After Action Report / Improvement Plan Operation Four With All Tabletop Exercise
ADMINISTRATIVE HANDLING INSTRUCTIONS
1. The title of this document is The "Operation Four With All - A Hospital Sustainability Tabletop Exercise" After Action Report.
2. The information gathered in this AAR/IP is classified as For Official Use Only (FOUO) and should be handled as sensitive information not to be disclosed. This document should be safeguarded, handled, transmitted, and stored in accordance with appropriate security directives.
3. At a minimum, the attached materials will be disseminated only on a need-to-know basis and when unattended, will be stored in a locked container or area offering sufficient protection against theft, compromise, inadvertent access, and unauthorized disclosure.
4. Points of Contact:
Hospital Emergency Management Department:
Tim Klippert
Poudre Valley Health System
(Office) 970-624-4171
(E-Mail)
Exercise Director:
Chris Floyd
Disaster Resistant Communities Group LLC
(Office) 850-241-3565
(E-Mail)
CONTENTS
ADMINISTRATIVE HANDLING INSTRUCTIONS 2
CONTENTS 3
EXECUTIVE SUMMARY 4
SECTION 1: EXERCISE OVERVIEW 5
Exercise Details 5
Participant Information 5
SECTION 2: EXERCISE DESIGN SUMMARY 6
Exercise Purpose and Design 6
Exercise Objectives, Capabilities and Activities 6
Scenario Summary 6
SECTION 3: ANALYSIS OF CAPABILITIES 7
SECTION 4: CONCLUSION 11
APPENDIX A: IMPROVEMENT PLAN 12
APPENDIX B: PARTICIPANT FEEDBACK (Strengths – Areas for Improvement) 13
APPENDIX C: ACRONYMS 15
EXECUTIVE SUMMARY
Operation Four With All - A Hospital Sustainability Tabletop Exercise was designed and facilitated to assess the capabilities of the Poudre Valley Health System to sustain hospital operations for 96 hours during a sever blizzard striking the region.
The purpose of this report is to analyze exercise results, identify strengths to be maintained and built upon, identify potential areas for further improvement, and support development of corrective actions.
Incorporated in Section 3: Analysis of Capabilities of this After Action Report is a comprehensive listing of each Target Capability with its associated Major Strengths, Primary Areas for Improvement and Improvement Recommendations
SECTION 1: EXERCISE OVERVIEW
Exercise Details
Exercise Name: / Operation Four With All - A Hospital Sustainability Tabletop ExerciseType of Exercise: / Tabletop
Exercise Start Date: / December 7, 2010
Duration: / 2 Hours
Location: / Ft Collins Co
Sponsor: / Poudre Valley Health System
Program: This exercise was designed and facilitated as part of the Joint Commission’s requirement for hospitals to have the capability and capacity to sustain operations for up to 4 days during an emergency or disaster.
Purpose: To facilitate an exercise designed to assess the capabilities of the Poudre Valley Health System to sustain hospital operations for 96 hours during a sever blizzard striking the region.
Mission: To provide an opportunity for the Poudre Valley Health System to assemble members of its Hospital Incident Command System and provide them with an opportunity to assess procedures and develop plans based of a severe weather scenario.
Scenario Type: Severe Weather (Blizzard)
Participant Information
Participant / LocationPoudre Valley Hospital
Medical Center of the Rockies
Number of Participants / 23 (Including Observers)
SECTION 2: EXERCISE DESIGN SUMMARY
Exercise Purpose and Design
To facilitate an exercise designed to assess the capabilities of the Poudre Valley Health System to sustain hospital operations for 96 hours during a sever blizzard striking the region.
Exercise Objectives, Capabilities and Activities
Capabilities-based planning allows for the exercise planning team to develop exercise objectives and observe exercise outcomes through a framework of specific action items that were derived from the Target Capabilities List (TCL). The capabilities listed below form the foundation for the organization of all objectives and observations in this exercise. Additionally, each capability is linked to several corresponding activities and tasks to provide additional detail.
Based upon the identified exercise objectives below, the exercise planning team decided to demonstrate the following capabilities during this exercise:
Hospital Incident Command SystemActivity / Target Capability
# 1 / Implement On-Site Incident Management
# 2 / Establish Full On-Site Incident Command
# 3 / Resource Management
# 4 / Develop Incident Action Plan (IAP)
# 5 / Demobilize Operations
Scenario Summary
The Boulder Forecast Office of the National Weather Service has just issued a Winter Storm Watch for Northern Colorado including Larimer County. The storm is predicted to move through the region within the next 12 to 36 hours.
As residents throughout Larimer County begin to brace themselves for what is predicted to by a record setting snowfall the National Weather Service issues a Winter Storm Warning.
SECTION 3: ANALYSIS OF CAPABILITIES
Hospital Incident Command System
Performance / Target CapabilityAdequate /
Activity # 1: Implement On-Site Incident Management
Associated Critical TasksTask # 1.1: HICS staff establishes Incident Command.
Adequate / Evaluator # 1
Observations / · Incident Command was established.
Recommendations / · None
Task # 1.2: Initiate and implement HICS.
