.

Real-world emergencies take priority.

Artificialities

During this exercise, the following artificialities apply:

Although the exercise documents describe a scenario that occurs at a football game at 8:00 pm,

the exercise will actually be conducted on October 11, 2017 between 8:00 am and 12:00 pm.

Not all resources may be involved in this exercise that normally would respond to these types of

incidents.



Emergency Support Function 8: Public Health and Medical Services (ESF-8) will operate out of

an alternate site during this exercise.

Another exercise, the Sierra Vista White Powder Exercise will be simulated as occurring at the

same time as the explosion incident in this exercise scenario. Exercise participants should

consider that both simulated incidents were caused by terrorists and that the entire region is

impacted at the same time.

Law Enforcement and Emergency Medical Services (EMS) agencies are not participating in this

exercise. However, exercise participants should recognize that an incident as significant as the

one described in the scenario would normally impact every element of Emergency Medical

Services (EMS) and Law Enforcement (LE) agencies in the Tucson area and larger areas of the

region.


Exercise Logistics 7 FOR OFFICIAL USE ONLY

EXERCISE LOGISTICS

Safety

Exercise participant safety takes priority over exercise events. The following general requirements apply

to the exercise:

A Safety Controller at each participating facility/agency site is responsible for participant safety;

any safety concerns must be immediately reported to the Safety Controller. The Safety

Controllers and Exercise Director will determine if a real-world emergency warrants a pause in

exercise play and when exercise play can be resumed.

For an emergency that requires assistance, use the phrase “real-world emergency.” The

following procedures should be used in case of a “real-world emergency” during the exercise:

o Anyone who observes a participant who is seriously ill or injured will immediately notify

emergency services and the closest facility/agency Controller, and, within reason and

training, render aid.

o Any facility/agency Controller made aware of a real emergency will internally initiate

“real-world emergency” facility procedures and notify the Exercise Director with the

location and description of the emergency.

o The Exercise Director will notify all participating facilities or agencies if there is a

community-wide ”real-world emergency” and the exercise needs to be stopped. A “real-

world” community-wide emergency may require that all facilities or agencies participate

in the response.

Fire Safety

Standard fire and safety regulations relevant to the jurisdiction or venue will be followed during the

exercise.

Emergency Medical Services

The jurisdiction or venue will coordinate with local Emergency Medical Services in the event of a real-

world emergency.

Weapons Policy

Players, Observers, Controllers, Evaluators, Actors, exercise planning staff, volunteers, or any other

persons participating in this exercise must observe a strict no weapons policy. No law enforcement

agencies or staff are involved in this exercise. Exercise participants MAY NOT, under any conditions, be

in possession of a weapon during the exercise.


Exercise Logistics 8 FOR OFFICIAL USE ONLY

Site Access and Security

All persons attending the exercise in any capacity will register at a Check-In Station located in an area

designated by your exercise site. Upon completion of the exercise, all persons should also check-out at

the same location.

If entry control is required for the exercise venue(s), the sponsor organization is responsible for

arranging appropriate security measures. To prevent interruption of the exercise, access to exercise

venue will be limited to exercise Players and guests with prior awareness. Players should advise

Controllers or Evaluators of any unauthorized persons.


Post Exercise and Evaluation Activities 9 FOR OFFICIAL USE ONLY

POST-EXERCISE AND EVALUATION ACTIVITIES

Hot Washes

Post-exercise Hot Washes (sometimes called debriefings) aim to collect sufficient relevant data to

support effective evaluation and improvement planning.

Agency Hot Wash

Facility/Agency Hot Washes must be conducted immediately with all exercise Players

following the end of the exercise at 11:30 am on October 11, 2017.

At the conclusion of exercise play, site Controllers will facilitate a Hot Wash to allow Players to discuss

strengths and areas for improvement during the exercise. Evaluators will seek clarification with regard

to Player actions and decision-making processes. Players are encouraged to participate; however,

Observers should not engage in the Hot Wash.

Player Feedback Forms

Player Feedback Forms will be provided by site Controllers to each facility/agency for Players and Actors

(if applicable) to complete. This will provide the Exercise Planning Team (EPT) with information about

exercise activities and exercise design. Player Feedback Forms should be distributed and collected

within each facility/agency and returned to the site Controller at the conclusion of the exercise.

