Professional Documents
Culture Documents
This section is a practical summary which the exercise planning team can use to
walk-through the Exercise Process.
Pre-Exercise Activities
Since emergency exercises are done to assess the effectiveness of the hospital
emergency operations plan, the first step in planning is to review the EOP. While
reviewing the EOP, the exercise planning team is suggested to consider the
1
This section is largely adapted from 1) “Exercise Design Independent Study Course.”
Emergency Management Institute - United Stated Federal Emergency Management Agency.
March 2003 and 2) Public Health Emergency Exercise Toolkit: Planning, Designing,
Conducting and Evaluating Local Public Health Emergency Exercises 2006, Columbia
University School of Nursing- Center for Health Policy - with the concepts applied to the
setting of Hospital and Health Facilities.
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following questions. This will guide the team through the succeeding steps of
exercise planning.
After reviewing the EOP, exercise planners should consider the needs of the hospital
or health facility for conducting emergency exercises. This will help determine what
type of exercise should be done. The aim of this activity is to focus attention on
particular hospital risks and vulnerabilities to help determine where there is need to
invest in training efforts.
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Communication System Breakdown ______________________
Compromise of Structural Integrity Other/s (please specify):
Loss of Power ______________________
Loss of Water Other/s (please specify):
Mass Evacuation ______________________
Mass Casualty Incident Other/s (please specify):
Overwhelmed Medical Services ______________________
Shortage of Medical Supplies Other/s (please specify):
______________________
Transportation Blockages
Hazard Priority
3. What are the Highest priority Hazards?
*Consider such factors as: Frequency of occurrence, Relative likelihood of
occurrence, Magnitude and intensity, Location (affecting critical areas or
infrastructure), Spatial extent, Speed of onset and availability of warning, Potential
severity of consequences to people, critical facilities, community functions, and
property, Potential cascading events
#1 Priority Hazard:
#2 Priority Hazard:
#3 Priority Hazard:
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Emergency Public Information (EPI) Other/s (please specify):
Damage Assessment ______________________
Transportation Other/s (please specify):
Resource Management ______________________
Continuity of Operations
Participants
7. Who (agencies, departments, operational units, personnel) need to participate in
exercises?
For example:
Have any entities updated their plans and procedures?
Have any changed policies or staff?
Who is designated for emergency management responsibility in your plans
and procedures?
With whom does your organization need to coordinate in an emergency?
What do your regulatory requirements call for?
What personnel can you reasonably expect to devote to developing an
exercise?
INTERNAL EXTERNAL
Administration Social Service Other Hospitals/ Health
Central Supply Toxicology Facilities
EMS/ Patient Transport Maintenance Ministry of Health
Service Medicine Department Local Government
Emergency Department Pediatrics Department Fire Department
Engineering and Physical Psychiatry Department Law Enforcement
Plant Radiology Department Media
Infection Control Surgery Department Other/s (please specify):
Intensive Care Unit Hospital-wide _____________________
Laboratory Other/s (please _____________________
Medical Staff specify): Other/s (please specify):
Nursing ______________________ _____________________
Pharmacy ______________________ _____________________
Public Affairs
Security
List specific personnel if applicable
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Standard Operating Procedures
Resource List
Maps, Displays
Reporting Requirements
Notification Procedures
Mutual Aid Pacts
Policy-Making Officials
Coordinating Personnel
Operations Staff
Volunteer Organizations
EOC/Command Center
Communication Facility
Warning Systems
Utility Emergency Preparedness
Damage Assessment
Techniques
Other/s (pls specify):
Past Exercises
9. If your organization has participated in exercises before, what did you learn from
them, and what do the results indicate about future exercise needs? You may
consider the following questions:
Who participated in the exercise, and who did not?
To what extent were the exercise objectives achieved?
What lessons were learned?
What problems were revealed, and what is needed to resolve them?
What improvements were made following past exercises, and have they
been tested?
Before an exercise can be planned and implemented, there must also first be an
inventory of resources available for its conduction. These include funding,
personnel, skills, facilities, time and support. Any deficiencies must be considered in
the planning of the exercise. An honest assessment of resources may lead to a
leveling of expectations on what can be accomplished, and adjustments in the
scope of and type of exercise to be used.
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Capability Assessment Checklist
Plans
1. How familiar are the exercise planners with the emergency plans, policies, and
procedures of the institution?
Very familiar
Only general familiarity
Familiar with only a portion
Need to review plans, policies and procedures
Time
2.a. How far in advance would the institution realistically have to schedule to plan
and design each of the following exercise activities effectively?
