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II. The Exercise Process1

Figure 2. Sequence of Tasks for a Successful Exercise

How are Emergency Exercises Conducted?

This section is a practical summary which the exercise planning team can use to

walk-through the Exercise Process.

Pre-Exercise Activities

1. Review the Emergency Operations Plan

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, ColumbiaUniversity School of Nursing- Center for Health Policy - with the concepts applied to thesetting of Hospital and Health Facilities.

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following questions. This will guide the team through the succeeding steps of

exercise planning.

EOP Review Questions

What does the plan tell us about ideal performance?

How are we supposed to implement policies and procedures in the event ofan emergency?

What responses are currently planned?

What are the hazards the plan is intended to address?

What resources, personnel, procedures will be used to resolve problems?

Are they different for various types of emergencies?

Do roles vary according to the type of emergency?

What training have response personnel experienced?

What training is necessary?

2. Conduct Needs Assessment

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.

Needs Assessment ChecklistPotential Hazards1. List the various hazards which threaten your institution. Use the followingchecklist as a starting point. (Check all that apply. You may extend beyond thespace provided.)

Bomb Threat Biological Attack Chemical Attack

Earthquake Epidemic Fire

Flooding Hazardous Material Release Violent Patient/ Personnel

Hostage/ Shooting Incident Radiologic Release Severe Weather

Tsunami Other/s (please specify):______________________

Other/s (please specify):______________________

Secondary Effects2. What secondary effects from the listed hazards are likely to impact yourinstitution? Use the following checklist as a starting point. (Check all that apply. Youmay extend beyond the space provided.)

Hospital Operation Interruptions Other/s (please specify):

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Communication System Breakdown Compromise of Structural Integrity

Loss of Power Loss of Water Mass Evacuation

Mass Casualty Incident Overwhelmed Medical Services Shortage of Medical Supplies

Transportation Blockages

______________________

Other/s (please specify):______________________ Other/s (please specify):______________________


Hazard Priority3. What are the Highest priority Hazards?*Consider such factors as: Frequency of occurrence, Relative likelihood ofoccurrence, Magnitude and intensity, Location (affecting critical areas orinfrastructure), Spatial extent, Speed of onset and availability of warning, Potentialseverity of consequences to people, critical facilities, community functions, and

property, Potential cascading events

#1 Priority Hazard:

#2 Priority Hazard:

#3 Priority Hazard:

*You may place additional hazard priorities as appropriateHazard Mapping4. What geographic area(s) or facility location(s) is (are) most vulnerable to the highpriority hazards?

(*You may extend beyond space provided)Plans and Procedures

5. What plans and proceduresemergency management program, emergency

operations plan, departmental standard operating procedures (SOPs)will guideyour organizations response to an emergency?

(*You may extend beyond space provided)

Functions6. What emergency management functions are most in need of rehearsal? (e.g.,What functions have not been exercised recently? Where have difficulties occurredin the past?) You can use the following checklist as a starting point.

Alert Notification (EmergencyResponse) Communications Coordination and Control


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Emergency Public Information (EPI) Damage Assessment

Transportation Resource Management Continuity of Operations


Participants7. Who (agencies, departments, operational units, personnel) need to participate inexercises?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 plansand 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

Administration Central Supply EMS/ Patient TransportService Emergency Department Engineering and PhysicalPlant Infection Control Intensive Care Unit

Laboratory

Medical Staff Nursing Pharmacy

Public Affairs Security

Social Service Toxicology Maintenance

Medicine Department Pediatrics Department

Psychiatry Department Radiology Department Surgery Department Hospital-wide

Other/s (pleasespecify):____________________________________________

EXTERNAL

Other Hospitals/ HealthFacilities

Ministry of Health Local Government Fire Department Law Enforcement

MediaOther/s (please specify):_____________________

_____________________Other/s (please specify):__________________________________________

List specific personnel if applicable


Programs Areas8. Mark the status of your emergency management program in these and otherareas to identify those most in need of exercising.

New Updated

Exercised

Used inEmergen

cy

N/A

Emergency Plan

Plan Annex(es)

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Standard Operating Procedures

Resource List

Maps, Displays

Reporting Requirements

Notification Procedures

Mutual Aid PactsPolicy-Making Officials

Coordinating Personnel

Operations Staff

Volunteer Organizations

EOC/Command Center

Communication Facility

Warning Systems

Utility Emergency Preparedness

Damage AssessmentTechniques

Other/s (pls specify):

Past Exercises9. If your organization has participated in exercises before, what did you learn fromthem, and what do the results indicate about future exercise needs? You mayconsider 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 theybeen tested?


