Transcript TOPOFF 3: New Jersey

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
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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
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VNN
New Jersey’s Overarching
Objectives
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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)
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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
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Planned covert release of Yersinia pestis in NYC 04 April
Operation is compromised prompting early release in NJ
(2 April)
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Linked to attack in New London
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Linked to UK and Canada (direct/indirect)
Driving Routes
Day One: Monday 4 APR 05
County
Cumulative
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
2501-5000
Salem
1
1501-2500
Atlantic
1
501-1500
Cumberland
1
Cape May
1
Total Cases of
Pneumonic Plague
5000+
101-500
0-100
TOTAL
1068
Day Five: Friday 8 APR 05
County
Cumulative
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
2501-5000
Salem
558
1501-2500
Atlantic
523
501-1500
Cumberland
133
Cape May
118
Total Cases of
Pneumonic Plague
5000+
101-500
0-100
TOTAL
37936
T3 Main Events: Summary
Local public health and health care partners
Reports of:
•Suspect human cases
•Animal die-offs
CDC epidemiology
team (on-site)
NJDHSS Communicable
Disease Service
NJ Department of
Agriculture
State Medical Examiner*
•Death counts
•Consultation
•Epidemiologic assistance
NJ PHEL
•Lab testing
CDC animal/vector
team*
CDC NCID*
Yersinia pestis confirmed*
~30,000 human plague cases (~30% mortality)*
~500 animal cases in rabbits and cats
(~40% mortality)*
* Notional play
Overview
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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
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D-Day
The FSE
The 1st Response
Health Simulation Mannequins
•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)
Operation Exodus
The Evacuation of the “Healthy
Sick” During TOPOFF 3
Operation Exodus
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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
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12 “Strike Teams” were dispatched to (8) Eight
Sending Health Care Facilities
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(7) Seven Acute Care Hospitals
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(1) One Long Term Care facility
Operation Exodus
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67 Ambulance Teams Participated:
 26 Licensed
 41 Volunteer
Staging :
 Meadowlands
 PNC Arts Center
Operation Exodus
Loaded 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
DHSS
HCO&A
Public
Govt. Agencies
T3 command and control structure– federal, state and local partners
Local
State
Federal/state
Joint Operations Center (JOC)/ Joint Field Office (JFO)
Federal
•DHS, FBI, DHHS, CDC
State
•Attorney General’s Office, NJDHSS, OEM
NJDHSS
•Health Command Center (HCC)
•Receipt/Stage/Storage Site (RSS)
•Emergency Communication
Center (ECC)
Acute care hospitals
State Police Office of Emergency
Management (OEM)
•Emergency Operations Center (EOC)
County OEMs
Local health departments
Command, Control, Management
Observations
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Federal officials in NJ–> roles unclear
yet. . .
NJ made policy decisions without
adequate intelligence input and federal
perspective
Command, Control, Management
Lessons learned
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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
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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 Delivery
Observations
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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
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Need to consider alternate POD
model(s) to accommodate mass nontargeted prophylaxis distribution (e.g.,
antibiotics to entire state during T3)
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Arrangements with Departments of
Corrections and Human Services, regarding
confined living facilities
Partnerships with industry, “taking care of
their own”; first responders
T3 Main Events: Summary
22 regional PODs,
local health
department assets
267 PODs, state assets*
189 PODs, federal
assets* (e.g., U.S.
Postal Service
resources)
> 400 PODs statewide*
> 10 million doses of antibiotic
prophylaxis distributed*
* Notional play
Medical Surge Capacity
Observations
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NJ able to shift resources inter- and intra-state
Request for assets without numbers to support
decisions
Lessons learned
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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
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Need to consider limited resources and
supplies, in face of “competition” with other
states and within own state
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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
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Overall, consistent messages facilitated
through:
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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
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Overall, consistent messages facilitated
through:
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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
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Continue to ensure “one message”
representing all agencies involved
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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
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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
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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
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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
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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
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Do no harm