บทถอดความฉบับเต็มของ From Plans to Practice: Exercising for Special Pathogen Readiness

managers, okay? 34 00:02:28,324 --> 00:02:31,764 So, there are an awful lot of people across the country who wear multiple 35 00:02:31,774 --> 00:02:37,004 hats, and it might be that your ER nurse manager or somebody else is having to 36 00:02:37,094 --> 00:02:41,157 wear a couple of these hats and figure out how to do drills and exercises. 37 00:02:41,787 --> 00:02:47,297 So first, can you sort of give us the background on what kinds of things these 38 00:02:47,307 --> 00:02:53,577 drills and exercises help walk people through, and why that's so important? 39 00:02:55,059 --> 00:02:57,254 Darrell Ruby: Yeah, Jill, great starting question. 40 00:02:57,706 --> 00:03:02,376 As I was thinking about this, I think, uh, the key that I want to get across is 41 00:03:02,436 --> 00:03:08,466 exercises really help organizations and people build capability to handle whatever 42 00:03:08,466 --> 00:03:13,866 comes next and to not be stymied when, uh, the incident that we're in in the moment 43 00:03:14,226 --> 00:03:19,111 doesn't go according to plan, because that happens every time we have an incident. 44 00:03:19,381 --> 00:03:23,671 So the exercises are really just one tool in that toolbox, and 45 00:03:23,671 --> 00:03:26,281 there's a lot of them, and we'll talk through some of them today. 46 00:03:26,281 --> 00:03:30,035 But really it spans all the different domains of both special 47 00:03:30,035 --> 00:03:33,725 pathogens preparedness as well as all hazard preparedness. 48 00:03:34,646 --> 00:03:34,976 Jill Morgan: Okay. 49 00:03:35,516 --> 00:03:36,116 Excellent. 50 00:03:36,186 --> 00:03:36,456 All right. 51 00:03:36,466 --> 00:03:41,482 So Jackson, I know NETEC has had these exercise templates for a while, so 52 00:03:41,482 --> 00:03:44,522 specifically what did y'all do to them? 53 00:03:44,522 --> 00:03:48,867 Because it seems to me that, no offense, I was an emergency room 54 00:03:48,867 --> 00:03:52,557 nurse who liked it when we got to play with exercises, but did not want 55 00:03:52,567 --> 00:03:53,997 to do the paperwork portion of it. 56 00:03:54,007 --> 00:03:58,577 So, pardon my prejudice about this, but what did you have to do to 57 00:03:58,577 --> 00:04:00,167 exercise templates to update them? 58 00:04:00,167 --> 00:04:04,937 'Cause it seems to me that it's sort of a once you've got it, just keep using it. 59 00:04:05,614 --> 00:04:06,284 Jackson Gruber: absolutely, yeah. 60 00:04:06,284 --> 00:04:09,934 So from a little bit of a background perspective, there used to be a ton of 61 00:04:09,934 --> 00:04:13,954 NETEC exercise templates on the website, and what we felt was that whenever 62 00:04:13,954 --> 00:04:17,514 individuals came to the website to download these templates, it might have 63 00:04:17,514 --> 00:04:21,954 been a little bit cumbersome, a little bit, concerning with the amount of 64 00:04:21,988 --> 00:04:23,648 documents that they were able to download. 65 00:04:23,698 --> 00:04:27,978 So what we did was we took the most critical exercise templates, things like 66 00:04:27,988 --> 00:04:32,068 your X plan, your exercise evaluation guide, and your after-action report, and 67 00:04:32,068 --> 00:04:33,828 we really did our best to streamline it. 68 00:04:34,118 --> 00:04:36,678 Additionally, inside of these exercise templates, we wanted to make sure 69 00:04:36,678 --> 00:04:39,438 that, make sure that they aligned with the National Special Pathogen 70 00:04:39,448 --> 00:04:43,448 System minimum capabilities and really outline the objectives to really meet 71 00:04:43,458 --> 00:04:45,208 those goals for those various tiers. 72 00:04:45,518 --> 00:04:49,188 So we feel like this new approach really allows for all of the different 73 00:04:49,218 --> 00:04:52,618 policies and procedures to be tested throughout exercise play, and can 74 00:04:52,618 --> 00:04:55,358 really build robust capabilities for those healthcare facilities. 75 00:04:56,282 --> 00:05:00,692 Jill Morgan: So I want to understand better about how these things fit and 76 00:05:00,692 --> 00:05:08,082 maybe in some ways help link our regional CONOPs and our public health plan and 77 00:05:08,152 --> 00:05:14,598 what we're doing with transport or, is this sort of a way to, we think of the 78 00:05:14,618 --> 00:05:18,418 NSPS as being sort of, you know, NETEC being the coordinating body for NSPS, 79 00:05:18,752 --> 00:05:22,192 are exercises and exercise templates sort of a way of pulling all those 80 00:05:22,242 --> 00:05:25,798 pieces together in one neat package? 81 00:05:26,453 --> 00:05:26,873 Darrell Ruby: Yeah. 82 00:05:26,873 --> 00:05:30,473 And I think before I touch on that, Jill, I wanna just add a little bit 83 00:05:30,473 --> 00:05:34,458 to what Jackson was saying, and you alluded to it, uh, at the beginning 84 00:05:34,458 --> 00:05:37,398 and the introduction about how long you and I have known each other. 85 00:05:38,092 --> 00:05:42,052 We've been in this business now for over 10 years, and there's been a 86 00:05:42,052 --> 00:05:46,312 lot learned over those 10 years, from lessons learned from real world events, 87 00:05:46,342 --> 00:05:51,482 there's been numerous outbreaks, all of us have exercised an awful lot, and 88 00:05:51,482 --> 00:05:53,402 there's been some operational response. 89 00:05:53,672 --> 00:05:58,225 And so really what we wanted to do is we did this update and it's ongoing. 90 00:05:58,225 --> 00:06:02,011 We haven't finished all of the templates yet, but we really wanted 91 00:06:02,011 --> 00:06:07,147 to take all those lessons learned as best we can, and update and reflect 92 00:06:07,147 --> 00:06:09,157 that in the templates that we created. 93 00:06:09,713 --> 00:06:13,675 And then did the question that, uh, you just asked, I think, what 94 00:06:13,675 --> 00:06:17,935 I really enjoy about exercises, and I say this a lot, oftentimes it's 95 00:06:17,935 --> 00:06:22,375 not the exercise that's the most beneficial, it's the exercise

design. 96 00:06:22,375 --> 00:06:25,885 So it's the process to get us from the beginning of the exercise 97 00:06:26,050 --> 00:06:30,640 planning to the exercise conduct and then the after action report. 98 00:06:30,970 --> 00:06:34,510 And if I'm being honest, I don't love putting together the after action report, 99 00:06:34,855 --> 00:06:37,687 as well, but it's a necessary process. 100 00:06:38,017 --> 00:06:41,827 But what I really do enjoy, and I learn so much, and I think everybody 101 00:06:41,827 --> 00:06:43,897 does, is through that exercise design. 102 00:06:43,897 --> 00:06:47,947 And so it helps build relationships with local public health and state 103 00:06:47,947 --> 00:06:52,747 public health, with our EMS partners and our healthcare coalitions and all 104 00:06:52,747 --> 00:06:57,103 those people that help support this type of work, so that when we do have 105 00:06:57,103 --> 00:07:01,685 incidents, not only do we have some muscle memory that we can fall back 106 00:07:01,685 --> 00:07:06,185 on and, and we're better prepared, but when we deviate from that plan, we've 107 00:07:06,185 --> 00:07:10,695 built those relationships and the trust that's so, uh, vital, to being able to 108 00:07:10,695 --> 00:07:12,945 respond, to what's, facing us right now. 109 00:07:14,268 --> 00:07:14,498 Jill Morgan: Yeah. 110 00:07:14,498 --> 00:07:17,303 I mean, I totally get it that, we really have been through 111 00:07:17,303 --> 00:07:19,173 quite a few episodes, right? 