183347186.xlsx.

ms_office

Phase IV

Jonathan Markowitz, Matt Davlin, John Fields

Phase IV: In this phase, we take the top risks (which were 'above the line' in Phase III) and perform evaluation on them across multiple c riteria. This analysis aims to further reduce the set of risks to be analyzed in later steps. In the rows below, those with colored backgrounds will be excluded from Phase V because of their combination of the criteria.
Multiple paths to failure Operating Environment Hardware/software/human /organizational Complexity and Emergent Behaviors

Rank 1 0006 Security 8 0008 Temporal 9 0009 Temporal 10 0010 Temporal 3 0019 Personnel

Sub topic Enemy Military Strike During Pandemic Outbreak Post-Pandemic Outbreak High Alert Clinical Staff

Undetectability

Uncontrollability

Irreversibility

Duration of Effects

Cascading Effects

Wear and Tear

Design Immaturity

# Highs

# Mediums

# Lows

L L L L L

H H H M H

H H H M H

H L M M M

H H M M M

H H H H H

H H M H H

NA NA NA NA H

H M M M M

M M L M M

L L L L L

7 5 3 2 5

1 2 4 6 4

2 3 3 2 2

5 0024 Patients

Non-infected with major injury

NA

6 0026 Patients 11 0027 Patients

Infected with major injury Local national contractor

L M

H L

H M

M L

H L

H M

H M

NA NA

M M

M M

L L

5 0

3 6

2 4

2 0028 Patients Host Nation 4 0029 Government 7 0030 Military Host Nation 12 0033 Government

Life-threatening injury Host Nation Hospitals Other military medical facilities

L M L

H H H

H H H

M M M

H H M

M M H

H H H

NA NA NA

H M H

H H M

L L L

6 5 5

2 4 3

2 1 2

Law Enforcement

NA

Comments on the Criteria Undetectability Most of these are very detectable in the event of pandemic influenza outbreak, hence most ratings of undetectability are mostly "L" uncontrollability Most of these subtopics are out of our control in the event of a pandemic influenza outbreak multiple paths to failure Many scenarios have multple paths to failure. Irreversibility once exposed and infected, treatment and the body's immune system can reverse the process, but it takes time. Duration of Effects If any of these risks materialize, the duration of effect will last at least a medium amount of time Cascading Effects Nearly all risks have cascading effects. The whole system is closely interrelated. Operating Environment External exposure and outside events significantly impact many risk scenarios. Wear and Tear NA except as it relates to staff getting worn out from long shifts. Hardware/software/human/organizational Patient/staff interfacing increases exposure and negative impacts risk scenarios. Complexity and Emergent Behaviors There is a medium level of unknown system-level behaviors that are not anticipated for most risk scenarios. Design Immaturity Low impact for all

Results of Exercise The risk of local national emergency services keeping roads open and a local national infecting the base , both scored no higher than medium. Less than 10 local nationals work on base. In the event of locking down the base, they will not be permitted access. Security Forces from the base can ensure roads are accessible for fuel truck or patient transfers. These issues can be easily resolved. Additioanlly, the post outbreak scenario can be managed through staffing schedules. The worried well patient influx can be managed through enforcing clinical standards. The scenarios in yellow will be excluded going forward.

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