3. Assess Capability to Conduct an Exercise

Before an exercise can be planned and implemented, there must also first be aninventory of resources available for its conduction. These include funding,personnel, skills, facilities, time and support. Any deficiencies must be considered inthe planning of the exercise. An honest assessment of resources may lead to aleveling of expectations on what can be accomplished, and adjustments in thescope of and type of exercise to be used.

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Capability Assessment Checklist

Plans1. How familiar are the exercise planners with the emergency plans, policies, andprocedures of the institution?

Very familiar

Only general familiarity Familiar with only a portion Need to review plans, policies and procedures

Time2.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 theexercise?Actual person days:Elapsed time to exercise:Experience3.a. When was the institutions last exercise?

3.b. What is the exercise planners previous experience with exercises? (Check allthat apply)Orientation: Presenter Participant

Drill: Controller ParticipantTabletop: Facilitator ParticipantFunctional: Controller Simulator Player EvaluatorFull-scale: Controller Responder Evaluator Victim3.c. What other exercise related experience is available from the facility staff andcommunity?


Facilities4. What physical facilities are used when conducting an emergency operation?

(*You may extend beyond space provided)Will they be required for the exercise?

Yes

No

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Will they be available for the exercise? Yes

NoCommunications5. What communications facilities and systems are used in a real emergency?

(*You may extend beyond space provided)Will they be required for the exercise?

Yes

NoWill they be available for the exercise?

Yes

NoAdministration6. Are the hospital director and emergency service coordinators orother administrative leaders expect to have a positive attitudetowards the exercise?

Yes

No

If NO, how can this be overcome?

(*You may extend beyond space provided)Barriers7. Are there any resource barriers that need to be overcome to carryout this exercise

Yes

NoIf YES, what are the barriers and how can they be overcome?

(*You may extend beyond space provided)Costs8.a. What types of costs might be included for these exercises in the institution? (Donot list actual figures just types of expenses such as wages, salaries,transportation, etc.)Orientation:

(*You may extend beyond space provided)Drill:

(*You may extend beyond space provided)Table top:

(*You may extend beyond space provided)Functional:

(*You may extend beyond space provided)Full-scale:

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(*You may extend beyond space provided)8.b. Are there ways that the institution can reduce costs? (eg. Combining exercisesamong different departments, cost-sharing, resource-sharing w/ nearby institutions)Explain


4. Define the Scope of the Exercise and Selection of Exercise Type

Exercise scope pertains to the limits of an exercise. There are five noted exercisescope elements.

1) Type of emergency- usually limited to one major hazard, although secondary

hazards may develop as the scenario unfolds. The emergency type may bechosen based on hazard priority, the types of actions that need to bepracticed, new problems that have just recently developed, or hazards whichhave not been exercised recently.

2) Location - the specific address where the simulated event will occur. For theincreasingly complex exercise types, it ideally should be at a place where thehazard could most likely occur for greater realism. Although logistic or safetyissues 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.

4) Participants - are selected based on the important functions to be done andneeds to be addressed They should be the ones who will really to carry outthose actions or make those decisions during an emergency.

5) Exercise Type - (orientation, drill, table top, functional, full-scale) is selectedbased on the identified needs and capability assessment. There must becongruence between what needs to be done and what can be realisticallydone to address those needs.

Determining the appropriate exercise type is given additional attention because is

one of the most important parameters that need to be settled upon early in process.The exercise type will determine the remainder of the planning process. Below areseveral suggested guide questions emergency management committees shouldconsider in making this decision.

What type of exercise best meets our training needs within the availableresources?

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?

Exercise Scope GuideExercise Scope

1. Type of emergencyWhat hazard will the exercise prepare for?

(*You may extend beyond space provided)2. LocationWhere will the simulated event occur?

(*You may extend beyond space provided)3. FunctionsWhat functions will be tested?

(*You may extend beyond space provided)4. ParticipantsWho will be participating in the exercise?


5. Exercise typeSelect the Exercise Type

Orientation

Drill Tabletop Functional Full-Scale

1. Address Costs

In addition to the capabilities assessment, attention must also be given to the costsand liabilities brought about by exercise conduction. In planning an exercise it mustbe ensured that the institution has the resources to support these activities. TheEmergency Planning Team should plan for the wide variety of apparent and hiddencosts at every stage of exercise development.

Cost Assessment Guide

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Guide Questions while assessing exercise costs1. Are there currently enough resources available to support exerciseexpenses?

Yes

NoIf YES, what are they?

(*You may extend beyond space provided)2. Are there hidden costs that need to be considered?

Yes

NoExamples: staff overtime salaries, contract services, equipment and materials, fuelfor equipment and transport, hospital liability insurance, and various othermiscellaneous expenses.If YES, what are they?

