Patient Movement in the Midst of a Disaster Designing a successful exercise with measureable objectives; including Joint Commission’s six critical areas

Objectives By the end of this session, you will be able to: Define the Homeland Security Exercise Evaluation Program (HSEEP) List the seven building blocks of exercise in order Identify how SMART elements are used in writing objectives Define the key elements of facilitating an exercise Review a table top active shooter exercise

HSEEP - Defined “Homeland Security Exercise Evaluation Program” Capabilities-based exercise program Ensures consistent terminology Provides tools and resources to help build self-sustaining exercise programs. Generic process that is flexible. Meets the NIMS goals in HSPD-8 Define HSEEP – Homeland Security Exercise Evaluation Program Capabilities-based off of the 37 Target Capabilities – provide handout Discuss new Core Capabilities and alignment with Target Capabilities Example: On-site Incident Management – in almost any type of exercise, strong command and control for managing the incident is necessary. This would be built into the objective later on. All exercises need to be built from the perspective of what capability(s) are we trying to measure. Same process is used with a tabletop as with a full-scale exercise. Provides compliance opportunity for grant funding. If you are using grant funds to support this exercise, you are required to follow the NIMS and HSEEP. …….Handout on Compliance in their packet

Benefits of HSEEP Proven effective to validate plans, policies, agreements, procedures, Streamlines the exercise process Builds on same elements for each type of exercise (discussion-based or operational) Identifies gaps Identifies strengths Thus identifying priorities for funding, resources, time, etc….. Validate plans, procedures, agreements… Work off the plans you have or do you even have a plan, this is a pretty common request that we need to try to correct.. Whether you are designing a table top or full-scale exercise the same design elements are used Identifies gaps through lessons learned from past exercises or real events Overall goal – helps prioritize your need for funding, resource, equipment and so on.

Building-Block Approach to Exercise Scheduling Uses a cycle of increasingly complex exercises Builds upon lessons learned from previous exercises x First 4 building blocks are discussion based – the last three are operations based As the blocks start off the complexity of the exercise move from a more simple exercise such a as a seminar to a more complex exercise such as a functional. Refer to South Sound Water Exercise – lessons learned from various exercises with integrated agencies and jurisdictions was that each had their own response plan to water rescue in Puget Sound; however, through the process of exercises and corrective action plan improvement, a regional plan was established between the agencies, including state and federal, and the local dispatch on how to use available resources around the Sound for water rescue This process supports relationships building and the ability to work through issues that come up in a less stress environment, not during a real life incident…

Seminar Discussion-based exercise Informal discussion Designed to orient participants to new or updated plans, policies, or procedures. Example: A Seminar to review the hospitals evacuation/surge capacity plans. Review plans or procedures after this type of exercise or if this was agency specific it would provide you the opportunity to review plans during the exercise.

Workshop Discussion-based Exercise Used to build a specific product such as a draft plan or policy Example: A workshop to develop a new plan for patient placement during an evacuation. The real difference between a seminar and a workshop is a workshop you can leave with a product, actually produce a plan, or SOP

Tabletop Exercise (TTX) Discussion-based Exercise Involves key personnel Discusses simulated scenarios Informal setting Used to assess plans, policies, and procedures, agreements Example: Hospital Command Center staff, Facilities, Security and nursing leadership meets to discuss an ICU evacuation based off of a fire scenario. Discussion based exercise involving key personnel from the participating agencies… A scenario starts the exercise with moves that take you through the overall exercise… a move is the story that gets you to the end to meet your objectives/goals. Once again, starts building those relationships… even though it is supported to be low stress there are participants that will feel like uncomfortable with not having the correct response or knowledge. You will see in some cases key personnel will bring support staff to defer to

Game Discussion-based Exercise Simulation of operations Involves two or more teams (competitive) Uses rules, data, and procedures designed to depict an actual or assumed real-life situation. Example: Emerging technology with online scenarios. Games – this exercise building block is an emerging technology exercise building block - it is designed to be a more competitive exercise than three prior. Military uses this block more often that we do. As we have completed the last of the 4 discussion based exercise I hope you can see where we have gone from an education exercise, to discussing plans, policies and SOP’s to a technology driven exercise in preparation for the operational based exercises.

Drill Operations-based Exercise Coordinated, supervised activity Tests a single, specific operation or function within a single entity using internal SOPs Example: Hospital conducts a decontamination drill Drill – this is the operations based exercise in the building block series. Testing one single function or sop. i.e. fire dept performs a ladder drill, schools complete a fire drill, hospitals perform a patient tracking drill etc. What does this building block do to get to the next slide; it continues the relationship building , conflicting SOP’s in preparation for a functional or full-scale

Functional Operations-based Exercise Examines and/or validates coordination, command, and control through use of injects Between various multi-agency coordination centers with key personnel Does not involve any “boots on the ground” Example: Fire in hospital scenario. Hospital Command Central activates and coordinates with first responders for patient movement As we are getting closer to the last of the building blocks this type of exercise is much more design intensive. You will need to identify an exercise director from your design team, (refer to someone in the audience), you will have a simulation cell, controllers, evaluators. Scenario driven with a MSEL (Master Scenario Events List) that will take you through the exercise with major injects and expected outcomes This will be facilitated in a room, it is not boots on the ground

Full-Scale Operations-based Exercise Multi-agency, multi-jurisdiction, multi-discipline Involves coordinating response Involves “boots on the ground” response Example: Earthquake scenario, one hospital in the region severely damaged and must evacuate to surrounding hospitals. This would involve, fire, hospital, EMS, transportation, law, EOCs, etc. Last of the 7 steps Full scale – brings all the components together , building capabilities to respond more effectively and efficiently to a real world incident Boots on the ground, not simulated, evaluators, controllers. MSEL to support the exercise to verify objectives are reached I would assume most of you perform this type of exercise. We hope you see the importance of the HSEEP model Started with an seminar - education and ended with multi agency, multi jurisdiction, multi discipline fullscale exercise.