112 00:07:19,173 --> 00:07:22,573 I mean, between, you know, we had a Marburg outbreak and we've had 113 00:07:22,583 --> 00:07:25,013 hantavirus, you know, Andy's hanta. 114 00:07:25,183 --> 00:07:28,959 We've had the World Cup, which of course I think prompted a lot of 115 00:07:28,969 --> 00:07:31,963 people to be thinking about what they were exercising and how. 116 00:07:32,304 --> 00:07:38,076 And you talk about this design, and I think that we like things to be sort of 117 00:07:38,076 --> 00:07:42,706 plug and play, but each of our communities have sort of their own set of risks, 118 00:07:42,746 --> 00:07:44,746 and we have our own set of capabilities. 119 00:07:44,746 --> 00:07:51,556 And how should people, think about adapting a template for their facility? 120 00:07:51,566 --> 00:07:53,016 I mean, how does that happen? 121 00:07:53,016 --> 00:07:56,726 Or, uh, can you give people some advice about that? 122 00:07:57,786 --> 00:07:58,136 Jackson Gruber: Yeah. 123 00:07:58,156 --> 00:08:01,346 I, I think the biggest piece of advice that I could give is to 124 00:08:01,376 --> 00:08:03,246 not eat the onion all at once. 125 00:08:04,036 --> 00:08:07,626 Sometimes whenever we're tasked with developing an exercise or even modifying 126 00:08:07,626 --> 00:08:11,996 exercise templates, we want to test every single thing inside of our plan. 127 00:08:11,996 --> 00:08:14,296 And my biggest, piece of advice would be to start small. 128 00:08:14,386 --> 00:08:18,469 Pick one, two, at most three objectives, and try to figure out how 129 00:08:18,469 --> 00:08:20,029 you can do those really, really well. 130 00:08:20,452 --> 00:08:23,859 And then after that, bring in additional stakeholders to help modify those 131 00:08:23,879 --> 00:08:27,339 plans after the exercise is done, after that after-action report is completed, 132 00:08:27,619 --> 00:08:30,689 and really begin to work through some of those improvement plan items. 133 00:08:31,069 --> 00:08:33,832 As Darryl and I have often joked, when it comes to exercise planning, 134 00:08:34,132 --> 00:08:37,422 the work really happens once that after-action report is completed. 135 00:08:37,652 --> 00:08:39,712 And that's when it's time to make those reflected changes 136 00:08:39,712 --> 00:08:40,952 into your plans and procedures. 137 00:08:41,414 --> 00:08:41,704 Jill Morgan: Yeah. 138 00:08:42,044 --> 00:08:46,651 So would it be reasonable, and, and, I promise I did not prepare 139 00:08:46,651 --> 00:08:49,471 these people for this question, but I'm gonna throw it at them anyway. 140 00:08:49,981 --> 00:08:56,011 So would it be reasonable to say a first foray into this for those facilities 141 00:08:56,011 --> 00:08:59,611 that are just getting their feet wet with this, you know, now the Joint Commission 142 00:08:59,611 --> 00:09:03,730 requirement for people to be prepared for special pathogens, would it be 143 00:09:03,880 --> 00:09:05,430 reasonable to say, Hey, you know what? 144 00:09:05,450 --> 00:09:09,187 A first exercise can just be your ED screening. 145 00:09:09,363 --> 00:09:10,903 Like, send somebody in. 146 00:09:10,913 --> 00:09:12,003 Did they get screened? 147 00:09:12,516 --> 00:09:16,676 Talk about like a micro drill, right? 148 00:09:16,676 --> 00:09:21,183 And I, I get that we all like the, big stuff and there's decon tents, and 149 00:09:21,183 --> 00:09:24,563 there's all sorts of other stuff you can get hooked up with, and moulage. 150 00:09:24,563 --> 00:09:30,723 And I mean, there's a lot that really gets people excited about this, but 151 00:09:30,723 --> 00:09:34,393 it's also exhausting, and I feel like we sort of, we do the requirement of 152 00:09:34,393 --> 00:09:35,933 something big like that every year. 153 00:09:36,133 --> 00:09:39,823 But I'm not sure it does the work of some of these smaller things 154 00:09:39,833 --> 00:09:43,063 that we could actually maybe take some really concrete action on. 155 00:09:44,613 --> 00:09:44,943 Darrell Ruby: Yeah. 156 00:09:44,943 --> 00:09:46,923 I think that's such a great point, Jill. 157 00:09:46,923 --> 00:09:49,083 See, you're way more than just an ED nurse. 158 00:09:49,293 --> 00:09:51,183 You're starting to get all this stuff down. 159 00:09:51,463 --> 00:09:53,383 Really that effective preparedness program Um. 160 00:09:54,022 --> 00:09:57,415 really uses what we call a progressive exercise approach. 161 00:09:57,742 --> 00:10:01,975 There's a diagram that I'm envisioning

now that, uh, the emergency managers 162 00:10:02,255 --> 00:10:06,388 understand very well, and it's this step level picture that talks 163 00:10:06,388 --> 00:10:11,308 about discussion-based exercises and operations based exercises. 164 00:10:11,578 --> 00:10:14,878 But to the point that you just made, it's really important to 165 00:10:14,878 --> 00:10:17,683 start small and take baby steps. 166 00:10:17,733 --> 00:10:22,533 And I love your example of simply doing like a walkthrough and, you know, where 167 00:10:22,533 --> 00:10:24,633 a patient may present in your facility. 168 00:10:24,903 --> 00:10:30,543 Maybe even just starting with the question is, "Is my facility ready for an Ebola 169 00:10:30,543 --> 00:10:32,973 patient, a special pathogens patient?" 170 00:10:33,243 --> 00:10:36,183 And looking at your points of entry and starting small. 171 00:10:36,483 --> 00:10:38,613 You can do that internally with your team. 172 00:10:38,863 --> 00:10:42,733 I really would encourage the hospitals out there in particular, but really 173 00:10:42,733 --> 00:10:47,083 all the partners from public health and EMS and healthcare coalitions to reach 174 00:10:47,083 --> 00:10:49,063 out to the respect in their region. 175 00:10:49,385 --> 00:10:51,123 They are an amazing resource. 176 00:10:51,496 --> 00:10:55,156 And we're funded, and we're called out to do this work, and we've got 177 00:10:55,156 --> 00:10:56,746 a lot of experience in doing it. 178 00:10:56,746 --> 00:11:01,446 But really just to kind of list some of the different types of exercises. 179 00:11:01,746 --> 00:11:03,726 And I think officially there's like seven. 180 00:11:03,726 --> 00:11:06,486 I won't get all nerded out, uh, in this podcast. 181 00:11:06,486 --> 00:11:10,026 But, you know, workshops really are designed to build awareness 182 00:11:10,026 --> 00:11:13,596 and relationships, so that's kind of the starting point oftentimes. 183 00:11:13,911 --> 00:11:18,201 Seminars kind of educate stakeholders, so when we update plans, maybe 184 00:11:18,201 --> 00:11:22,311 our concept of operation plans, a seminar is a great way to do that. 185 00:11:22,711 --> 00:11:25,651 All of us have probably done tabletop exercises. 186 00:11:25,651 --> 00:11:29,671 Those explore decision making and coordination and communication. 187 00:11:29,871 --> 00:11:34,101 I think unfortunately, a lot of people just rely on those and don't go to that 188 00:11:34,101 --> 00:11:39,141 operational level of exercising where you do drills that are really focused on 189 00:11:39,141 --> 00:11:44,451 simple steps, like the one you mentioned, where an individual presents at your 190 00:11:44,822 --> 00:11:49,526 first nurse or the nurse's station or somewhere in your facility, then we 191 00:11:49,526 --> 00:11:53,876 focus on identify, isolating, in form, And that's where the mystery patient 192 00:11:53,876 --> 00:11:58,856 drill template that has been refreshed and far and away is the most downloaded

