Statewide Medical & Health Exercise Controller/Evaluator Training

1. November 3, 2011 Statewide Medical& Health ExerciseController/Evaluator Training

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

3. Annual Statewide Medical and Health Exercise coordinated by California Department of Public Health (CDPH) An opportunity to exercise the entire medical and health mutual aid and response system across the County & State An opportunity to identify systematic and individual areas for improvement and best practices to share with others Can be used to meet other exercise requirements (e.g., HPP, Joint Commission) Exercise Purpose

4. Operational Area /EMS Agency/Public Health • Interoperable Communications • Intelligence/Information Sharing and Dissemination • Environmental Health • Emergency/Department Operations Center Management/Resource Management • Hospitals • Communications • Intelligence/Information Sharing and Dissemination • Medical Surge • Hospital Command Center Management • Public Safety and Security Response Objectives

5. Clinics • Communications • Intelligence/Information Sharing and Dissemination • Medical Surge • Emergency Operations Center Management • Fire/EMS/Ambulance Provider Agencies • Communications • Intelligence/Information Sharing and Dissemination • Medical Surge • Emergency Operations Center Management Objectives (Cont.)

6. Scenario Highlights • JRIC issues warnings to local health departments and water systems concerning threats and recent incidents • Healthcare facilities experiencing an unusual increase in the volume of patients presenting with similar gastrointestinal symptoms • EMS system is overwhelmed by high call volumes (Do not share this information with Players) Exercise Overview

7. Scenario Highlights (Cont.) • JRIC issues an alert that a terrorist organization has claimed responsibility for contaminating a major branch of the water delivery system • Threat is supported by evidence that contamination has occurred • Health Officer issues a “Do Not Use” order for the water system that serves your community • Presence of an unknown contaminant • Results of water testing may not be available for 24 hours or more (Do not share this information with Players) Exercise Overview (Cont.)

8. Exercise Documentation • Controller and Evaluator (C/E) Handout • Player Briefing • Communications Directory/EXPLAN • Master Scenario Events List (MSEL) • Evaluation Form • Participant Feedback Form • Website: http://ems.dhs.lacounty.gov/Disaster/Announcement.htm Exercise Overview (Cont.)

9. Schedule of Events

10. Exercise Director • Gary Chambers, LA County EMS Agency • SimCell Director/Senior Controller • Nick Lowe, Cal EMA • Controllers • Evaluators • Simulators Exercise Staff

11. Assumptions • Real-world emergencies take priority • Exercise participants will comply with real-world response procedures unless otherwise directed by Control staff • Communications Directory • Quick reference for who is and isn’t playing • Provides contact information so exercise participants can safely communicate during the exercise • Must contact only those listed Exercise Implementation

12. Exercise Communications • Exercise Language • “This is an exercise” • “Real-World” • “Timeout” • Site Safety and Security • Exercise Identification/Credentials Exercise Implementation (Cont.)

13. SIMULATION

14. Three major activities: • Delivering injects to players (outgoing) • Simulating non-participating entities (inbound) • Documenting participant responses • SimCell Limits • Only simulating non-participating entities • Players need to identify who they want to talk to • Will not make decisions for players • May have limited knowledge/expertise • May need to do follow up and call back • Use the SimCell Phone List SimCell Operations

15. Control

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

17. Player Briefing Highlights • Objectives • Exercise Mechanics/Functionality • Rules of Play • Background Scenario Player Instructions

18. 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 Player Instructions (Cont.)

19. 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 Player Instructions (cont.)

20. 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 Participant Interaction

21. 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 • 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 Participant Interaction (Cont.)

22. 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 Controller Responsibilities

23. 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 and implement the scenario according to the MSEL • “Eyes and ears” of the SimCell and Exercise Director • Have patience, allow exercise to play out • If possible, capture notes to assist Evaluators Controller Responsibilities (Cont.)

24. Conduct a Hotwash • Held immediately following ENDEX • 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? • Hotwash slide included in Player Briefing • Distribute and collect Participant Evaluation Forms Post-Exercise Activities

25. Evaluation

26. 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) Evaluation Purpose

27. 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 Evaluation Guidance

28. Observe and Record • During exercise play, discussion periods and the Hotwash • 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 Evaluator Guide/Form Evaluation Guidance (Cont.)

29. 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 • Do not focus exclusively on specific tasks • Whether or not Players achieved the desired OUTCOME is more important than how they attained it • Be aware of: • The integration of different functions • Coordination of the overall response • Timeline • Discrepancies may indicate issues Evaluation Guidance (Cont.)

30. Before the exercise: • Review agency plans and procedures • Be familiar with the Evaluator Guide, Scenario/ Injects and Exercise Objectives • Arrive at the venue 60 minutes before StartEx Evaluator Responsibilities

31. 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 Evaluator Responsibilities (Cont.)

32. Capture notes during the Hotwash • Collect documentation from players • Player Logs • MSEL forms • Player ICS forms, Incident Action Plans, written Press Releases, etc. • Collect and review Participant Feedback Forms Post-Exercise Activities

33. Attend Exercise Evaluation Conference (EEC) • Date: Wednesday, November 30th • Time: 0800-1200 (Registration at 0730) • Location: Long Beach Memorial • Attendees include Primary Controller/Evaluator (1 person per hospital/clinic) • Facilitated discussion of all aspects of the exercise • Design process • Review exercise in accordance with objectives and observations • Feedback from Hotwash and Participant Critiques Post-Exercise Activities (Cont.)

34. 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 Post-Exercise Activities (Cont.)

35. After-Action Report (AAR) Template • Simplified HSEEP Template • Identify strengths and areas for improvement for each objective • Populate Improvement Plan (IP) • Due January 16, 2012 • Email to Gary Chambers, LA County EMS Agency gchambers@dhs.lacounty.gov Evaluation Write Ups

36. Review the: • Controller/Evaluator Handbook • Master Scenario Events List (MSEL) and Scenario • Plans and procedures • Bring appropriate materials with you on the day of the exercise • Clipboards, note pads, pens, camera, good shoes, etc. • Be early for assignments • Be prepared to complete or participate in assignments after the exercise (e.g., Hotwash, EEC, AAR) • Respect your role and take your responsibilities seriously • Exercise success is more dependent on the exercise staff than on the players In preparation

37. Thank you and enjoy the experience!