The Center for Disaster Risk Policy

BETA Fish Exercises (AMTS)

It has become clear that one of the steps a local community must take to prepare for the medical response to a disaster or catastrophic mass casualty incident is the development of an Alternative Medical Treatment Site plan. Hospitals across Florida are extremely busy on a daily basis. In a disaster situation, hospitals become overwhelmed and it is essential that their resources remain available for treating critical patients. One method to achieve this is to open Alternative Medical Treatment Sites (AMTS) to handle "green tagged" or "minor" patients.

The Florida Department of Health and the Center for Disaster Risk Policy undertook a series of tabletop and drill format exercises to help enhance Florida's pre-hospitalization response capabilities through evaluating and strengthening the concept of AMTS.

Entitled "BETA Fish Exercise", the Florida counties of Leon, Martin and Orange were identified to test their AMTS plans via these exercises. Contained in the BetaExercise website are the exercise documents which outline how the series of exercises were developed, designed and facilitated along with the various tools used to make this series of exercises both a learning opportunity and a capacity building initiative.

Overwhelming Outbreak

In the aftermath of the numerous disasters and the ongoing threat of public health emergencies within our state, the Florida Department of Health, as lead agency for Emergency Support Function (ESF) 8 [Health and Medical], has classified Public Health-Typed Teams to facilitate resource management to impacted communities. These typed teams will be deployed to support local communities whose resources have been overwhelmed by the magnitude of an incident. Two of these typed teams, Environmental Health Strike Teams (that focus on investigation and inspection of environmental sources of contamination) and Epidemiology Strike Teams (that provide investigation expertise of human sources of infection) exist to assist local communities without the needed resources to deal with disease outbreaks.

The purpose of this exercise is to place Environmental Health and Epidemiology Strike Teams in an outbreak event where they will have to perform the full range of tasks required when activated, along with coordination between teams to identify and contain a contagion. The mission of this exercise is to provide a realistic outbreak scenario and environment within which the Environmental Health and Epidemiology Strike Teams may accomplish the Exercise Purpose.

The scenario revolves around an initial outbreak of unidentified type and origin within the exercising community selected by the region. The victims, who number in the hundreds with two fatalities, are from local schools and elder-care facilities. The size of the victim population has overwhelmed the County Health Department's resources to effectively investigate and contain either the contagious or environmental cause of this illness. The Regional Environmental Health and Epidemiology Strike Teams will be deployed in support of the impacted county. Prior to deployment, these teams will have received the status of the investigative actions already taken by the County Health Department, namely the sampling and exclusion of food items at the affected schools and elder-care facilities. The strike teams' mission will to be continued investigation and inspections of the affected facilities to determine the cause and develop containment strategies for eliminating further spread.

The Overwhelming Outbreak 001-007 is a series of exercises conducted in succession using a chain of stations to simulate the major functions accomplished during an environmental health and epidemiological investigation of a widespread outbreak in various Florida counties. The day-long exercises are conducted to test Environmental Health and Epidemiology Strike Teams in as realistic an outbreak situation as possible.

Beleaguered Bus

The intent of the Beleagured Bus exercise is to develop and deliver a series of realistic public health preparedness exercises that could be played out in any county within a given region. The exercises are designed to test and evaluate each county's response to a mass casualty incident involving an exotic infectious disease or a bio-terrorism event. The exercise series is presented in three phases; an orientation, a tabletop, and a full field exercise.

The exercise schedule begins with a series of orientations for participating counties. The orientation gathers county responders (law enforcement, emergency medical services, emergency management, fire & rescue, hospitals, and county health departments) and provides an overview of the exercise purpose and content.

The second opportunity for the county response community to meet was a tabletop exercise conducted in each of the counties prior to the full scale event. In addition to ID cards, badges, etc., the most important identification at an emergency event is face recognition. The tabletop provides an opportunity for all county responders to strategize about their actions at the scene of a bus with passengers carrying an exotic and serious communicable disease.

The true test for participating counties is a series of full-scale exercises using a chartered bus with screened and trained participants of all ages, genders, and varied backgrounds. The date the exercise takes place is known by each county, but the exact location and time are kept as exercise confidential.

