CONTROLLER AND EVALUATOR TRAINING September 30, 2014

1. Los Angeles County Emergency Medical Services AgencySTATEWIDE MEDICAL AND HEALTHFUNCTIONAL EXERCISE CONTROLLER AND EVALUATOR TRAININGSeptember 30, 2014

2. Agenda • Exercise Overview • Objectives • Schedule • Implementation • Simulation Cell (SimCell) • Control Instructions • Evaluation Instructions

3. EXERCISE OVERVIEW

4. Program Phases – Building Block • Phase 1) Multimedia training, including: • Disaster preparedness and response • Medical and health coordination • Requesting medical and health resources • California Public Health and Medical Emergency Operations Manual training • Phase 2) Organization specific self-assessment tools to identify strengths and weaknesses • Phase 3) A tabletop exercise to discuss current plans, policies and procedures • Phase 4) A functional exercise to test current plans, policies and procedures

5. Exercise Highlights • Thursday, November 20, 2014 • Exercise Play: 9:00 AM – 12:00 PM* • Focus: • Coordination of surveillance activities and health system capabilities anticipated when managing a medical surge caused by possible MERS-CoV infections • Play throughout the State • Los Angeles County Participants • Hospitals • Clinics • Long Term Care Facilities • Surgery Centers • Dialysis Centers • Ambulance Providers • Emergency Management Providers(DMH, DPH, DHS, CEOC, LAC-EOC) • LEMSA • Home Health

6. Objectives • Organized by Discipline and Capability • Operational Communication • Public Health and Medical Services(Formerly Medical Surge/ Epidemiological Surveillance and Investigation) • Operational Coordination(Formerly Emergency Operations Center Management) • Public and Private Services and Resources(Formerly Volunteer Management and Donations) • Marry State and County objectives & capabilities • Each sector selected its own objectives • Each participant organization can tailor to their needs

7. Scenario TIP: Scenario specifics contained in the MSEL should not be given to players in advance of the exercise. • Two individuals have been diagnosed with MERS-CoVone nine days ago and a second three days ago • Significant numbers of patients with influenza like illness inundate the healthcare system requesting testing and treatment for MERS • Increased numbers of ILI cases with a 10% increase in admissions with acute respiratory illnesses • Guidance on specimen collection, laboratory techniques, and necessary levels of isolation and personal protective equipment • Ambulance companies and 9-1-1 system are overwhelmed

8. Exercise Schedule

9. Exercise Documentation • Exercise materials provided on EMS website • Can be used as templates for future efforts • Controller and Evaluator (C/E) Handbook • Exercise Plan (ExPlan) • Communications Directory (including SimCell) • Sent directly to participants via email • Master Scenario Events List (MSEL) • Combined EEG/After Action Report/Improvement Plan Template • Participant Feedback Form-Coming soon • Website: http://dhs.lacounty.gov/wps/portal/dhs/ems/disastermedicalservices

10. Exercise Participants • Players:Active role in performing their regular roles and responsibilities in response to the scenario. Individuals and performance are evaluated. • Controllers: Controllers plan, manage and ensure the integrity of the exercise. Direct the pace, provide key data to players, and may prompt certain player actions to ensure exercise continuity. • Simulators: Simulators play the role of non-participating organizations or individuals. Provide injects to players to prompt actions in accordance with scenario. Operate from the Simulation Cell (SimCell), but may occasionally have face-to-face contact with players. • Evaluators:Assess the performance of players and the design of the exercise and provide feedback on designated functional areas.

11. Exercise Participants (Cont.) • Actors: Realisticallyact out the roles of individuals involved with or impacted by the scenario for players to directly respond to in person. Usually asked to evaluate the performance of players as well. • Observers: Observers do not play in the exercise, nor do they perform any control or evaluation functions. They are not to interfere with exercise play. • Support Staff: Individuals who perform administrative and logistical support tasks during the exercise (e.g., registration, catering).

12. Exercise Implementation • Assumptions • Real-world emergencies take priority • Exercise participants will comply with real-world response procedures unless otherwise directed • Exercise Communications • Exercise Language • Site Safety and Security • Exercise Identification/Credentials

13. Simulation Cell (SimCell)

14. SimCell Operations • Three major activities • Delivering injects to players (outgoing) • Simulating non-participating entities (inbound) • Documenting participant responses

15. SimCell Positions • SimCell Lead Controller • Track and coordinate all scenario events • Identify how problems can be resolved • Directs and provides guidance to simulators • Can be contacted by Controllers at play sites regarding exercise status • Simulators • Track injects, participant calls into the SimCell, and associated follow-up responses • Ensure realism and accuracy in all exercise communication • Place injects, answer phones and respond to player questions, create new injects to encourage additional participation • Conduct research and provide explanations for observed player actions during the exercise