(*You may extend beyond space provided)3. Are there untapped resources that can still be accessed to support

the exercise?

Yes

NoIf YES, what are they?


2. Write a Statement of Purpose

A statement of purpose defines what gain is expected from the exercise. It is abroad statement of objectives, which governs the subsequent steps. It clarifies forhospital administrators and potential participants why the exercise is beingconducted. It is also useful in communicating plans to the media and other external

agencies.

Statement of Purpose Sample FormSTATEMENT OF PURPOSE

The purpose of the proposed emergency management exercise is to improve thefollowing emergency functions/operations:

a. (*You may list as many operations as appropriate)

b.

c.

d.

by involving the following agencies/personnel/departments:

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a. (*You may list as many entities as appropriate)

b.

c.

d.

in a (specify exercise type to be used) simulating a (specify hazard)

at (specify location) on (specify date).

3. Gain Support, Announce the Exercise, Send an Exercise Directive

Drawing of support from those in authority and using that mandate to garnercooperation from the designated participants is a crucial step in exercisedevelopment. This entails gaining approval from the highest possible official in yourinstitution. Even if the hospital director or chief executive does not directlyparticipate in the exercise, his/her endorsement can help acquire the cooperation ofthose who are selected to take part. Often it is only through this endorsement thatstaff and resource mobilization necessary in conducting the exercise can berealized. Without which the activity would be difficult if not impossible toaccomplish.

Gaining the support of the chief executive may not always be easy, but severalstrategies may be helpful such as:

Sell the process. The needs assessment, capability analysis, purposestatement, and objective are important building blocks for the exercise. Butthey also provide valuable tools for selling the idea professionally to thehospital administrators and the chief executive of your organization.

Protect the organization. Make a conscientious effort to protect the hospitaland health facility from unnecessary expenses, or potential law suits whichmay arise from the exercise.

Gaining support for an entire comprehensive exercise program. Hospitaladministrators may be more receptive to an exercise that is part of a proven,consistent, and goal-oriented program than to an isolated exercise.

Once this administrative mandate is achieved, announce the exercise in order to

gain broad support from the institutional constituents. The announcement maycome in the form of an exercise directive memo distributed by the office of thehospital director or chief executive, but the exercise planning team must beprepared to write it. This directive not only serves to disseminate informationregarding the exercise to the constituents, but also gives authority to the exerciseplanning team to conduct the exercise and tap the necessary resources andpersonnel required in the activity.

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Sample Exercise Directive MemoEXERCISE DIRECTIVE MEMO

Date:

TO: (Involved departments/agencies)

FROM: (Chief Administrative Officer)SUBJECT: EMERGENCY EXERCISE

A (specify exercise type) involving (specify hazard)will be scheduled for(specify date or approximate dates)

The purpose of the proposed exercise is to improve the following emergencyoperationsa. (*List appropriate functions/ operations)

b.

c.

It is important that your agency participate in this exercise. We encourageinvolvement at the highest level.

I believe we all realize the importance of emergency exercises as a means tocommunity preparedness. I fully support this exercise and intend to join with you inparticipating.

The Emergency Management Committee will be coordinating the exercise. They willbe contacting you to make necessary arrangements for the development andconduct of the exercise. For purposes of realism and interest, details of the exercisesituation will not be made known prior to the exercise.

For further information please contact (specify appropriate contact person)at(specify contact information) .

4. Establishing the Exercise Planning Team and Subordinate Units.

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Figure 3. Exercise Planning Organizational Structure

Often taken from members of the Emergency Management Committee, theExercise Planning Team is formed to be over-all in charge of the exercise fromdesign to execution. They may do the required tasks themselves, or through theoverseeing of various specialized subordinate units.

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, andsimulations), the expected time table, what is expected of participants andvolunteers, 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 theconduction phase, and is responsible to ensure that the exercise purpose andobjectives are achieved in a realistic manner.

3) The Logistics Team gathers all supplies materials equipment, services, andfacilities required for the implementation of the exercise.

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4) The Physical Arrangement Team which is in charge of the venue and otherfacility arrangements.

5) The Simulators Team which is responsiblefor simulating the variousagencies which may interact and send messages the players during an exercise.

6) The Victim Actors Team identifies the victims played, orients them into theirassigned roles, deploys them to assigned areas, and coordinates with theemergency medical service for any untoward incidents affecting the victim actors.

7) *The Exercise Evaluation Team reviews all existing evaluation tools anddevelops new tools based on the objectives, identifies and orients evaluators on thetool to be used, reproduces and distributes the tool, deploys evaluators to assignedareas, collates all evaluation findings, and develops final report withrecommendations.

