After Action Report / Improvement Plan CHECS – An Inter-Hospital Communications Exercise

CHECS – An Inter-Hospital Communications Exercise

Southeast Region

March 15, 2011

AFTER ACTION REPORT / IMPROVEMENT PLAN

Colorado Hospital Association

ADMINISTRATIVE HANDLING INSTRUCTIONS

1.  The title of this document is The "CHECS - An Inter-Hospital Communication Exercise - Southeast Region" 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 Representative:
[CLIENT ORGANIZATION REPRESENTATIVE NAME]
Colorado Hospital Association
(Office) [CLIENT ORGANIZATION REPRESENTATIVE PHONE]
(E-Mail) [CLIENT ORGANIZATION REPRESENTATIVE EMAIL]
Exercise Director:
Ginny Schwartzer
All Clear Emergency Management Group
(Office) 919-323-9995
(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 12

APPENDIX A: IMPROVEMENT PLAN 13

APPENDIX B: PARTICIPANT FEEDBACK (3 THUMBS UP – 3 THUMBS DOWN) 14

APPENDIX C: ACRONYMS 15

EXECUTIVE SUMMARY

CHECS - An Inter-Hospital Communication Exercise - Southeast Region was designed and facilitated to [REASON FOR EXERCISE]

During the exercise participants:

·  [GENERAL ACTIVITY 1]

·  [GENERAL ACTIVITY 2]

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: / CHECS - An Inter-Hospital Communication Exercise - Southeast Region
Type of Exercise: / Tabletop
Exercise Start Date: / March 15, 2011
Duration: / Three Hours
Location: / Southeast Region
Sponsor: / Colorado Hospital Association
Program: [EXERCISE PROGRAM]
Purpose: [EXERCISE PURPOSE]
Mission: [EXERCISE MISSION]
Scenario Type: [SCENARIO TYPE]

Participant Information

Participant / Organization
Bob Chambers / Arkansas Valley Regional Medical Center
Charles Martin / Prowers Medical Center
David Porter / Southeast Colorado Hospital
Eric Griffin / Weisbrod Memorial County Hospital
Number of Participants / 11

SECTION 2: EXERCISE DESIGN SUMMARY

Exercise Purpose and Design

[EXERCISE PURPOSE]

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:

CHECS Evaluation
Activity / Target Capability
# 1 / CHECS Emergency Notification Process
# 2 / Resource Request Process

Scenario Summary

It is late April and the severe weather associated with a line of thunderstorms moving through the area prompts the local forecast office of the National Weather Service to issue a Tornado Watch for the region at 1:10PM MST.

At 2:11PM, meteorologists at the National Weather Service notice what appears to be the formation of a tornado on their Doppler weather radar. They immediately issue a Tornado Warning for Baca County.