16. SimCell Operations • SimCell Limits • Only simulating non-participating entities • If they’re playing…contact them directly! • Players need to identify who they want to talk to (be specific) • Will not make decisions for players • May have limited knowledge/expertise • May need to do follow up and call back • Use the Communications Directory provided by EMS via email to registered participants-emailed to functional and full scale participants only- USE for exercise only

17. SimCell Responsibilities • Before the Exercise • Review any emergency plans, procedures, and protocols available to you relevant to your assignment • Review the exercise materials issued to you, including the objectives, scenario, MSEL/injects, and evaluation forms

18. SimCell Responsibilities (Cont.) • During the Exercise • Ensure all planned injects are submitted to the appropriate agencies on time (unless otherwise instructed) and in the correct format • Receive player communications, then write, coordinate, and transmit appropriate responses in a timely manner • Ensure SimCell operations are coordinated and congruent with the overall exercise operations

19. SimCell Responsibilities (Cont.) • During the Exercise • Keep the SimCell lead controller apprised of developments, problems, issues, or concerns • Attempt to accurately portray the information contained in inject forms to the players • Record all calls received and made on the SimCell Activity Log • Any new injects developed for the exercise should be submitted to the SimCell Lead Controller for approval before being used in the exercise

20. SimCell Responsibilities (Cont.) • Phone Instructions • When answering a phone in the SimCell or at another simulated entity location always answer with “This is the SimCell” • Inquire to the participant regarding their name, agency/facility and who they are trying to reach if they do not provide this information • Ensure you re-iterate “This is an exercise” prior to providing any answers or feedback to participants

21. Exercise Control

22. Controller Purpose • Ensure the integrity of the exercise • Responsibilities • Exercise mechanics and functionality • Deliver injects to drive play • Provide Player Briefing • Objectives are being met • Actor management • Participant behavior/activities • Safety/security • Facilitate Hotwash

23. Controller Positions • Exercise Director • Final authority on all aspects of the exercise, including starting, modifying, or ending the exercise • Works with the Senior Controller to ensure the exercise runs smoothly and all objectives are met

24. Controller Positions (Cont.) • Senior Controller • Coordinates with the Exercise Director on exercise control and safety issues • Monitors activities at each exercise venue • Tracks whether objectives have been met or require further attention • Controllers • Each exercise venue will have its own Controller(s) • Responsible for keeping the exercise on schedule and suggesting potential modifications or injects • The SimCell will have a lead controller who is responsible for managing the SimCell

25. Controller Responsibilities • Before the Exercise • Review applicable plans and procedures that will be activated during the exercise • Know the scenario and MSEL • Arrive at the venue 60 minutes before StartEx • Provide the Player Briefing

26. Controller Responsibilities (Cont.) • During the Exercise • Locate necessary communications equipment and test it to ensure systems are operational • Monitor flow and sequence of events during play according to the MSEL • Manage the flow of exercise play • “Eyes and ears” of the SimCell and Exercise Director • Controllers must work with the SimCell to maintain appropriate exercise pacing • “Speed up” play if Players aren‘t challenged • “Slow down” play if Players are overwhelmed • Have patience, allow exercise to play out • If possible, capture notes to assist Evaluators

27. Controller Responsibilities (Cont.) • Conduct a Hotwash • Held immediately following EndEx • Hotwash slide contained in Player Briefing • Opportunity for PLAYERS to comment on their experience • What went well? • What needs improvement? • Plans, organization, equipment, training, exercise • Any surprises? • Improvements to exercise implementation? • Distribute and collect Participant Feedback Forms

28. Player Instructions • Controllers ensure Players are ready to participate • Player Briefing Highlights • Scenario (provided on website) • Exercise Objectives (provided on website) • Exercise Mechanics/Functionality • Start time • End Time • Description of Exercise staff • Rules of Play • Real world vs Exercise language

29. Player Instructions (Cont.) • Key Messages & Enforcement • Will not have prior knowledge of the scenario beyond the contents of the Player Briefing • Must understand the scope of the exercise and which organizations are participating • Expected to recognize that certain artificialities are built into the scenario to meet exercise objectives • e.g., Instruct players not to fight the scenario

30. Player Instructions (Cont.) • Key Messages & Enforcement (Cont.) • Need to follow real world response procedures and act as if the emergency were real • Demonstrate all actions necessary to meet exercise objectives • Players must receive information from their own sources (e.g., other players or SimCell) • Should “verbalize” their responses and maintain activity logs • Turn in all documentation to the Controller or Evaluator

31. Participant Interaction • Players direct requests for additional info to Controllers and the SimCell • Players and Controllers/Evaluators will not engage in casual conversation • Players must adhere to all Controller instructions • “Controller Prerogative” may countermand a Player’s actions to preserve the continuity, integrity and/or objectives of the exercise

