You are on page 1of 32

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, Columbia
University School of Nursing- Center for Health Policy - with the concepts applied to the
setting of Hospital and Health Facilities.

Page | 1
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 of
an 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 Checklist


Potential Hazards
1. List the various hazards which threaten your institution. Use the following
checklist as a starting point. (Check all that apply. You may extend beyond the
space provided.)
 Bomb Threat  Hostage/ Shooting Incident
 Biological Attack  Radiologic Release
 Chemical Attack  Severe Weather
 Earthquake  Tsunami
 Epidemic  Other/s (please specify):
 Fire ______________________
 Flooding  Other/s (please specify):
 Hazardous Material Release ______________________
 Violent Patient/ Personnel
Secondary Effects
2. What secondary effects from the listed hazards are likely to impact your
institution? Use the following checklist as a starting point. (Check all that apply. You
may extend beyond the space provided.)
 Hospital Operation Interruptions  Other/s (please specify):

Page | 2
 Communication System Breakdown ______________________
 Compromise of Structural Integrity  Other/s (please specify):
 Loss of Power ______________________
 Loss of Water  Other/s (please specify):
 Mass Evacuation ______________________
 Mass Casualty Incident  Other/s (please specify):
 Overwhelmed Medical Services ______________________
 Shortage of Medical Supplies  Other/s (please specify):
______________________
 Transportation Blockages
Hazard Priority
3. What are the Highest priority Hazards?
*Consider such factors as: Frequency of occurrence, Relative likelihood of
occurrence, Magnitude and intensity, Location (affecting critical areas or
infrastructure), Spatial extent, Speed of onset and availability of warning, Potential
severity 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 appropriate


Hazard Mapping
4. What geographic area(s) or facility location(s) is (are) most vulnerable to the high
priority hazards?

(*You may extend beyond space provided)


Plans and Procedures
5. What plans and proceduresemergency management program, emergency
operations plan, departmental standard operating procedures (SOPs) will guide
your organization’s response to an emergency?

(*You may extend beyond space provided)


Functions
6. What emergency management functions are most in need of rehearsal? (e.g.,
What functions have not been exercised recently? Where have difficulties occurred
in the past?) You can use the following checklist as a starting point.
 Alert Notification (Emergency  Other/s (please specify):
Response) ______________________
 Communications  Other/s (please specify):
 Coordination and Control ______________________

Page | 3
 Emergency Public Information (EPI)  Other/s (please specify):
 Damage Assessment ______________________
 Transportation  Other/s (please specify):
 Resource Management ______________________
 Continuity of Operations
Participants
7. Who (agencies, departments, operational units, personnel) need to participate in
exercises?
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 plans
and 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 EXTERNAL
 Administration  Social Service  Other Hospitals/ Health
 Central Supply  Toxicology Facilities
 EMS/ Patient Transport  Maintenance  Ministry of Health
Service  Medicine Department  Local Government
 Emergency Department  Pediatrics Department  Fire Department
 Engineering and Physical  Psychiatry Department  Law Enforcement
Plant  Radiology Department  Media
 Infection Control  Surgery Department Other/s (please specify):
 Intensive Care Unit  Hospital-wide _____________________
 Laboratory  Other/s (please _____________________
 Medical Staff specify): Other/s (please specify):
 Nursing ______________________ _____________________
 Pharmacy ______________________ _____________________
 Public Affairs
 Security
List specific personnel if applicable

(*You may extend beyond space provided)


Programs Areas
8. Mark the status of your emergency management program in these and other
areas to identify those most in need of exercising.
New Update Exercise Used in N/
d d Emergen A
cy
Emergency Plan
Plan Annex(es)

Page | 4
Standard Operating Procedures
Resource List
Maps, Displays
Reporting Requirements
Notification Procedures
Mutual Aid Pacts
Policy-Making Officials
Coordinating Personnel
Operations Staff
Volunteer Organizations
EOC/Command Center
Communication Facility
Warning Systems
Utility Emergency Preparedness
Damage Assessment
Techniques
Other/s (pls specify):

Past Exercises
9. If your organization has participated in exercises before, what did you learn from
them, and what do the results indicate about future exercise needs? You may
consider 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 they
been tested?