8) *The Documentation Team which ensures adequate documentation of thedrill (ie. pictures, videos, notes, timers, etc) from pre-planning, planning, execution

and post-incident evaluation and provides the final report on the events of theexercise.

9) The Emergency Medical Service Team which provides emergency medicalservice during the conduct of the exercise, and ensures all participants, victims,simulators, evaluators, observers, and by-standers are safe during the conduct ofthe exercise.

10) The Food and Refreshments Team which is in charge of providingnourishment during the entire process.

*Due to their importance additional discussion is given to the roles of the exercisedesign and exercise evaluation committee subsequently.

5. Organizing the Design Team

There are many tasks involved in the designing of an exercise. They often requirethe efforts of a dedicated Exercise Design Team and Leader.

The Exercise Design Team Leader is responsible for the entire exercise designprocess, 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 tocoordinate the exercise design with efforts of the other exercise teams.

Among other tasks, the Exercise Design Team:

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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 variousbackgrounds representing the different departments and relevant agencies. If thesize of the team becomes unwieldy, a smaller core group can be assembled. Thiscore group can subsequently draw on the other members as needed.

It is recommended that the members of the exercise design team should not haveany key responsibilities in the departments participating in the exercise. Since, theymight not be able to participate fully in the exercise if they have been involved in itsdesign.Additionally, the person designated to be the incident commander or person with

the chief responsibility for managing emergency events should be reserved to be aplayer in the exercise. However if staffing limitations do not permit this, he may optto participate in the exercise design, but only on a limited basis. The incidentcommander should ideally assign others to develop and conduct the exercise.

6. Organizing the Evaluation Team

Evaluation begins when exercise design begins.

One of the members of the exercise planning team should be assigned to the role ofExerciseEvaluation Team Leader or Chief Evaluator. This individual will beprimarily responsible for:

1) Evaluation methodology2) Selecting and training the evaluation team, and3) Preparing the final evaluation report.

Selecting an exercise evaluation team leader early in the design process serves toensure that evaluation becomes an integral part of exercise development. This canhelp maintain the integrity of the evaluation function as being separate from thecontrol and simulation functions. Also, it can ensure that at least one person candevote time and mental effort to the larger task of evaluation.

An exercise evaluation team is formed to assist the Chief Evaluator. The

corresponding size and composition of the exercise evaluation team will depend onthe type of exercise, its complexity, and the availability of people to serve. Insmaller exercises, the team may report to the chief evaluator directly, or in largerexercises an Evaluation Directormay need to be assigned to oversee the differentexercise team units.

An orientation meeting is usually done to train the evaluation team. During thismeeting the exercise scenario, rules of play, objectives, evaluation requirements

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and procedures, and proper use of evaluation forms are discussed. Someinexperienced evaluators may also benefit from use of some practice drills. Inaddition, evaluators from outside the institution may need information about thefacility, its procedures, and personnel. All evaluators must be reminded and trainedto be as unobtrusive as possible since it is well documented fact that the merepresence of an evaluator can affect the behavior of those being observed, possibly

resulting in inaccurate data.

Table 3. Overview table the task categories of the exercise evaluationteam, and the exercise planning team and other subordinate units duringthe different phases of exercise conduction.

TASK CATEGORIESPreexercise phase Exercise Phase Postexercise Phase

Planning team andother subordinateunits

Review plan

Assesscapability

Address costs

and liabilities Gain

support/issueexercisedirective

Organize thedesign team

Draw up aschedule

Design exercise

Prepare facility

Assemble propsand otherenhancements

Briefparticipants

Conductexercise

ExerciseRecovery andreturn anddisposal of

exercisematerials

Participate inpostexercisemeetings

Evaluation Team Selectevaluation teamleader

Developevaluationmethodology

Select andorganizeevaluation team

Train evaluators

Observeassignedobjectives

Documentactions

Assessachievement ofobjectives

Participate inpostexercisemeetings

Prepareevaluationreport

Participate infollow-upactivities

7. Organizing the Documentation Team

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 Documentermay 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.

Documentation activities include, but are not limited to: recording attendance and minutes of meetings

taking photographs/ videos of exercise events

keeping an organized record of all released documents

Documentation is done throughout the entire exercise process - from planning,

preparation, execution, and post-exercise evaluation. This serves to have an

organized record of proceedings for review and evaluation at a later date. This

serves as proof of accomplishment used in presentation to administrative officials

and regulatory agencies. This can also be used in advocating further exercise

activities.

