After Action Report / Improvement Plan Rumble In The Rubble Functional Exercise

Rumble in the Rubble – A Hospital / Healthcare Facility

Functional Exercise

April 18, 2012

AFTER ACTION REPORT / IMPROVEMENT PLAN

Washington Health Care Coalition – Region 9

ADMINISTRATIVE HANDLING INSTRUCTIONS

1.  The title of this document is The "Rumble In The Rubble - A Hospital / Health Care Facility Functional Exercise" After Action Report.

2.  The information gathered in this AAR/IP is classified as For Official Use Only (FOUO) and should be handled as sensitive information not to be disclosed. This document should be safeguarded, handled, transmitted, and stored in accordance with appropriate security directives.

3.  At a minimum, the attached materials will be disseminated only on a need-to-know basis and when unattended, will be stored in a locked container or area offering sufficient protection against theft, compromise, inadvertent access, and unauthorized disclosure.

4.  Points of Contact:
Emergency Management:
Darrell Ruby
Spokane Department of Emergency Management
(Office) 509-324-1451
(E-Mail)
Public Health:
Patti Richards
Spokane County Public Health
(Office) 509-324-1451
(E-Mail)

CONTENTS

ADMINISTRATIVE HANDLING INSTRUCTIONS 2

CONTENTS 3

EXECUTIVE SUMMARY 4

SECTION 1: EXERCISE OVERVIEW 5

Exercise Details 5

Participant Information 6

SECTION 2: EXERCISE DESIGN SUMMARY 8

Exercise Purpose and Design 8

Exercise Objectives, Capabilities and Activities 8

Scenario Summary 9

SECTION 3: ANALYSIS OF CAPABILITIES 10

SECTION 4: CONCLUSION 93

APPENDIX A: IMPROVEMENT PLAN 95

APPENDIX B: PARTICIPANT FEEDBACK (3 THUMBS UP – 3 THUMBS DOWN) 96

APPENDIX C: ACRONYMS 112

EXECUTIVE SUMMARY

Rumble In The Rubble - A Hospital / Health Care Facility Functional Exercise was designed and facilitated to evaluate player actions against current response plans and capabilities for a structural damage to a health care facility response.

The purpose of this report is to analyze exercise results, identify strengths to be maintained and built upon, identify potential areas for further improvement, and support development of corrective actions.

Incorporated in Section 3: Analysis of Capabilities of this After Action Report is a comprehensive listing of each Target Capability with its associated Major Strengths, Primary Areas for Improvement and Improvement Recommendations

SECTION 1: EXERCISE OVERVIEW

Exercise Details

Exercise Name: / Rumble In The Rubble - A Hospital / Health Care Facility Functional Exercise
Type of Exercise: / Tabletop
Exercise Start Date: / April 18, 2012
Duration: / Four Hours
Location: / Various locations through Region 9
Sponsor: / Washington Health Care Coalition – Region 9
Program: The exercise was developed to evaluate player actions against current response plans and capabilities for a structural damage to a health care facility response.
Purpose: The Exercise Planning Team selected objectives that focus on evaluating emergency response procedures, identifying areas for improvement, and achieving a collaborative attitude. This exercise will focus on the following objectives:
1.  Communications. Participating agencies will use at least three methods of communication to respond within 30 minutes of receiving notification in an emergency situation.
2.  Memoranda of Understanding and Agreements. Participating agencies will identify specific MOUs needed to support response to the exercise injects and identify potential MOUs needed with partner agencies by the end of the exercise.
3.  Bed Tracking. Hospitals will report bed tracking information using available bed tracking tools within 30 minutes of receiving the request by inject according to their facility plans reporting process.
4.  Evacuation. Participating agencies may use facility evacuation plans to evaluate their facilities’ abilities to evacuate an affected portion of their facility within 60 minutes (or time prescribed in the facility plan).
5.  Alternate Care Facility. Participating agencies may use the Alternate Care Facility checklist or similar jurisdiction specific form to identify specific location and resources needed to establish an ACF by the end of the exercise.
6.  Medical Reserve Corps. Participating agencies (Spokane only) may notify and request activation of the Medical Reserve Corps volunteers within 60 minutes according to established guidelines within their jurisdiction.
7.  Fatality Management. By the conclusion of the exercise, agencies choosing to address the issue of greater than normal number of fatalities will have notified at least two agencies relevant to fatality management as identified within their agency plans or protocol.
Mission: To provide an opportunity for various healthcare providers that make up the Region 9 – Washington Health Care Coalition to assess their capabilities.
Scenario Type: Building Collapse

Participant Information

Participant / Location
ARC of Spokane
Camas Center Clinic
Coalition of Responsible Disabled (CORD)
Columbia Basin Health Association
Dayton General Hospital
Deaconess Medical Center
Eastern State Hospital
Ferry County Memorial Hospital
Garfield County Hospital
Holy Family Hospital
Lake Roosevelt Community Health Center
Lakeland Village
Lincoln Hospital
NATIVE Health Clinic of Spokane
Newport Community Hospital
Odessa Memorial Healthcare Center
Providence Mt Carmel Hospital
Providence Sacred Heart Medical Center
Providence St Joseph's Hospital
Pullman Regional Hospital
Spokane Digestive Disease Center
Spokane Veterans Administration Medical Center
St Luke's Rehabilitation Institute
Tri-State Memorial Hospital
Valley Hospital and Medical Center
Whitman Hospital and Medical Center
Number of Participants / 129

SECTION 2: EXERCISE DESIGN SUMMARY

Exercise Purpose and Design

The purpose of this exercise was to evaluate player actions against current response plans and capabilities for a structural damage to a health care facility response.