Evaluation

Exercise Evaluation Guides

Exercise Evaluation Guides (EEGs) assist Evaluators in collecting relevant exercise observations.

Individual Players are not identified in the Exercise Evaluation Guides (EEGs). Instead, the Exercise

Evaluation Guides (EEGs) document exercise objectives and aligned core capabilities, capability targets,

and critical tasks. The Exercise Evaluation Guides (EEGs), coupled with Player Feedback Forms and

Agency Hot Wash Forms, are used to evaluate the exercise and compile the After-Action Report (AAR).

After-Action Report

Following the exercise, an After-Action Report (AAR) is developed to summarize key information related

to exercise evaluation. The After-Action Report (AAR) focuses on the overall analysis of core

capabilities, including capability performance, strengths, and areas for improvement, rather than

individual facility or agency performance. After-Action Reports (AARs) also include basic exercise

information, including the exercise name, type of exercise, dates, location, participating organizations,

capability areas, specific threat or hazard, a brief scenario description, and the name of the exercise

sponsor and Point of Contact (POC).


Post Exercise and Evaluation Activities 10 FOR OFFICIAL USE ONLY

After-Action Conference

An After-Action Conference will be held on November 2, 2017.

After completion of the draft After-Action Report (AAR), Controllers, Evaluators, decision- and policy-

makers, and other members of the Exercise Planning Team (EPT) will conduct an After-Action

Conference (AAC) to present, discuss, and refine the draft After-Action Report (AAR), and to develop an

Improvement Plan (IP). This conference is a chance to present the draft After-Action Report (AAR) to

participating facilities/agencies in order to solicit feedback and make necessary changes.

Improvement Planning

Improvement planning is the process by which the observations recorded in the After-Action Report

(AAR) are resolved through development of corrective actions, which are prioritized and tracked as a

part of a continuous Corrective Action Program (CAP). The Improvement Plan (IP) identifies specific

corrective actions, assigns them to responsible parties, and establishes target dates for their completion.

It is created by officials from the organizations participating in the exercise, and discussed and validated

during the After-Action Conference (AAC).


Participant Information and Guidance 11 FOR OFFICAL USE ONLY

PARTICIPANT INFORMATION AND GUIDANCE

Exercise Rules

The following general rules govern exercise play:

Real-world emergency actions take priority over exercise actions.

Exercise Players will comply with real-world emergency procedures, unless otherwise directed by

the control staff.

All communications (including written, radio, telephone, electronic, and e-mail) during the exercise

will begin and end with the statement “This is an exercise.”

Media personnel and Observers are not to interfere with the Players as they are working to

complete their assignments.

Player Instructions

Players should follow certain guidelines before, during, and after the exercise to ensure a safe and

effective exercise.

Before the Exercise

Review appropriate organizational plans, procedures, and exercise support documents.

For those Players who will be reporting to the site prior to the start of the exercise: Be at the

appropriate site at least 30 minutes before the exercise starts. Wear the appropriate uniform

and/or identification item(s).

Sign in when you arrive.

If you gain knowledge of the scenario before the exercise, do not communicate that information

with other exercise participants.



During the Exercise

Respond to exercise events and information as if the emergency were real, unless otherwise

directed by an exercise Controller.

Controllers will only provide information to encourage missions and/or tasks to be completed.

Players are expected to obtain necessary information by utilizing existing emergency

information channels unless told differently.

Do not engage in personal conversations with Players, Controllers, Evaluators, Observers, or

media personnel. If you are asked an exercise-related question, give a short, concise answer. If

you are busy and cannot immediately respond, indicate that, but report back with an answer as

soon as possible.

If you do not understand the scope of the exercise, or if you are uncertain about an

organization’s participation in an exercise, ask a Controller or the Site Lead.

Parts of the scenario may seem implausible. Recognize that the exercise has objectives to

satisfy and may require incorporation of unrealistic aspects. Every effort has been made by the

exercise’s trusted agents to balance realism with safety and to create an effective learning and

evaluation environment.

All exercise communications will begin and end with the statement “This is an exercise.” This

precaution is taken so that anyone who overhears the conversation will not mistake exercise

play for a real-world emergency.

For an emergency that requires assistance, use the phrase “I have a real-world emergency.”

