Training and testing: guiding towards readiness Jonathan Bundt, LMFT, MN CEM

Policies and Procedures Sectors of Excellence Prepared to Respond Emergency Plan Policies and Procedures Communication Plan Training and Testing

Pacing ourselves

Critical guidance themes Review and updates minimally on an annual basis Training must include the initial onboarding of all employees, volunteers and others (and documented) Demonstration of knowledge and conducting drills and exercises to test plans By November 15 must complete: All staff training Participate in full scale exercise that is community based (if one is not available then facility based.) Unique variances: Outpatient providers do not need to provide sustenance needs Home health and hospice must communicate evacuation needs LTC and psychiatric residence but share plan with residents, family members and representatives

FIVE “R”S of exercise Realism Repetition Review of Performance Responsibility

Training and Testing Program “Must reflect the risks identified in the facility’s risk assessment…” Potential elements to test: Communicating facility closure. Who do you notify? Patient tracking and record sharing Transportation procedures All trainings/tests must be documented and maintained for at least 3 years. Delivery method can vary All trainings must be documented in staff training file

Who is trained and what is tested Training- education and instruction Anyone that touches the response: Patient, family representative Staff (onboarding and ongoing) Contractors Volunteers Testing is the operationalized process of evaluating the effectiveness of training and the response program. Identification of gaps Is there a written program that has been reviewed and updated, at least annually Demonstration of knowledge

Unique variances in training Multi locations must have training that is site specific Sites can have discretion on what they want to train. Use lessons learned from previous exercises and real world events like Hollywood Hills Items identified from annual review This can be new evacuation procedures Review role of each staff person and train to the role If you experience a real world activation of your emergency plan, you are exempt for the next year from that event.

Exercise program Building Blocks of Exercise Design Operations-Based Drills Functional (FE) Full-scale (FSE) Multi-Year Planning Engaging stakeholders Resource management Exercise phases Exercise types Discussion Based Seminars Workshops Tabletops (TTX) Games Building Blocks of Exercise Design

Core of exercise design Process Initial Concept Objectives Scenario Design Final prep Execution/ Evaluation Improvement

Table top exercise Group discussion that can vary in level of complexity Identified facilitator, using a narrative Creating a relevant scenario Challenge statements to work on Who should be there? Key personnel who will be involved in decision making Used to assess plans, policies and procedures

Drills Building blocks of a response Testing Use of a fire extinguisher Emergency notification of staff Patient movement Transportation and vendors resource availability unannounced Verbal test of staff “Who do you contact if this happens…?” Could ask a patient: “What do you do to remove yourself from a dialysis machine right now? What are your alternate service locations?” LTC will include unannounced staff drills

Full Scale Exercise Assesses facility's functional capabilities by simulating a response to an emergency that would impact the facility’s operations. Involves multi agencies, jurisdictions and disciplines. Multi regional elements Realism Utilization of a healthcare coalitions Comprehensive documentation of: Participants Lessons learned Improvement

documentation TTX and FSE include the exercise plan, After Action Report, and other support documents Documentation of attempts to identify a FSE Improvement plan and how the emergency plan has been updated

Homeland security Exercise Evaluation program (hseep) Is a capabilities and performance-based exercise program that provides a standardized methodology and terminology for exercise design, development, conduct, evaluation, and improvement planning. Your programs DO NOT have to be compliant to the HSEEP process!

Full Scale Exercise management Foundation Planning timelines Planning team Planning conferences Design and Development Capabilities, Tasks and Objectives Scenario Documentation Logistics Exercise Conduct Setup Presentations Personnel Evaluation Hot wash and debrief After action report/ Improvement plan Improvement plan Tracking and planning

Planning conferences Concept and Objectives (C&O) Type, scope, objectives Initial Planning Conference (IPC) Lays foundation Assigns responsibility to planning team members Mid Term Planning (MPC) Resolves logistical and organizational issues Master Scenario Events Lists (MSEL) Final Planning Conference (FPC)

Documentation Exercise plan (EXPLAN) Controller and Evaluator (C/E) Handbook Master Scenario Events List (MSEL) Briefings Exercise Evaluation Guides (EEG)

Evaluation Evaluators Whom are they? What is their role? Helping them be successful Debriefing Small and large groups Role players “Hot wash”

After Action Report and improvement plan AAR Pulling it together AAR meeting Final finances Documentation ownership Improvement Plan Tracking improvement Keeping the momentum Returning to training and testing

Here we go: lets start a Tabletop exercise

Participant Expectations Scribe for group to identify discussions, decisions and lessons learned No stress and non-judgmental exercise environment Don’t make too many assumptions about what you can do and what is understood about the scenario Don’t over think the current situation Residential versus home or outpatient programs will have different elements. Some agencies will have elements of both!

Exercise Objectives Assess the capability to identify and notify staff of current situation. How and what is communicated? Identify what emergency plans are available to activate for an immediate response to the emergency. Develop plans that don’t exist that will have to be developed on the fly for your agency. Maintain situational awareness of safety issues for residents/patients, staff, volunteers, family members and visitors.

Initial Incident Information Insert your reality: Facility flooding Utility outage: power and water Regional impact Decision to evacuate the facility has been made Incident is occurring in real time of today and this time Deliver at 12:00 hours There has been a mechanical failure in the local water supply. The city is unable to provide water to not only the long term care facility, but to the entire city at this time. The backup water supply plan that the city has in place is also impacted due to chemical contamination that is associated with the initial mechanical failure. At this time, the city is advising all consumers of water to find alternate sources of water for the next 24 hours. The local convenience stores, grocery stores, and other retailers are already rationing their available water. The ration is two cases per person, per purchase, with a total limit of 6 cases total per day, and only for those who have an identification card or utility bill that states that they are a city resident. All retailers within an hour driving distance from the facility are already reporting that their stock is depleted.

Contact information Jonathan Bundt Jonathan@MasaConsulting.com 952-922-0422