Strong / Evaluator # 1
Observations / · Once HICS or the EOP had been activated those persons that filled each role had a very strong knowledge of what their roles and responsibilities were.
· Discussions throughout the exercise were very well thought out, including the concept of ramification of all actions now and impact later.
· Only week point was asked by one of the participants was how do we know that that the Hospital Command Center has been activated. This may have been an issue with the artificiality of the exercise that the notification process would have really happened in real life.
Recommendations / · Ensure that those who are on the Incident Management Team know how they will be notified of the Hospital Command Center being activated.
Task # 1.3: First arriving HICS staff initiates site management and control.
Adequate / Evaluator # 1
Observations / · There was a lot of discussion around this being a Sunday and at what level do the staff respond based on the knowledge of the weather alerts.
· It was decided to conduct a conference call with all the key persons involved in decision making for the facilities.
· Activation of the Hospital Command Center was held off until there was more information available in regards to how severe the weather will become.
Recommendations / · I would recommend a staged response.
· Weather Outlooks have a certain response level, Weather Advisories have a certain response level and Severe Weather Warnings have a certain response level. This will help the person in charge (hospital supervisor) with guidelines to follow an algorithm and not get caught behind the eight ball with an event.
Performance / Target Capability
Strong /
Activity # 2: Establish Full On-Site Incident Command
Associated Critical TasksTask # 2.1: Establish the command structure and Hospital Command Center (HCC) to manage the incident and meet objectives.
Strong / Evaluator # 1
Observations / · Once established and everyone got in to the groove, the Incident Management Team worked very well together and supported each other decisions well.
· The team collaborated well and asked pertinent questions about the situation.
· A good point that was brought up was the geographical locations of the off-site clinics. There could be different situations among the management of the various off-site clinics that would allow them to continue to operate or to shut down sooner than expected.
· This team had great forward thinking about current situational awareness and the forethought about future needs.
Recommendations / · None
Performance / Target Capability
Adequate /
Activity # 3: Resource Management
Associated Critical TasksTask # 3.1: Establish processes to order, track, assign, and release incident resources.
Strong / Evaluator # 1
Observations / · Current supply needs were assessed several times.
· Request for supplies at an early stage was made which included; linens, food and other materials.
· Processes were established in which to track all requested supplies.
· The Incident Management Team discussed limiting usage and encourage reuse age of appropriate items.
· Decrease linen use as appropriate.
· Most importantly the Incident Management Team incorporated lessons learned from past experiences.
Recommendations / · Remember that early request for supplies may be a good thing as late requests will get you caught behind the eight ball.
Task # 3.2: Monitor / measure performance of assigned resources and request additional resources as needed.
Adequate / Evaluator # 1
Observations / · Snow removal was defiantly a concern of the Incident Management Team.
· Early notification to the snow removal teams was mentioned several times along with the equipment to support these people.
Recommendations / · None
Performance / Target Capability
Adequate /
Activity # 4: Develop Incident Action Plan (IAP)
Associated Critical TasksTask # 4.1: Establish incident objectives, priorities, and operational periods.
Strong / Evaluator # 1
Observations / · This task was addressed several times with great feedback from each Incident Management Team member.
· Knowledge of the Incident Action Plan seemed to be very strong as well as the purpose of having a current Incident Action Plan.
Recommendations / · Continue to work and challenge yourself on the development of Incident Action Plans.
Task # 4.2: Plans Officer develops IAP to establish priorities, procedures, and actions to be accomplished to meet the incident Objectives for each operational period. IAP is approved by IC.
Adequate / Evaluator # 1
Observations / · I think that the Plans Chief had good input but it sounded more like the Incident Commander led the discussion.
Recommendations / · Remember to establish and maintain clear roles when activating the Hospital Incident Command System.
Performance / Target Capability
Adequate /
Activity # 5: Demobilize Operations
Associated Critical TasksTask # 5.1: Evaluate conditions to determine actions to be taken to demobilize operations.
Adequate / Evaluator # 1
Observations / · This was towards the end of the time for the exercise so it was rushed, however a good short discussion ensued regarding:
1. Deactivation of the Hospital Incident Command System.
2. Returning to normal operations.
3. Tracking and replacement of expended resources.
Recommendations / · I would suggest that lessons learned from previous real life events be collected and incorporated into a check list to use when demobilizing.
· Maybe develop, facilitate and evaluate an exercise focusing solely on demobilization.
SECTION 4: CONCLUSION
Exercises such as this one allow personnel to validate training and practice strategic and tactical prevention, protection, response and recovery capabilities in a risk-reduced environment. Exercises are the primary tool for assessing preparedness and identifying areas for improvement, while demonstrating community resolve to prepare for major incidents.
Exercises aim to help entities within the community gain objective assessments of their capabilities so that gaps, deficiencies, and vulnerabilities are addressed prior to a real incident.
Exercises are the most effective (and safer) means to:
· Assess and validate policies, plans, procedures, training, equipment, assumptions, and interagency agreements;
· Clarify roles and responsibilities;
· Improve interagency coordination and communications;
· Identify gaps in resources;
· Measure performance; and
· Identify opportunities for improvement.