The following procedures should be used in case of a “real-world emergency” during the

exercise:

o Anyone who observes a participant who is seriously ill or injured should immediately

notify emergency services and the closest member of the planning staff, and, within

reason and training, render aid.

o When a Controller, Evaluator or Planning Staff Member becomes aware of a real

emergency, stoppage of the exercise at the emergency location will be initiated,

appropriate resources for the emergency will be obtained, and the Exercise Director will

be provided with the location of the emergency and resources needed, if any.

Maintain a log of your activities. Many times, this log may include documentation of activities

that may have not been recorded by the Controller or Evaluator.



After the Exercise

As a Player, participate in the Hot Wash at your venue with Controllers and Evaluators.

Complete the Player Feedback Form. This form allows you to comment candidly on emergency

response activities and exercise effectiveness. Provide the completed form to an Evaluator.

Provide any notes or materials generated from the exercise to your Evaluator for review and

inclusion in the After-Action Report (AAR)

Simulation Guidelines

Because the exercise is of limited duration and scope, certain details will be simulated. The Simulation

Cell (SimCell) will simulate the roles and interactions of nonparticipating organizations or individuals.

The physical description of what would fully occur at the incident sites and surrounding areas will be

relayed to Players’ site leads or Controllers.

Player Communications

Exercise communications do not interfere with “real-world emergency” communications. Players

should use routine organization communications systems. These notification methods include:

MedsComm Ringdown – MedsComm (the medical communications system for 911 Emergency

Medical Services) will have an event opened on EMResource for this exercise.

AzHAN – The Arizona Health Alert Network - A mass notification software program that will be

utilized by Emergency Support Function 8: Public Health and Medical Services (ESF-8) and the

Exercise Director.

EMTrack – A web-based patient tracking system used to track patients throughout an event. It

can also be utilized to reunify patients and families. Agencies without access to EMTrack

receiving Actors from the scene will be using a furnished a paper tracking form.

EMResources – The bed poll is conducted and posted daily by 8:00 am statewide.

Survey Monkey – Messages requesting information for situational awareness and resource

coordination may be done by phone, email, or Survey Monkey.

Additional communication assets may be made available as the exercise progresses. Each site or

organization coordinates its internal communication networks and channels.

All participating organizations are included in the Players Communications Directory.



Public Affairs

Agencies participating in this exercise should contact Emergency Support Function 8: Public Health and

Medical Services (ESF-8) to coordinate public information messaging prior to disseminating public

information directly to the media. The sponsor organization and participating organizations are

responsible for coordinating and disseminating public information before the exercise. Each venue

should follow internal procedures.


Appendix A: Acronyms A-1 FOR OFFICIAL USE ONLY

APPENDIX A: ACRONYMS

Acronym Term

AAC After Action Conference

AAR After Action Report

CAP Corrective Action Program

C/E Controller/Evaluator

EEG Exercise Evaluation Guide

EMS Emergency Medical Services

EOC Emergency Operations Center

EPT Exercise Planning Team

ESF-8 Emergency Support Function 8: Public Health and Medical Services

ExPlan Exercise Plan

FEMA Federal Emergency Management Agency

FOUO For Official Use Only

FSE Full Scale Exercise

HICS Healthcare Incident Command System

HPP Healthcare Preparedness Program

HSEEP Homeland Security Exercise and Evaluation Program

ICP Incident Command Post

ICS Incident Command System

IED Improvised Explosive Device

IP Improvement Plan

JIC Joint Information Center

JIS Joint Information System

LE Law Enforcement

MCI Mass Casualty Incident

MOU Memorandum of Understanding

NIMS National Incident Management System

OEM Office of Emergency Management

PCHD Pima County Health Department

PCOEM Pima County Office of Emergency Management

PHEP Public Health Emergency Preparedness

PIO Public Information Officer


Appendix A: Acronyms A-2 FOR OFFICIAL USE ONLY

Acronym Term

POC Point of Contact

SimCell Simulation Cell

SME Subject Matter Expert

SoAZHCC Southern Arizona Health Care Coalition

TMC Tucson Medical Center

UMC University Medical Center

VIP Very Important Person

2017 u of a game changer full scale exercise · 2017-09-20 · tohono o’odham, pascua yaqui, and...

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