Orientation:
Drill:
Tabletop:
Functional:
Full-scale:
2.b. How much preparation time can reasonably be allocated to developing the
exercise?
Actual person days:
Elapsed time to exercise:
Experience
3.a. When was the institution’s last exercise?
3.b. What is the exercise planners’ previous experience with exercises? (Check all
that apply)
Orientation: Presenter Participant
Drill: Controller Participant
Tabletop: Facilitator Participant
Functional: Controller Simulator Player Evaluator
Full-scale: Controller Responder Evaluator Victim
3.c. What other exercise related experience is available from the facility staff and
community?
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Will they be available for the exercise?
Yes No
Communications
5. What communications facilities and systems are used in a real emergency?
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(*You may extend beyond space provided)
8.b. Are there ways that the institution can reduce costs? (eg. Combining exercises
among different departments, cost-sharing, resource-sharing w/ nearby institutions)
Explain
Exercise scope pertains to the limits of an exercise. There are five noted exercise
scope elements.
2) Location - the specific address where the simulated event will occur. For the
increasingly complex exercise types, it ideally should be at a place where the
hazard could most likely occur for greater realism. Although logistic or safety
issues may necessitate a compromise to an area similar to the ideal location.
3) Functions - are the list of operations which the participants are to practice.
The procedures to be tested should be within a certain function and well
defined.
What type of exercise best meets our training needs within the available
resources?
What experience have personnel had with the various types of exercises?
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What exercises are most needed?
What stress level do we want?
What types of exercises are mandated by regulatory requirements?
Orientation
Drill
Tabletop
Functional
Full-Scale
1. Address Costs
In addition to the capabilities assessment, attention must also be given to the costs
and liabilities brought about by exercise conduction. In planning an exercise it must
be ensured that the institution has the resources to support these activities. The
Emergency Planning Team should plan for the wide variety of apparent and hidden
costs at every stage of exercise development.
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Guide Questions while assessing exercise costs
1. Are there currently enough resources available to support exercise
expenses? Yes No
If YES, what are they?
b.
c.
d.
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a. (*You may list as many entities as appropriate)
b.
c.
d.
Drawing of support from those in authority and using that mandate to garner
cooperation from the designated participants is a crucial step in exercise
development. This entails gaining approval from the highest possible official in your
institution. Even if the hospital director or chief executive does not directly
participate in the exercise, his/her endorsement can help acquire the cooperation of
those who are selected to take part. Often it is only through this endorsement that
staff and resource mobilization necessary in conducting the exercise can be
realized. Without which the activity would be difficult if not impossible to
accomplish.
Gaining the support of the chief executive may not always be easy, but several
strategies may be helpful such as:
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Sample Exercise Directive Memo
EXERCISE DIRECTIVE MEMO
Date:
b.
c.
The Emergency Management Committee will be coordinating the exercise. They will
be contacting you to make necessary arrangements for the development and
conduct of the exercise. For purposes of realism and interest, details of the exercise
situation will not be made known prior to the exercise.
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Figure 3. Exercise Planning Organizational Structure
Examples of these specialized teams include but are not limited to:
1)*The Exercise Design Team – which will plan the exercise, how it will be done,
what scenario will be used if applicable (including assumptions, artificialities, and
simulations), the expected time table, what is expected of participants and
volunteers, and all other matters pertaining to how the exercise is to be conducted.
2) The Exercise Control Team – which operates during part or all of the
conduction phase, and is responsible to ensure that the exercise purpose and
objectives are achieved in a realistic manner.
3) The Logistics Team – gathers all supplies materials equipment, services, and
facilities required for the implementation of the exercise.
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4) The Physical Arrangement Team – which is in charge of the venue and other
facility arrangements.
6) The Victim Actors Team– identifies the victims played, orients them into their
assigned roles, deploys them to assigned areas, and coordinates with the
emergency medical service for any untoward incidents affecting the victim actors.
7) *The Exercise Evaluation Team – reviews all existing evaluation tools and
develops new tools based on the objectives, identifies and orients evaluators on the
tool to be used, reproduces and distributes the tool, deploys evaluators to assigned
areas, collates all evaluation findings, and develops final report with
recommendations.
*Due to their importance additional discussion is given to the roles of the exercise
design and exercise evaluation committee subsequently.
There are many tasks involved in the designing of an exercise. They often require
the efforts of a dedicated Exercise Design Team and Leader.
