Emergency preparedness: Drills and exercises in the LTC Environment Exercise planning: November 2017 Luke Bowen, MBA, EMT-P I/C Operations Manager Macomb County EMS Medical Control Authority Region 2 North Healthcare Coalition Serving Macomb, Oakland, and Saint Clair Counties  

Introductions Luke Bowen, MBA, EMT-P I/C Operations Manager- Macomb County EMS Medical Control Authority 30 Years in EMS 15+ years teaching experience (5 years FT) MCA responsibilities include emergency management role in Macomb County EOC Local, state, and national speaker on various EMS topics Attend and teach several courses at the National Fire Academy in Emmitsburg, MD Includes courses on drill/exercise response and design Have created and coordinated several county-wide disaster response exercises

Objectives/outline Review key principals of emergency preparedness Importance of ERG/EOP/EP development and updates Review hazard identification (all-hazards approach) The role of drills and exercises to enhance response within your facility Post exercise analysis and implementing change based on lessons learned Hot-wash and AAR-IP November 2017 LTC Exercise: Overview and Objective Creation

Fundamentals of emergency prep Four element model Five element model (2015) Prepare for any emergency Respond to the emergency Recover from the emergency Mitigate and prevent an emergency Prevention. Prevent, avoid or stop an imminent, threatened or actual act of terrorism. Protection. Protect our citizens, residents, visitors and assets Mitigation. Reduce the loss of life and property by lessening the impact of future disasters. Response. Respond quickly to save lives, protect property and the environment, and meet basic human needs in the aftermath of a catastrophic incident. Recovery. Recover through a focus on the timely restoration, strengthening and revitalization of infrastructure, housing and a sustainable economy https://www.fema.gov/national-preparedness-goal

All-hazards approach Nuclear event Government de-stabilization (invaded by Canada!) Weather Mechanical system failure (burst water pipe) Service interruption (power, water, sanitation) Vendor/supplier failure (food, linen, medical supplies) Pandemic (H1N1 influenza) Civil unrest- terrorist event

HVA- Hazard vulnerability analysis

Why do we exercise our plans? Currency Intimate knowledge Low frequency – high acuity event Staff turn-over Proficiency Efficiency LIFE SAFETY!

One-Minute “Time-Out” Exercise Exercise vs. drill One-Minute “Time-Out” Exercise

Exercise vs. drill

Planning and resources

Before design- we write smart objectives (Time Based)

Post exercise hot-wash A hot-wash is the immediate "after-action" discussions and evaluations of an agency's (or multiple agencies') performance following an exercise, training session, or major event. The main purpose of a hot-wash session is to identify strengths and weaknesses of the response to a given event, which then leads to another governmental phase known as "lessons learned," which is intended to guide future response direction in order to avoid repeating errors made in the past. A hot-wash normally includes all the parties that participated in the exercise or response activities. These events are used to create the After Action Report- Improvement Plan

Aar-ip after-action report - improvement plan Detailed written report which comprehensively covers the event Name, date, time, location Objectives Stakeholders Summary of exercise MSEL Master Scenario Event List Assessment of objectives and outcomes Lessons learned Improvement plan

NExT STEPS See: LTC Exercise- Exercise Overview See: Exercise Sit Man (Situation Manual)

Example 1 Revision as s.m.a.r.t objective Entrance and exit to the facility. Revision as s.m.a.r.t objective Assess the ability to restrict access to the facility to necessary staff and identified responders during a closed pod exercise.

Example 2 Revision as s.m.a.r.t objective Staging – are we really prepared to “triage” and treat victims? Revision as s.m.a.r.t objective Assess the ability to rapidly assess a large number of residents who were potentially exposed to residents having signs and symptoms of fever.

Example 3 Revision as s.m.a.r.t objective Unified Command – blending the facility knowledge of each patient and their specific needs in order to coordinate safe evacuation technique with our community emergency responders Revision as s.m.a.r.t objective Assess the ability for the facility incident commander to interact with patient transport services in order to safely move affected patients to an alternate care facility.

Example 4 Revision as s.m.a.r.t objective Tracking evacuated patients, sending staff with these patients, follow up with the patient to ensure new location was able to meet their needs. Revision as s.m.a.r.t objective Write objective here.

Example 5 Revision as s.m.a.r.t objective Activate our ICS Assess the ability engage all of those with defined capability within the organizations incident command structure in order to effectively activate the incident command system.

Example 6 Revision as s.m.a.r.t objective Contact the Local Health Department, along with our hospital and pharmacy. Revision as s.m.a.r.t objective Write objective here.