8. Preparing Exercise Objectives

Objectives are descriptions of performance expected of participants to demonstratecompetence.They are derived from the needs assessment, and noted problem areas. Theindentified needs are translated into specific actions stated in observable forms. Itshould state, Whoshould do what, underwhatconditions, andwhatstandards.

SAMPLE OBJECTIVE

Standards Conditions(Within 5 minutes ) (after the hospital fire notice is given),

Who Specific Actionthe (members of the EOC) will (complete notification procedures tolocal fire authorities.)

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 acronymcharacterizes 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 tounderstand.

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Measurable: The objective should set the level of performance, so that the resultsare observable, and it can told when the objective has been achieved.

Achievable: The objective should not be too difficult to achieve. Achieving it shouldbe 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 theexercise.

Task oriented: The objective should focus on a behavior or procedure. Withrespect to exercise design, each objective should focus on an individual emergencyfunction.

An exercise may contain from two to three, to as many objectives as appropriate.But on average ten or fewer objectives is recommended to remain manageable.

9. Writing the narrative

A narrative is a brief description of simulated events that lead up to the minute theexercise begins.It sets the mood for the exercise and sets the stage for later action by providing theinformation 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 thepresent tense in order to convey urgency and tension. The situation is usuallydeveloped chronologically and emphasizes the emergency environment. Thenarrative should work to capture the participants attention, and motivate them tobe actively involved.

Below is a narrative outline form that can be used as a starting point to develop anappropriate exercise narrative.

Narrative Outline GuideNARRATIVE OUTLINE

What emergency event:

How fast, strong, deep, dangerous:

How it was found out:

Response made:

Damage reported:

Sequence of events:

Current time:

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Was there advance warning:

Location:

Relevant weather conditions:

Other factors that would influence emergency procedures:

Predictions for the future:

10.Listing Major & Detailed events

Major and detailed events are simulated occurrences large and small which takeplace after and as a result of the emergency described in the narrative. Theyprovide unity to an exercise and link simulated events to actions participantsperform in order to meet the objectives.

Example of Related Scenario, Major Event, Detailed Event, & Expected ActionNarrative Scenario Major Event Detailed Event Expected ActionEarthquake Hospital Structural

DamageOperating RoomGas Pipe Leak

Activation ofOperating RoomEvacuationProcedure

Major events are the potential large problems resulting from an emergency. Theyare based on occurrences that likely follow the exercise narrative and generatepossible situations for testing exercise functions. Detailed events in turn are themore specific problem situations which requiring participants to respond in

expected actions to fulfill exercise objectives. In smaller exercises, there might notbe a need to distinguish between major and detailed events.

These events can be developed in several ways. Examples include:

Beginning with an identified action then listing a detailed event related to amajor event that may lead to this expected action.

Making a list of specific events closely linked with expected actions thenselecting the ones most likely produce the actions desired.

These methods are only bound by an exercise design teams creativity and focus inproducing the objectives of the exercise.

Sample Events ListEVENTS

Major Event #1

Detailed Events:1.

2.

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Major Event #2

Detailed Events1.

2.

(* You may choose add major and detailed events as necessary.)

11.Determining expected actions

Expected actions are the actions or decisions that should be demonstrated byparticipants to display competence in the exercise and fulfill the exercise objectives.Expected actions are usually a break down of an exercise objective. The goal inexercise planning is to write the script and messages in such a way that will promptthe participants to perform the expected actions. A detailed event can result in oneor several expected actions. There are four general types of actions that theparticipants may carry out. But these can be better specified in the exercise plan.

Verification: Gather or verify information

Consideration: Consider information, discuss among players, negotiate, consultplan

Deferral: Defer action to later, put action on priority list

Decision: Deploy or deny resources.

Expected actions are used to evaluate whether there was appropriate response toan emergency situation. In order to determine whether an action is appropriate fora given event one must simply go back to the EOP.

An Expected Actions Planning Table can help organize the process.

Expected Actions Planning TableExpected Actions Planning Table

Detailed Event Expected Action Participant /Department

Objectiveaddressed

(* You may choose to place additional spaces as necessary.)

12.Writing Messages

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Messages are used to communicate detailed events to participants. They are meantto evoke expected actions from participants to meet the exercise objectives. Incomposing messages for an exercise, it is helpful to always begin with an expectedaction. Consider what content and which message source would motivate theexpected action or actions.

Messages no matter how simple or complex have four main variables. Whichanswers, WHO sends WHATto WHOM, via HOW, and with WHAT EFFECT?

Message Source (WHO): Who sends the message? (must be a credible source)

Transmission Method (HOW): How the message is transmitted? (must be acredible means of transmission)

Message Content (WHAT): Information conveyed? (Does this message containthe information needed by the recipient to make a decision?)

