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TOPOFF 3. David Gruber Assistant Commissioner - NJDHSS Division of Emergency Preparedness and Response Joseph A. Barone Professor and Chair - EMSOP Chair - Executive Council – MEDPREP. Acknowledgements. Dave Gruber, Jim Blumenstock, Commissioner Jacobs NJ OEM and State Police - PowerPoint PPT PresentationTRANSCRIPT
TOPOFF 3David Gruber
Assistant Commissioner - NJDHSSDivision of Emergency
Preparedness and Response
Joseph A. BaroneProfessor and Chair - EMSOPChair - Executive Council –
MEDPREP
Acknowledgements
Dave Gruber, Jim Blumenstock, Commissioner Jacobs
NJ OEM and State Police Middlesex County Public Health Dept.
Connecticut Dept. of Public Health
Scotland Yard
TOPOFF 3 “Live” Video
VNN
New Jersey’s Overarching Objectives
1. Administer effective and efficient prophylaxis distribution.
2. Identify necessary staffing patterns for the “comprehensive” health care system.
3. Exercise the disaster-declaration process.
4. Examine the processes associated with quarantine and/or isolation orders.
5. Explore the existing hospital capacities and related administrative systems.
6. Examine continuity of government and business operations in public and private sectors.
Overarching Objectives (cont)
7. Test the epidemiological processes and procedures to include the coordination of health care activities with law enforcement.
8. Examine the in-State resources and Federal support for mortuary care.
9. Evaluate the effectiveness of the EMAC. 10. Assess existing mental health strategies
for emergency workers and the public. 11. Explore the coordination of intelligence
and investigative authorities. 12. Test the abilities of State and local
governments and the private sector to conduct Risk Assessment, and manage a public information program.
Scenario
Planned covert release of Yersinia pestis in NYC 04 April
Operation is compromised prompting early release in NJ (2 April)
Linked to attack in New London
Linked to UK and Canada (direct/indirect)
Driving Routes
Total Cases of Pneumonic Plague
5000+
2501-5000
1501-2500
501-1500
101-500
0-100
Day One: Monday 4 APR 05 CountyCumulative
Cases
Union 453
Middlesex 384
Essex 64
Hudson 36
Monmouth 31
Somerset 18
Passaic 17
Bergen 16
Morris 9
Mercer 7
Burlington 6
Ocean 5
Sussex 6
Warren 5
Hunterdon 3
Camden 2
Gloucester 2
Salem 1
Atlantic 1
Cumberland 1
Cape May 1
TOTAL 1068
Total Cases of Pneumonic Plague
5000+
2501-5000
1501-2500
501-1500
101-500
0-100
CountyCumulative
Cases
Union 6436
Middlesex 6155
Essex 3212
Hudson 3190
Monmouth 2773
Somerset 1748
Passaic 2109
Bergen 2044
Morris 1587
Mercer 1542
Burlington 1038
Ocean 978
Sussex 836
Warren 782
Hunterdon 760
Camden 742
Gloucester 672
Salem 558
Atlantic 523
Cumberland 133
Cape May 118
TOTAL 37936
Day Five: Friday 8 APR 05
Local public health and health care partners
NJDHSS Communicable Disease Service
CDC animal/vectorteam*
CDC epidemiology team (on-site)
Reports of:•Suspect human cases•Animal die-offs
NJ Department of Agriculture
* Notional play
Yersinia pestisYersinia pestis confirmed* confirmed*
~30,000 human plague cases (~30% mortality)*~30,000 human plague cases (~30% mortality)*
~500 animal cases in rabbits and cats ~500 animal cases in rabbits and cats (~40% mortality)*(~40% mortality)*
State Medical Examiner*
•Consultation•Epidemiologic assistance
T3 Main Events: Summary
CDC NCID*
NJ PHEL
•Lab testing
•Death counts
Overview Hospitalized 30,000+ Fatalities 8000+ All state acute care hospitals participate (FQHCs)
SNS received (Push package + VMI) 22 PODs opened throughout state (actual), 400+ notional (LINCS agencies)
SEOC,HCC,CEOC open Joint FBI Public Health Epi investigation FBI takedown of bio-lab NJSP takedown of safe house JOC,JFO,JIC stand up
Now the fun stuff
The Full Scale Exercise
D-Day
The FSE
The 1st Response
•Computer programmable training aids present physiological signs and symptoms associated with chemical, biological, nuclear, radiological, and explosive events and respond realistically to the medical procedures of responders
•Supports overall trauma and mass casualty incident medical training
•Will provide training to hospital, EMS, and non-hospital based healthcare professionals
•Part of the State’s mass casualty incident training program (trainers will use all mannequins (10) at a single site to enhance the realism of a simulated mass casualty incident)
Health Simulation Mannequins
Operation Exodus
The Evacuation of the “Healthy Sick” During
TOPOFF 3
Operation Exodus
Transfer approximately 100 non-infected “healthy sick” patients from (8) eight hospitals/facilities in northern and central New Jersey
Evacuate these patients to other areas of the country via military aircraft in concert with NDMS
Operation Exodus
12 “Strike Teams” were dispatched to (8) Eight Sending Health Care Facilities
(7) Seven Acute Care Hospitals
(1) One Long Term Care facility
Operation Exodus
67 Ambulance Teams Participated: 26 Licensed 41 Volunteer
Staging : Meadowlands PNC Arts Center
Operation ExodusLoaded Stretcher Patients
Strategic National Stockpile Operations
• Be careful what you don’t ask for (10M doses)
• Just cause you got it, doesn’t mean you got it (Fed release)
• Even when you finally get it, doesn’t mean you can use it (Cipro for plague)
VMI focus
How much is too much
County/local ability to receive
Command, Control, Communications
Lab
Op
s
IT
Hu
man
Services
Hospitals/FQ
HC
/
LTC
Public Health
Logistic (SNS/SSS)
HA
N
Fed
eral
Cel
lE
MS
PIO
Ad
min
Lab Building
OIT
SRSS
Off si
te o
ps
CDRS
Epi Investig
ation
JICJOC
FB
I
OC
T
DH
SD
EP
Phon
eG
ov
offic
e
EMS/General
OEM EOC
AG
HH
S
CD
C
Hospita
ls
EMS DispatchEMS TF
Press
BENS
Public
PODSLINCSNJH
A
Me
dic
al
Co
mm
and
HCO&A
DHSSDHSS
Govt. AgenciesGovt. Agencies
Other
Other
Agenci
es/O
rgs
Agenci
es/O
rgs
NJDHSS•Health Command Center (HCC)•Receipt/Stage/Storage Site (RSS)•Emergency Communication Center (ECC)
State Police Office of Emergency Management (OEM)•Emergency Operations Center (EOC)
Joint Operations Center (JOC)/ Joint Field Office (JFO)
Federal •DHS, FBI, DHHS, CDC
State•Attorney General’s Office, NJDHSS, OEM
Local health departments
County OEMsAcute care hospitals
T3 command and control structure– federal, state and local partnersL
oca
lS
tate
Fed
eral
/sta
te
Command, Control, Management
Observations Federal officials in NJ–> roles unclear yet. . .