(*You may extend beyond space provided)

3. Assess Capability to Conduct an Exercise

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

Page | 5
Capability Assessment Checklist
Plans
1. How familiar are the exercise planners with the emergency plans, policies, and
procedures of the institution?

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

Time
2.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 the
exercise?
Actual person days:
Elapsed time to exercise:
Experience
3.a. When was the institution’s last exercise?

3.b. What is the exercise planners’ previous experience with exercises? (Check all
that apply)
Orientation:  Presenter  Participant
Drill:  Controller  Participant
Tabletop:  Facilitator  Participant
Functional:  Controller  Simulator  Player  Evaluator
Full-scale:  Controller  Responder  Evaluator  Victim
3.c. What other exercise related experience is available from the facility staff and
community?

(*You may extend beyond space provided)


Facilities
4. 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

Page | 6
Will they be available for the exercise?  
Yes No
Communications
5. 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 No
Will they be available for the exercise?  
Yes No
Administration
6. Are the hospital director and emergency service coordinators or  
other administrative leaders expect to have a positive attitude Yes No
towards the exercise?
If NO, how can this be overcome?

(*You may extend beyond space provided)


Barriers
7. Are there any resource barriers that need to be overcome to carry  
out this exercise Yes No
If YES, what are the barriers and how can they be overcome?

(*You may extend beyond space provided)


Costs
8.a. What types of costs might be included for these exercises in the institution? (Do
not 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:

Page | 7
(*You may extend beyond space provided)
8.b. Are there ways that the institution can reduce costs? (eg. Combining exercises
among different departments, cost-sharing, resource-sharing w/ nearby institutions)
Explain

(*You may extend beyond space provided)

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 exercise
scope elements.

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


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

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


needs to be addressed – They should be the ones who will really to carry out
those actions or make those decisions during an emergency.

5) Exercise Type - (orientation, drill, table top, functional, full-scale) is selected


based on the identified needs and capability assessment. There must be
congruence between what needs to be done and what can be realistically
done 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 are
several suggested guide questions emergency management committees should
consider in making this decision.

 What type of exercise best meets our training needs within the available
resources?
 What experience have personnel had with the various types of exercises?

Page | 8
 What exercises are most needed?
 What stress level do we want?
 What types of exercises are mandated by regulatory requirements?

Exercise Scope Guide


Exercise Scope
1. Type of emergency
What hazard will the exercise prepare for?

(*You may extend beyond space provided)


2. Location
Where will the simulated event occur?

(*You may extend beyond space provided)


3. Functions
What functions will be tested?

(*You may extend beyond space provided)


4. Participants
Who will be participating in the exercise?

(*You may extend beyond space provided)


5. Exercise type
Select 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 costs
and liabilities brought about by exercise conduction. In planning an exercise it must
be ensured that the institution has the resources to support these activities. The
Emergency Planning Team should plan for the wide variety of apparent and hidden
costs at every stage of exercise development.

Cost Assessment Guide

Page | 9
Guide Questions while assessing exercise costs
1. Are there currently enough resources available to support exercise  
expenses? Yes No
If YES, what are they?

(*You may extend beyond space provided)


2. Are there hidden costs that need to be considered?  
Yes No
Examples: staff overtime salaries, contract services, equipment and materials, fuel
for equipment and transport, hospital liability insurance, and various other
miscellaneous 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 No
If YES, what are they?

(*You may extend beyond space provided)

2. Write a Statement of Purpose

A statement of purpose defines what gain is expected from the exercise. It is a


broad statement of objectives, which governs the subsequent steps. It clarifies for
hospital administrators and potential participants why the exercise is being
conducted. It is also useful in communicating plans to the media and other external
agencies.

