The document summarizes a full-scale regional exercise held in 2009 to test the Chempack system for responding to a mass casualty chemical incident. The exercise involved multiple hospitals, emergency response agencies, and public health organizations across Region D. Key capabilities that were tested included emergency management planning, communications, safety/security, staff responsibilities, and patient management. Participating organizations provided positive feedback on communication channels and identified opportunities to improve transport protocols and additional training. The regional poison control center also participated and gained experience handling a high volume of exposure calls over a short period during the simulated incident.

1. Why Hold an Exercise? Chempack: Region D Exercise Partnerships and Best Practices Charlotte S. Clark, CHSP, CHEC-III Manager, Emergency Management Emergency Medical Services Division Grady Health System

2. Overview May 20 th , 2009 Full-scale Region D Exercise Test the Chempack system

3. Protocols Specific Protocols for accessing the Chempack can be made by the attending physician in the Emergency Department of a hospital, by the Georgia Poison Center or by public officials

4. Regional Coordinating Hospitals Grady is the RCH for Region “D” Georgia’s 15 Regional Coordinating Hospitals

5. Can EMS provide needed patient Transfers? Will Patients Be Transferred To Another Facility Activate the Mutual Aid Compact? Manage the Emergency Internally Contact Your Regional Coordinating Hospital Grady 404-319-6516 (S/L 28*719) S/L 28*553 Activate Hospital Emergency Management Plan Contact EMS Providers Are Hospital Resources from Another Region Needed Coordinate Hospital Resources within the Region Transfer Patients by EMS Your RCH will Contact Other Regional Coordinating Hositals For Assistance Contact Public Health Emergency Coordinator District via Southern Linc Radio Contact GHA 770-249-4500 S.L.28*649 Send out Emergency Disaster Alerts No No Coordinate witih EMA and Others to Obtain Needed Resources Contact County EMA Contact District Public Health Mutual Aid Activation Yes Yes No Yes No Yes Resume Normal Operations Disaster

6. Regional Coordinating Hospitals Alert and Notification Process A hospital in need of assistance contacts their RCH The RCH starts the notification process with GHA When that happens, the following actions occur: Emergency emails are immediately sent to all hospitals A request to post bed reports is sent to all hospitals in Georgia Live Process is activated and linked to the GHA site for event management

7. Testing Capabilities The exercise in 2009 was held to test capabilities for an organophosphate-related mass casualty incident: Emergency Management Planning Activities Communications Resources and Assets Safety and Security Staff Responsibilities Patient Management

8. Planning Teams 2009 Participating Organizations: Federal: CDC State : Georgia Division of Public Health Georgia Poison Center Georgia Hospital Association GEMA Region D External Partners: District 3-4 Public Health (East Metro) District 3-5 Public Health (DeKalb County) DeKalb County Fire and Rescue (DEMA) Rockdale County Emergency Management Agency East Metro Ambulance Angel Flight MMST

9. Participating Region D Hospitals Planning Group: Grady Health System Children’s Healthcare of Atlanta DeKalb Medical Center Gwinnett Medical Center Southside Medical Center Kindred Atlanta Hospital Rockdale Medical Center Piedmont Hospital Atlanta Medical Center South Fulton Medical Center Planning Teams 2009

10. Participating Atlanta Medical Center CHOA – Egleston DeKalb E.M.A. DeKalb Medical Center – Main Campus DeKalb Medical Center – Downtown Decatur DeKalb Medical Center – Hillandale John’s Creek Hospital Emory University Hospital Emory University Orthopedic and Spine Hospital Georgia Hospital Association Grady Health System Gwinnett Medical, Lawrenceville Gwinnett Medical, Duluth

11. Participating (continued) Kindred Hospital Atlanta North Fulton Northside Hospital Piedmont Fayette Piedmont Ridgeview Institute Rockdale Medical Center Saint Joseph’s Hospital Shepherd Center South Fulton Medical Center Southside Medical Center Talbott Recovery Campus Wesley Woods Center

12. Communications Notification capabilities: Primary – Message911 Secondary – Email system “ Off the grid” communication capabilities come from the SouthernLINC radio system for hospitals, local public health staff and EMA emergency operations centers From the command center during an event via landline and Event Log on Live Process Virtual communication with Live Process showed itself to be a valuable asset Emergency Physician at Grady HCC acted as consultant with hospitals and health centers Georgia Poison Center also assisted in numerous discussions of patient care

13. Resources and Assets Staff & Hospital Command Centers – Staffed during the event following NIMS compliant Healthcare Incident Command System version 4 (HICS4) Chempack - Requested and virtually sent GPC – Coordinated the placement of the unit and performed in advisory capacity Partners – Excellent communication with external partners Monitor – Supplies and equipment needs

14. Safety & Security Patient Management Staff Responsibilities Lockdown of the facilities is a critical component during an exercise or real event Coordination with law enforcement partners Patient Management and Responsibilities of Staff during the event were varied from hospital to hospital, with scheduling, triage and assessment needs in the E.D., and hazardous materials containment in the Decon tents Additional training will help overall

15. Strengths and Weaknesses One notable weakness in this area was confusion on the part of some hospitals over transport of the Chempack to a requesting hospital or health center A strength was that Pharmacy Departments consistently did a good job of coordinating with the Poison Center and managing the assets Again, training and review sessions are an asset any time

16. Georgia Poison Center Dr Gaylord Lopez, Executive Director of the Georgia Poison Center reports interesting information from the Chempack exercise: Results showed the center had good practice using other resources and dedicated personnel In a two hour period of time, they fielded 20 calls regarding 200 patients with organophosphate types of exposures

17. The Participants of the Exercise 78% Participation

18. Poison Center (continued) In the Poison Center, eight staff members took part in the exercise, performing duties other than their normal day of answering calls Data Specialists Public Health Specialists Medical Toxicologists Plus other personnel

19. Questions? Contact Information Charlotte S. Clark, CHSP, CHEC-III Manager, Emergency Management [email_address] 404-616-7106