Tools for Planning and Conducting Relevant Exercises for Health Care

Facilities

Presented by: BCFS Health and Human Services Emergency Management Division

Dee Grimm RN, JDLisa Amaya, MHA

Webinar Objectives• Understand the importance of exercises for

health care facilities • Discuss how to design, implement, and

coordinate an effective exercise plan • Learn how to effectively conduct an exercise • Use the information learned from the exercise

to better prepare for real disasters

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Why do we exercise? • Regulatory

requirements (JC, OSHA, CMS, NFPA)

• To evaluate our level of preparedness for a real disaster

• To improve our organizations capacity to execute its response plan

• To find out if our plans really work

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Joint Commission Requirements • Test Emergency Operations Plan (EOP) twice a

year, either in response to an actual emergency or in a planned exercise. Tabletop ONLY is not acceptable.

• One exercise to include an actual or simulated influx or patients

• Conduct exercise in an escalating event without community support once a year

• Participate in one community-wide exercise(EM. 03.01.03)

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Joint Commission Requirements cont.• Incorporate a likely scenario that allows evaluation

of the six critical areas – resources and assets, communications, security, staff roles and responsibilities, utility systems, patient clinical and support care activities

• Must reflect likely disaster scenario related to Hazard Vulnerability Analysis (HVA)

• One person who is knowledgeable in goals and expectations of exercise to monitor performance

• Completed exercises are critiqued through a multi-disciplinary process

(EM. 03.01.03)

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CMS – Training and Testing • Program based on emergency plan, risk

assessment and communication plan • Maintain and at a minimum update annually • Provide training to all staff, registry, volunteers,

and maintain documentation• Demonstrate staff knowledge of emergency

plans

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CMS – Training and Testingcont.• Participate in a community drill or individual

facility-based exercise • Full scale and tabletop exercises (TTX)• Must analyze response and revise plan

accordingly• Complies with Federal and State laws

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Homeland Security Exercise and Evaluation Program (HSEEP)• HSEEP purpose:

- The Homeland Security Exercise and Evaluation Program (HSEEP) is a capabilities and performance-based exercise program which provides a standardized policy, methodology, and terminology for exercise design, development, conduct, evaluation, and improvement planning. -

• HSEEP volumes can be adapted to a variety of scenarios and events (e.g., natural disasters, terrorism, technological calamities)

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Homeland Security Exercise and Evaluation Program (HSEEP)cont. • Conforming to Best Practices

- Adherence to the policy and guidance presented in the HSEEP Volumes ensures that exercise programs conform to established best practices and helps provide unity and consistency of effort for exercises at all levels of government.

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Types of Exercises• Discussion-Based

- Workshops- Tabletops - Games/Models- Simulations

• Operations-Based - Drills- Functional - Full Scale

https://HSEEP.dhs.gov

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How Do You Know What to Exercise?• Emergency Operations Plans (EOPs)/ Hazard

Vulnerability Analysis (HVA) • Review regulatory requirements • Review past exercises/After Action Reports (AAR)• New policies and procedures • New facilities, personnel, or equipment added to your

organization• Coordination with local or state jurisdictions, related

agencies

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Sequence of Tasks

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Exercise Design Team • Develop objectives • Develop scenario• Develop sequence of events • Develop messages • Assist in the development and distribution of pre-exercise

materials • Assist in pre-exercise training sessions • Participate in actual exercise and follow-up evaluation• Contribute to the development of the After Action Report

(AAR)

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Define Objectives • What is the objective (purpose) of your exercise?• Objectives are used to evaluate performance of

participants and systems • Based on facility assessments – What needs to be

tested? (see “How do you know what to exercise?” slide) • Must be clear and concise (SMART)• Must state a standard of performance • Tied to target capabilities in the HSEEP process • Drives the development of evaluations

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SMART Objectives

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Sample Objectives• Test our communication system to see if it

works correctly • Demonstrate the ability to assemble our

Incident Command Team within 30 minutes of notification of a disaster

• Identify and activate an alternative backup communication system within 30 minutes of the primary system failure

• Identify primary reason for slow response of ambulance units

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Compose a Scenario • Brief description of events that have occurred

up to the minute the exercise begins • Sets the mood and stage for action • Specific sequence of events • Follows chronological order • Present tense

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Develop Sequence of Events • Exercise scenario details

- Links the simulated events to actions you want people to take

- Provides unity to exercise- Should follow the statement of purpose and

objectives - List expected actions you want participants to carry

out in order to demonstrate competence

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Major Event• Small fire occurs within a three story long-term

care facility housing 150 residents. • Thirty (30) of those residents reside on a

specialized unit for patients with Alzheimer's.• An electrical control panel in the basement

creates a smoke condition that activates fire detection and suppression systems throughout the building.

• Electrical service in the facility is lost.• Residents begin to panic and complain of the

smoke.

