183346613.xlsx.

ms_office

Phase III

Jonathan Markowitz, Matt Davlin, John Fields

Phase III: Here we take the information generated in phase II, and narrow the number of risks to be considered for future steps. This aims to reduce the number of entries for Phase IV, so that the process is manageable.
Extremely High Risk

Most likely Effect Total Failure Additional 50% Loss of work capacity Additional 25% loss of work capacity

unlikely

somewhat 6

moderate

likely

Likelihood probable

High Risk Moderate Risk Low Risk

5,11,12,34 3,15,18,31,3 1 2 2,14,17

24,26, 28,29,33

19, 27, 30

25 21, 23 20, 22 9,10

Additional 10% loss of life 4,7,13,16 Normal

Analysis: For our scenario, preventing loss of life is the mission. Therefore, we have altered the groupings for impact to focus solely on loss of life. On the surface, these impact levels may seem like they treat loss of life in a casual manner; however, in wartime environments the real objective is to ensure mission success this can be accomplished doing the greatest good for the greatest number of people. In our formulation, we have set our 'target' (benign impact) as having the loss of life be 'normal' for the number of exposed/infected patients and severity of each of their injuries. In this case, 'normal' means the outcome for the patient is what can be expected from medical treatment under the best conditions. Improving treatment beyond the 'normal' level of care in this outpatient clinic is an entirely different challenge, and is not addressed here. For example, each impact level above 'normal' connotes this situation:
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183346613.xlsx.ms_office

Phase III

Jonathan Markowitz, Matt Davlin, John Fields

For example, each impact level above 'normal' connotes this situation: given the base populace in infected with pandemic influenza, what is the additional loss of life incurred because of this exposure, versus if you had those same casualties during the annual flu cycle. If the clinic had a patient with massive injuries, it could possibly transport him/her to a higher level of care, if the pandemic influenza event were not present. But in an pandemic influenza environment, that person would likely not be able to be treated as effectively, and this could result in a death. This is the idea of the additional death.
Ultimately, we are trying to mitigate the impact of the pandemic influenza event, and how it affects the clinic's ability to treat patients. Complete failure, in this case, is that the clinic is unable to treat any casualties of the pandemic

For phase IV, let us carry forward any risk that results in complete failure at any likelihood: * Any likely event that results in more than marginal impact * Any moderate probability event that results in more than 50% failure rate * Any probable event that results in nominal or great impact

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183346613.xlsx.ms_office

Phase II(basis of Phase III)

Jonathan Markowitz, Matt Davlin, John Fields

ID

Head Topic 1 Security 2 Security 3 Security

Subtopic Protection / Building Protection / (PPE) Restrict movement

Risk Scenario Limited security staff; unable to restrict access to facility/exposing staff.

Likelihood Unlikely

Type of Impact 25% Loss of work capacity 10% loss of of work capacity 25% Loss of work capacity

Severity Level

Timeline

4 Security 5 Security 6 Security 7 Temporal 8 Temporal 9 Temporal 10 Temporal 11 Infrastructure

Cyber Security Disease Containment Enemy Military Strike Steady State (normal) During Pandemic Outbreak Post-Pandemic Outbreak

Limited PPE unable to protect the staff from exposure Somewhat Security unable to restrict movement of personnel; leading to additional exposures Somewhat Terrorists target clinic computer systems, surreptitiously plant viruses that either cripple the system or worse, create dubious results Unlikely Somewhat Somewhat Unlikely Likely Probable Probable Somewhat

10% loss of of work capacity 50% Loss of work capacity Complete failure 10% loss of of work capacity 50% Loss of work capacity 10% loss of of work capacity 10% loss of of work capacity 50% Loss of work capacity

12 Infrastructure 13 Infrastructure 14 Infrastructure 15 16 17 18 Infrastructure Infrastructure Infrastructure Infrastructure

19 Personnel 20 Personnel

21 Personnel 22 Patients 23 Patients

Run out of isolation rooms Risk of an attack on the base while disease raging, delaying response. Steady state becomes 'predictable', so the unexpected situations are not planned for Staffing levels are inadequate to keep up with influx of patients; staff infected Staff worn out and 'recovery' back to steady state takes longer than normal Risk of 'worried well' swarming clinic while not High Alert actually infected Clinic not able to stay in a "clean" state causing Clinic Clean State additional exposures Local power sources fail; Diesel backup generators have limited fuel, and require frequent Power replenishment. Clinic not able to be repaired due to damage from Clinic Infrastructure natural disaster; personnel/material not available Satellite link fails; servers go down; no internet/comm Communcation connectivity If power fails, sewage pumps will not work, greater Sewage risk infection/disease. Tempory Morgue Convert space for temperary interment if needed. Isolation Risk of running out of isolation room space Quarantine Risk of running out of quarantine room space Direct patient care leaves clinical staff susceptible to Clinical Staff infection Non-clinical staff ill-suited to assist in patient care, but Non-Clinical Staff required to do so Risk of one medical equipment repair technician getting ill and unable to perform his job, single point Maintenance of failure if he gets ill Infected only Risk of exposing other patients, staff, base personnel Non-infected minor Risk of being infected at clinic, if not treated, injury injury could worsen to major injury Risk of being exposed at the clinic, if not treated, injury could worsen and lead to death; exceeds the Non-infected with capability of the clinic; access may be restricted to major injury other bases, civilian hospitals Risk of exposing others (patients, staff, base personnel) at the clinic, if not treated, injury could Infected with minor worsen to major injury exceeding the capabilities of injury the clinic

Somewhat Unlikely Somewhat Somewhat Unlikely Somewhat Somewhat Probable Likely

50% Loss of work capacity 10% loss of of work capacity 10% loss of of work capacity 25% Loss of work capacity 10% loss of of work capacity 10% loss of of work capacity 25% Loss of work capacity 50% Loss of work capacity 10% loss of of work capacity

Moderate Likely Moderate

10% loss of of work capacity 10% loss of of work capacity 10% loss of of work capacity

24 Patients

Moderate

50% Loss of work capacity

25 Patients

Moderate

25% Loss of work capacity

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183346613.xlsx.ms_office

Phase II(basis of Phase III)

Jonathan Markowitz, Matt Davlin, John Fields

26 27

28 29 30 31 32

33

34

Risk of infecting others (patients, staff, base personnel) at clinic,injury could worsen and lead to Infected with major death; exceeds the capability of the clinic; access may Patients injury be restricted to other bases, civilian hospitals Moderate Local national Patients contractor Risk of bringing infection from local community Probable Access to other locations may be restricted; patients may not be allowed to be transferred except in lifeLife-threatening threatening cases; MEDEVAC helicopter may be Patients injury unavailable Moderate Host Nation The local community may be exposed during a Host Nation Government Hospitals pandemic influenza event Moderate Other military Other military medical facilities will also be burdened Military medical facilities an unable to accept patient transfers Probable Aid/ Relief Non Government Organizations Risk of infecting staff/depleting resources Somewhat Non Government Red Cross Risk of infecting staff/depleting resources Somewhat Law Enforcement may not be able to keep public order and keep roads open for Emergency Services Host Nation Government Law Enforcement (Fire and Rescue) Moderate Host nation military may hamper travel to and from the medical facilities, causing delay in patient Host Nation Government Military treatment and transport Somewhat

50% Loss of work capacity 50% Loss of work capacity

50% Loss of work capacity 50% Loss of work capacity 50% Loss of work capacity 25% Loss of work capacity 25% Loss of work capacity

50% Loss of work capacity

50% Loss of work capacity

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