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Full-Scale Exercise Tests Regional Emergency Preparedness

What if a disease outbreak overwhelmed hospitals in a neighboring state and then made its way to Cleveland? This month, area hospitals and a number of other organizations had the opportunity to test that scenario through a full-scale exercise aimed at evaluating regional emergency preparedness for responding to this type of an event. Named Botched Up, the exercise scenario involved a botulism outbreak that began in the Detroit area and subsequently spread to Cleveland. The exercise took place over a three-day period, from Monday, Aug. 13 through Wednesday, Aug. 15.

Under the scenario, an outbreak caused by commercially sourced food resulted in hospitals throughout Michigan being overwhelmed with patients. A federal declaration activated the National Disaster Medical System (NDMS), calling for transportation of patients to Cleveland. After patients arrived, it was determined the botulism source was also a vendor at a conference in Cleveland. Cleveland-area hospitals, already caring for an influx of patients from Michigan, were expected to be impacted with local victims of botulism.

HOSPITAL ROLE
The scenario resulted in hospitals receiving a surge of patients seeking care for neurological symptoms caused by possible bacterial ingestion and fear-induced panic. Hospital participation required the activation of each facility’s emergency operations plan (EOP), emphasizing the policies and procedures for care of staff and patients in response to a foodborne illness outbreak. The focus of hospitals’ testing activities was on EOP activation communication, multiagency coordination and medical surge. Hospitals were given the opportunity to adjust their level of participation in the exercise to meet their own individual needs and requirements.

All hospital operations during this exercise were run on-site at participating facilities. The patient reception area, where out-of-state patients were received, was operated out of Burke Lakefront Airport for patient arrival, evaluation and distribution to receiving hospitals. The Cuyahoga County Emergency Operation Center was fully activated and supported by multiple agency representatives that would be needed to assist with response coordination.

Andrea Bishop, BSN, project manager, Emergency Preparedness for The Center for Health Affairs, participated in the exercise planning and was located at Burke Lakefront Airport during the event, coordinating the state patient tracking system, OHTrac. Beth Gatlin, RN, MA-HSM, director, ASPR Emergency Preparedness for The Center, was a member of the team at the Cuyahoga County Emergency Operations Center, where she worked to coordinate hospital resource requests.

EXERCISE DESIGN
The regional emergency preparedness exercise was designed to establish a learning environment for players to practice and test emergency response plans, policies, and procedures as they pertain to an out-of-state biological illness outbreak resulting in a public health emergency that required the activation of the NDMS and the Cleveland Federal Coordination Center.

The NDMS coordinates the efforts of federal partners, which include the U.S. departments of Homeland Security, Health and Human Services, Defense, and Veterans Affairs. Together, these entities work in collaboration with the states and other appropriate public or private entities to respond to the needs of victims of a public health emergency, and to be present at locations, for limited periods of time, when such locations are at risk of a public health emergency. Federal Coordination Centers receive, triage, stage, track and transport inpatients affected by a disaster or national emergency to a participating NDMS inpatient hospital capable of providing the required care.

Exercise planning and development was conducted by representatives of the Louis Stokes VA Medical Center, Northeast Ohio hospitals, public health, Cleveland and Cuyahoga County emergency management, and The Center for Health Affairs. Through the design process and the execution of the exercise, important relationships were developed and nurtured among response partners as they worked in tandem to respond to the simulated public health emergency event.

The Botched Up exercise was designed through the combined efforts of multiple jurisdictions throughout the Northeast Ohio region to fulfill a variety of exercise requirements for participating organizations. These include requirements for a tri-annual Federal Coordination Center NDMS activation as well as capability objectives associated with the Hospital Preparedness Program, the federally funded initiative managed by The Center for Health Affairs. This complex regional exercise afforded an invaluable collaborative learning opportunity for the approximate 40 participating agencies, including the VA, hospitals, public health, first responders, emergency management and volunteer teams throughout the region.

For more on The Center’s regional emergency preparedness activities, contact us.