Healthy NH Shelters October 29 2014 Acknowledgements Shelter

Healthy NH Shelters October 29, 2014

Acknowledgements Shelter Surveillance Work Group and Exercise Planning Team Participants Funding – that’s you!

Thank you! Manchester Health Department for letting us use their space American Red Cross for providing refreshments

Healthy NH Shelters Exercise Briefing October 29, 2014 Manchester Health Department Exercise Scope: tabletop; 2 hours Mission area: Response

Objectives and Public Health Preparedness Capabilities Exercise Objective Core Capability Identify the roles and responsibilities of the participating agencies during health surveillance in mass care shelters. PHP Capability 1: Community Preparedness; Identify all existing laws, plans, policies and procedures related to health surveillance in shelters and how they can be coordinated for a more efficient response. PHP Capability 7: Mass Care HP Capability 1: Healthcare System Preparedness

Exercise Objective Core Capability Evaluate the guidance, policies, and protocols to implement health surveillance in mass care shelters. PHP Capability 7: Mass Care; Evaluate communication flow and information sharing between the shelters, the SEOC and the NH DHHS ICC/DPHS. PHP Capability 3: Emergency Operations Coordination; Assist the shelter with identifying and implementing infection prevention and control measures for the shelter. PHP Capability 13: Public Health Surveillance and Epidemiological Investigation PHP Capability 6: Information Sharing

Participant Roles and Responsibilities Players: Respond to situation presented based on current plans, policies, and procedures Observers: Support players in developing responses, but do not participate in moderated discussion Facilitators: Provide situation updates and moderate discussions Evaluators: Observe and document player discussions

Exercise Structure 2 modules Break Hotwash & Evaluation Forms

Exercise Guidelines This is an open, low-stress, no-fault environment. Varying viewpoints, even disagreements, are expected. Base your responses on the current plans and capabilities of your organization. Decisions are not precedent setting; consider different approaches and suggest improvements. Issue identification is not as valuable as suggestions and recommended actions that could improve efforts; problem-solving efforts should be the focus.

Assumptions and Artificialities The exercise is conducted in a no-fault learning environment wherein capabilities, plans, systems, and processes will be evaluated The exercise scenario is plausible, and events occur as they are presented All players receive information at the same time

Module 1: Storm Headless Horseman

Module 1 Objectives (30 mins) Identify the roles and responsibilities of the participating agencies during health surveillance in mass care shelters. Identify all existing laws, plans, policies and procedures related to health surveillance in shelters and how they can be coordinated for a more efficient response.

10/22/14 In the news…… ISIS Using Chemical Weapons? Ebola Quarantine Rules Will Hawaii’s Volcanic Menace Stop?

10/22/14 – Weather Forecast A major storm with torrential downpours and heavy winds is expected to hit NH Worry With about power outages and flooding Halloween around the corner the storm was nicknamed the Headless Horseman

Discussion What is your agencies role preevent when bad weather is coming? Is there anything being done to pre-designate or set-up shelters?

10/23/14 – Storm Headless Horseman hits NH Heavy High rains winds Saturated ground

10/23/14 Flash of NH Flood Watch in effect for entire state

10/23/14 Multiple vehicle accidents across state 1 fatality; 5 sent to the hospital One person sent to the hospital after trying to clear a fallen tree from his driveway

10/24/14 – after the storm DPW starts to clear the damage Flash flood warning goes into effect Power is out to 300, 000 people across NH

10/24/2014 – Shelter Granite State High School opens a shelter for residents, pets and individuals with functional needs It is run by the municipality with help from the Public Health Region

10/24/14 – ARC Shelter American Red Cross sets up a shelter in the neighboring region

Discussion What is your agencies role in setting up, running or assisting shelters during emergencies? How can your agency help with surveillance in shelters?

Discussion Are there existing laws, plans, policies or procedures that can assist with conducting surveillance in shelters?

Surveillance in Shelters When does the surveillance process start for shelters? Should any of the surveillance forms be started prior to opening a shelter?

Module 2: Granite State High School Shelter

Module 2 Objectives (70 mins) Evaluate the guidance, policies, and protocols to implement health surveillance in mass care shelters. Evaluate communication flow and information sharing between the shelters, the SEOC and the NH DHHS ICC/DPHS. Assist the shelter with identifying and implementing infection prevention and control measures for the shelter.

10/25/14 Power outages expected to be out for approximately 710 days Flooding severe in some places and people can’t return home

10/25/14 Both shelters are filling up quickly Granite State High School shelter 120 residents 30 volunteers/staff during the day 15 volunteers/staff at night 1 -2 medical staff available each shift

Granite State High School Number 68 35 1 2 30 Category Number Females Families w/o children 52 Males 14 Families w/children Service Dogs 10 People with durable medical equipment 2 Group Home staff 15 Shelter staff – night shift Group Home adult residents Shelter staff – day shift

Discussion Who oversees surveillance and infection control in shelters? Who would be tasked to contact the state to report outbreaks or communicable diseases? Who is responsible for triage at the shelter?

Discussion What communication pathways exist between shelters (including ARC shelters) and the state?

10/25/14 Granite State High School is working with the municipality and giving updates on shelter counts and issues to the LEOC Shelter mentions that they may need help with medical supplies for some of the residents from the group home The residents from the group home brought some yummy delicious Halloween cupcakes they made before the storm hit and shares them with everyone…. they are so nice!

SEOC to GSHS The SEOC ESF-8 reaches out to the GSHS to checkin and asks if they have started to conduct surveillance using the forms GSHS didn’t know they were supposed to fill out forms

Discussion How can the GSHS access the forms? What can the SEOC do to assist the shelter? How can the shelter get the forms to the SEOC daily?

Discussion Who keeps track of the summary forms and monitors for trends? If a possible outbreak is identified, who assists?

10/26/14 – 10/28/14 GSHS has been filling out the summary form and sending it to the NH DHHS ICC email address daily

10/28/14 – Concord, we have a problem 14 12 12 10 8 6 Vomiting 5 4 Diarrhea Fever 2 29. 10. 20 14 28. 10. 27. 20 14 26. 10. 20 14 1 0

Discussion What Who is the problem? gets notified? takes control of the outbreak investigation?

Discussion What additional information is needed from the shelter? What measures are given to the shelter to try to stop the outbreak? What actions should have been taken before this started to prevent it?

Back to the cupcakes… Two of the ill residents are from the group home and one of the ill residents is a staff person from the group home. Investigation reveals that all the ill residents ate the cupcakes One resident is transported to the hospital for dehydration and test results point to norovirus

American Red Cross Shelter If this same situation happened at an ARC shelter: Who is notified? Who is in charge of notifying the state of an outbreak situation? What ARC resources are available to help mitigate the situation?

Remaining Thoughts?

Hotwash Strengths Areas for Improvement

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