193 00:11:58,856 --> 00:12:04,210 template on the site, provides a ton of different opportunities to even break up 194 00:12:04,510 --> 00:12:09,573 that mystery patient drill, before you might do it in a surprise type manner. 195 00:12:09,783 --> 00:12:12,303 And I want to emphasize, you know, that should always be 196 00:12:12,303 --> 00:12:13,743 coordinated with leadership. 197 00:12:13,743 --> 00:12:17,843 You should never just, you know, drop these things into a facility, but there 198 00:12:17,843 --> 00:12:19,763 are different ways you can approach it. 199 00:12:20,033 --> 00:12:23,803 And then lot of times a multi-year exercise plan will culminate in a full 200 00:12:23,803 --> 00:12:29,108 scale exercise where we have a patient at one hospital or an urgent care, 201 00:12:29,108 --> 00:12:32,708 and they need to be transported to a higher level of care, whether it's the 202 00:12:32,708 --> 00:12:37,088 regional center or what we call the National Special Pathogens Level three 203 00:12:37,088 --> 00:12:39,308 Assessment Centers simply to be tested. 204 00:12:39,308 --> 00:12:44,138 So there is a lot of different things that you can exercise, and we 205 00:12:44,138 --> 00:12:47,738 really do encourage people to break those up into bite-sized chunks. 206 00:12:48,879 --> 00:12:53,529 Jill Morgan: You know, I know that we're obviously part of NETEC and, and the NSPS, 207 00:12:53,529 --> 00:12:59,116 and we think a lot about these special pathogens events, but is there room using 208 00:12:59,116 --> 00:13:02,946 these templates for people to get ready for something like measles, which might 209 00:13:02,946 --> 00:13:07,456 be around the corner for them or in their neighborhoods and communities already? 210 00:13:07,456 --> 00:13:11,916 And, and maybe as an adult, if you only take care of adults at your facility, 211 00:13:11,926 --> 00:13:15,706 maybe you don't think you need to get ready for measles, but trust me, you do. 212 00:13:15,916 --> 00:13:19,986 There are an awful lot of adult measles cases going around right now, and, 213 00:13:20,026 --> 00:13:24,286 and that's because sometimes people are under or unimmunized as children 214 00:13:24,286 --> 00:13:28,016 and don't even know it or may not have the information they need to know. 215 00:13:28,542 --> 00:13:33,212 And so, could you use these even though we probably created them for special 216 00:13:33,212 --> 00:13:35,912 pathogens for something more ordinary? 217 00:13:37,026 --> 00:13:37,746 Jackson Gruber: Absolutely, yeah. 218 00:13:37,746 --> 00:13:41,506 And we really took this type of plug-and-play model as we were developing 219 00:13:41,516 --> 00:13:43,106 these scenarios for that exact reason. 220 00:13:43,376 --> 00:13:46,526 So it wouldn't take much to just edit out a VHF scenario and put 221 00:13:46,526 --> 00:13:48,036 in measles in that same place. 222 00:13:48,596 --> 00:13:51,716 And as we kind of walk through an exercise that's specific to identify, 223 00:13:51,746 --> 00:13:54,456 isolate, and inform, I think it's critically important to call out, 224 00:13:54,813 --> 00:13:58,003 with it being a template, there's not as large of a lift when it comes to 225 00:13:58,003 --> 00:13:59,763 making these templates ready for use. 226 00:14:00,196 --> 00:14:03,890 And I think this makes it easier for different practitioners across your 227 00:14:03,890 --> 00:14:06,650 health system that are tasked with doing these exercises to do them at 228 00:14:06,690 --> 00:14:08,210 different times of the day, right? 229 00:14:08,210 --> 00:14:11,680 So we know special pathogens don't always show up during bankers' hours. 230 00:14:11,940 --> 00:14:14,940 Uh, so being able to kind of run one of these during shift change or even into the 231 00:14:14,940 --> 00:14:19,006 night shift, makes it critically important to, test when your plan might fail, right? 232 00:14:19,016 --> 00:14:22,846 So if you know we have a lot of really good day shift ED nurses who are really 233 00:14:22,846 --> 00:14:25,936 on top of the identify, isolate, and inform process, but when we go to the 234 00:14:25,936 --> 00:14:29,140 night shift, that might have some, some newer nurses on our team, you know, 235 00:14:29,140 --> 00:14:32,190 this might be a good opportunity to see where you might have gaps in your 236 00:14:32,190 --> 00:14:34,380 education and those overall processes. 237 00:14:34,460 --> 00:14:36,920 But yeah, totally easy to adapt these and make them fit 238 00:14:36,920 --> 00:14:37,940 your needs for your facility. 239 00:14:38,526 --> 00:14:38,726 Jill Morgan: Yeah. 240 00:14:38,726 --> 00:14:41,624 I'm glad you mentioned hitting all shifts and things like that because 241 00:14:41,624 --> 00:14:44,677 I think, going back to one of the things Darrell said, you know, 242 00:14:44,677 --> 00:14:49,064 making sure that administration, your operations folks are tuned into this. 243 00:14:49,304 --> 00:14:54,911 But so frequently, remembering my own ET nurse experience, you know, 244 00:14:54,911 --> 00:14:57,541 there are an awful lot of times at nights and on weekends you feel 245 00:14:57,541 --> 00:15:02,851 like, oh, well, sure, all the helpful ancillary departments are gone, right? 246 00:15:02,851 --> 00:15:05,191 I don't have-- my IP's not here. 247 00:15:05,191 --> 00:15:06,161 I don't have leadership. 248 00:15:06,161 --> 00:15:09,551 I might have a house supervisor if I'm lucky, and that, that might be it. 249 00:15:09,871 --> 00:15:15,554 So making sure that your plans work, as our public health director used 250 00:15:15,554 --> 00:15:20,554 to say, 5:00 on a Friday of a holiday weekend or, you know, 2:00 AM on a 251 00:15:20,554 --> 00:15:23,094 holiday weekend, that's super important. 252 00:15:23,404 --> 00:15:26,164 And yet it's also a pain, right? 253 00:15:26,164 --> 00:15:30,104 I mean, like it-- you're not gonna be popular by saying, 254 00:15:30,114 --> 00:15:31,514 "Hey, it's Labor Day weekend. 255

00:15:31,514 --> 00:15:36,171 We're gonna have an exercise or a drill." So I think that it is a matter of getting 256 00:15:36,171 --> 00:15:41,201 that buy-in, understanding why it's so important, and really, rather than being 257 00:15:41,211 --> 00:15:46,191 something that's an extra burden for those night shift or weekend shift people, 258 00:15:46,361 --> 00:15:50,651 you're also saying, Look, what might come out of this is we need a better list. 259 00:15:50,881 --> 00:15:54,361 We need a better informed list so we can reach the right people. 260 00:15:54,361 --> 00:15:57,344 Because you're right, they're not down the hall on the weekends. 261 00:15:57,544 --> 00:16:00,974 We can't just get them by doing an overhead page, for instance. 262 00:16:00,974 --> 00:16:03,294 We have to actually know the phone numbers. 263 00:16:03,294 --> 00:16:07,354 And, and a lot of us rely on relationships in hospitals, which is great. 264 00:16:08,177 --> 00:16:11,504 But if you have a new nurse, as you said, Jackson, who's working , they 265 00:16:11,504 --> 00:16:14,634 may not know that, you know, Sally is the infection preventionist. 266 00:16:14,634 --> 00:16:17,784 She's got to rely on looking at finding somebody's pager 267 00:16:17,784 --> 00:16:19,274 or phone, cell phone number. 268 00:16:20,274 --> 00:16:22,684 So how do you sell this? 269 00:16:23,124 --> 00:16:28,251 Thinking about the job of convincing people that this is really important. 270 00:16:28,261 --> 00:16:32,051 I know we've got some drills and exercises that are required, right? 