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Developing your injects • Communicate details to

participants • Used to evoke a specific

measurable response • Should generate an

expected action • Transmitted via phone,

radio, fax, or by person• Keep it realistic

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Sample Injects• The media arrives to get information about the

event. • At the same time, family members arrive on

location or call the facility to inquire about their loved ones.

• While evacuating, one resident inadvertently exits the building becoming disoriented thereby initiating a “Code Gray” or resident elopement alert.

• Need ambulance units to transport 20 medically fragile patients

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Putting it all together • Exercise Plan (ExPlan) • Master Scenario

Events List (MSEL)• Controller and

Evaluator (C/E) Handbook

• Exercise Evaluation Guides (EEGs)

• Player Handout

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Exercise Plan (ExPlan)• Overview – type of exercise, scope, dates,

locations, narratives, and objectives • Distribution audience – players and observers• Assumptions, artificialities, simulations • Exercise management structure and

responsibilities • Safety and security • Administration and logistics

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Master Scenario Events List (MSEL)

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Controller and Evaluation (C/E) Handbook• Assumptions, artificialities,

simulations • Concept for management,

control, and simulation • Assigned controllers and

responsibilities • Problem resolution and

reporting procedures • Communication, logistics,

administrative support procedures

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Exercise Evaluation Guides (EEGs)• Exercise concept • Assumptions,

artificialities, and simulation

• Concept for evaluation team

• Evaluation team responsibilities and procedures

• Evaluation team support

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Player Handout • Key information for players• Exercise scope – concept, narrative, and

assumptions• Player procedures and responsibilities • Safety and security• Communications• Player exercise briefing schedule • Maps, charts, and pertinent visuals

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Full Scale Exercise (FSE)

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FSE Overview • Most functions within the EOP are tested • Realism created by “victims”, equipment, and

personnel • Players are from all levels of personnel or

government • Real-time actions generate real responses • Multi-agency involvement • EOC is activated • Messages can be visual as well as prescripted

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Special Considerations • Site selection • Scene management • Personnel and

resources • Response capacity • Safety and legal

liability • Emergencies • Media

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Scene Management • Weather and

environment factors • Set-up of victims • Staging area • Moulage • Disaster simulation • Props and materials • Number of controllers

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Personnel and Resources • Participant time • Overtime cost • Allocation of

equipment (fuel) • Replacement of

damaged items • Allocation of supplies • Depletion of real

response capacities • Visuals (maps, charts,

videos, and laptops)

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Safety and Legal Liability • Assign each team member to examine the

safety issues with their discipline • Include safety procedures in all handbooks• Examine site before the exercise • Ensure safety officer has authority to terminate

an activity or exercise if necessary • Provide for call-off procedures • Safety procedures are explained to EVERYONE

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Use of Casualty Volunteers

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The Evaluation Process

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Evaluating starts at the beginning• Pre-exercise Phase

- Match evaluation with objectives - Develop evaluation methodology - Select and train evaluators

• Exercise Phase - Observe assigned objectives - Document observations

• Post-exercise Phase- Assess achievement of objectives - Develop evaluation report - Participate in After Action Meetings (AAM)

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Evaluation Methodology • How the team will be

structured • Objectives to be

measured • Criteria used to

determine if exercise is successful

• Evaluation forms to be used

• Lines of authority

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Effective Evaluation • Plan the observation

process• Be unobtrusive • Provide points of review

for reach objective being evaluated

• Make evaluation forms simple and clear

• Know what elements are key evaluation points

• Evaluate processes, not people

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Evaluation Debriefing • Hotwash

- Immediately after exercise - Need a controller to

facilitate - For players only - Keep it brief- Evaluators will record

comments on debriefing logs

- Hand out Participant Feedback Forms to be turned in prior to exit

- Not to critique exercise itself, but actions during the exercise

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Data Collection/Analysis • Evaluators retain notes and records of the

exercise to support the development of the After Action Report (AAR)

• Consolidate data and determine whether participants performed critical tasks. Were objectives met?

• AAR must include overview of performance related to exercise objectives while highlighting strengths and areas for improvement

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Improvement Planning • Conduct After Action Meeting (AAM) to review

After Action Report (AAR) • Determine corrective actions- should be

concrete, actionable steps intended to resolve capability gaps identified in exercise

• Ensure accountability when identifying corrective action owners/assignees

• Develop deadlines for implementation of corrective actions

• Finalize AAR/Improvement Plan (IP)

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Keys to a Successful Exercise • Everyone is on the same page • Everyone understands their roles • Effective communications• A safe environment • Happy volunteers • Excellent supervision and control • Productive and meaningful evaluation process

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Questions Presenters: Denise Grimm & Lisa Amaya, BCFS HHS EMD Contact: Loretta Kuhn, Asst. Director & HPP Manager (903) 593-4722/ Loretta@rac-g.org / rac-g.org

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