Schools

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Schools Pandemic Influenza Public Health
Emergency Exercise Program
LOCAL DISTRICT TABLETOP EXERCISE (TTX)
A part of the LAUSD Series sponsored by the Los
Angeles County Department of Public Health
LOCAL DISTRICTS 6, 7 8 MAY 14, 2008
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Welcome Introductions
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Exercise Logistics

• Phones, Pagers, Blackberries, iPhones, etc.
• Restrooms
• Refreshments
• Parking Validation
• Seating Arrangements

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Situation Manual

• Exercise Schedule
• Introduction
• Module 1Pandemic Outbreak Overseas
• Module 2 Outbreak in the U.S.
• Module 3 Outbreak in LAUSD
• Appendices
• Acronyms Glossary of Terms
• Toolkit Overview
• The PSI Student Dismissal/Social Distancing
  FAQs
• Pandemic Influenza Resources
• LAUSD LACDPH Contact Lists
• Presentations and Notes Pages
• Reference Graphics

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Feedback Form

• Broken down by Exercise Section/Module
• Record Notes, Thoughts, Issues, Strengths,
  Recommendations
• Complete throughout exercise
• Be thorough
• Turn in at the conclusion of the exercise

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Exercise Schedule
800 am Welcome and Introduction 820 am
Presentation LAC Department of Public Health
850 am Presentation LAUSD Student Medical
Services 910 am Presentation LAUSD
Emergency Services District Nursing Services
930 am Break 940 am Presentation LAUSD
District Nursing Services Medweb 950 am
Module 1 Pandemic Outbreak Overseas 1020 am
Module 2 Outbreak in the U.S. 1100 am Module
3 Reported Cases within LAUSD 1155 am
Evaluations and Closing Remarks
A detailed agenda can be found under the
Exercise Schedule tab.
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Exercise Overview
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Exercise Program Overview
The Schools Pandemic Influenza and Public Health
Emergency Exercise Program is sponsored by LACDPH
and is being conducted to

1. Facilitate partnerships, communication and
   coordination between schools, school districts
   and LACDPH and
2. To increase awareness of the issues regarding
   planning for and responding to an influenza
   pandemic or other public health emergency.

Please turn to page 5 in your SITMAN
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Exercise Program Overview

• Consists of two primary series
• LAUSD
• 3 Local District Exercises
• 1 EOC Exercise
• LACOE
• 1School Nurse Administrator Exercise
• 1 Special Populations Exercise
• 1 School District Administrator Exercise

Please turn to page 5 in your SITMAN
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Exercise Scope

• This exercise will focus on the roles of LACDPH,
  LAUSD and individual schools in mitigating,
  preparing for, and responding to, a potential
  influenza pandemic or other infectious disease
  outbreak.
• Target audience members for this exercise include
  LACDPH Service Planning Area (SPA)
  representatives, LAUSD Local District Parent
  Ombudsmen, School Administrators, Nurse
  Administrators, and Local District Operations
  Coordinators.

Please turn to page 6 in your SITMAN
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Exercise Purpose

• The purpose of this exercise is to provide
  participants an opportunity to assess current
  capabilities for an influenza pandemic or other
  public health emergency in Los Angeles County.
• The exercise will focus on the policies and
  procedures that guide public health, schools and
  LAUSD in command and control coordination,
  critical decisions, notifications, and the
  integration of external assets necessary to save
  lives and protect public health and safety.
• The role of public information strategies will
  also be critical to the overall response effort.

Please turn to page 6 in your SITMAN
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LAUSD Series Goal

• To enhance the ability of the Los Angeles Unified
  School District to mitigate, prepare for, and
  respond to an influenza pandemic or other public
  health emergency.

Please turn to page 7 in your SITMAN
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LAUSD Series Objectives

• Familiarize participants with the specific roles,
  responsibilities and capabilities of LACDPH and
  LAUSD in managing the response to an influenza
  pandemic or other public health emergency.
• Discuss the issues, concerns and impact regarding
  potential social distancing measures and school
  closure/distance learning strategies.

Please turn to page 8 in your SITMAN
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LAUSD Series Objectives

• Present ideas, methodologies and materials
  regarding pandemic influenza and other public
  health emergencies to assist schools in educating
  children, parents, teachers, support staff, and
  administrators.
• Discuss the communicable disease surveillance and
  reporting process(s) for schools, particularly at
  locations where school nurses are not onsite.