271 00:16:32,051 --> 00:16:37,311 I, I-- and I can't quote chapter and verse, but I know that there 272 00:16:37,311 --> 00:16:38,121 are some that are required. 273 00:16:39,111 --> 00:16:42,461 But for the rest of these, for things like getting prepared for a special 274 00:16:42,471 --> 00:16:45,181 pathogen, how do we make the sale? 275 00:16:45,341 --> 00:16:47,431 Is there a convincing argument? 276 00:16:47,441 --> 00:16:49,250 Is there a group of people? 277 00:16:49,708 --> 00:16:54,208 Are there secret terms like saying, well, this is, you know, I don't 278 00:16:54,208 --> 00:16:59,518 know, one of the acronym-laden phrases you guys use for like, this is why 279 00:16:59,518 --> 00:17:04,342 this is so important because it helps us comply with commandment X. 280 00:17:05,551 --> 00:17:07,924 Darrell Ruby: I think that's a challenge for all of us, but I 281 00:17:07,924 --> 00:17:10,624 think the key is having a champion. 282 00:17:10,881 --> 00:17:13,954 From a hospital perspective, oftentimes the preparedness 283 00:17:13,954 --> 00:17:16,054 champion is the emergency manager. 284 00:17:16,471 --> 00:17:19,794 Sometimes there's more than one, especially in larger hospitals. 285 00:17:20,155 --> 00:17:23,168 Other times it's not uncommon for the emergency manager 286 00:17:23,168 --> 00:17:25,208 to be wearing multiple hats. 287 00:17:25,208 --> 00:17:30,121 But the other key is to partner with those functional areas or departments, 288 00:17:30,391 --> 00:17:31,891 that really have the expertise. 289 00:17:31,891 --> 00:17:36,931 And so for special pathogens, the way I often look at it is uh, infection 290 00:17:36,931 --> 00:17:41,974 prevention and the clinical leaders, especially in our EDs, especially 291 00:17:41,974 --> 00:17:45,941 in our smaller rural hospitals, are so important to coordinate with. 292 00:17:46,336 --> 00:17:50,649 But the key to having success, I think, is to have leadership support. 293 00:17:50,985 --> 00:17:54,123 And that can be a challenge in many of our facilities. 294 00:17:54,468 --> 00:17:58,766 Everybody recognizes that they are probably not as prepared as they'd 295 00:17:58,766 --> 00:18:00,735 like to be for a special pathogen. 296 00:18:00,879 --> 00:18:05,769 But circling back to a comment you made about how doing a special pathogen 297 00:18:05,769 --> 00:18:10,599 exercise can help in another area, the process, whether you're responding to 298 00:18:10,599 --> 00:18:16,529 measles or a special pathogens or even an MCI, there are some similarities. 299 00:18:16,529 --> 00:18:21,269 And so that's the key, I think, to integrate into your overall exercise plan 300 00:18:21,269 --> 00:18:26,699 for a facility so that you can realize that whether you're exercising for special 301 00:18:26,699 --> 00:18:31,924 pathogens or whether you're doing some other type of exercise, we're working on 302 00:18:31,924 --> 00:18:34,024 our coordination and our communication. 303 00:18:34,264 --> 00:18:37,324 We're building partnerships with those key partners, whether it's 304 00:18:37,324 --> 00:18:40,954 internal partners and all the departments that may be impacted. 305 00:18:41,224 --> 00:18:45,668 Could be infection prevention, it could be our uh, EVS and our, our housekeeping 306 00:18:45,668 --> 00:18:48,008 partners, could be our security teams. 307 00:18:48,248 --> 00:18:52,118 Is that any exercise is gonna build those relationships. 308 00:18:52,395 --> 00:18:56,411 And then one other thing, and I'll stop on this answer our responses. 309 00:18:56,771 --> 00:19:01,391 really the key to success is not to find no gaps when we exercise. 310 00:19:01,718 --> 00:19:06,654 A successful enter, exercise, identifies areas for us to continue to improve, 311 00:19:06,654 --> 00:19:11,444 and that's why we should, consistently exercise, is so that we can discover 312 00:19:11,594 --> 00:19:13,544 where we can become more ready. 313 00:19:14,843 --> 00:19:14,943 Jill Morgan: Yeah. 314 00:19:14,943 --> 00:19:18,177 And you mentioned a couple things there that I want to go back to. 315 00:19:18,536 --> 00:19:25,043 Can you explain all hazards, MCIs and special pathogen events or even 316 00:19:25,093 --> 00:19:32,410 drills and how those things all sort of have some very similar principles? 317 00:19:33,372 --> 00:19:34,052 Jackson Gruber: Absolutely, yeah. 318 00:19:34,052 --> 00:19:38,072 So, as we kind of think

about mass casualty incidents or MCIs, it's really 319 00:19:38,072 --> 00:19:41,942 important to denote what that threshold is, and if it is outside of your your 320 00:19:41,952 --> 00:19:45,672 jurisdictional or your locality's a-ability to respond to that incident. 321 00:19:45,952 --> 00:19:48,532 Uh, the main things here is that communication aspect, right? 322 00:19:48,532 --> 00:19:52,122 So whether it's a measles patient or a viral hemorrhagic fever patient, 323 00:19:52,385 --> 00:19:56,508 or even just a concerning individual coming into your ED, your communication 324 00:19:56,508 --> 00:19:59,448 practices are likely going to be very similar across the board. 325 00:19:59,448 --> 00:20:01,828 And that communication is gonna be critically important as to when 326 00:20:01,878 --> 00:20:05,678 individuals get notified, if we're notifying the right stakeholders whenever 327 00:20:05,678 --> 00:20:08,645 these individuals come through our door, and kind of things of this nature. 328 00:20:08,675 --> 00:20:11,932 One thing that I want to highlight, taking a step back real quick, is you 329 00:20:11,932 --> 00:20:15,192 had talked about why should healthcare facilities do these exercises? 330 00:20:15,402 --> 00:20:18,535 And I think it's really important to note the old adage of, an ounce of 331 00:20:18,535 --> 00:20:20,305 prevention is worth a pound of cure. 332 00:20:20,605 --> 00:20:22,325 There is a cost to preparedness, right? 333 00:20:22,325 --> 00:20:24,275 We know that running these exercises isn't free. 334 00:20:24,275 --> 00:20:26,805 It takes people's time away from their already busy schedules. 335 00:20:27,055 --> 00:20:30,105 There's probably some financial contribution that is needed to 336 00:20:30,105 --> 00:20:32,695 ensure that you have the right PPE at your facility and things like 337 00:20:32,695 --> 00:20:36,762 that, but when you have an incident at your facility, that cost can grow 338 00:20:37,082 --> 00:20:39,052 exponentially if you are not prepared. 339 00:20:39,052 --> 00:20:42,162 So being able to identify where those gaps are at inside of your plans 340 00:20:42,192 --> 00:20:46,942 before an incident occurs is gonna save you a ton of money in the long run. 341 00:20:47,132 --> 00:20:49,722 And it's also gonna keep your staff safe, which is our number one priority. 342 00:20:50,204 --> 00:20:50,444 Jill Morgan: Yeah. 343 00:20:50,504 --> 00:20:51,714 It's sort of like a fire drill, right? 344 00:20:51,724 --> 00:20:55,364 I mean, we may all roll our eyes, but they're super important. 345 00:20:55,644 --> 00:20:58,914 You don't want to be wondering where those things are or what to 346 00:20:58,924 --> 00:21:00,640 do when something like that happens. 347 00:21:01,010 --> 00:21:04,830 And I wonder if, and I know this doesn't apply necessarily to the 348 00:21:04,890 --> 00:21:08,950 updated templates, which is what we're here to talk about, but if 349 00:21:08,950 --> 00:21:14,440 somebody's had a patient walk in, they've had maybe something like a, 350 00:21:14,441 --> 00:21:18,886 multi-casualty event, and I'm thinking about my ED days, many years ago. 351 00:21:18,886 --> 00:21:22,536 We're in a very, very small hospital, and if you had six people from 352 00:21:22,536 --> 00:21:26,076 a car accident, that completely overwhelmed our emergency department. 