1. Mexico 2017

2. Santa Barbara County Disaster Healthcare Partners Coalition Presents
Disaster Exercises How to conduct a disaster exercise that prepares your staff & meets CMS disaster rule requirements

3. Welcome EARTHQUAKE Scenario: Post on the board! Write down:
2 things you think your facility or agency should practice for an earthquake event
Post on the board!

4. Santa Barbara County Public Health Emergency Medical Services Agency
and
Emergency Medical Services Agency
Jan Koegler, MPH
Program Manager
Stacey Rosenberger, MPH
Emergency Planner

5. Mexico 2017

7. Agenda: Disaster Exercises
Benefits and requirements for disaster exercises
How to conduct a “tabletop” exercise
Required forms: Exercise plans and after action reports
How to conduct a full scale exercise
Practice: Let’s conduct a full scale exercise

8. Benefits and Requirements of Disaster Exercises
Prepares and protects your clients, facility, or agency
Educates your staff re: procedures
Team building
Meets accreditation or licensing requirements
Meets Centers for Medicare- Medicaid disaster rule requirements

9. Four core elements of CMS rule
Emergency Plan
Based on a risk assessment
Use an all- hazards approach to risk assessment
Update plan
annually
Policies & Procedures
Develop based on risk assessment and emergency plan
Must address: subsistence of staff and patients, evacuation, sheltering in place, tracking patients and staff
Review/Update annually
Communications Plan
Complies with Federal and State laws
Coordinate patient care within facility, across providers, and with state and local public health and emergency management
Annual update
Training & Exercise Program
Develop training program
Initial and annual training on policies & procedures
Conduct drills and exercises
Tabletop annually
Full-Scale community based exercise annually

10. Annual Exercise requirements
Conduct one FULL SCALE EXERCISE annually
Must participate in a community based exercise if offered
The PHD annual medical and health exercise in November is a community based exercise
SNF/ICF’s have option to do PHD/ EMS Agency annual evacuation exercise as full scale
Conduct one additional exercise
Can be a tabletop exercise

11. Types of Disaster Exercises
TABLETOP
FUNCTIONAL
FULL-SCALE
“Talk –Thru”
Demonstrates:
Knowledge of policy/ procedures
Facilitator presents a scenario and ask key staff questions.
Staff should answer according to existing policies and procedures
Determine additional policy and procedures needed
“Hands On”
Facility ability to locate and activate plans, assign roles.
Activate Command Center.
Communication with partners
Staff knowledge of forms and procedures
Activate staff call back and alerts.
“Walk-Thru”
Ability to activate command center according to policy, communicate, assign roles, use checklists and policies
AND
Moves patients, supplies, equipment, staff
Triage for patients
Set up of surge areas
Use of generator to test essential services
Use of paper forms.

12. Disaster Exercise Process
Read/Train
Procedure
Discuss Procedure “talk thru”
Do Procedure “walk thru”

13. Tabletop “Talk-thru” Large OR Small

14. Step 1: Assemble planning group
Who to Invite to a planning meeting:
Who is responsible for emergency operations during a real event?
Administrator, managers, supervisors
Who is responsible for writing emergency plans and procedures?
Safety officer, environmental services, other
Who is responsible for safety and facilities day to day?
Facilities personnel, office administrators

15. Step 2: Meet with Planning group
Present the hazard
“Earthquake that disrupts utilities and damages facilities”
Determine policies and procedures to test
Earthquake procedures
Utility outage procedures
Request a facilitator for the tabletop
Staff who is used to facilitating meetings
Hired or volunteer facilitator
Determine who to invite and date/time of exercise

16. Who will Facilitate?

17. Step 3: Determine Objective (s) to “Test”
You can’t test everything in your policy/procedure
Prioritize and pick 1-3 objectives:
“Exercise our SNF facility plan to provide care with a loss of utilities for 36 hours after an earthquake”
Write a scenario that sets the scene
Develop questions to “test” your policies and procedures
Assign a Scribe: to capture answers/suggested improvements for your after action report