You Tell Us! Activate the Hospital Command Center What building blocks are needed to successfully evaluate the following: (Sample) Patient care during an incident Seminar to explain plans Tabletop to walk through the plan, setup, and resources Drill to triage patients, as walkthrough Full scale exercise – from activation request to actually moving patients Slide transition Sample: what building blocks would you feel would best support this scenario of a “setting up a mass shelter” Seminar – educate participants on what a mass shelter is and why it would be used Table top to walk you through the plans, set up, sop’s contact info Drill to physically set up cots or set up feeding station etc Then completing it with a full scale from activation to volunteers/actors arriving to demob. Here is one for you – for you to test the city EOC, what building blocks would you use? Seminar -- educate them on EOC Operations, personnel, responsibility Workshop - put together pod supplies, SOPs TTX -- review activation of the EOC Game – competitive game between 2 pods to see who could arrive and setup first Drill – going through a telephone tree notification Functional – radio operations relaying messages into the EOC or policy group making decision Full-Scale – activation to demobilization That completes the HSEEP building blocks 10 minute break – please be back on time Activate the Hospital Command Center

What are Objectives ? Cornerstone of design and development Define specific goals Provide framework for scenario development Drive formulation of Master Scenario Events List (MSEL) Guide development of individual organizational objectives Provide evaluation criteria by focusing on what needs to be accomplished during exercise Lessons Learned: Limit the number of objectives to enable exercise conduct, facilitate reasonable scenario design, and adequately support successful completion of the exercise. Need to focus on primary objectives rather than a long list; stay within the scenario.

Exercise Design Planning Team Creates the Objectives Uses HICS structure Includes representation from key participating agencies Incorporates Subject Matter Experts (SMEs) Employs project management principles Follows a standardized design/development process Support of leadership in each participating agency Effective Project Management Principles include: Identification, development, and management of critical and supportive activities; Frequent communication about project status; Use of management plans and timelines (e.g., project management timeline, scheduling software, Gantt charts). Elements may also include: Establishing support from leadership Team Commitment Developing timelines Multi-year planning Budgeting Grant management Staff hiring (or recruiting Exercise Design team members) Funding allocation Expenditure tracking Identify necessary documentation

Differences in Objectives Discussion-Based Exercise Objectives: Typically focus on strategy and policy-oriented issues (discuss/review plans, SOPs) Operations-Based Exercise Objectives: Typically focus on integration of multiple entities and systems-level and tactical-level issues (activation of plans, SOPs)

SMART Objectives Simple: an easily understood statement Measurable: can be gauged against a standard Achievable: challenging but not impossible Realistic: plausible for your jurisdiction and germane to what you want to accomplish Task-oriented: tied to a task and measures what you want to exercise

Example Objective Discuss the process for establishing… WHO: Hospital command WHAT: to include naming the incident and setting incident objectives and priorities CONDITIONS: during a chemical/hazmat spill STANDARDS: in accordance with existing standard operating procedures (SOPs). Addresses tasks 5.1- Establish Incident Command and 6.1 – Establish incident objectives, priorities, and operational periods

Sample Objective Discuss the process for establishing hospital command to include naming the incident and setting incident objectives and priorities during a chemical/hazmat spill in accordance with existing standard operating procedures (SOPs). So when you read it like this, you can see how it is a discussion based exercise because it is focusing on strategy and policy.

Who is Involved in an Exercise? Participants Evaluators Observers/VIPs Facilitators Recorders Controllers Actors Volunteers Simulators Talking Points There are four personnel roles for discussion-based types of active personnel that we will discuss. Evaluators work closely with the participants and provide a direct link between the facilitator and the participants during the exercise discussion. Facilitators provide leadership for the evaluation team and keep the exercise moving. Recorders should not have an active role in the discussions, but should record all exercise play relevant to the evaluation. Observers should be given access to the discussions, but should not interfere in exercise play. Each of these will be discussed in greater detail in the slides that follow. Notes Do not discuss each of these in detail. Each is covered in the slides that follow.

Facilitators Discussion-Based: Operations-Based: Facilitates discussion and coordinates issues between groups Focuses the group’s discussions on specific areas and questions Recognizes issues to be resolved Verifies notes provided by the recorder Operations-Based: N/A Roles and Characteristics: Should be comfortable talking in front of large groups of people Knowledgeable on plans and policies Exercise facilitator is the administrative leader of the discussion-based exercise, coordinating the activities of the evaluators and participants. Reviews expectations, objectives, and rules of play for the exercise Introduces and/or presents the various modules Facilitates discussion and coordinates issues between groups Identify how issue resolution be accomplished – may be during “hot wash” -- there are options on how to resolve the issues that are identified during the discussion-based exercise. Group facilitator Focuses the group’s discussions on specific areas and questions Recognizes issues to be resolved – be sensitive to “hot topics” – allow discussion to occur but be able to “pull back” when necessary. Ensures a group spokesperson is designated and prepared to report back during the plenary session Verifies notes provided by the Recorder Tools to be Provided: Knowledge about the SOPs, EOPs, culture of the group Available SMEs participating Exercise Handbook appropriate to the discussion-based exercise

Review Active Shooter Table Top Exercise… Thank you for your participation Marci Scott, Program Manager Pierce County Dept. of Emergency Management mscott@co.pierce.wa.us