Exercise! Exercise! Exercise!

You could say that those of us who work in preparedness are a little obsessed with making sure we’ve got our emergency kits stocked and ready, our emergency plans up to date, and our neighbors are ready too.  So we’ve got a few households in Georgia ready for a public health emergency (and a few others around the country – don’t forget about friends and family!), but how do we get the country ready?  How do we get the government and other response organizations prepared?

The answer, just like learning how to ride a bike, is practice. Practice, practice, and more practice.  And this past week, CDC participated in a government-wide exercise that tested our preparedness and response capabilities.  The National Exercise Program Capstone Exercise (NEPCE) 2014 is a congressionally mandated preparedness exercise to test, assess, and improve the nation’s preparedness and resiliency.  CDC’s Office of Public Health Preparedness and Response (PHPR) and the National Center for Environmental Health and the Agency for Toxic Substances and Disease Registry (NCEH/ATSDR) worked together to participate in this event.  

NEPCE 2014 was designed to educate and prepare the whole community – from schools to businesses and hospitals to families – to prevent, mitigate against, protect from, respond to, and recover from acts of terroristic and catastrophic incidents. This was the first Capstone Exercise, formerly known as National Level Exercise, incorporated into the newly revised National Exercise Plan (NEP), concluding and building on two years of smaller scale exercises.  The NEP includes exercises of all types, designed to engage all levels of government, non-government organizations and private sector organizations. 

This exercise culminated over nine months of interagency planning efforts among DHS, HHS and CDC along with our state and local partners.  CDC planning officials attended planning meetings in Washington, D.C. to integrate CDC operations into the exercise. Additionally, CDC deployed four public health personnel with the HHS Incident Response Coordination Team to Sacramento, California, during the exercise to simulate coordination activities that CDC would normally provide to the impacted population.

History Repeats Itself for Exercise Purposes

The exercise scenario centered on a 9.2 magnitude earthquake in Alaska that caused catastrophic damage across multiple communities, requiring federal response and recovery assistance.  A similar event happened in Alaska at the same time in 1964.

As it did 50 years ago, the earthquake resulted in several tsunamis with substantial threat and damage to critical infrastructure like buildings, bridges, and roads, along with injuries, deaths, and population displacement across Alaska and Canada. While national officials confronted earthquake and tsunami impacts, disruption in and around Juneau, the capital, resulted in a requirement for government entities to relocate to alternate sites.

RADM Scott Deitchman, M.D. M.P.H., USPHS, Assistant Surgeon General who is the Associate Director for Environmental Health Emergencies in NCEH/ATSDR served as the Incident Manager and lead for the exercise. He remarked, “I appreciated the opportunity the exercise gave us, like the rest of government, to exercise how we would respond to a catastrophic disaster of this magnitude. A real earthquake, like a nuclear detonation, suddenly puts you in a situation where the things we take for granted – communications systems to give messages to the public, transportation systems to send responders to the area, data systems for collecting surveillance data – all are gone. How do we launch a public health response in that setting? In exercises like this, the goal is to “test to fail” – to see where things break down, in a setting where we can learn without failing people in actual need. That gives us the opportunity to strengthen our response systems in anticipation of a real disaster.”

One of CDC’s primary missions is to ensure that we are prepared to assist the nation to respond to, recover from, and alleviate the impacts of public health disasters.  Participation in last week’s exercise enhanced our overall ability to support our nation during emergency situations. 

During this and other exercises, all aspects of CDC’s response capabilities are tested.  Managed out of CDC’s Emergency Operations Center (EOC), this exercise brought together experts in public health preparedness, as well as those with expertise in earthquakes.  During a real emergency, CDC would activate the EOC in order to help coordinate the Agency’s response.  Although no exercise will truly mimic a real life emergency, we do everything possible to imagine what could happen – from dealing with power outages to delays in supplies reaching affected areas to incorrect media reports and wild rumors – in order to test who we would respond.  After the exercise is over, we work with the other organizations involved and analyze what went well and what could be improved upon next time.

David Maples, Exercise Lead for OPHPR’s Division of Exercise Operations, commented, “The Alaska Shield earthquake exercise provided CDC the primary venue to validate our All-Hazards Plan and its Natural Disaster Annex and Earthquake Appendix.  We engaged our whole of community partners in this exercise at the federal, state and local levels, our tribal partners as well as several non-governmental organizations and private public health partners.  Maintaining these relationships is essential to our ability to get our public health guidance and messaging into the hands of those impacted by an event like this.  In a catastrophic natural disaster similar to the one we just exercised, CDC’s mission is just the beginning. Similar to our real world response to Superstorm Sandy, the recovery phase of an event like this will challenge our public health capabilities for some time.  But that is the goodness of our Public Health Preparedness and Response exercise program; it gives us the opportunity to prepare for no-notice disasters and emergent outbreaks before they occur.”