Bioshield

Bioshield is a full-scale exercise designed to test the State's ability to receive and disseminate pharmaceuticals to citizens during a Weapons of Mass Destruction incident. The Office of Emergency Operations, within the Florida Department of Health, is responsible for assuring that Florida has a plan to accept the Strategic National Stockpile (SNS) and make it available in a location that most efficiently meets the needs of the local affected community. During the exercise, Florida communities tested their ability to receive SNS materials from the state and distribute them to their citizens via Points of Dispensing (POD).

The first day of the four day exercise tests the policies, processes and procedures used to coordinate information between the State Emergency Operations Center, the Department of Health (DOH) ESF8 Senior Policy Group, and selected players within the communities. Day two of the exercise consists of a full-scale activation and operation of a Receipt, Storage & Shipment/Logistical Staging Area (RSS/LSA) facility using materials provided by the Strategic National Stockpile (SNS) Training Package. The third day of the exercise (May 4th) is devoted to Point of Dispensing (POD) exercises within the communities themselves. Using simulators and dispensing SNS materials prepared at the RSS/LSA and delivered via ground or helicopter transportation, communities test their local plans for dispensing to an impacted population. The fourth and final day of the exercise provides an opportunity to recover all the materials distributed to CRI POD's for return to the Centers for Disease Control and Prevention (CDC).

Continuity of Operations Planning [COOP]

CDRP offers extensive planning for State of Florida and local governments through Continuity of Operations Planning (COOP) training. COOP plans are important because they outline a plan that will allow government entities to perform their minimum essential functions (MEF) during any emergency or hazard scenario. With the appropriate COOP plans in place, essential government functions such as public safety, public works, and health care can be available even when the traditional operations centers have been effected by a disaster. CDRP has assisted 5 counties and 2 State of Florida Departments in developing their COOP plans to ensure that the essential functions of government are available to Florida citizens under all scenarios.

Extreme Exposure

Extreme Exposure simulates a catastrophic mass casualty incident resulting from detonation of radiation dispersal device. The scenario is played out in an area specific to each of Florida's participating counties. The exercise is the culmination of radiation response training provided by the Florida Department of Health, Bureau of Radiation Control to county responders in November and December 2006. While this training was helpful in providing the basics of radiation incident response, it was not a prerequisite for the exercise.

The XXX⁰⁷ table top exercise is based on a radiological dispersion device that detonates within the local community causing dozens of initial casualties. The purpose of the exercise was to provide training to public health workers and emergency response agencies to effectively and efficiently respond to a biohazard release in their regions. The initial explosion is a backdrop to the impacts of widespread radiation as the aftermath. The questions and prompts in the half-day table top exercise lead discussions to center around local impacts of exposure to a radiological weapon of mass destruction (WMD).

Participants were separated into small groups of three to four individuals, working through the scenario on the group's laptop using the Tabletop Exercise System Technology (TEST). The group facilitator for this exercise was Mr. Rob McDaniel, Center for Disaster Risk Policy, Florida State University. Mr. Mc Daniel interacted with the individuals groups, answering questions and ensuring that no single group fell behind.

The exercise was designed to provide participants with an opportunity to assess current capabilities to perform the critical tasks required to respond to a public health emergency resulting from a bioterrorism attack. Through assessment of those capabilities, participants identified strengths, weaknesses, and future training needs.

Influenza Control Exercise [ICE]

The Florida Department of Health's Influenza Control Exercise (ICE) series administered through the Center for Disaster Risk Policy (CDRP) is designed to provide state, county, city and community participants the opportunity to discuss, examine and improve response to a pandemic influenza.

ICE was developed to help meet certain gaps that were identified through a statewide assessment focused on the preparedness of the state's health and medical infrastructure in the context of pandemic influenza. The county level assessments assessed each county's preparedness capacity to operationalize and respond as a community. The Department created an Emerging Event Team (EET) which included representation from all department divisions and county health departments. This team was tasked with validation and prioritization of the identified gaps and to ensure proposed projects would support gap closure within three years.