Statement of Purpose Sample Form


STATEMENT OF PURPOSE

The purpose of the proposed emergency management exercise is to improve the


following emergency functions/operations:

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

b.

c.

d.

by involving the following agencies/personnel/departments:

Page | 10
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 garner
cooperation from the designated participants is a crucial step in exercise
development. This entails gaining approval from the highest possible official in your
institution. Even if the hospital director or chief executive does not directly
participate in the exercise, his/her endorsement can help acquire the cooperation of
those who are selected to take part. Often it is only through this endorsement that
staff and resource mobilization necessary in conducting the exercise can be
realized. Without which the activity would be difficult if not impossible to
accomplish.

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

 Sell the process. The needs assessment, capability analysis, purpose


statement, and objective are important building blocks for the exercise. But
they also provide valuable tools for selling the idea professionally to the
hospital administrators and the chief executive of your organization.
 Protect the organization. Make a conscientious effort to protect the hospital
and health facility from unnecessary expenses, or potential law suits which
may arise from the exercise.
 Gaining support for an entire comprehensive exercise program. Hospital
administrators 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 may
come in the form of an exercise directive memo distributed by the office of the
hospital director or chief executive, but the exercise planning team must be
prepared to write it. This directive not only serves to disseminate information
regarding the exercise to the constituents, but also gives authority to the exercise
planning team to conduct the exercise and tap the necessary resources and
personnel required in the activity.

Page | 11
Sample Exercise Directive Memo
EXERCISE 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 emergency


operations
a. (*List appropriate functions/ operations)

b.

c.

It is important that your agency participate in this exercise. We encourage


involvement at the highest level.

I believe we all realize the importance of emergency exercises as a means to


community preparedness. I fully support this exercise and intend to join with you in
participating.

The Emergency Management Committee will be coordinating the exercise. They will
be contacting you to make necessary arrangements for the development and
conduct of the exercise. For purposes of realism and interest, details of the exercise
situation 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.

Page | 12
Figure 3. Exercise Planning Organizational Structure

Often taken from members of the Emergency Management Committee, the


Exercise Planning Team is formed to be over-all in charge of the exercise from
design to execution. They may do the required tasks themselves, or through the
overseeing 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, and
simulations), the expected time table, what is expected of participants and
volunteers, 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 the
conduction phase, and is responsible to ensure that the exercise purpose and
objectives are achieved in a realistic manner.

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

Page | 13
4) The Physical Arrangement Team – which is in charge of the venue and other
facility arrangements.

5) The Simulators Team – which is responsible for simulating the various


agencies which may interact and send messages the players during an exercise.

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

7) *The Exercise Evaluation Team – reviews all existing evaluation tools and
develops new tools based on the objectives, identifies and orients evaluators on the
tool to be used, reproduces and distributes the tool, deploys evaluators to assigned
areas, collates all evaluation findings, and develops final report with
recommendations.

8) *The Documentation Team – which ensures adequate documentation of the


drill (ie. pictures, videos, notes, timers, etc) from pre-planning, planning, execution
and post-incident evaluation and provides the final report on the events of the
exercise.

9) The Emergency Medical Service Team – which provides emergency medical


service during the conduct of the exercise, and ensures all participants, victims,
simulators, evaluators, observers, and by-standers are safe during the conduct of
the exercise.

10) The Food and Refreshments Team – which is in charge of providing


nourishment during the entire process.

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

5. Organizing the Design Team

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

The Exercise Design Team Leader is responsible for the entire exercise design
process, 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 to
coordinate the exercise design with efforts of the other exercise teams.

Among other tasks, the Exercise Design Team:

Page | 14
 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 various
backgrounds representing the different departments and relevant agencies. If the
size of the team becomes unwieldy, a smaller core group can be assembled. This
core group can subsequently draw on the other members as needed.