353 00:21:26,626 --> 00:21:31,766 But if you have something like that happen that is sort of an all hands on 354 00:21:31,766 --> 00:21:35,136 deck or just an overwhelming experience or a really frightening one for your 355 00:21:35,136 --> 00:21:42,889 staff, are there ways you can sort of retrofit that to something to help you 356 00:21:42,889 --> 00:21:44,619 get the most out of that experience? 357 00:21:44,619 --> 00:21:48,159 And what I mean by that is like the lessons learned we would like for 358 00:21:48,159 --> 00:21:51,459 people to still get out of those, even if it wasn't a planned exercise. 359 00:21:51,899 --> 00:21:56,789 It happened and we wanna, you know, like I think Darrell is perhaps the 360 00:21:56,789 --> 00:22:00,099 only part of this that he doesn't really enjoy is the after-action reports 361 00:22:00,099 --> 00:22:03,986 are like, is that where you really dive into the after-action reports? 362 00:22:03,996 --> 00:22:06,316 How do we make that count as an exercise? 363 00:22:06,326 --> 00:22:07,526 How do we get the most out of it? 364 00:22:08,960 --> 00:22:11,474 Darrell Ruby: I might have used this quote before, and I, I 365 00:22:11,474 --> 00:22:12,884 know you've heard it before. 366 00:22:12,884 --> 00:22:16,544 Jackson also uses this, you know, "Never let a good disaster go to 367 00:22:16,544 --> 00:22:20,989 waste." And and I think the key that you just touched on that I'm thinking 368 00:22:20,989 --> 00:22:25,559 about is whenever there's an incident, you know, small or large, it's really 369 00:22:25,559 --> 00:22:30,915 important that we take some time on the backend and reflect and do what 370 00:22:30,915 --> 00:22:33,255 we call that hot wash or that debrief. 371 00:22:33,390 --> 00:22:37,999 and, take those lessons learned and capture them and then figure out 372 00:22:37,999 --> 00:22:41,929 where they fit into our plans and policies and what need to be updated. 373 00:22:42,319 --> 00:22:46,915 And then if I think about these templates, the idea of these templates, and the 374 00:22:46,915 --> 00:22:50,455 ones that are on the NETEC webpage that we've updated, we've already talked 375 00:22:50,455 --> 00:22:52,375 about the mystery patient drill template. 376 00:22:52,765 --> 00:22:56,707 And I think it's important that we really call out the work that Dr. 377 00:22:56,872 --> 00:23:00,917 Cyra Madada and the New York City health and Hospitals team did because 378 00:23:01,157 --> 00:23:04,337 they're the ones that really designed that mystery patient drill template. 379 00:23:04,743 --> 00:23:08,937 And they use it for everything from

H five to measles to viral 380 00:23:08,937 --> 00:23:11,120 hemorrhagic fever and everything else. 381 00:23:11,120 --> 00:23:13,040 And so it's a great way to do that. 382 00:23:13,310 --> 00:23:16,730 The other template that we haven't talked about and I really wanna highlight is 383 00:23:16,935 --> 00:23:21,742 we've added a template for national Special Pathogen System or NSPS 384 00:23:21,742 --> 00:23:23,722 Level one and Level two facilities. 385 00:23:23,962 --> 00:23:28,047 And the reason why we combine those is because both the Level one and the 386 00:23:28,052 --> 00:23:32,385 Level two facilities have the same expectation for the treatment of a 387 00:23:32,385 --> 00:23:34,155 patient for the duration of care. 388 00:23:34,605 --> 00:23:39,765 And so we have taken some objectives, which are the foundation which, 389 00:23:39,856 --> 00:23:41,715 an exercise is based upon. 390 00:23:41,945 --> 00:23:47,105 There's a scenario as well, and and it really, The intent of any template is 391 00:23:47,105 --> 00:23:49,475 to reduce the barrier to starting it. 392 00:23:49,886 --> 00:23:53,925 But I really wanna encourage people to not just take that template. 393 00:23:53,925 --> 00:23:58,245 Sometimes The, the risk to a template is people take it and they think they 394 00:23:58,245 --> 00:24:01,695 don't have to go through exercise design and some of that longer, 395 00:24:01,695 --> 00:24:04,035 harder work, and that's not the case. 396 00:24:04,035 --> 00:24:07,335 You really need to take that template, you need to modify it based 397 00:24:07,335 --> 00:24:10,425 on the objectives that you wanna do for this particular exercise. 398 00:24:11,145 --> 00:24:15,705 And if you look at the Level one and two templates, there's way more objectives 399 00:24:15,765 --> 00:24:21,485 in those templates than we would ever recommend a facility do in one exercise. 400 00:24:21,695 --> 00:24:24,712 But it's intended to allow you to kind of pick and choose. 401 00:24:24,862 --> 00:24:28,762 And so it's a menu driven, and it's, you know, everything from coordination 402 00:24:28,762 --> 00:24:32,799 with lab, to that all important identify, isolate, and inform. 403 00:24:32,799 --> 00:24:37,219 And so we really hope these templates will reduce that barrier 404 00:24:37,219 --> 00:24:39,589 for facilities to do an exercise. 405 00:24:39,859 --> 00:24:44,359 But then the other thing we will always encourage facilities to do is take that 406 00:24:44,359 --> 00:24:49,199 exercise template, customize it, go through an exercise design process, make 407 00:24:49,199 --> 00:24:53,579 it your own, and then kind of back to the last question you ask, make sure you 408 00:24:53,579 --> 00:24:58,702 document our lessons learned, write that after action report and look at what plans 409 00:24:58,702 --> 00:25:01,059 and policies we need to update as a result 410 00:25:02,214 --> 00:25:04,404 Jill Morgan: Yeah, you want good things to come out of these things. 411 00:25:04,804 --> 00:25:06,694 They're labor-intensive. 412 00:25:06,734 --> 00:25:10,014 They're a tremendous amount of work for the both the planners and the 413 00:25:10,014 --> 00:25:14,497 people who are, surprise, involved at the actual action portion of it. 414 00:25:14,827 --> 00:25:20,539 But I think knowing that you get something out of it, knowing that maybe this will 415 00:25:20,549 --> 00:25:25,320 bring attention to something that you don't have that you need, or, you know, 416 00:25:25,360 --> 00:25:29,030 a person that doesn't answer their phone or whatever it is, you want those 417 00:25:29,030 --> 00:25:34,290 things to be amplified and actually documented so that things can improve. 418 00:25:35,090 --> 00:25:38,754 There are an awful lot of facilities that, I think all of us sort of skate 419 00:25:38,774 --> 00:25:44,057 in some area or another, and these exercises help us identify where 420 00:25:44,057 --> 00:25:46,187 those weaknesses or thin ice is. 421 00:25:46,537 --> 00:25:48,077 So yeah, I think that's a great point. 422 00:25:49,267 --> 00:25:54,940 I wanna ask about, we use, I use the phra- the two terms virtually 423 00:25:54,950 --> 00:25:57,139 interchangeably, drills and exercises. 424 00:25:57,684 --> 00:26:04,278 So Jackson, school me on how I'm doing that incorrectly and why 425 00:26:04,328 --> 00:26:08,678 I should use the terms in a more precise manner, or give me a free 426 00:26:08,678 --> 00:26:12,598 pass that I can still say drills and exercises as if they're just one thing. 