Exercise Objectives, Capabilities and Activities

Capabilities-based planning allows for the exercise planning team to develop exercise objectives and observe exercise outcomes through a framework of specific action items that were derived from the Target Capabilities List (TCL). The capabilities listed below form the foundation for the organization of all objectives and observations in this exercise. Additionally, each capability is linked to several corresponding activities and tasks to provide additional detail.

Based upon the identified exercise objectives below, the exercise planning team decided to demonstrate the following capabilities during this exercise:

Communications
Activity / Target Capability
# 1 / Initial Incident Communication
# 2 / Physical Structure Support
# 3 / Notification and Coordination with Outside Partners
Memoranda of Understanding and Agreements
Activity / Target Capability
# 1 / Review Current Agreements with Outside Agencies
Bed Tracking
Activity / Target Capability
# 1 / Access Bed Tracking Electronic Tools
Evacuation and Shelter-In-Place
Activity / Target Capability
# 1 / Evacuate Patients in Affected Area of Facility
# 2 / Patient Tracking
Alternate Care Facility / Medical Surge
Activity / Target Capability
# 1 / Establish Alternate Care Facility (ACF)
Fatality Management
Activity / Target Capability
# 1 / Establish Fatality Management Plan

Scenario Summary

A heavy, wet snowfall last night has resulted in extreme weight on the roofs of many facilities. More snow is expected in the next three hours and then temperatures will rise to the low 40s.

A member of housekeeping staff has notified her supervisor that a large amount of water is leaking from the ceiling and maintenance was called to check the area. Maintenance says the area is unsafe and the structural integrity of the area may be compromised at this time.

SECTION 3: ANALYSIS OF CAPABILITIES

Communications

Performance / Target Capability
[OVERALL] /
Activity # 1: Initial Incident Communication
Associated Critical Tasks
Task # 1.1: Communicate incident information to facility leadership per protocols.
Strong / Tri-State Memorial Hospital
Observations / None
Recommendations / None
Strong / Lincoln Hospital
Observations / Communications chain was strong from initial identification of problem, to contacting Facilities for evaluation and Contacting hospital Administration for awareness. Being small facility with limited staff facilitates communication because everyone knows everyone in the facility and their role.
Recommendations / None
Adequate / Coalition of Responsible Disabled (CORD)
Observations / Don't have written notification procedures in place, but it's a very small facility so they all knew that they would just contact one of the directors if an event happened.
Recommendations / Have written notification procedures in plan with multiple methods to contact directors as well as Board of agency to keep them informed.
Weak / Columbia Basin Health Association
Observations / Difficult to reach Clinic Manager staff at beginning of exercise, once communication established this improved.
Recommendations / Create list of primary and secondary contacts, ensure availability of some level of management in the event there is an incident.
Strong / Garfield County Hospital
Observations / The initial incident information was straight forward. All leadership members of the Hospital District AND Public Health were present.
Recommendations / None
Strong / Valley Hospital and Medical Center
Observations / None
Recommendations / None
Strong / Dayton General Hospital
Observations / All members were aware of protocol and who to contact during the exercise
Recommendations / None
Weak / Tri-State Memorial Hospital
Observations / None
Recommendations / None
Strong / Whitman Hospital and Medical Center
Observations / Radio and phone communications were clear and complete.
Recommendations / None
Adequate / Pullman Regional Hospital
Observations / After some initial prompting, the communication to the appropriate people was adequate.
Recommendations / None
Strong / Odessa Memorial Healthcare Center
Observations / None
Recommendations / None
Strong / ARC of Spokane
Observations / Incident notification established and used frequently.
Recommendations / None
Adequate / Valley Hospital and Medical Center
Observations / Initial notification via internal verbal page using a coded announcement. Page was not heard by all and initial response some went to command center others went to incident site location. Cell Phones contained within Command Center not pre-programmed with ICS position specifics numbers
Recommendations / Group communicated confusion point and addressed trigger points very well. Internal plans are going to be addressed about announcements and response location. I would recommend that not until after an initial size-up that not all "responders" report to the incident site as it appears pre-planned. Having all command and general staff "at the incident site" could very well minimizes an ongoing support and recovery operations.
Strong / Dayton General Hospital
Observations / Seemed to communicate well with each other and staff.
Recommendations / None
Strong / St Luke’s Rehabilitation Institute
Observations / None
Recommendations / None
Strong / Dayton General Hospital
Observations / Seemed to communicate well with staff and Call down tree worked very well.
Recommendations / None
Strong / Deaconess Medical Center
Observations / Used internal alert system well. Discovered one gap and immediately corrected the problem.
Recommendations / None
Strong / Eastern State Hospital
Observations / Communication chain of command followed.
Recommendations / None
Adequate / Newport Community Hospital
Observations / Good dialog with participants with who would be notified.
Recommendations / None
Strong / Deaconess Medical Center
Observations / The incident command structure was keep keenly aware of the developments during the event.
Recommendations / None
Strong / