Mass Fatality Management Tabletop Exercise Public Health Area

Mass Fatality Management Tabletop Exercise Public Health Area 1 Florence May 6, 2008 1

Organization of the Exercise 1. 2. 3. 4. 5. 6. Introduction—objectives of the exercise, my role as facilitator, and your roles as participants Context—words from a survivor of the Pandemic of 1918 and an overview of current world and local events Scenario Injects—a pre-pandemic situation and a during-thepandemic situation, each introduced by a simulated local television news cast Small Group Discussion—following each scenario, a set of discussion questions will be presented, please discuss these questions at your table Large Group Discussion—volunteers will be asked to share their table’s reflections on the discussion questions Panel of Experts—our speakers and faith-based representatives will be at the Speakers Table to provide feedback and clarification 2

Objectives Provide a public information exchange with two purposes: (1) to apply information shared by today’s speakers to a mass fatality event and (2) to provide a forum for the ten target sectors to discuss how they will handle a mass fatality incident. Facilitate planning by provoking consideration of gaps that need to be filled and changes needed in your community’s fatality management protocol. Provide valuable feedback for policy formulation at all levels of government, business, and the private sector relating to managing mass fatality incidents. 3

Facilitator’s Role Describe the exercise, its purpose and processes Guide the discussion Time management Initiate and maintain dialog Summarization 4

Role of the Participants Share expertise Assess others’ ideas objectively and professionally Encourage sharing of ideas 5

Mrs. Edna Register Boone Experiences of the 1918 Pandemic 6

Mrs. Boone Video 7

The State of Affairs Today US Military Operations Involved in a war in Iraq and Afghanistan Peace-time troops deployed worldwide US troops are exposed on a daily basis to foreign cultures and ways of life Alabama National Guard troops have served or serve in Iraq, Afghanistan, Kosovo, Egypt, the Persian Gulf states, the Horn of Africa and Central America. 8 Among the states, Alabama is third in number of National Guard and US Army Reserve troops deployed in the Global War on Terror (GWOT) with more than 13,000 National Guard rotating between the theaters of operations and home

The State of Affairs Today Recent Mass Fatality Events Deaths in the US influenza pandemics of 1918, 1957 and 1968--500,000 70,000 32,000 respectively Deaths from hurricanes Ivan, Dennis, Katrina and Rita exceeded 1,259. The Fall 2007 Minneapolis bridge collapse resulted in 13 fatalities The March 2007 Enterprise tornado resulted in 9 deaths completely overpowering local resources 9 The March 2004 Madrid, Spain terrorist train attack resulted in 191 fatalities and 1,755 wounded The 1992 Mobile/Saraland Amtrak train derailment resulted in 44 fatalities The Oklahoma Mura Federal Building terrorist attacks resulted in 168 fatalities The events of September 11, 2001 resulted in over 3,000 fatalities in New York City, Washington, DC, and Pennsylvania

The State of Affairs Today Alabama’s International Face World class championship golf changed the fact of Alabama’s tourist industry attracts visitors from around the nation and world Travel associated with international trade brings international visitors through our airports, marine terminals, and Interstate Highways These visitors mix freely with Alabamians and many become long term residents who travel between Alabama and their home countries 10 Alabama’s two medical schools hosts international students Birmingham and Mobile who travel freely between the host city and home--some within the communities where transmission of contagious outbreaks Religious and medical missionary residents of Alabama travel out of the country and return The growing number of land based and off shore casinos in Louisiana, Mississippi, and Alabama create a corridor for the introduction and spread of any contagious element

Local News Item 1 11

Exercise Scenario – 1 (MidNovember) The World Health Organization (WHO) has confirmed sustained human-to-human transfer of a virulent influenza virus in several Asian countries and has determined that an influenza pandemic is imminent (WHO Phase 5). CDC has advised that the pandemic influenza virus is likely to reach one or more contiguous 48 states in the next 30 days. (USG Stage 4). The US Department of Homeland Security (DHS) has asked the states to determine appropriate counter measures. 12 The Alabama Emergency Management Agency (AEMA) convenes a meeting of all response partners to plan strategically. Citizens express concerns about loved ones stationed overseas, border security and risk of exposure during the busy travel season. Public Health and its response partners are preparing for the potential of mass vaccination/prophylaxis clinics

Discussion Questions--1 What are the priority concerns of your organization at this time? Has your organization developed a continuity of operation plans (COOP); if so, what does it cover. If not, what should you be considering NOW to prepare your organization? What public safety issues should be anticipated and what preventive and response actions should be taken? 13

Local News Item 2 14

Exercise Scenario – 2 (MidFebruary) A pandemic of influenza has been underway for 14 weeks. The CDC has set the Pandemic Severity Index to its highest level—Category 5. Public Health reports infection rates exceeding 30% of the population with 793 new cases reported daily in Public Health Area 1. The total number of cases in PHA 1 approaches 787,000 with 1,666 deaths. 15 Neighboring states are similarly affected with a slightly less severe outbreak in Mississippi and a slightly greater one in Georgia Physician offices, clinics, and hospital emergency rooms have been overwhelmed. Government, utilities, and business are reducing available services. The death toll is staggering averaging 17 per day in PHA 1 with a peak of 26 in one day, mid last week. Yesterday there were 11 deaths recorded.

Discussion Questions--2 What resources are in place for the collection, identification, transportation and storage of the dead? Does your organization’s COOP need to be modified? What public safety, legal, environmental, health, and economic issues face your organization? How will the religious and cultural expectations concerning the treatment of death be handled? How do we address the physical and mental well being of responders, persons providing essential services, and their families? What should we be doing to help the general public? 16

Summary 17