427 00:26:13,677 --> 00:26:14,937 Jackson Gruber: Yeah, Jill, and that's a tough question, 428 00:26:14,937 --> 00:26:16,347 especially, especially for me. 429 00:26:16,347 --> 00:26:18,347 I'm gonna give you the free pass on that one. 430 00:26:18,417 --> 00:26:18,797 Um, I 431 00:26:18,867 --> 00:26:19,227 Jill Morgan: think the 432 00:26:19,647 --> 00:26:22,807 Jackson Gruber: real important thing here is that when you look at exercises, 433 00:26:23,047 --> 00:26:26,327 there is a bunch of different exercises that could be leveraged here, right? 434 00:26:26,327 --> 00:26:29,097 You have a tabletop exercise, like Darrell mentioned, that's predominantly 435 00:26:29,097 --> 00:26:32,943 discussion-based that really walks through plans and procedures, not 436 00:26:32,943 --> 00:26:36,853 necessarily from a actually doing them perspective, but just discussing as 437 00:26:36,853 --> 00:26:38,717 to what does that process look like. 438 00:26:39,040 --> 00:26:42,080 You might have functional communications exercises where you're picking up the 439 00:26:42,080 --> 00:26:44,490 phone and you're calling your neighbor down the street and say, "Hey, here's 440 00:26:44,490 --> 00:26:48,047 the scenario. Here's what's going on, go through your process now." And then you 441 00:26:48,047 --> 00:26:49,597 might have full-scale exercises, right? 442 00:26:49,597 --> 00:26:53,027 So these are things of where you have, planes,

trains, buses, ambulances, 443 00:26:53,027 --> 00:26:57,257 whatever you wanna kinda have going on, occurring in real time, in 444 00:26:57,257 --> 00:26:59,267 real motion to point A to point B. 445 00:26:59,607 --> 00:27:03,827 When it comes to drills, I really view these as more so interfacility activities, 446 00:27:04,147 --> 00:27:09,883 that are not necessarily super, partner engaging, but they can be, and they allow 447 00:27:09,893 --> 00:27:14,327 for really smaller and more simplified processes, whereas an exercise really 448 00:27:14,327 --> 00:27:17,273 kinda goes through that entire process of an ex- but I'll kinda open up to 449 00:27:17,273 --> 00:27:19,497 Darrell, the true exercise, expert here 450 00:27:21,015 --> 00:27:23,498 Darrell Ruby: Yeah, I'll, uh, echo what Jackson said. 451 00:27:23,498 --> 00:27:26,468 Uh, I'll I'll certainly give you a pass on, you know, use of 452 00:27:26,468 --> 00:27:28,921 drills and exercises, together. 453 00:27:29,125 --> 00:27:30,281 I do it as well. 454 00:27:30,524 --> 00:27:33,914 I think the thing that I really wanna emphasize that we've talked about a 455 00:27:33,914 --> 00:27:38,864 little bit is there are a wide variety of different types of exercises. 456 00:27:39,215 --> 00:27:43,261 And if you're a facility and you're not-- you're a little confused about 457 00:27:43,261 --> 00:27:47,613 that, reach out to your emergency manager and let them help you with this. 458 00:27:47,883 --> 00:27:51,443 But really, drills, are focused on a very specific task. 459 00:27:51,663 --> 00:27:54,513 A concrete example of that, you mentioned earlier, you know, we 460 00:27:54,513 --> 00:27:58,089 never like to exercise on like Labor Day weekend and stuff. 461 00:27:58,299 --> 00:28:02,334 We actually have a planned alerting drills scheduled for this Saturday, 462 00:28:02,334 --> 00:28:04,014 so Labor Day weekend for our team. 463 00:28:04,254 --> 00:28:07,314 Hopefully, they're not listening and, uh, you know, get prepared for this. 464 00:28:07,314 --> 00:28:08,664 But it's, it's very simple. 465 00:28:08,941 --> 00:28:12,571 All we're doing is I've got a pre-scripted message that's gonna get 466 00:28:12,571 --> 00:28:14,971 sent by our alerting system to our team. 467 00:28:15,301 --> 00:28:18,301 And the reason why we're doing it specifically on Labor Day weekend 468 00:28:18,301 --> 00:28:23,411 is we wanna see how that impacts ability to develop a staffing plan. 469 00:28:23,715 --> 00:28:26,981 And this is a very low cost exercise for us. 470 00:28:27,082 --> 00:28:32,118 It is an exercise, but it's a very focused drill on alerting and that communication 471 00:28:32,118 --> 00:28:33,948 like Jackson was alluding to. 472 00:28:34,278 --> 00:28:35,838 And so we'll send it out. 473 00:28:35,838 --> 00:28:38,838 We tell people to respond to it as if it's a real world event. 474 00:28:39,198 --> 00:28:42,728 Uh, We're saying that we need to activate within eight hours, so that 475 00:28:42,728 --> 00:28:44,858 helps us build our staffing plan. 476 00:28:45,171 --> 00:28:48,531 And we're not gonna look at that until next week when we're back in the office. 477 00:28:48,771 --> 00:28:51,441 You know, So it's not anything we have to do other than just 478 00:28:51,441 --> 00:28:53,121 have it ready to go this weekend. 479 00:28:53,535 --> 00:28:57,431 And then, you know, when we interchange drills and exercises, the other 480 00:28:57,431 --> 00:29:00,971 thing that often gets interchanged is we talk about doing training 481 00:29:01,241 --> 00:29:02,891 when we're doing an exercise. 482 00:29:03,101 --> 00:29:06,031 And the purest in me kinda, bristles a little bit, but the 483 00:29:06,031 --> 00:29:10,971 reality is every exercise we do does also provide some training. 484 00:29:11,301 --> 00:29:16,221 And so those things, just like the wheel of building a plan, organizing to that 485 00:29:16,221 --> 00:29:20,901 capability, conducting training, and then doing an exercise, they're always 486 00:29:20,901 --> 00:29:23,851 happening almost always simultaneously. 487 00:29:24,161 --> 00:29:27,761 But the takeaway really is there's lots of different ways in this 488 00:29:27,761 --> 00:29:32,621 progressive exercise approach to build a capability in our work around 489 00:29:32,621 --> 00:29:34,421 special pathogens preparedness. 490 00:29:34,963 --> 00:29:35,143 Jill Morgan: Yeah. 491 00:29:35,143 --> 00:29:39,583 I love the idea of really thinking about this as progressive, as 492 00:29:39,583 --> 00:29:41,043 you said, of building blocks. 493 00:29:41,053 --> 00:29:45,383 So if you're new to this business, if you're new to either emergency 494 00:29:45,393 --> 00:29:48,283 management or maybe you're just new to the special pathogen side of 495 00:29:48,283 --> 00:29:57,136 things, you don't have to dive into, having a fake Ebola patient, pregnant, 496 00:29:57,196 --> 00:29:59,276 delivering outside your ED, right? 497 00:29:59,276 --> 00:30:01,376 I mean, like, like that's everybody's nightmare. 498 00:30:02,216 --> 00:30:06,166 You can start with some really simple things that you either tabletop, like 499 00:30:06,166 --> 00:30:10,210 Darrell said, or you can have somebody come through and say, "Okay, so, you know, 500 00:30:10,260 --> 00:30:14,890 like what would you do if…" And what kind of screening questions, and who does 501 00:30:14,900 --> 00:30:18,870 them, and really kind of getting each-- If you could work on each of the little 502 00:30:18,870 --> 00:30:27,140 pieces of the identify, the isolate, the inform, your PPE, then by the time you get 503 00:30:27,170 --> 00:30:31,280 that built, and you get that momentum, and you've done your after-action, and you've 504 00:30:31,290 --> 00:30:36,170 actually addressed all the deficits you're gonna find, and you will, we all still do. 505 00:30:36,780 --> 00:30:42,460 Then you can think about some of the stuff that jazzes people a lot, which 506 00:30:42,460 -->