32. Participant Interaction (Cont.) Controllers only provide Players with info when specifically designated (e.g., injects) Controllers and Evaluators should not provide players with feedback or guidance on their actions/ performance

33. Evaluation

34. Evaluation Purpose The fundamental purpose of the exercise Evaluators collect data, conduct analysis, and provide findings/recommendations Evaluator findings/recommendations based on evaluation guides, plans/procedures, personal expertise and experience Provide the foundation for the After Action Report (AAR) and Improvement Plan (IP)

35. Evaluator Guidance • No fault exercise • Learning environment • Judge the plans and capabilities, NOT the players • Identify Lessons Learned • Best Practices • Areas for Improvement • Assess the level of preparedness • Ensure opportunities for Player demonstration

36. Evaluator Guidance (Cont.) • Observe and Record • During and after exercise • Tips and Key Focus Areas: • Activities that directly relate to goals and objectives • Expected actions associated with Injects • Decision-makers and key decisions • Critical events/initiating scenario events • Deviation from plans/procedures • Include times (both start and end) • Use the Exercise Evaluation Guide (EEG)

37. Evaluator Guidance (Cont.) • Tips and Key Focus Areas (Cont.) • What to look for • What happened? When? • How did Players coordinate? • How did Players use plans & procedures? • Adequacy of equipment/facilities/resources to support task accomplishment • Focus on outcomes and pathways • Do not focus exclusively on specific tasks • Focus on what they accomplished and how they accomplished it

38. Evaluator Guidance (Cont.) • Be aware of • The integration of different functions • Coordination of the overall response • Timeline • Discrepancies may indicate issues

39. Evaluator Guidance (Cont.) • Before the Exercise • Review the appropriate plans, procedures, and protocols • Attend required briefings • Review and be familiar with the appropriate exercise materials • Be familiar with After-Action Report (AAR) requirements and write up templates • Report to the exercise location at the time designated in the Exercise Schedule • Obtain or locate necessary communications equipment and test it to ensure satisfactory communication between Controllers and the Exercise Staff

40. Evaluator Guidance (Cont.) • During the Exercise • Capture detailed notes • Position yourself so you can hear/see • Ask questions of players as necessary • Don’t interfere with exercise play • Notify the Controller of any exercise issues

41. Evaluator Guidance (Cont.) • After the Exercise • Capture notes during the Hotwash • Collect documentation from players • Player Logs • Inject/MSEL forms • Player ICS forms, Action Plans, Press Releases, etc. • Collect and review Participant Feedback Forms • Attend C/E Debrief at your site • Submit evaluation write-ups • Identify strengths and areas for improvement for each objective • Populate Improvement Plan (IP)

42. Post-Exercise Activities

43. Post-Exercise Activities • Attend Exercise Evaluation Conference (EEC) • Date: Thursday, December 18, 2014 • Time: 0900-1200 (Registration at 0830) • Location: LA County EMS Agency, Hearing Room 10100 Pioneer Blvd, Santa Fe Springs • Attendees include Senior Controller/Evaluator • Max 2 persons per facility/organization • Facilitated discussion of all aspects of the exercise • Design process • Review exercise in accordance with objectives and observations • Feedback from Hotwash and Participant Critiques

44. Post-Exercise Activities (Cont.) • Exercise Evaluation Conference Format • ONE representative to speak for each agency/ organization • Provide overall summary • Provide 3 practices to “sustain” and recommendations on how to sustain them • Provide 3 practices to “improve” and recommendations on how to improve them • A mix of organization-specific and system-wide strengths and areas for improvement

45. Evaluation Write Ups • After-Action Report (AAR) Template • Identify strengths and areas for improvement for each objective • Populate Improvement Plan (IP) • DueJanuary 22, 2015 • Email to Gary Chambers, LA County EMS Agency gchambers@dhs.lacounty.gov

46. In Conclusion • Review the: • Controller/Evaluator Handbook • MSEL and scenario • Plans and procedures • Bring appropriate materials with you • Clipboards, note pads, pens, camera, good shoes, etc. • Be early for assignments • Be prepared to complete or participate in activities after the exercise • Respect your role and take your responsibilities seriously • Exercise success is more dependent on the exercise staff than on the players

47. The EEG/AAR/IP Form

48. “One form to make it simple” First few pages are for the Exercise Evaluation Guides (EEGs) for use by the evaluators during the exercise Middle Pages are the After Action Report (AAR) to be completed by the Lead Evaluator Last pages are the Improvement Plan (IP) to be completed by organizational management staff

49. The Evaluator’s Impression

50. Strengths and Improvement Needed