Please turn to page 8 in your SITMAN
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Exercise Structure
Presentations
Scenario Discussion
Evaluation Adjournment
Facilitated Feedback
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Informational Presentations
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BREAK
Please return in 10 minutes.
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Schools Toolkit
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Schools Toolkit

• Purpose
• The purpose of the Schools Toolkit is to assist
  schools and school districts in Los Angeles
  County to mitigate, prepare for, respond to, and
  recover from an influenza pandemic or other
  public health emergency.
• Structure Layout
• Master
• Administrator Toolkit
• Note Toolkit provided via CD-ROM in your SITMAN.

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Schools Toolkit

• Parent Staff Letters
• Disease Catalogue that provides approved language
  for a number of public health diseases of concern
  to schools, such as pandemic influenza and MRSA
• FAQs for each disease in the Catalogue
• COOP information
• Supply Lists
• Informational Posters
• PowerPoint Presentations
• NIMS/ICS resources
• Annotated index describing the Toolkit elements
• Introduction that explains how to use the Toolkit

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(No Transcript)
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Exercise Scenario
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Roles and Responsibilities
Participants respond to the situation presented
based on expert knowledge of plans and
procedures. Observers support the discussion
groups as they develop responses to the situation
in the caucus sessions. Facilitators provide
situation updates and moderate discussions.
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Assumptions/Artificialities

• Scenario is based upon a pandemic influenza
  outbreak but the exercise takes an all-hazards
  approach.
• Scenario time period September 2008 and
  continues through March 2009.
• Scenario is plausible and events occur as
  presented.
• Use existing plans, policies, procedures.

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Ground Rules

• Exercise Ground Rules
• This is a safe, open environment.
• there is no textbook solution.
• Keep the goals and objectives in mind.
• Treat the scenario as real.
• Play your role.
• Participate openly.
• respect the observations, opinions and
  perspectives of others.
• This is an opportunity to discuss and present
  multiple options and possible solutions.
• Ask questions, share thoughts, offer solutions.
• Stay focused.

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Module 1 Pandemic Outbreak Overseas
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Background

• Pandemics occur cyclically
• 3 in the 20th Century
• Experts agree We are long overdue
• Bird/Avian Flu (H5N1) incited global concern in
  recent years.
• 1997 Hong Kong Outbreak (6 deaths)
• WHO Alert Phase 3 since November 2005.

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Background

• Schools are potential sites for the spread of
  disease, including influenza.
• Schools are an information source for community
  residents.
• Schools are sources of valuable resources for
  emergency response.
• Schools are sources of health monitoring
  information.

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September 2008

• Human-to-human transmission of avian influenza
  8 cases total.
• Viral cultures collected are identified as type
  AH7N1, a subtype never before isolated in humans.

• Chain of infection began with a 37-year old woman
  exposed to dead poultry chicken feces.
• She passed the virus to her 10-year old nephew
  who then passed it on to his father.

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September/October 2008

• A containment strategy was implemented, however,
  several additional cases were reported.
• The WHO solicits Tamiflu donations, while the CDC
  begins work on a reference strain for vaccine.
• Riots begin to occur in major cities throughout
  Southeast Asia.

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September/October 2008

• Additional outbreaks are confirmed throughout
  Southeast Asia at an average attack rate of 30.
• The novel influenza virus begins to make
  headlines worldwide and becomes the lead story on
  major U.S. new networks and newspapers.
• WHO investigations indicate extensive person to
  person transmission and multiple strains.

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October 2008

• In the U.S., pre-pandemic vaccine and antiviral
  stockpiles are deployed as supplies allow.
• The WHO notifies the CDC and other national
  health agencies of the progress of the pandemic.
• LACDPH coordinates with LAUSD other school
  districts to review pandemic guidance documents.
• LAUSD leadership schedules an impromptu
  conference call to discuss preparedness measures.

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Casualties
Reported Cases of Pandemic Influenza, as of
November, 2008
Worldwide Worldwide Worldwide
1,090 436 381
U.S. U.S. U.S.
0 0 0
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Breakout Group Session

• You have 15 minutes to discuss the questions.
• Select a spokesperson.
• Your facilitator will let you know which
  questions to focus on.
• Identify
• Additional Questions
• Critical Issues
• Decisions to be addressed
• Record notes on the Evaluation Feedback Form.
• Focus on Strengths Areas for Improvement
• Use the information available make the best
  decision possible.