18. Tabletop Template

20. Tabletop Exercise Plan Template

21. Tabletop Exercise Plan Template
Do you want to provide these plans, policies, or procedures in advance?

22. Sample Tabletop Questions In the “Situation Manual Tabletop Template”

23. Tabletop in Action : Let’s Practice
Staff and Supplies:
Facilitator
Scribe(s)
Whiteboard or Large Sticky Paper/Pens so that comments are seen by all
Evaluation Forms

24. Tabletop in Action: Let’s Practice
Scenario: Today at 5:00 pm a 7.4 earthquake occurs. Power is out and cell communication is sporadic. Power is not expected for 72 hours. It is 90 degrees.
Our facility appears to have suffered at least some damage and at least 5 injuries of staff and patients are reported.
Objectives for the Tabletop
Exercise facility ability to provide essential care after an earthquake with a 72 hour power outage
Exercise facility ability to communicate with staff during a disaster with limited cell service.
Other: What do you want to practice?

25. Tabletop in Action: Questions to “test” your policies and procedures
Objective:
Exercise facility ability to provide essential care after an earthquake with a 72 hour power outage
What actions are our staff supposed to take during an earthquake?
Is this stated in a policy or safety plan? Where is the procedure located?
Does our facility have a plan to assess and treat staff and patients/clients injured during an earthquake? If yes, where is it?
When were staff trained on this plan? Have we tested this procedure?

26. Tabletop in Action: Questions to “test” your policies and procedures
Objective:
Exercise facility ability to provide essential care after an earthquake with a 72 hour power outage
“What type of heating and cooling can we provide during the impact of the power outage?”
“Who is responsible for the HVAC? Where do they live? Who is the back up?”
“According to our procedure, how will you communicate with the next shift of staff?”

27. Tabletop in Action: Questions to “test” your policies and procedures
“Power is out and cell communication is sporadic.”
Objective: Exercise facility ability to communicate with staff during a disaster with limited cell service.
“Do we have an emergency communication plan”
“According to our procedure, how will you communicate with the next shift of staff?”
“What is our facility’s plan to communicate with staff on shift? And off shift?”
“Do we need to write a communication plan or procedure for disasters/outages?”

28. Tabletop Debrief “Hot Wash”
For each question wrap up with a review and ask participants (noting responses):
What did you learn during the tabletop?
What went well?
What critical issues for improvement were noted?
What additional critical issues did you identify?
What do we need to do now?
Get participants’ commitment to next steps:
Add a back up generator maintenance role
Provide staff with generator training
Update procedure

29. Participants Evaluate Tabletop

30. After Action Report

31. What is a Full Scale Exercise?
Staff demonstrate knowledge of emergency plans
Moving people & equipment
Activating Plans
We will help you understand how to do a full-scale exercise!

32. Disaster Exercise Process
Read/Train
Procedure
Discuss Procedure “talk thru”
Do Procedure “walk thru”

33. Training on Procedures

34. Tabletop “Talk-thru” Discussion Large OR Small

35. Full Scale Exercise – Do Procedure
Forms you will need:
Full scale exercise plan
Schedule of exercise events and evaluation guide
Participant evaluation form
After action report

36. Full Scale Exercise Plan: Template

37. Template: Full Scale Exercise Plan

39. Template: Full Scale Exercise Plan

40. Template: Full Scale Exercise Plan- Safety

41. Template: Full Scale Exercise Plan- Schedule of Events AND Evaluation

42. Template: Full Scale Exercise Participant Feedback Form

43. Template: Full Scale Exercise After Action Report

44. Full Scale Exercise - Activities
Earthquake/Evacuation of facility:
Accounting for patients/clients/public
Activating your response plan
Activating “Who is in charge” command structure
Triage and treatment of injured
Accessing and using your emergency supplies
Tracking patients/clients who are moved
Practicing Communication Plan
Assessing and reporting your status to PHD
Making a resource request
Conducting a building assessment