The Exercise Design Team Leader is responsible for the entire exercise design
process, and is in charge on managing all related administrative functions.
This role should be given to a capable and experienced individual who can
devote a considerable amount of time to the activity.
He or she must be familiar with the EOP, and has a sound understanding of
the responsible departments that will be participating.
He must also be a part of, or report to, the exercise planning team in order to
coordinate the exercise design with efforts of the other exercise teams.
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Determines the exercise objectives
Tailors the scenario
Develops the sequence of events and associated messages
Assists in the development and distribution of pre-exercise materials, and
Helps conduct pre-exercise training sessions.
Ideally, members of the exercise design team are selected from various
backgrounds representing the different departments and relevant agencies. If the
size of the team becomes unwieldy, a smaller core group can be assembled. This
core group can subsequently draw on the other members as needed.
It is recommended that the members of the exercise design team should not have
any key responsibilities in the departments participating in the exercise. Since, they
might not be able to participate fully in the exercise if they have been involved in its
design.
One of the members of the exercise planning team should be assigned to the role of
Exercise Evaluation Team Leader or Chief Evaluator. This individual will be
primarily responsible for:
1) Evaluation methodology
2) Selecting and training the evaluation team, and
3) Preparing the final evaluation report.
Selecting an exercise evaluation team leader early in the design process serves to
ensure that evaluation becomes an integral part of exercise development. This can
help maintain the integrity of the evaluation function as being separate from the
control and simulation functions. Also, it can ensure that at least one person can
devote time and mental effort to the larger task of evaluation.
An orientation meeting is usually done to train the evaluation team. During this
meeting the exercise scenario, rules of play, objectives, evaluation requirements
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and procedures, and proper use of evaluation forms are discussed. Some
inexperienced evaluators may also benefit from use of some practice drills. In
addition, evaluators from outside the institution may need information about the
facility, its procedures, and personnel. All evaluators must be reminded and trained
to be as unobtrusive as possible since it is well documented fact that the mere
presence of an evaluator can affect the behavior of those being observed, possibly
resulting in inaccurate data.
Early in the exercise process, the Exercise Planning Team assigns an Exercise
Documentation Team Leader or Chief Documenter. This person is responsible
for ensuring proper documentation of all exercise activities, and maintaining an
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organized record of these events. The Chief Documenter may do this by
undertaking all tasks himself or with the help of an Exercise Documentation
Team. The documentation team may also choose to hire a dedicated secretary and
or photographer/ videographer to assist in these tasks.
SAMPLE OBJECTIVE
Standards Conditions
(Within 5 minutes ) (after the hospital fire notice is given),
Objectives are essential during all stages (design, execution , evaluation, follow-up)
of the exercise process.
A useful guideline for writing objectives is the “S.M.A.R.T.” system. This acronym
characterizes elements of good objectives: Simple, Measurable, Achievable,
Realistic, and Task oriented.
Simple: A good objective is simply and clearly phrased. It is brief and easy to
understand.
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Measurable: The objective should set the level of performance, so that the results
are observable, and it can told when the objective has been achieved.
Achievable: The objective should not be too difficult to achieve. Achieving it should
be within the resources that the organization is able to commit to an exercise.
Realistic: The objective should present a realistic expectation for the situation.
Even though an objective might be achievable it might not be realistic for the
exercise.
A narrative is a brief description of simulated events that lead up to the minute the
exercise begins.
It sets the mood for the exercise and sets the stage for later action by providing the
information that the participants will need during the exercise.
A good narrative is usually one to five paragraphs long. To set the appropriate tone,
the writing style should be very specific, using short sentences, and phrased in the
present tense in order to convey urgency and tension. The situation is usually
developed chronologically and emphasizes the emergency environment. The
narrative should work to capture the participants’ attention, and motivate them to
be actively involved.
Below is a narrative outline form that can be used as a starting point to develop an
appropriate exercise narrative.
Response made:
Damage reported:
Sequence of events:
Current time:
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Was there advance warning:
Location:
Major and detailed events are simulated occurrences – large and small – which take
place after and as a result of the emergency described in the narrative. They
provide unity to an exercise and link simulated events to actions participants
perform in order to meet the objectives.
