"Beleaguered Bus" is a community-based preparedness exercise led by the local county health department, but includes local law enforcement, hospitals, EMS/EMT, emergency management & other partners. Passengers on the bus introduce an unknown contagious disease to the target county triggering establishment of NIMS/ICS, interagency communications & coordination, epidemiological investigation, triage & transportation to closest medical facility. 12 of 13 of the counties (mostly rural with Leon Co. 260,000 pop.-was the largest) in the North Florida Regional Domestic Security Task Force have conducted "Beleaguered Bus," with the last county too hurricane damaged to participate this year. Each county demonstrated its competency in communication, NIMS/ICS/HEICS, disease investigation, EOC activation, triage, & other All Hazards response activities.
"Beleaguered Bus" accomplishes a coordinated county response to a public health emergency event. The intent of this practice is to support the "plan, train, exercise and evaluate" process at the local county level to improve local response to a public health emergency. By participating in this exercise with local partners, the county health department will better conduct its mission to promote and protect the health and safety of all people in the county during a public health emergency or other all hazards event.
The public health issue addressed is a coordinated countywide response to a public health emergency involving the sudden introduction of a contagious disease. This exercise was based upon CDC & HRSA public health preparedness directives, critical capacities in those cooperative agreements, FL Governor Jeb Bush's Executive Order on terrorism preparedness and response, and afer action data from previous regional preparedness exercises involving county public health, hospital, law enforcement and other community partners. The "Beleaguered Bus" exercise allows each county to demonstrate its competency in responding to a public health emergency by activating established plans, protocols & other relationships. Evaluating that performance is part of the process with lessons learned being integrated into local emergency operations plans (EOPs) and preparedness training. This is modeled on the "Public Health Ready" loop of "Plan, Train, Exercise & Evaluate."
"Beleaguered Bus" allows a county of any size to demonstrate local capacity to respond to a public health emergency. Previous exercises focused on the large counties/cities and did not include an epidemiological investigation. There are also a large number of community volunteer participants as bus passengers from Red Cross, local scouting, et. al. Although this has worked very well in the rural counties of North Florida, "Beleaguered Bus" can also be used as a public health add on for large county field exercises with a law enforcement primary focus.
Agency Community RolesLeon County Health Department houses the regions preparedness staff who support the other 12 counties. Leon CHD, with funding provided by the State Health Office (Focus Area G--Office of Performance Improvement), contracted with Florida State University to design and implement the "Bus"exercises. Each local CHD hosts a review of public health emergency response plans, tabletop exercises with local community partners, hospitals, etc., prior to the exercises and after the exercise the local county health department continues to foster the relationships established during "Beleaguered Bus".
The principle stakeholders, in addition to the local CHD, are law enforcement, emergency management, EMS/EMT, fire and rescue, Red Cross, and local hospitals. They work with the local CHD, Regional Public Health Preparedness staff & FSU contractors to coordinate the exercise schedule, evaluate response, provide "passengers", & interaction with local media. The local county health department holds open houses and inter-agency meetings to review the requirements of "Beleaguered Bus." This includes a review of existing emergency response plans, trained personnel & other local analysis. The post-exercise evaluation builds upon these relationships and sets a precedent for future emergency preparedness cooperation for all hazards events or another "Bus" ride. For those counties who completed "Beleaguered Bus" prior to the '04 Hurricane Season, their response to this unprecedented series of events was greatly enhanced by this exercise. Since hurricanes, unlike terrorist events, do not discriminate based on county size, the concept of "Beleaguered Bus" proved out in improved response to a real disaster(s).
The local CHD identifies stakeholders that will be part of the exercise.
Develop the exercise scenario for the particular county including disease type, timing & other coordination (exact time and location are kept secret from the county as is the disease).
Local CHD hosts overview meeting and tabletop exercise with support from regional staff .
The "Bus" arrives and the county responds.
After action "Hot Wash" is conducted to capture initial comments of all participants and evaluators .
An after action report is written and distributed.
Plan, train, exercise & evaluate cycle (ala "Ready") is followed as the after action report is used to update EOPs, modify training plans and prepare for the next exercise or all hazards incident response.
"Beleaguered Bus" assists NIMS-compliance as a developing standard for all partners who participate, not just local county health department. The entire process takes 60 days.