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Discussion Session
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Feedback Session
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Module 2 Outbreak In The U.S.
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November/December 08

• The WHO recommends that each country implement
  its pandemic plan.
• Meanwhile, influenza continues to spread
  throughout Southeast Asia.
• An unusually severe influenza cluster is
  identified in 5 individuals living in Miami, FL.
• More cases identified in Europe, Africa, and
  Canada.

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December 08/January 09

• CDC confirms the pandemic strain in Miami.
• Several U.S. cities and transportation hubs begin
  to report cases reaching as far west as Texas.
• The local press contacts LAUSD for a statement.

• Discussions take place at the Federal and State
  levels with unions and professional associations
  of educators, administrators school boards
  regarding the unfolding events.
• LAUSD maintains a proactive posture.

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Casualties
Reported Cases of Pandemic Influenza, as of
January, 2009
Worldwide Worldwide Worldwide
183,750,041 61,250,035 5,145,006
U.S. U.S. U.S.
10,375,082 1,125,006 241,509
Los Angeles County Los Angeles County Los Angeles County
0 0 0
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Discussion Session

• You have 20 minutes to discuss the questions.
• Select a spokesperson.
• Your facilitator will let you know which
  questions to focus on.
• Identify
• Additional Questions
• Critical Issues
• Decisions to be addressed
• Record notes on the Evaluation Feedback Form.
• Focus on Strengths Areas for Improvement
• Use the information available make the best
  decision possible.

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Discussion Session
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Feedback Session
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Module 3 Reported Cases Within LAUSD
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February 2009

• Pandemic influenza is confirmed in CA, with over
  a dozen confirmed cases within LAUSD.
• A Public Health Emergency is proclaimed by the
  LAC Health Officer.

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February 2009

• LAUSD Emergency Operations Centers (EOC) is
  activated.
• Order to dismiss students from all schools is
  issued.

• Staff will continue to be paid under the disaster
  proclamation.

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February 2009

• The State issues the following guidance
• Individual services may be reduced or
  discontinued.
• Meals, school projects/assignments and phone
  tutoring may be modified.
• Delivery of health-social service programs should
  be re-evaluated.
• Continuing learning methodologies should be
  evaluated for implementation.
• School superintendents are working with school
  districts and health officials to facilitate
  coordination.

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March 2009

• 2 of Americans infected with H7N1 die.
• Hospitals are overwhelmed and staff shortages
  limited capacity at the height of the outbreak.
• Parents appeal to the media regarding their
  growing concerns of child safety once schools
  reopen.
• Rumors and misinformation are abundant among
  several internet sources frequented by students,
  such as MySpace and Facebook.

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Casualties
Reported Cases of Pandemic Influenza, as of
March, 2009
Worldwide Worldwide Worldwide
551,250,041 183,750,041 15,435,006
U.S. U.S. U.S.
31,125,082 3,375,021 724,560
Los Angeles County Los Angeles County Los Angeles County
95,172 10,575 2,220
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Discussion Session

• You have 25 minutes to discuss the questions.
• Select a spokesperson.
• Your facilitator will let you know which
  questions to focus on.
• Identify
• Additional Questions
• Critical Issues
• Decisions to be addressed
• Record notes on the Evaluation Feedback Form.
• Focus on Strengths Areas for Improvement
• Use the information available make the best
  decision possible.

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Discussion Session
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Feedback Session
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Post-Exercise Survey

• Part of a pre- and post- exercise assessment
• Questions regarding exercise content
• Used to measure effectiveness of exercise
• Results reflected in After-Action Report
• Used to determine content for future training and
  exercise events

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After-Action Report

• Lists strengths and makes actionable
  recommendations for improvement
• Data collected via Evaluation Documents and
  Evaluators
• Provided to exercise planning team for revision
  and approval
• Contact lead agencies to obtain a copy

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Feedback Form

• Remember to Record
• Notes
• Thoughts
• Issues
• Strengths
• Recommendations

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Concluding Remarks
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Thank you for your participation!
Please remember to turn in

• Feedback Evaluation Forms
• Post-Exercise Survey