45. Evacuation-How will you exercise?
Move from one side of building to another
Move mock patients or real patients out of building
Collect personal belongings, medical records, medication etc.
Time test how long it will take
Make sure staff account for clients and follow all procedures for residential clients
Reminder: Review your CMS and accreditation requirements-differs by facility type

46. Full Scale Evacuation of ICF

47. Full Scale: Accepting Evacuees

48. Full Scale: Mock Evacuees/Patients

49. Full Scale: Power Outage Activities
Demonstrate and evaluate how your agency/facility would do in a power outage:
Staff access disaster plan, patient forms, and conduct a staff call back without power or only generator power
Turn off power and go to generator only. Have staff care for patients on generator only (or no power).
Staff demonstrate actions required in plan related to keeping patients safe if no HVAC
Administrator decides at what point evacuation from facility or home (home health) is necessary
Have staff demonstrate ability to access all lanterns, lights, fans, etc. and assess their functionality/capacity.

50. Full Scale: Sewage Outage
Staff demonstrate what agency/facility would do in a sewage outage:
Set up emergency toilet supplies and determine how long they would last
Set up emergency handwashing supplies and determine how long they would last
Staff use plan/procedure that states what you will do if no sewage
Make requests for portapotties through vendor, public health, or city EOC.

51. Full Scale: Food and Water
Determine requirements and/or need for food and water supplies in your facility or agency
Staff assess food and water status
Report how long food and water would last
Get out your disaster menu

52. Full Scale: Medical Surge
Set up area for patient care overflow inside building or in parking lot
Use tents or pop ups, conference rooms, waiting areas
Bring out surge supplies
Assign staff to areas and roles
Prepare for injured from earthquake or for patients from a damaged facility
Example: Isla Vista Clinic patients go to UCSB student health

53. Full Scale Demonstration
Hand colored card admin (leader procedure), staff (25-5 injured), clients/patients (20-10 that are injured
Play earthquake sound
Drop and cover
Injured stay where you are
Set up command structure
Use PHD earthquake checklist or hospital incident command guide, building assessment form, status form, staff accounting form, first aid kit

54. Getting Ready for Full Scale Exercise
Tabletop policies and procedures
Make any changes to policies and procedures that were identified during the tabletop
Train staff on policy & procedure changes
Identify areas you want to test during full scale exercise
Develop exercise plan (schedule, who will participate, clients or patients involved, actors, logistics etc.) and provide staff with information about the exercise (possible training on their roles)

55. Training on Procedures

58. Basic Areas to Test:
Set up Command Structure
Set up your ICS structure and assign staff to roles
Triage and Treat
Identify staff and patients that have been injured during the event- triage & treat
Assess Your Facility
Assess your facility: structure, power, water etc.
Communicate your status
Communicate the status of your facility to the PHD and licensing

59. Let’s Practice Full Scale

60. Your Role X= injured and unable to move L = Incident Commander
Purple = Command Staff Yellow = Staff Blue = Patients/Clients/Re sidents Evaluator=2
X= injured and unable to move
L = Incident Commander

61. Command staff- following the earthquake come to the front of the room to get your assignments
Staff- check on your patients and conduct any tasks command staff assigns you; if injured stay where you are
Patients- ask staff what is going on, if injured stay where you are

63. Debrief “Hotwash” What went well? What could be improved?
What supply or equipment issues did you notice?
What improvements are needed in our procedures?
What kind of training is needed?

64. Evaluation Form

65. After Action

66. Next Steps Conduct Full Scale Exercise on or before November 16th
Attend October 10 or 12 training
Plan & conduct Tabletop at facility
Plan for Full-Scale Exercise
Conduct Full Scale Exercise on or before November 16th

67. Resources

68. Thank You!
Please remember to complete & turn in your evaluation