Disaster

Preparedness
Tabletop
Exercise
LaNay Abogah BSN, RN, CEN
 Purpose
● Generate conversation and discussion related to
disaster preparedness and processes in the
emergency department
● Process improvement; identify holes in current
processes
● Optimize our ability to provide quality patient care
while in a different workflow
● Expand knowledge of incident command system (ICS)
 ● Non punitive
● Educational
Forum
● Respectful
● Low Stress
● Think outside the
box!
 Tabletops are a multidisciplinary
exercises that require input for
all members of the healthcare
team in order to provide quality
Who should be patient care and ensure safety
involved? for staff and patients.
 Tell a Friend!

Tabletop Exercises are on going and we need the

input of:
● PAR ● Admistation
● BHE ● House
● Social Work Supervisor
● Nursing ● Pharmacy
● Techs ● EMS
● Respiratory ● Facilitators
● Physicians
● EKG
● ????????
 Objectives

● Implementation of ED Code Yellow pathway

● Identify the need for standing up ICS structure
● Identify and understand roles through the use of
job action sheets
● Proper resource utilization
● Safety
Phases of Disaster
Management
● Mitigation
● Preparation
● Response
● Recovery
 Mitigation

Mitigation is the effort to reduce loss of life and property

by lessening the impact of disasters. In order for
mitigation to be effective we need to take action now—
before the next disaster—to reduce human and financial
consequences later (analyzing risk, reducing risk, and
insuring against risk).

Fema, 2019
 Disaster mitigation is
done through:
If you stay ready, ● Tabletops
● Disaster HERT/HOT team
you don’t have to exercises
● Disaster committee meetings
get ready! ● National and local conferences
Phases 1: Preparation
Aurora Fire Department dispatch calls stating a device
has exploded at the Aurora Mall. There are least 20
green patients with minor lacerations and 5 red
patients. All patients are covered in white powder that
is aerosolized and everyone is coughing. They are
sending patients your way and want to know how
many you can take.
 Preparation

● Activate ED Code Yellow

● Current staffing
● Assign staff roles (Job Action Sheets)
● Department/Hospital Status
● How many patients can we safely manage?
● Who to notify?
● Initiate ICS structure
● Department Resources (HERT team)?
Cart 1: Locate at
the charge nurse
desk.
Cart 3: Locate

Disaster close to the

ambulance
Cart 2:
Locate at Carts entrance with
person
Pivot designated to
do triage.
What’s in Those Carts?

● Vest for care team members

● Flash light
● Triage tape
● Geiger counter
● Bull horn
● Radios
● There is also an infectious disease cart
 Dispatch calls again stating Medic 101 is 5
minutes out with 1 red patient with shrapnel
injuries to face a torso. Medic 108 and 110 are
also enroute with 2 more red patients. There
are several other ambulances on scene with 4
green and 10 yellow patients.

The Phone Rings! Dispatch mentions that before the device

exploded a man put a bag down and yelled
something about the American government and
Anthrax.

What do you do with this information?

Anthrax
Anthrax is an acute infectious disease caused by the spore-
forming bacterium Bacillus anthracis (B. anthracis). B. anthracis
spores are highly infective and can cause inhalation, cutaneous,
or gastrointestinal anthrax. Inhalation anthrax results from
breathing in spores and is of great concern due to its high fatality
rate. Person-to-person spread is rare.

Emergency response workers, including law enforcement, public

health, and healthcare workers, are also at risk of exposure if B.
anthracis is used as a biological weapon.

U.S. Department of Health and Human Services, 2018

HERT Team
● Active dialogue with the
HERT team is imperative
to the safety of patients
and staff.
● Supplying HERT team with
resources
(water/food/breaks) and
trained staff to ensure
their safety
First Red Patient Arrives
● Decon Process
● Triage (SALT)
● Disaster Registration
● Move Patients on Board
● Zone Set Up
● Managing Ambulatory Patients
Reponse

● How to resolve issues (who’s running this show?)

● Managing staff response to Everbridge page
● Managing staff fears related to biological weapon
● Media
● Effective management of resources
Recovery
● Treatment at management of patients with respiratory
anthrax .

Pharmacy, Respiratory, House Supervisor

input

● When to stand down ICS structure

● Managing staff exposures to biological weapons
● Managing on going public concern (long term impact on the
community)
Conclusion
● The suspect was captured
● The FBI and CDC are continuing their
investigation. The substance does not
appear to be Anthrax.
● All patients are been treated with
antibiotics and there were no fatalities.
● The media is broadcasting the latest
information which has eased public
fears.
Debrief/Hot Wash

Should be done as quickly after the disaster as possible.

● What have we learned?

● What resources were lacking, under utilized, poorly utilized?
● What can we do better?
● Acknowledgement and resources for emotional stress related to event.
Questions????
What is Mitigation? (2019). FEMA.gov. Retrieved from
https://www.fema.gov/what-mitigation.
Anthrax. (2018). Center for Disease Control and Prevention.
Retrieved from https://www.cdc.gov/niosh/topics/anthrax/