This exercise succeeded in addressing all of the above as it provided examples of good to excellent participant knowledge, teamwork, communication and use of plans and procedures while pointing out areas in need of improvement and clarification.
Listed below is a summary of the level of performance the Target Capabilities and Tasks evaluated during the exercise. This summary outlines the areas in which Poudre Valley Health System is strong as well as identifying areas that the departments should invest future planning, training and exercise funds on.
Hospital Incident Command SystemActivity / Target Capability / Performance
# 1 / Implement On-Site Incident Management / Adequate
# 2 / Establish Full On-Site Incident Command / Strong
# 3 / Resource Management / Adequate
# 4 / Develop Incident Action Plan (IAP) / Adequate
# 5 / Demobilize Operations / Adequate
Disaster Resistant Communities Group LLC – www.drc-group.com 3 | Page
After Action Report / Improvement Plan Operation Four With All Tabletop Exercise
APPENDIX A: IMPROVEMENT PLAN
This Improvement Plan has been developed specifically for Poudre Valley Health System based on the results of Operation Four With All - A Hospital Sustainability Tabletop Exercise conducted on December 7, 2010. These recommendations draw on both the After Action Report and the After Action Conference.
Capability / Observation / Recommendation / Responsible Agency / Completion DateImplement On-Site Incident Management
Establish Full On-Site Incident Command
Resource Management
Develop Incident Action Plan (IAP)
Demobilize Operations
Disaster Resistant Communities Group LLC – www.drc-group.com 3 | Page
After Action Report / Improvement Plan Operation Four With All Tabletop Exercise
APPENDIX B: PARTICIPANT FEEDBACK(Strengths – Areas for Improvement)
StrengthsThe ONX System was very visual and kept everyone engaged.
Good participation from the group that was being "exercised".
We are always able to learn more in a group setting. This is why tabletop exercises are valuable.
Team work was amazing.
Communication processes are well thought through including duplication and back up.
I believe we have developed a number of communication means and methods to ensure that we are maximizing our communication opportunities. These include Everbridge, Virtual information Center (VIC), ARES, Facebook and Twitter.
The maps helped visualize locations of other health facilities and how they might be affected by the storm as well as how to respond to each location.
The maps assisted in identifying where essential staff lived and where they might be directed to access emergency transportation to the hospital.
We have put supply chains and agreements in place to ensure that sufficient quantities of needed supplies will be available to meet the emergency needs and requirements for our two major hospitals.
One of the exercise maps identified where storm shelters had been set up at schools so the hospital could direct non-essential staff and families there if necessary.
We have a very good handle on the Hospital Incident Command System processes.
We have trained a number of staff in the Hospital Incident Command System processes as well as the Hospital Command Center functionality.
The identification of resources and who was responsible for those went well.
The communication tree was identified and in place as well as who would start the calls.
Secondary communication plans are in place.
Areas for Improvement
It would have been better to open the Hospital Command Center earlier for exercise play. Good discussion did result though.
We struggled on whether to open the Hospital Command Center or not and spent too much time on this issue. For exercise play, we got stuck. For real life though, it was very good to participate in the discussion regarding this issue.
Having someone from the off-site clinics to participate in the exercise would have been beneficial.
Clear process for activation of your Hospital Command Center.
Not enough explanation or practice working with the maps.
Would help to understand mapped information if there was a legend to explain the various symbols.
Would be interested in more information about how maps can help in hospital decision support.
Clear process for providing information out to staff.
Clear response maybe an algorithm for weather situations.
Ensure that all Incident Management Team members are aware of their tasks and the various options that can be taken to complete a task.
Need to prepare check lists for various Hospital Incident Command System functions.
Ensuring that we have established some designated communication methods for all of the clinics and office areas within the PVHS umbrella.
Reassess our ability to initiate and operate our Emergency Operation Plan over a large geographical area.
Identify communication options to ensure coverage of all of clinics within the PVHS.
Overview, education, guidance and procedures for all of the diverse clinical and office locations.
Eliminate duplication of work or calls to all that need notification.
Inform grounds and security of potential for storms from notification stream.
Ensure weekends work the same as weekdays as far as notifications are concerned.
Annually test our procedures we said we would do in the exercise.
APPENDIX C: ACRONYMS
Acronym / MeaningCOMM / Communications
CONOPS / Concept of Operations
EOC / Emergency Operations Center
ESF / Emergency Support Function
HICS / Hospital Incident Command System
IAP / Incident Action Plan
IC / Incident Command
ICS / Incident Command System
IMT / Incident Management Team
JIC / Joint Information Center
LOFR / Liaison Officer
MOA / Memorandum of Agreement
MOU / Memorandum of Understanding
NIMS / National Incident Management System
OPS / Operations
PIO / Public Information Officer
SERT / State Emergency Response Team
SitRep / Situation Report
SOG / Standard Operating Guideline
SOP / Standard Operating Procedure
UC / Unified Command
Disaster Resistant Communities Group LLC – www.drc-group.com 3 | Page