The document outlines a tabletop exercise conducted in Greene County to enhance preparedness for an Ebola outbreak, focusing on prevention, response, and operational coordination. Participants engage in three modules, discussing cases of suspected and confirmed Ebola infections while identifying resource gaps and improving response strategies. The exercise emphasizes a collaborative, no-fault learning environment for public health officials and agencies to evaluate and enhance their emergency response capabilities.

1. Ebola Threat 2014
Tabletop Exercise (TTX)
W. SEAN HOLLAND
P u b l i c He a l t h Eme r g e n c y
P r e p a r e d ne s s C o o r d i n a t o r
Gr e e n e C o u n t y P u b l i c He a l t h De p a r tme nt

2. Introductions
 Name, Agency, Position
 Current Ebola-related activities
 What you hope to learn from TTX?

3. Exercise Overview
Exercise Scope:
This is a Tabletop Exercise, planned for approximately 2
hours at Greene County Emergency Services & Training
Center. Exercise play is limited to discussion.
Mission Area(s):
Prevention, Response

4. Objective and Core Capabilities
Determine current resource and system/process gaps
within Greene County’s ability to prevent and respond
to Ebola Virus Disease.
Core Capabilities (Appendix D):
Operational Coordination
Environmental Response/Health and Safety
Public Health and Medical Services

5. 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
 Facilitator: Provide situation updates and moderate
discussions
 Evaluators: Observe and document player discussions

6. Exercise Structure
This exercise will be a multimedia, facilitated exercise
by a facilitator.
Players will participate in the following three modules:
Module 1: Person Under Investigation
Module 2: Confirmed Case
Module 3: Exposed Family Members

7. Exercise Structure
 Each module begins with the facilitator presenting a
multimedia update (Powerpoint) that summarizes key
events occurring within that time period. After the
updates, participants review the situation and engage in
functional group discussions of appropriate issues
for pre-event and incident.
 After these functional group discussions, participants will
engage in a moderated plenary discussion in which a
spokesperson from each group will present a
synopsis of the group’s actions, based on the scenario.

8. 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
response efforts; problem-solving efforts should be the
focus

9. 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

10. Agenda (Appendix A)
Time:
0940 Background Information
0950 Module 1: Person Under Investigation
1010 Break
1020 Module 2: Confirmed Case
1040 Module 3: Exposed Family Members
1100 Break
1110 Hot Wash
1120 Closing Comments

11. Background Info on Ebola
 Ebola virus disease (EVD)
 First identified 1976; 1,716 Total Cases 1976-2013
(WHO)
 Symptoms include: fever, headaches, muscle pain,
weakness, diarrhea, vomiting, abdominal pain, and
unexplained hemorrhage (late sign)
 Symptoms on average develop between 8 to 10 days
after exposure (can range between 2-21 days)

12. Background Info on Ebola
Key Points:
 Persons traveling are not considered at risk unless
they visit one of the affected countries
 Virus spread through DIRECT CONTACT with blood
or bodily fluids of a patient with Ebola
 A person infected with Ebola is not contagious until
symptoms appear

13. Background Info on Ebola
 Primarily reported in
Liberia, Guinea, and
Sierra Leone
 5 additional countries
have reported cases
 14,413 cases / 5,177
deaths as of 11 November
2014 (CDC)

14. New York State Actions
 Commissioner’s Order 10/17/2014
 Hospitals, Health Departments, Clinics, EMS Agencies
 Commissioner’s Order 10/27/2014
 Local Health Departments – Quarantine Orders
 Screening at JFK International Airport
 Reporting to LHDs of ALL individuals with a recent
(21 days) travel history to affected nations

15. NYSDOH Risk Categories (Appendix C)
* If entering through JFK, LHD notified if Quarantine Order issued upon entry

16. Module 1: Person Under Investigation
November 20, 2014; 09:00
An individual returned to Greene County from missionary
work in Liberia. (Departed Liberia on November 18, 2014)
Screening at JFK International determines no active
symptoms.
NYSDOH determined this person to be High Risk and issued
a Quarantine Order in NYC. NYSDOH has provided transport
to residence in Greene County with notification to GCPHD.

17. Key Issues
 This individual meets the criteria to be considered a
Person Under Investigation (High Risk)
 If they were to develop Ebola Virus Disease, they
would likely be contagious to others.
Source: Bloomberg.com

18. Public Health and Medical Services
 How will public health share necessary information
regarding a PUI in Greene County to other agencies?
 Will quarantine be required and what would be the
process for initiating an Order?
 What notification(s) will occur, when and to whom?

19. Operational Coordination
 What actions must be taken to serve an Order for
quarantine?
 What systems/processes are in place at 911 Center or
law enforcement agencies to facilitate this?
 What resources might be necessary to enforce the
Order?
 What notification(s) will occur, when and to whom?

20. Module 2: Confirmed Case
November 21, 2014; 08:00
Public Health has issued a Quarantine Order
effective November 20, 2014. Active monitoring has
shown NO SYMPTOMS.
Source: NYTimes.com

21. Module 2: Confirmed Case
November 22, 2014; 09:00
Person has developed a fever and diarrhea this morning.
They dial 911 and request emergency medical services.
Patient is transported to appropriate hospital facility for
evaluation/treatment.
The patient isolated at a local hospital facility and laboratory
testing has returned a positive result for Ebola Virus Disease.

22. Key Issues
 The patient definitely has Ebola Virus Disease, which
presents a threat to all healthcare workers involved
in their care.
Source: WindsorStar.com

23. Public Health and Medical Services
 Will the emergency medical service providers require a
quarantine order or active monitoring?
 What epidemiological investigations will be necessary and
how will they be performed?
 What resources and systems/processes are in place for
emergency medical services?

24. Operational Coordination
 What coordination needs exist between various
departments/agencies?
 What will the messaging be to the public and how
will it be delivered?
 What resources and systems/processes are in place
for the receiving hospital?

25. Module 3: Exposed Family Members
November 22, 2014; 17:00
The patient who has laboratory confirmed Ebola Virus
Disease has a spouse and two children at home. They
have no symptoms at this time but the spouse is
concerned regarding their health and welfare.

26. Key Issues
 The patient may have
shed virus in the home
and the family members
may have been exposed.
 Various services may
need to be provided to
these family members.
Source: BangorDailyNews.com

27. Public Health and Medical Services
 What epidemiological investigations will be necessary and
how will they be performed?
 Will the family members require a quarantine order; what
is their risk level?
 How will the family members be provided food and other
essentials?

28. Operational Coordination
 What will the messaging be to the public and how will it be
delivered?
 Will there be a need for law enforcement to enforce the
quarantine order or restrict access of others to the
residence? How would this be coordinated?
 In the event that the family needs to be relocated, how will
this coordination occur and who would be the likely lead
agency?

29. Hot Wash
 Strengths
 Areas for Improvement
 Please complete Participant Feedback Forms

30. Closing Comments
 Did we meet our objective and will participation in
this TTX assist you with your agency goals?
 Thank you for attending!
 After-Action Report will be sent to all participants.