Example of Related Scenario, Major Event, Detailed Event, & Expected Action
Narrative Scenario Major Event Detailed Event Expected Action
Earthquake Hospital Structural Operating Room Activation of
Damage Gas Pipe Leak Operating Room
Evacuation
Procedure
Major events are the potential large problems resulting from an emergency. They
are based on occurrences that likely follow the exercise narrative and generate
possible situations for testing exercise functions. Detailed events in turn are the
more specific problem situations which requiring participants to respond in
expected actions to fulfill exercise objectives. In smaller exercises, there might not
be a need to distinguish between major and detailed events.
These methods are only bound by an exercise design team’s creativity and focus in
producing the objectives of the exercise.
Detailed Events:
1.
2.
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Major Event #2
Detailed Events
1.
2.
Expected actions are used to evaluate whether there was appropriate response to
an emergency situation. In order to determine whether an action is appropriate for
a given event one must simply go back to the EOP.
12.Writing Messages
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Messages are used to communicate detailed events to participants. They are meant
to evoke expected actions from participants to meet the exercise objectives. In
composing messages for an exercise, it is helpful to always begin with an expected
action. Consider what content and which message source would motivate the
expected action or actions.
Messages no matter how simple or complex have four main variables. Which
answers, “WHO sends WHAT to WHOM, via HOW, and with WHAT EFFECT?”
Message Source (WHO): Who sends the message? (must be a credible source)
Recipient (TO WHOM): Who should receive the message? (Who would credibly
receive it, and who ultimately need to receive it to take action?)
All these variables will influence the action taken. (TO WHAT EFFECT)
CONTENT:
ACTION TAKEN:
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13.Developing the Master Scenario Events List
The outputs from the design process are pulled together in a Master Scenario
Events List (MSEL) or Master Schedule. This is a chart which controllers and
simulators can refer to in order to keep the exercise on track. It is a listing of the
events or messages, the time it is to be released, and the expected actions from the
participants.
Although the MSEL is the over-all guide for the exercise, organizers should still
remain flexible and appropriately adjust to the participant responses and exercise
situation as it develops. The goal should be to accomplish the objectives rather than
being overly strict in following the time schedule.
A wide variety of exercise enhancements can help achieve this goal. These may
include visuals, communications equipment, people and props, and use of other
materials and resources. For example in drills or full-scale exercises the use of real
equipment and actual locations is inherently realistic, but the additional use of
simulated victims with convincing mock injuries can make the exercise even more
compelling. In turn, table-top or functional exercises can also be enhanced by the
use of actual equipment and materials used and available at the EOC during a real
emergency.
Exercise enhancements need not require a lot of money or energy. The resources
used can be from common items already available in the emergency operations
center or within the health facility. All that is needed is a little creativity and
resourcefulness to transform a mundane exercise into a more exciting and
engaging activity for all parties involved.
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15.Developing the Evaluation Format
Criteria to determine if an exercise has been successful must be based on the listed
objectives and expected actions. It is from the expected actions that that pertinent
evaluation measures can be developed.
There are countless variations on how evaluation can be done. Below are sample
evaluation forms which may be adapted for use as appropriate.
A. Observation Checklist
One of the most basic observation tools is the observation checklist. The Objectives,
Expected actions and When, Where, and by Whom they should be done are pre-
listed in the form. The evaluator merely has to note if these were performed
accordingly. It allows for simple monitoring of objectives and the performance of
expected actions.
Observation Checklist
OBSERVATION CHECKLIST
Objective Expected Players Locati Expecte Don Not Commen
Action to on d Time e Don ts:
Observ e
e
SAMPLE
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Key event monitoring involves monitoring the participants’ responses during key
events in the exercise. Key events are the occurrences in the developing scenario
particularly designed to place stress on selected elements of the EOP. The players’
responses to these events are subsequently noted in a Key Event Response Form
C. Problem Log
The problem log is a tool which can be accomplished by anyone involved in the
exercise (participants, controllers, simulators, evaluators, etc). It allows
identification of potential problems which can then be analyzed after the exercise to
determine their source (plan, preparedness, training, simulation) and which require
appropriate corrective action.
Problem Log
PROBLEM LOG
Name: Date:
Exercise (ie. Conta
Assignme participant/controller/simulator/evaluator/ ct No:
nt: etc)
Time Event / Message Problem Analysis (Leave
Library No. (if Blank)
known)
D. Evaluator Checklist
This evaluator checklist is a more comprehensive form that involves assessing the
completion of objectives through note of accomplishment of specific point of review.