00:30:46,320 is, the big exciting exercises with EMS and fire trucks, and then, you know, 507 00:30:46,320 --> 00:30:50,090 everybody all involved, and have at it. 508 00:30:50,480 --> 00:30:56,930 But you can really start small and progress there and get a tremendous amount 509 00:30:56,930 --> 00:30:58,730 done that's gonna help your facility. 510 00:30:59,320 --> 00:31:03,210 Help your facility be ready, help protect your facility from having like 511 00:31:03,410 --> 00:31:07,370 measles sitting in your waiting room, or protect your facility by making sure 512 00:31:07,370 --> 00:31:09,490 that your staff know where their PPE is. 513 00:31:09,710 --> 00:31:13,386 I mean, all those kind of little building blocks that are so critical 514 00:31:15,080 --> 00:31:15,374 Darrell Ruby: Yeah. 515 00:31:15,374 --> 00:31:21,174 I I would submit to you oftentimes people like to get really deep into some of 516 00:31:21,174 --> 00:31:26,341 those what ifs and contingencies and, circling back to what we talked about 517 00:31:26,341 --> 00:31:31,188 earlier, one of the most important things is to simply ask, "Are we ready for that 518 00:31:31,458 --> 00:31:33,798 Ebola patient to walk in my front door?" 519 00:31:34,178 --> 00:31:36,394 And it doesn't have to be anything elaborate. 520 00:31:36,941 --> 00:31:42,026 Get your infection prevention, get an ED leader or someone who's a 521 00:31:42,176 --> 00:31:46,376 champion for it and your emergency manager and just kind of walk that 522 00:31:46,376 --> 00:31:47,876 route and that point of entry. 523 00:31:48,146 --> 00:31:50,536 But it's just like any other scenario. 524 00:31:50,776 --> 00:31:52,976 Are we ready for the mass casualty incident? 525 00:31:53,246 --> 00:31:55,136 Are we ready for the chemical incident? 526 00:31:55,196 --> 00:31:57,026 Are we ready for the active shooter? 527 00:31:57,236 --> 00:31:58,556 They're all very similar. 528 00:31:58,706 --> 00:32:03,026 Of course, in our world, we're, we're singularly focused on viral hemorrhagic 529 00:32:03,026 --> 00:32:05,546 fever and special pathogens types events. 530 00:32:05,786 --> 00:32:06,986 But start small. 531 00:32:07,556 --> 00:32:11,426 Work with the other leaders within your facility, even if they're, you 532 00:32:11,426 --> 00:32:17,246 know, part-time and wear multiple hats and walk your route and then build 533 00:32:17,246 --> 00:32:19,556 up to doing a mystery patient drill. 534 00:32:19,766 --> 00:32:24,056 And take a look at the template that's on the NETEC website because there's a number 535 00:32:24,056 --> 00:32:29,400 of different resources that can help an individual or a facility to break this 536 00:32:29,423 --> 00:32:31,883 larger exercise into bite-sized chunks. 537 00:32:33,764 --> 00:32:35,692 Jackson Gruber: And to piggyback off of what Darrell was saying there real 538 00:32:35,692 --> 00:32:39,499 quick while, you know, full-scale exercises are immensely cool, right? 539 00:32:39,499 --> 00:32:41,749 Seeing things move down the road is super, super awesome. 540 00:32:41,749 --> 00:32:44,549 But when you look at workshops and seminars, there is still 541 00:32:44,549 --> 00:32:45,729 a ton of value there, right? 542 00:32:45,729 --> 00:32:48,869 So we often say inside of the emergency management world that you 543 00:32:48,869 --> 00:32:51,559 should never be shaking hands for the first time during a disaster. 544 00:32:51,915 --> 00:32:55,225 And this is really that opportunity to begin building those relationships 545 00:32:55,225 --> 00:32:57,785 with your critical stakeholders, whether it's infection prevention, 546 00:32:57,785 --> 00:33:01,765 your state public health partners, your laboratory teams, or your EMS agencies. 547 00:33:01,765 --> 00:33:05,665 It's really important to understand who the right point of contact is beforehand, 548 00:33:05,685 --> 00:33:09,635 understand where they might have some gaps and weaknesses inside of their plans 549 00:33:09,635 --> 00:33:13,785 and procedures, and really build when you're ready, that exercise to kind of 550 00:33:13,795 --> 00:33:15,515 meet everyone's needs at the same time. 551 00:33:15,635 --> 00:33:18,785 That being said, it's still really important to have your objectives really 552 00:33:18,785 --> 00:33:21,295 fine-tuned and in scope for that exercise 553 00:33:22,001 --> 00:33:22,261 Jill Morgan: Yeah. 554 00:33:22,261 --> 00:33:26,331 So if the question that you're wondering at your own facilities, are we ready? 555 00:33:28,583 --> 00:33:29,923 Start asking, right? 556 00:33:29,943 --> 00:33:30,673 Start asking. 557 00:33:31,093 --> 00:33:35,163 Assemble the right group of people, start walking through, ask some what 558 00:33:35,163 --> 00:33:37,893 if questions, and see for yourself. 559 00:33:38,623 --> 00:33:44,973 The idea that just seems so big to take on, but there really are some like baby 560 00:33:44,973 --> 00:33:49,613 steps and as you said, sort of along the spectrum of drills and exercises. 561 00:33:49,613 --> 00:33:51,900 You don't have to start at the, fire engine end. 562 00:33:51,900 --> 00:33:55,910 You know, you can really start small and tabletop things and have these 563 00:33:55,920 --> 00:34:00,880 seminars and discussions and, and make progress that's going to really 564 00:34:01,010 --> 00:34:05,030 help you with buy-in at your facility, help your staff feel more comfortable 565 00:34:05,040 --> 00:34:06,750 about what their responsibilities are. 566 00:34:06,980 --> 00:34:10,879 Make sure you're closing some of those gaps that you can drive a truck through. 567 00:34:11,454 --> 00:34:12,273 We all have them. 568 00:34:12,382 --> 00:34:15,302 Don't worry about it if you discover them, that's what these things 569 00:34:15,322 --> 00:34:20,429 are for, to find them out before you end up with a real situation. 570 00:34:20,719 --> 00:34:24,309 You know, whether that's, "Oh, I didn't realize that, the beeper 571 00:34:24,319 -->

00:34:27,946 goes off," or that the, We don't have anybody answering that phone." 572 00:34:28,256 --> 00:34:31,436 Those are critical things, but they happen everywhere. 573 00:34:31,436 --> 00:34:32,726 It's not just your place. 574 00:34:32,726 --> 00:34:33,546 Don't worry about it. 575 00:34:33,926 --> 00:34:39,236 Just find it out, take action, move on, because we all have things 576 00:34:39,236 --> 00:34:42,646 that we work on every single time. 577 00:34:42,676 --> 00:34:44,996 I mean, I love what you said about earlier, and I can't even remember which 578 00:34:44,996 --> 00:34:49,096 one of you said it, but that if you have a drill or exercise and it all works 579 00:34:49,096 --> 00:34:52,716 perfectly, you probably didn't drill or exercise the right things because that's 580 00:34:52,716 --> 00:34:55,139 just not-- you want to find the stuff. 581 00:34:55,189 --> 00:34:59,569 You want to find what the weaknesses and pinch points and whatever 582 00:34:59,569 --> 00:35:01,499 else your terminology is for that. 583 00:35:03,137 --> 00:35:06,830 Darrell Ruby: Yeah, I think exercises, and I might've said this earlier, are 584 00:35:06,830 --> 00:35:09,200 really about people and partnerships. 585 00:35:09,375 --> 00:35:12,950 and, And the goal of these templates are to reduce barriers. 586 00:35:13,220 --> 00:35:17,360 And if you haven't looked at the NETEC exercise landing page lately, I'd 587 00:35:17,360 --> 00:35:21,020 really encourage you to take a look because as Jackson touched on earlier, 588 00:35:21,610 --> 00:35:26,215 why we did this was there were too many templates on that page, and I 589 00:35:26,215 --> 00:35:28,195 think it was a little bit overwhelming. 