It is recommended that the members of the exercise design team should not have
any key responsibilities in the departments participating in the exercise. Since, they
might not be able to participate fully in the exercise if they have been involved in its
design.

Additionally, the person designated to be the incident commander or person with


the chief responsibility for managing emergency events should be reserved to be a
player in the exercise. However if staffing limitations do not permit this, he may opt
to participate in the exercise design, but only on a limited basis. The incident
commander 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 of
Exercise Evaluation Team Leader or Chief Evaluator. This individual will be
primarily responsible for:

1) Evaluation methodology
2) Selecting and training the evaluation team, and
3) Preparing the final evaluation report.

Selecting an exercise evaluation team leader early in the design process serves to
ensure that evaluation becomes an integral part of exercise development. This can
help maintain the integrity of the evaluation function as being separate from the
control and simulation functions. Also, it can ensure that at least one person can
devote 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 on
the type of exercise, its complexity, and the availability of people to serve. In
smaller exercises, the team may report to the chief evaluator directly, or in larger
exercises an Evaluation Director may need to be assigned to oversee the different
exercise team units.

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

Page | 15
and procedures, and proper use of evaluation forms are discussed. Some
inexperienced evaluators may also benefit from use of some practice drills. In
addition, evaluators from outside the institution may need information about the
facility, its procedures, and personnel. All evaluators must be reminded and trained
to be as unobtrusive as possible since it is well documented fact that the mere
presence 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 evaluation


team, and the exercise planning team and other subordinate units during
the different phases of exercise conduction.
TASK CATEGORIES
Preexercise phase Exercise Phase Postexercise Phase
Planning team and  Review plan  Prepare facility  Exercise
other subordinate  Assess  Assemble props Recovery and
units capability and other return and
 Address costs enhancements disposal of
and liabilities  Brief exercise
participants materials
 Gain
support/issue  Conduct  Participate in
exercise exercise postexercise
directive meetings
 Organize the
design team
 Draw up a
schedule
 Design exercise

Evaluation Team  Select  Observe  Assess


evaluation team assigned achievement of
leader objectives objectives
 Develop  Document  Participate in
evaluation actions postexercise
methodology meetings
 Select and  Prepare
organize evaluation
evaluation team report
 Train evaluators  Participate in
follow-up
activities

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

Page | 16
organized record of these events. The Chief Documenter may 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 demonstrate


competence.
They are derived from the needs assessment, and noted problem areas. The
indentified needs are translated into specific actions stated in observable forms. It
should state, “Who should do what, under what conditions, and what
standards”.

SAMPLE OBJECTIVE

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

Who Specific Action


the (members of the EOC) will (complete notification procedures to
local 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 acronym
characterizes 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 to
understand.

Page | 17
Measurable: The objective should set the level of performance, so that the results
are observable, and it can told when the objective has been achieved.

Achievable: The objective should not be too difficult to achieve. Achieving it should
be 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 the
exercise.

Task oriented: The objective should focus on a behavior or procedure. With


respect to exercise design, each objective should focus on an individual emergency
function.

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 the
exercise begins.
It sets the mood for the exercise and sets the stage for later action by providing the
information 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 the
present tense in order to convey urgency and tension. The situation is usually
developed chronologically and emphasizes the emergency environment. The
narrative should work to capture the participants’ attention, and motivate them to
be actively involved.

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

Narrative Outline Guide


NARRATIVE OUTLINE
What emergency event:

How fast, strong, deep, dangerous:

How it was found out:

Response made:

Damage reported:

Sequence of events:

Current time:

Page | 18
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 take
place after and as a result of the emergency described in the narrative. They
provide unity to an exercise and link simulated events to actions participants
perform in order to meet the objectives.