SECTION 3: ANALYSIS OF CAPABILITIES

CHECS Evaluation

Performance / Target Capability
[OVERALL] /
Activity # 1: CHECS Emergency Notification Process
Associated Critical Tasks
Task # 1.1: Implement initial notification plans and protocols.
Strong / Evaluator # 1
Observations / ·  All hospitals will notify other hospitals within the region if their hospital has been impacted. Arkansas valley mentions utilizing EMSystems as a backup communication tool to the telephone. Powers states that they would use the telephone and EMResoruce. Southeast indicates that they would only use EMResource, however in a different inject they indicate that they would notify regional hospitals using 800 MHz radios. Weisbrod only lists utilizing the telephone. It is not known from the inject responses whether the 800 MHz radio system is available to all hospitals but if it is, it would be an appropriate backup to the telephone and internet based system.
Recommendations / ·  The CHECS plan, page 4 item 6(b) indicates that the appropriate method for notifying the other hospitals is by telephone backed up by the EMResource. There is no mention of the use of EMSystems or 800 MHz radio. If these systems are to be used, they should be included in the plan. Hospitals in the region should explore alternative methods of notification beyond the use of telephone or internet. Systems such as a trunked, repeated, emergency radio communication system should be considered as should a satellite telephone/ 2-way radio system.
Task # 1.2: Communicate important event information to non-affected hospitals.
Adequate / Evaluator # 1
Observations / ·  All hospitals in the area identified that their information needs would be: the number of patients involved, their severity, status of utilities, inventory of medical supplies. Weisbrod includes in their message that they have been impacted, that they have many patients coming from the community, and that they need assistance with medical personnel and transportation” They make no reference to what medical personnel would be needed from the neighboring hospitals so the other hospitals could begin calling in staff to send help. The EMResource message is vague saying only that they are diverting to other hospitals. There is no mention of the situation and why they are diverting. Southeast’s message includes who, what, where, how which is good, but it would be helpful to the other hospitals to know when the event occurred. Also Southeast only described making the notification through EMresource and not through a telephone call first as outlined on page 4 item 6 (b) of the CHECS plan. Prowers’ message includes who, what, where, how which is good, but it would be helpful to the other hospitals to know when the event occurred.
Recommendations / ·  All hospitals plan to utilize telephones as the primary contact method. Alternate systems need to be considered. EMSystems is not mentioned in the CHECS plan as a notification tool. All hospitals did not follow the notification message criteria listed on page 4 of the CHECS plan with information on “who, what, where, when, how” of the incident. The initial notification message that the hospitals are using between each other varies. A template should be considered to be included in the CHECS plan that has predetermined information that hospitals need in order to take internal action to assist the affected hospital since the information on page 4, item 6 (c) of the CHECS plan appears to be too vague to be useful during a crisis. Weisbrod should include more detailed information on the hospital’s system status should be provided to the neighboring hospitals, such as if the hospital is on backup power. Both the telephone message and EMResource message should be the same in the event only one of the two messages are received. Arkansas valley should include more detailed information on the hospital’s system status should be provided to the neighboring hospitals, such as if the hospital is on backup power.
Task # 1.3: Non-affected hospitals receive notification of event and follow internal procedures to respond to the event notification.
Adequate / Evaluator # 1
Observations / ·  Hospitals have adequate internal notification plans to notify critical staff and administration. Weisbrod indicates that they have access to the sheriff's department "reverse call" telephone notification system. Southeast would call in additional staff from other shifts, except the night staff. The hospital would activate the triage process and create sections within the hospital to be allocated to the patient severity types. Supply inventory would be performed, as well as a gap analysis of communication needs Powers identifies that the administrator on call makes the decision to activate the disaster call tree, but notification to him is reliant upon the nurse in charge. In the notes, it indicates that the nurse in charge will only call him if the nurse in charge has time. It is unknown who the backup to the nurse in charge is to contact the administrator. Further, Prowers identifies only the CEO, COO, Chief Clinical officer, and CFO are to be contacted while other hospitals are including their nursing department, and emergency preparedness officer Southeast mentions the use of EMSystems to obtain bed count from other hospitals in the southeast region but there is no mention of EMsystems in the CHECS plan. All hospitals, except for Arkansas Valley, would activate their Hospital Command Center (HCC) The support hospitals all planned to assist Southeast but had differing methods of doing so. Weisbrod self describes not having the action steps outlined in what actions will take place once the hospital receives an event notice. All hospitals have identified numerous external partners to notify. Weisbrod Memorial added that they would call emergency services serving their area to receive a damage assessment to determine what community needs may exist. Powers describes not having a current, up to date listing of external partners and they identified this as an action item for them to address.
Recommendations / ·  Utilizing a telephone notification system may provide a fast, effective method of notifying critical staff. Powers should include language in their plan that the administrator on call will be contacted when an event is identified as being a crisis situation and who the position in charge for that would be and a backup for that position. This should not be dependent upon the nurse in charge "having time." Powers may also want to consider staffing additional positions in the HCC beyond that of the CEO, COO, CCO, and CFO to some department heads that have personnel, supplies, and equipment that may be needed by the affected hospital. Also clinical care department heads that may need to have input in the event patient transfers must take place.
Task # 1.4: Event information is updated throughout the event.
Strong / Evaluator # 1
Observations / ·  The telephone calls and EMResource were proved functional during the exercise.
Recommendations / ·  None
Performance / Target Capability
[OVERALL] /
Activity # 2: Resource Request Process
Associated Critical Tasks
Task # 2.1: Affected hospital communicates need for resources, assets or equipment to non-affected hospitals within the region.
Adequate / Evaluator # 1
Observations / ·  Prowers, Southeast, Weisbrod, and Arkansas valley all plan to use the telephone as the primary resource request tool. Only Southeast mentions the use of a written request, while Weisbrod plans to use EMresource. The CHECS plan on page 5b (i) states that hospitals will telephone first and then follow up with a written request. Arkansas valley intends to contact the assisting hosptials' emergency preparedness coordinators when the CHECS plan calls for contacting the individual in appendix C of the CHECS plan (pg 5 b (i)) which may be different than the preparedness coordinator. The one resource request form that was provided appeared to be completed correctly, however no guidance document was provided to accompany the form.
Recommendations / ·  All hospitals should review the CHECS plan and receive additional training on the resource request section if needed. The Colorado Hospital MOU, resource request form and completion guide should be included as appendices to the CHECS plan.
Task # 2.2: Affected and non-affected hospitals have internal procedures which outline processes to request resources and obtain appropriate internal approvals.
Strong / Evaluator # 1
Observations / ·  Southeast includes an effective and logistical decision tree for identifying the need for additional resources. Southeast completed a resource request form for the blankets. The form appeared to be completed correctly however there was no guide provided along with the form to determine if this was true. Prowers does not include enough information to determine the effectiveness of their approval mechanisms. Arkansas valley did not explain their decision making and assessment process enough to determine if it would be effective. However the approval and implementation process appears to be effective. Weisbrod intends to use current vendors first and surrounding hospitals second. Unless vendors maintain a 24/7 operation and maintain sufficient levels of supply, it may be faster to get the initial request out to the surrounding hospitals first and then contact the vendors second. It does not appear that Weisbrod has effectively planned for the financial approval as the board must be contacted to see if a financial limit must be applied.
Recommendations / ·  Arkansas valley should have an emergency purchasing authority process as it appears that much of their operation expects to remain in a normal operating mode which is not likely during a crisis. Weisbrod should have a predetermined financial limit and emergency purchasing powers.
Task # 2.3: Non-affected hospitals receive Resource Request form and offer requested support.
Adequate / Evaluator # 1
Observations / ·  Southeast, Weisbrod, and Arkansas Valley hospitals described plausible internal methods of arranging for supplies internally to support the affected hospital. Prowers did not provide adequate information on their internal processes beyond indicating that the laundry would complete a log form for the blankets. Someone at Prowers should have to sign off on sending the resource and that approval chain was not listed. Weisbrod indicated that it was unable to recieve the resource request form. The response indicated that the other hospitals were unable to respond back with a completed resource request form.
Recommendations / ·  Follow up on why the other hospitals were unable to respond back with a completed resource request form should occur, as well as the reason why Weisbrod was unable to receive the form.

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.