Evaluator Checklist
EVALUATOR CHECKLIST
Evaluator: Date:
Location: Function being
Evaluated:
Objective
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No.:
Objective:
SAMPLE OBJECTIVE
Points of Review:
Please answer the following: Y = Yes, N = No, NA = Not applicable, NO = Not
observed
SAMPLE POINTS FOR REVIEW Y N NA NO
1. Status boards availability in facility
2. Status boards utilized
3. Status boards kept updated
4. Maps available
5. Maps up to date
Comments:
E. Narrative Summary
Narrative Summary
NARRATIVE SUMMARY
Objective Number: Criterion Number:
Evaluator: Location:
Issue:
A specific statement of the problem, plan, or procedure that was observed
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improve operational capability
Individual Responsible
Time: Date __/___/__ Suspense __/__/__
Assigned: Date:
In addition to these tools or others which the evaluation team may develop, more
information can be obtained through the conduction of postexercise debriefing and
evaluation team meetings (discussed later). The final output of the entire evaluation
process is the after action report which is to be utilized for implementing
improvements to the EOP and EMP.
During an Exercise
All the planning and preparation culminates in the conduction of the exercise.
Pre-conduction
Even just prior to the start of an exercise there are still several tasks that should be
accomplished.
Last minute briefing for all exercise staff and participants confirming that
everyone understands what are expected of them and the readiness to
proceed. The IIMAC system for structured briefing may be used. It divides the
briefing into 5 specific areas.
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Final positioning of simulated casualties, props, special effects, staff, and
participants.
Once all final preparations are complete, the Exercise Director heading the exercise
control team can give the signal for the exercise to begin.
Conduction Proper
The actual conduction phase allows for assessment of response capacity, training of
participants, and validation of competency. During this time, the facilitator or
controller assumes responsibilities for conduction and ensuring that the exercise
objectives are tested. This includes the following tasks:
Special Considerations
The actual execution of the exercise will depend upon the type of exercise, and the
specific plans developed in its conduction. However, there are common elements
which may aid the success of the activity.
The aim is to reduce risk and address potential hazards even before they
even occur.
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5) Be open to capitalize on problem situations. Complicating situations
that place additional stress on the system may be useful in more
effectively assessing the institutions’ response capabilities. But in no
instance should safety considerations be compromised for the sake of
pushing through with the exercise.
Post exercise meetings are often of two types: The Player Debriefing, and the
Evaluation Team Meeting.
Player Debriefing
Hot Debrief:
After the exercise’s conclusion the planners and participants met briefly to discuss
the exercise conduct and planning process. Discussion primarily focused on
(Number) of Aspects: (List Aspects)
Discussion Points Per listed Aspect
1.
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2.
1 2 3 4 5 6 7 8 9 10
Very Poor
Very Good
1 2 3 4 5 6 7 8 9 10
Very Poor
Very Good
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4. Did the problems presented in the exercise adequately test
readiness capability to implement the plan? Yes No
If NO, briefly explain why:
Some time after the exercise and Players’ debriefing, the evaluation team will
convene to analyze the exercise and prepare for the after action report. The team
goes through the evaluation forms, debriefing responses, and any other data to
discuss how well the exercise objectives were met. There can be additional
meetings as needed to analyze the data and prepare the After Action Report. Other
members from the exercise planning team or subunits may be invited to provide
their input. This process should be done some time shortly after the exercise while
memories are still fresh.
The final output of the evaluation team meetings is the compiled After Action
Report (AAR) which documents the effectiveness of the exercise. This AAR is used
to instigate corrective action in the EMP or how it is implemented and it may also
serves as the basis for future exercises. It should distributed to the chief executive
of the institution, as well as each participating department, and other affected units.
There are no set formats for the AAR. However the topics listed in the outline below
are usually covered. The final document can be as long or as short as the extent of
the exercise requires.
Introduction
Main purpose of the report, why it is being submitted, preview of main topics,
evaluation methodology used, and perhaps a general summary of main
problems and recommendations.
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Statement of the Problem
Purpose of the exercise
Exercise Summary
Goals and Objectives
Preexercise activities
Participants and agencies
Description of Exercise Scenario
Recommendations
Training needs
Changes in the Emergency Plan
Other corrective Actions
changes in policy
resource acquisition or allocation
personnel training
decision to conduct further exercises
1) Clearly assigning tasks and schedules and designate responsibility for each
recommended improvement.
2) Establishing a monitor plans to track the progress of recommendations
implementation.
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3) Completing the cycle by incorporation of the testing of noted improvement
indictors into succeeding exercises.
Because in the end, the recommendations, and the exercise itself, would indeed be
useless if no efforts are placed into their implementation.
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