Example of Related Scenario, Major Event, Detailed Event, & Expected Action
Narrative Scenario Major Event Detailed Event Expected Action
Earthquake Hospital Structural Operating Room Activation of
Damage Gas Pipe Leak Operating Room
Evacuation
Procedure

Major events are the potential large problems resulting from an emergency. They
are based on occurrences that likely follow the exercise narrative and generate
possible situations for testing exercise functions. Detailed events in turn are the
more specific problem situations which requiring participants to respond in
expected actions to fulfill exercise objectives. In smaller exercises, there might not
be 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 a
major event that may lead to this expected action.
 Making a list of specific events closely linked with expected actions then
selecting the ones most likely produce the actions desired.

These methods are only bound by an exercise design team’s creativity and focus in
producing the objectives of the exercise.

Sample Events List


EVENTS
Major Event #1

Detailed Events:
1.

2.

Page | 19
Major Event #2

Detailed Events
1.

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 by


participants to display competence in the exercise and fulfill the exercise objectives.
Expected actions are usually a break down of an exercise objective. The goal in
exercise planning is to write the script and messages in such a way that will prompt
the participants to perform the expected actions. A detailed event can result in one
or several expected actions. There are four general types of actions that the
participants 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, consult


plan

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 to
an emergency situation. In order to determine whether an action is appropriate for
a given event one must simply go back to the EOP.

An Expected Actions Planning Table can help organize the process.

Expected Actions Planning Table


Expected Actions Planning Table
Detailed Event Expected Action Participant / Objective
Department addressed

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

12.Writing Messages

Page | 20
Messages are used to communicate detailed events to participants. They are meant
to evoke expected actions from participants to meet the exercise objectives. In
composing messages for an exercise, it is helpful to always begin with an expected
action. Consider what content and which message source would motivate the
expected action or actions.

Messages no matter how simple or complex have four main variables. Which
answers, “WHO sends WHAT to 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 a


credible means of transmission)

Message Content (WHAT): Information conveyed? (Does this message contain


the 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 use


the method of transmission that would likely be used in an actual emergency
(landline, cell phone, radio, in person, written note, fax, email, etc). Messages must
also be ideally sent through credible sources and appropriate channels, in order to
motivate the participant to act accordingly. Distraction messages however may also
be placed into the exercise if the goal is to examine how participants will react to
them.

In short, keep the message realistic. A message is successful if it is able to motivate


the expected action.

Sample Message Format


EMERGENCY EXERCISE
<MESSAGE>
NO: TIME:

TO: METHOD FROM:

CONTENT:

ACTION TAKEN:

Page | 21
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 and
simulators can refer to in order to keep the exercise on track. It is a listing of the
events or messages, the time it is to be released, and the expected actions from the
participants.

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

Master Scenario Events List


MASTER SCENARIO EVENTS LIST
Time Message/ Event Expected Actions

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

14.Finalizing Exercise Enhancements

Exercises are meant to simulate an emergency as realistically as the type of


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

A wide variety of exercise enhancements can help achieve this goal. These may
include visuals, communications equipment, people and props, and use of other
materials and resources. For example in drills or full-scale exercises the use of real
equipment and actual locations is inherently realistic, but the additional use of
simulated victims with convincing mock injuries can make the exercise even more
compelling. 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 real
emergency.

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

Page | 22
15.Developing the Evaluation Format

Evaluation is the process of observing and recording exercise activities, comparing


the performance of the participants against the objectives, and identifying strengths
and weaknesses.

For evaluation goals to be met, a systematic and methodical approach must be


given to evaluation planning and conduction. This involves determining:

1) The structure of the evaluation team


2) The objectives to be measured
3) The observation methods and recording forms to be used.

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

There are countless variations on how evaluation can be done. Below are sample
evaluation 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 performed
accordingly. It allows for simple monitoring of objectives and the performance of
expected actions.