NJ made policy decisions without adequate intelligence input and federal perspective
Command, Control, Management
Lessons learned Need to identify all potential federal resources and attempt to optimize interface with federal agencies in advance
Need to ensure that state is involved in decision process regarding federal assets
Need to ensure that federal agencies acknowledge any state request with written documentation
Tuesday Evening: The Magic Begins
• Conference call NJ, JFO, White House/HHS/DHS
• Feds go postal
• NJ says “yo”
NOTIONALITY, the Miracle Drug
• Medications (10M doses before disease identified)
• PODS (post offices)
• People (15K NJ workers)
• Medical professionals (25K surrounding states)
• Medical Facilities (10K bed hospital)
Medication Delivery
Observations Ciprofloxacin and gentamicin lack FDA approval for treatment and prophylaxis of plague IND protocol for use; challenges in getting written Emergency Use Authorization
Adverse events routine reporting mechanisms through FDA
Medication DeliveryObservations Federally-operated PODs unclear whether operating under considerations (e.g., safety, facilitated crowd movement) as outlined in NJDHSS POD manual
No limits regarding antibiotics received from SNS but. . .
“Competition” with other states for limited resources
Medication Delivery
Lessons learned Need to consider alternate POD model(s) to accommodate mass non-targeted prophylaxis distribution (e.g., antibiotics to entire state during T3) Arrangements with Departments of Corrections and Human Services, regarding confined living facilities
Partnerships with industry, “taking care of their own”; first responders
22 regional PODs, local health department assets
267 PODs, state assets* 189 PODs, federal assets* (e.g., U.S. Postal Service resources)
* Notional play
> 400 PODs statewide*> 400 PODs statewide*
> 10 million doses of antibiotic > 10 million doses of antibiotic prophylaxis distributed* prophylaxis distributed*
T3 Main Events: Summary
Medical Surge CapacityObservations NJ able to shift resources inter- and intra-state
Request for assets without numbers to support decisions
Lessons learned If alternate site facilities that cannot provide maximal levels of medical care are used, need to factor in ethical considerations when triaging patients to these facilities
Medical Surge Capacity
Lessons learned Need to consider limited resources and supplies, in face of “competition” with other states and within own state Consider individual facility stockpiling of supplies (learn from “shortages”)
Decreased staff numbers and those with special skills/training “just in time” training
“Snow-day” model
Communications: Public Information
Observations Overall, consistent messages facilitated through: Multi-agency coordination to adapt and respond to evolving event
Use of prepackaged materials (“shelf kits”) and regular communication with local agencies and hospitals
Communications: Public Information
Observations Overall, consistent messages facilitated through: Multi-agency coordination to adapt and respond to evolving event
Use of prepackaged materials (“shelf kits”) and regular communication with local agencies and hospitals
Communications
Lessons learned Continue to ensure “one message” representing all agencies involved Medication recommendations Infection control and personal protective equipment recommendations (e.g., anticipate N95 v. surgical mask discussion also in pandemic influenza event)
Educational materials Make sure that all assets are in the loop
Blood Center Operations
Observations American Association of Blood Banks Inter-organizational Task Force activated to address donor deferral and quarantine
National Blood Exchange emergency blood supply to NJ not all NJ blood centers apprised of process for receiving deliveries*
* Notional play
What does it mean to go “RED”
Food Sector Activities
Observations Inter- and intra-state travel restrictions initially entertained during early phases of outbreak devastating effect on food distribution*
Decisions based on inadequate intelligence, need to do something
* Notional play
Food Sector Activities
Lessons learned NJ Food Council’s Food Sector Advisory Committee: Consider master plan to share sector resources, locations, inventory
Develop company-specific plans for retail store or distribution center regarding restoring product supply and staffing
Barone’s Observations
We are better prepared Systems can get quickly overwhelmed
The little things will screw you up
There are lots of moving parts Need to have processes in place and DRILL, DRILL, DRILL
Good Advice
Do no harm