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)

To enhance realism, particularly in functional or full scale exercises, it is best to usethe method of transmission that would likely be used in an actual emergency(landline, cell phone, radio, in person, written note, fax, email, etc). Messages mustalso be ideally sent through credible sources and appropriate channels, in order tomotivate the participant to act accordingly. Distraction messages however may alsobe placed into the exercise if the goal is to examine how participants will react tothem.

In short, keep the message realistic. A message is successful if it is able to motivatethe expected action.

Sample Message FormatEMERGENCY EXERCISE

NO: TIME:

TO: METHOD FROM:

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 andsimulators can refer to in order to keep the exercise on track. It is a listing of theevents or messages, the time it is to be released, and the expected actions from theparticipants.

Although the MSEL is the over-all guide for the exercise, organizers should stillremain flexible and appropriately adjust to the participant responses and exercisesituation as it develops. The goal should be to accomplish the objectives rather thanbeing overly strict in following the time schedule.

Master Scenario Events ListMASTER SCENARIO EVENTS LIST

Time Message/ Event Expected Actions


14.Finalizing Exercise Enhancements

Exercises are meant to simulate an emergency as realistically as the type ofexercise warrants.

The more realistic the scenario, atmosphere, and equipment and materials madeavailable to the participants the more likely they will be engaged, and the morethey will gain from the exercise.Exercise enhancements are the tools , materials, and strategies used to add to therealism of the exercise.

A wide variety of exercise enhancements can help achieve this goal. These mayinclude visuals, communications equipment, people and props, and use of othermaterials and resources. For example in drills or full-scale exercises the use of realequipment and actual locations is inherently realistic, but the additional use ofsimulated victims with convincing mock injuries can make the exercise even morecompelling. 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 realemergency.

Exercise enhancements need not require a lot of money or energy. The resourcesused can be from common items already available in the emergency operationscenter or within the health facility. All that is needed is a little creativity andresourcefulness to transform a mundane exercise into a more exciting andengaging activity for all parties involved.

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15.Developing the Evaluation Format

Evaluation is the process of observing and recording exercise activities, comparingthe performance of the participants against the objectives, and identifying strengthsand weaknesses.

For evaluation goals to be met, a systematic and methodical approach must begiven to evaluation planning and conduction. This involves determining:

1) The structure of the evaluation team2) The objectives to be measured3) The observation methods and recording forms to be used.

Criteria to determine if an exercise has been successful must be based on the listedobjectives and expected actions. It is from the expected actions that that pertinentevaluation measures can be developed.

There are countless variations on how evaluation can be done. Below are sampleevaluation 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 performedaccordingly. It allows for simple monitoring of objectives and the performance ofexpected actions.

Observation ChecklistOBSERVATION CHECKLIST

Objective ExpectedAction

PlayerstoObserve

Location

Expected Time

Done

NotDone

Comments:

SAMPLE

1. Activationof IncidentCommandSystem inresponse tonoted Fire

Alerttransmitted toDeputyIncidentCommander

DutyStaffNurse

7th

Floor7:50am


B. Key Event Response Form

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Key event monitoring involves monitoring the participants responses during keyevents in the exercise. Key events are the occurrences in the developing scenarioparticularly designed to place stress on selected elements of the EOP. The playersresponses to these events are subsequently noted in a Key Event Response Form

Key Event Response Form

KEY EVENT RESPONSE FORMEvent No: Scheduled Date/

Time:Initially Input: Actual Date/ Time:Response Date/ Time Position Responding Action Taken


C. Problem Log

The problem log is a tool which can be accomplished by anyone involved in theexercise (participants, controllers, simulators, evaluators, etc). It allowsidentification of potential problems which can then be analyzed after the exercise todetermine their source (plan, preparedness, training, simulation) and which requireappropriate corrective action.

Problem LogPROBLEM LOG

Name: Date:ExerciseAssignme

nt:

(ie.participant/controller/simulator/evaluator/

etc)

Contact No:

Time Event / MessageLibrary No. (ifknown)

Problem Analysis (LeaveBlank)


D. Evaluator Checklist

This evaluator checklist is a more comprehensive form that involves assessing thecompletion of objectives through note of accomplishment of specific point of review.