Observation Checklist
OBSERVATION CHECKLIST
Objective Expected Players Locati Expecte Don Not Commen
Action to on d Time e Don ts:
Observ e
e
SAMPLE

1. Activation “Alert” Duty 7th 7:50am  


of Incident transmitted to Staff Floor
Command Deputy Nurse
System in Incident
response to Commander
noted Fire

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

B. Key Event Response Form

Page | 23
Key event monitoring involves monitoring the participants’ responses during key
events in the exercise. Key events are the occurrences in the developing scenario
particularly designed to place stress on selected elements of the EOP. The players’
responses to these events are subsequently noted in a Key Event Response Form

Key Event Response Form


KEY EVENT RESPONSE FORM
Event No: Scheduled Date/
Time:
Initially Input: Actual Date/ Time:
Response Date/ Time Position Responding Action Taken

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

C. Problem Log

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

Problem Log
PROBLEM LOG
Name: Date:
Exercise (ie. Conta
Assignme participant/controller/simulator/evaluator/ ct No:
nt: etc)
Time Event / Message Problem Analysis (Leave
Library No. (if Blank)
known)

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

D. Evaluator Checklist

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

Evaluator Checklist
EVALUATOR CHECKLIST
Evaluator: Date:
Location: Function being
Evaluated:
Objective

Page | 24
No.:
Objective:
SAMPLE OBJECTIVE

Demonstrate adequacy of displays to support the emergency operations plan during


the exercise

Points of Review:
Please answer the following: Y = Yes, N = No, NA = Not applicable, NO = Not
observed
SAMPLE POINTS FOR REVIEW Y N NA NO
1. Status boards availability in facility
2. Status boards utilized
3. Status boards kept updated
4. Maps available
5. Maps up to date
Comments:

(*You may extend beyond space provided)

E. Narrative Summary

The narrative summary is an open-ended questionnaire discussing the issues


encountered during an exercise, and identifying possible solutions and responsible
personnel or departments. It is a highly useful tool in getting qualitative input from
the evaluator. However, it requires more effort, training, and motivation from the
individual responding to the questions.

Narrative Summary
NARRATIVE SUMMARY
Objective Number: Criterion Number:
Evaluator: Location:
Issue:
A specific statement of the problem, plan, or procedure that was observed

(*You may extend beyond space provided)


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

Page | 25
improve operational capability

(*You may extend beyond space provided)


Office of Primary Responsibility
The department, agency or organization responsible for implementation of
corrective actions
Department, Agency, or Organization:

Individual Responsible
Time: Date __/___/__ Suspense __/__/__
Assigned: Date:

In addition to these tools or others which the evaluation team may develop, more
information can be obtained through the conduction of postexercise debriefing and
evaluation team meetings (discussed later). The final output of the entire evaluation
process is the after action report which is to be utilized for implementing
improvements 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 be
accomplished.

 Final test of important systems and materials, such as technology dependent


tools (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 that
everyone understands what are expected of them and the readiness to
proceed. The IIMAC system for structured briefing may be used. It divides the
briefing 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 communication
between parties)

Page | 26
 Final positioning of simulated casualties, props, special effects, staff, and
participants.

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

Conduction Proper

The actual conduction phase allows for assessment of response capacity, training of
participants, and validation of competency. During this time, the facilitator or
controller assumes responsibilities for conduction and ensuring that the exercise
objectives 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 the
exercise 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 the
specific plans developed in its conduction. However, there are common elements
which may aid the success of the activity.

1) Foster realism. Players should be encouraged to treat the event as


they would an actual emergency.
2) Maintain valid timelines through the use of a master schedule. In case
of 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 scenario
events and release of exercise messages. Keep the right pace to facilitate
player engagement and participation. But be flexible within limit of
maintaining the exercise objectives.
4) Safety should be a common concern in all emergency exercises. Safety
recommendations include:

 Notification alerts of exercise conduction, for both the participants


and 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 if
situation dictates.