590 00:35:28,525 --> 00:35:33,145 A lot of them were zip files that had multiple folders within the zip file. 591 00:35:33,415 --> 00:35:38,215 And so, uh, our intent when we started on this was to make it simpler and 592 00:35:38,215 --> 00:35:40,938 easier, and I, I think we've done that. 593 00:35:41,238 --> 00:35:45,588 But the other thing I'll say is don't hesitate to reach out to the respect in 594 00:35:45,588 --> 00:35:50,178 your region because they are familiar with these templates, and they do have 595 00:35:50,178 --> 00:35:55,476 the Luxury of being singularly focused on special pathogens preparedness, and they 596 00:35:55,476 --> 00:35:59,796 can help you break down some of these templates that are there into bite-sized 597 00:35:59,796 --> 00:36:01,896 chunks to become better prepared 598 00:36:02,860 --> 00:36:04,930 Jackson Gruber: And on that same chord, you know, if you do choose 599 00:36:04,930 --> 00:36:07,710 to download these exercise templates and you do utilize them across your 600 00:36:07,710 --> 00:36:09,523 facility, give us some feedback. 601 00:36:09,533 --> 00:36:12,763 So there's an opportunity to utilize the NETEC Contact Us link 602 00:36:13,213 --> 00:36:15,143 and let us know what you think about these exercise templates. 603 00:36:15,163 --> 00:36:19,090 We know that there's gonna be a need for further revision and modifications 604 00:36:19,090 --> 00:36:20,900 across these templates, but if there's something of where we've 605 00:36:21,050 --> 00:36:22,940 totally missed the mark, let us know. 606 00:36:22,940 --> 00:36:25,630 We're happy to make further changes to these documents. 607 00:36:25,640 --> 00:36:29,030 If there's a need to have additional resources that really walk through how 608 00:36:29,030 --> 00:36:32,807 do you conduct exercise play, how do you identify the right stakeholders 609 00:36:32,807 --> 00:36:34,883 inside of your facility, let us know. 610 00:36:35,307 --> 00:36:38,830 We're happy to build some one-page supplemental information as well. 611 00:36:39,103 --> 00:36:41,973 But we don't know what we need to change unless you guys let us know. 612 00:36:41,973 --> 00:36:44,953 So feel free to download those and, and give us your feedback 613 00:36:45,921 --> 00:36:46,171 Darrell Ruby: Yeah. 614 00:36:46,171 --> 00:36:48,316 And one thing, uh, kind of looking ahead. 615 00:36:48,456 --> 00:36:51,821 So one of the things that Jackson and I have talked about a lot through 616 00:36:51,821 --> 00:36:56,501 this last year that we've been uh, working on the updates is that we wanna 617 00:36:56,501 --> 00:37:00,821 create a PowerPoint template that's gonna support tabletop exercises. 618 00:37:01,211 --> 00:37:06,211 Tabletop exercises really are one of the simplest and most effective ways to bring 619 00:37:06,211 --> 00:37:11,281 these partners together to talk about special pathogens or any number of things. 620 00:37:11,491 --> 00:37:16,565 So our plan here in the near future is to put that template up on the page 621 00:37:16,565 --> 00:37:21,725 in a PowerPoint format that can be modified for any facility, whether it's 622 00:37:21,725 --> 00:37:26,225 a hospital, a public health partner, an EMS agency, a healthcare coalition 623 00:37:26,225 --> 00:37:30,275 partner, that they can use that to bring their partners together and exercise. 624 00:37:30,545 --> 00:37:34,480 But just to reiterate what Jackson said too is please give us feedback. 625 00:37:34,690 --> 00:37:38,900 Uh, if we can improve these to help, uh, to be easier, that's 626 00:37:38,900 --> 00:37:40,125 ultimately what we wanna do. 627 00:37:41,749 --> 00:37:42,389 Jill Morgan: Excellent. 628 00:37:42,449 --> 00:37:46,629 I think all of us like the idea of making something that can seem 629 00:37:46,629 --> 00:37:48,789 overwhelming as simple as possible. 630 00:37:48,939 --> 00:37:54,099 And for those facilities out there that are really just taking the 631 00:37:54,099 --> 00:37:58,429 first steps towards getting prepared for a special pathogens event, and 632 00:37:58,615 --> 00:38:02,415 I want to emphasize, it doesn't have to be an Ebola or a Marburg. 633 00:38:02,879 --> 00:38:04,339 Talk to your infection preventionist. 634 00:38:04,349 --> 00:38:06,699 There are an

awful lot of places across the country right now trying 635 00:38:06,699 --> 00:38:11,112 to figure out how to do contact tracing on tens or hundreds of 636 00:38:11,112 --> 00:38:12,862 exposures to things like measles. 637 00:38:13,962 --> 00:38:17,422 There are people that have had folks walk in their hospital with 638 00:38:17,532 --> 00:38:22,522 any number of pathogens that can be dangerous to your staff, and really the 639 00:38:22,532 --> 00:38:24,172 ongoing operations of your hospital. 640 00:38:24,172 --> 00:38:29,325 So this is not something that has to be a never event, and if we 641 00:38:29,325 --> 00:38:33,515 think about it as a never event, I'm afraid we'll never actually make 642 00:38:33,545 --> 00:38:36,075 the steps necessary to get prepared. 643 00:38:36,095 --> 00:38:41,762 So I think of it, as I said before, a lot like having a fire drill, 644 00:38:42,222 --> 00:38:45,812 having smoke detectors, making sure that people know what the plan is. 645 00:38:45,822 --> 00:38:50,312 So I really appreciate Jackson and Darrell being here today and talking 646 00:38:50,312 --> 00:38:55,962 about this, and hopefully encouraging you guys to check out the website. 647 00:38:55,962 --> 00:38:58,412 The link will be accompanying the podcast. 648 00:38:59,292 --> 00:39:04,175 Look at the templates and really try to take some baby steps towards this. 649 00:39:04,465 --> 00:39:09,905 Think about perhaps incorporating a special pathogens angle to your next drill 650 00:39:09,905 --> 00:39:13,895 or exercise, and using the templates and then giving us some feedback so that we 651 00:39:13,895 --> 00:39:19,855 can, again, sort of as the process goes, create and then evaluate and improve. 652 00:39:19,865 --> 00:39:22,152 So thank you guys very much. 653 00:39:22,172 --> 00:39:26,112 It's been great to talk to you today about emergency management in general, 654 00:39:26,112 --> 00:39:31,032 and certainly these updated exercise templates on the NETEC website. 655 00:39:31,452 --> 00:39:34,862 So thanks to you and the emergency management working group for 656 00:39:34,862 --> 00:39:35,772 putting all this together. 657 00:39:36,818 --> 00:39:37,818 Darrell Ruby: Yeah, happy to. 658 00:39:37,818 --> 00:39:39,498 Uh, thanks Jill for inviting us 659 00:39:40,064 --> 00:39:40,144 Jackson Gruber: Yeah. 660 00:39:40,174 --> 00:39:40,654 Thanks, Jill 661 00:39:42,081 --> 00:39:44,361 Jill Morgan: For those of you listening at home, thanks for tuning in to this 662 00:39:44,381 --> 00:39:49,605 episode on the new updated exercise templates on the NETEC website. 663 00:39:49,965 --> 00:39:53,531 We hope you'll join us for future episodes on a wide range of topics: 664 00:39:53,608 --> 00:39:56,378 healthcare worker safety, personal protective equipment, infectious 665 00:39:56,388 --> 00:39:59,328 diseases, oh, trash, who knows what. 666 00:40:00,098 --> 00:40:03,308 If you have any questions for NETEC or ideas about future shows, please feel 667 00:40:03,308 --> 00:40:10,478 free to contact us at info@netec.org or find us on the web at netec.org/podcast, 668 00:40:10,868 --> 00:40:14,508 where you can also subscribe to future episodes and find out more information 669 00:40:14,538 --> 00:40:19,620 about today's topic, with the link to the exercise templates on the NETEC website. 670 00:40:20,270 --> 00:40:23,670 So thank you very much for joining us on "Transmission Interrupted." 671 00:40:28,365 --> 00:40:28,715 Darrell Ruby: Right.