Evaluator ChecklistEVALUATOR CHECKLIST

Evaluator: Date:Location: Function being

Evaluated:Objective

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No.:Objective:SAMPLE OBJECTIVE

Demonstrate adequacy of displays to support the emergency operations plan duringthe exercise

Points of Review:Please answer the following: Y = Yes, N = No, NA = Not applicable, NO = NotobservedSAMPLE POINTS FOR REVIEW Y N NA NO1. Status boards availability in facility2. Status boards utilized3. Status boards kept updated4. Maps available5. Maps up to dateComments:


E. Narrative Summary

The narrative summary is an open-ended questionnaire discussing the issuesencountered during an exercise, and identifying possible solutions and responsiblepersonnel or departments. It is a highly useful tool in getting qualitative input fromthe evaluator. However, it requires more effort, training, and motivation from theindividual responding to the questions.

Narrative SummaryNARRATIVE SUMMARY

Objective Number: Criterion Number:Evaluator: Location:

Issue:A specific statement of the problem, plan, or procedure that was observed


Discussion:A discussion of the issue and its specific impact on operational capability

(*You may extend beyond space provided)Corrective Action Recommendation:

Recommended course (s) of action to improve performance or resolve the issue to

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improve operational capability

(*You may extend beyond space provided)Office of Primary Responsibility

The department, agency or organization responsible for implementation ofcorrective actions

Department, Agency, or Organization:

Individual ResponsibleTime: Date

Assigned:__/___/__ Suspense

Date:__/__/__

In addition to these tools or others which the evaluation team may develop, moreinformation can be obtained through the conduction of postexercise debriefing and

evaluation team meetings (discussed later). The final output of the entire evaluationprocess is the after action report which is to be utilized for implementingimprovements to the EOP and EMP.

During an Exercise

16.Conducting the 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 beaccomplished.

Final test of important systems and materials, such as technology dependenttools (computers, projectors, radios, other communications devices, etc.)which are prone to bogging down in the middle of the exercise.

Last minute briefing for all exercise staff and participants confirming thateveryone understands what are expected of them and the readiness toproceed. The IIMAC system for structured briefing may be used. It divides thebriefing into 5 specific areas.

I Information (Why the exercise is taking place)I - Intention (What the exercise is intends to do goal and objectives)M - Method (How the exercise will run)A - Administration (All the administrative arrangements for the exercise)C Communication (All arrangements concerned with communicationbetween parties)

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Final positioning of simulated casualties, props, special effects, staff, andparticipants.

Once all final preparations are complete, the Exercise Director heading the exercisecontrol team can give the signal for the exercise to begin.

Conduction Proper

The actual conduction phase allows for assessment of response capacity, training ofparticipants, and validation of competency. During this time, the facilitator orcontroller assumes responsibilities for conduction and ensuring that the exerciseobjectives are tested. This includes the following tasks:

Presenting the players with the exercise narrative

Announcing the first event of the scenario

Stimulating player responses without assuming control of play unless theexercise sidetracked from the objectives.

Managing the flow and pace of the exercise through the use of messages

Special Considerations

The actual execution of the exercise will depend upon the type of exercise, and thespecific plans developed in its conduction. However, there are common elementswhich may aid the success of the activity.

1) Foster realism. Players should be encouraged to treat the event asthey would an actual emergency.2) Maintain valid timelines through the use of a master schedule. In caseof divergences from the plan and schedule, the Exercise Director may

address these situations accordingly.3) Sustain action. This can be done by timely progression of scenarioevents and release of exercise messages. Keep the right pace to facilitateplayer engagement and participation. But be flexible within limit ofmaintaining the exercise objectives.4) Safety should be a common concern in all emergency exercises. Safetyrecommendations include:

Notification alerts of exercise conduction, for both the participantsand by-standers

Availability and use of personal protective equipment when

necessary Presence of an emergency medical team for unforeseen incidents

Policy and procedures for early termination of the exercise ifsituation dictates.

The aim is to reduce risk and address potential hazards even before theyeven occur.

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5) Be open to capitalize on problem situations. Complicating situationsthat place additional stress on the system may be useful in moreeffectively assessing the institutions response capabilities. But in noinstance should safety considerations be compromised for the sake ofpushing through with the exercise.

6) Finally, at the end of exercise execution, there must also be provisionsfor a system recovery and return to normal operations. Although primarilythe responsibility of the maintenance staff and physical arrangementteam a group effort in returning everything to their proper place is highlyencouraged.

Post Exercise Activities

17.Conducting Post-exercise meetings

Post exercise meetings are often of two types: The Player Debriefing, and the

Evaluation Team Meeting.

Player Debriefing

The Player debriefing also known as a hot debriefing is conducted immediatelyafter an exercise. Cold debriefs can also be conducted some days after theexercise. In either case, they involve getting feedback of participants opinions,critique, and suggestions regarding the activity. It usually begins with the controllerconducting the meeting and reviewing the goals of the exercise giving generalcomments on both the successes and short falls of the activity. Each of the playersis then given time to give a brief response. This meeting is for participants, and theorganizing team at this point should limit their input so as not to plant bias in the

responses. A balanced and open atmosphere for both positive and negativefeedback should be established and all comments recorded for use in the afteraction report.