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

Page | 27
5) Be open to capitalize on problem situations. Complicating situations
that place additional stress on the system may be useful in more
effectively assessing the institutions’ response capabilities. But in no
instance should safety considerations be compromised for the sake of
pushing through with the exercise.

6) Finally, at the end of exercise execution, there must also be provisions


for a system recovery and return to normal operations. Although primarily
the responsibility of the maintenance staff and physical arrangement
team a group effort in returning everything to their proper place is highly
encouraged.

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 immediately


after an exercise. “Cold debriefs” can also be conducted some days after the
exercise. In either case, they involve getting feedback of participants’ opinions,
critique, and suggestions regarding the activity. It usually begins with the controller
conducting the meeting and reviewing the goals of the exercise giving general
comments on both the successes and short falls of the activity. Each of the players
is then given time to give a brief response. This meeting is for participants, and the
organizing 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 negative
feedback should be established and all comments recorded for use in the after
action report.

Exercise Debriefing Form


Exercise Debriefing
Overview
Date/Location:

(Department/Institution) hosted a (Type of Exercise) on (Date)


Attendees included representatives from (List of Attendees)

Hot Debrief:
After the exercise’s conclusion the planners and participants met briefly to discuss
the exercise conduct and planning process. Discussion primarily focused on
(Number) of Aspects: (List Aspects)
Discussion Points Per listed Aspect
1.

(*You may extend beyond space provided)

Page | 28
2.

(*You may extend beyond space provided)


3.

(*You may extend beyond space provided)


Points of Action
Problem Summary Recommended Action Responsible Person/
Department

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

It is important to be systematic in the debriefing, and a standardized questionnaire


may 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 open
to do so in writing. A good format may include both simple objective checklist type
questions and an open-ended segment for elaboration.

Exercise Critique Form


EXERCISE CRITIQUE FORM
Name of Exercise: Date:
Participant Name: Department/Agency:
Role:  Player  Facilitator  Simulator  Victim-Actor  Observer
Please take a few minutes to fill out this form. Your opinions and suggestions will
help 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 10
Very Poor
Very Good

2. Compared to the previous exercise this one was:

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

3. Did the exercise effectively simulate the emergency environment  


and emergency response activities? Yes No
If NO, briefly explain why:

(*You may extend beyond space provided)

Page | 29
4. Did the problems presented in the exercise adequately test  
readiness capability to implement the plan? Yes No
If 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.

(*You may extend beyond space provided)

Evaluation Team Meeting

Some time after the exercise and Players’ debriefing, the evaluation team will
convene to analyze the exercise and prepare for the after action report. The team
goes through the evaluation forms, debriefing responses, and any other data to
discuss how well the exercise objectives were met. There can be additional
meetings as needed to analyze the data and prepare the After Action Report. Other
members from the exercise planning team or subunits may be invited to provide
their 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 Action
Report (AAR) which documents the effectiveness of the exercise. This AAR is used
to instigate corrective action in the EMP or how it is implemented and it may also
serves as the basis for future exercises. It should distributed to the chief executive
of 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 below
are usually covered. The final document can be as long or as short as the extent of
the exercise requires.

After Action Report Outline


AFTER 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 main
problems and recommendations.

Page | 30
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 develop


recommendations to the design or execution of the EOP. These recommendations
deal 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 chief


executive, emergency management program committee, and other key decision
making units. They then decide on which recommendations are appropriate and
achievable 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 each
recommended improvement.
2) Establishing a monitor plans to track the progress of recommendations
implementation.

Page | 31
3) Completing the cycle by incorporation of the testing of noted improvement
indictors into succeeding exercises.

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

Tracking Improvement Checklist


Tracking Improvement Checklist
Emergency Command Operatio Planning Logistics Finance
Manageme ns
nt Function
Items for Corrective
Action Actions
SAMPLE O P C S Purchase
Improve of
notification personnel
of pagers
personnel
outside
hospital

P = Primary Responsibility S = Secondary/Support O = Oversight C=


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

Page | 32