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

2. 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

3. 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

4. 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.

5. 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…

6. 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.

7. 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

8. 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

9. 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.

10. 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

11. 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

12. 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.

13. 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

14. 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.

15. 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

16. 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)

17. 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

18. 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

19. 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.

20. 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.

21. 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

22. Review Active Shooter Table Top Exercise…
Thank you for your participation
Marci Scott, Program Manager
Pierce County Dept. of Emergency Management