Exercise Debriefing FormExercise Debriefing

OverviewDate/Location:

(Department/Institution) hosted a (Type of Exercise) on (Date)Attendees included representatives from (List of Attendees)

Hot Debrief:After the exercises conclusion the planners and participants met briefly to discussthe exercise conduct and planning process. Discussion primarily focused on(Number) of Aspects: (List Aspects)Discussion Points Per listed Aspect1.


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2.

(*You may extend beyond space provided)3.


Points of ActionProblem Summary Recommended Action Responsible Person/

Department


It is important to be systematic in the debriefing, and a standardized questionnairemay also be used. A written form may also be provided to participants to fill out so

that those who are hesitant to comment in the group discussion may be more opento do so in writing. A good format may include both simple objective checklist typequestions and an open-ended segment for elaboration.

Exercise Critique FormEXERCISE CRITIQUE FORM

Name of Exercise: Date:Participant Name: Department/Agency:

Role: Player Facilitator Simulator Victim-Actor ObserverPlease take a few minutes to fill out this form. Your opinions and suggestions willhelp us prepare better exercises in the future.1. Please rate the overall exercise on the following scale.

1 2 3 4 5 6 7 8 9 10Very PoorVery Good

2. Compared to the previous exercise this one was:

1 2 3 4 5 6 7 8 9 10Very PoorVery Good

3. Did the exercise effectively simulate the emergency environmentand emergency response activities?

Yes

NoIf NO, briefly explain why:


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4. Did the problems presented in the exercise adequately testreadiness capability to implement the plan?

Yes

NoIf NO, briefly explain why:

(*You may extend beyond space provided)5. The following problems should be deleted or revised:

(*You may extend beyond space provided)6. I suggest that you add the following problems for the next exercise:

(*You may extend beyond space provided)7. Please add any other comments or suggestions.


Evaluation Team Meeting

Some time after the exercise and Players debriefing, the evaluation team willconvene to analyze the exercise and prepare for the after action report. The teamgoes through the evaluation forms, debriefing responses, and any other data todiscuss how well the exercise objectives were met. There can be additionalmeetings as needed to analyze the data and prepare the After Action Report. Othermembers from the exercise planning team or subunits may be invited to providetheir input. This process should be done some time shortly after the exercise while

memories are still fresh.

18.Writing the After Action Report

The final output of the evaluation team meetings is the compiled After ActionReport (AAR) which documents the effectiveness of the exercise. This AAR is usedto instigate corrective action in the EMP or how it is implemented and it may alsoserves as the basis for future exercises. It should distributed to the chief executiveof 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 beloware usually covered. The final document can be as long or as short as the extent of

the exercise requires.

After Action Report OutlineAFTER ACTION REPORT OUTLINE

Introduction

Main purpose of the report, why it is being submitted, preview of main topics,evaluation methodology used, and perhaps a general summary of mainproblems 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

Accomplishments and shortfalls

Evaluation Group findings

Summary of postexercise debriefing

Recommendations

Training needs

Changes in the Emergency Plan Other corrective Actions

19.Conducting follow-up activities

One of the main goals of conducting emergency exercises is to developrecommendations to the design or execution of the EOP. These recommendationsdeal specifically with the:

Soundness of the exercise plan

Availability of resources to support the plan

Adequacy of training for personnel to carry it out.

Recommendations written in After Action Report are reviewed by the chiefexecutive, emergency management program committee, and other key decisionmaking units. They then decide on which recommendations are appropriate andachievable in the institution. These may translate to:

changes in policy

resource acquisition or allocation

personnel training

decision to conduct further exercises

From there, Exercise Follow-up strategies include:

1) Clearly assigning tasks and schedules and designate responsibility for eachrecommended improvement.2) Establishing a monitor plans to track the progress of recommendationsimplementation.

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3) Completing the cycle by incorporation of the testing of noted improvementindictors into succeeding exercises.

Because in the end, the recommendations, and the exercise itself, would indeed beuseless if no efforts are placed into their implementation.

Tracking Improvement ChecklistTracking Improvement ChecklistEmergencyManagement Function

Command Operations

Planning Logistics Finance

Items forAction

CorrectiveActions

SAMPLEImprovenotificationofpersonneloutsidehospital

O P C S Purchaseofpersonnelpagers

P = Primary Responsibility S = Secondary/Support O = Oversight C =Coordinator Role(* You may choose to place additional spaces as necessary.)

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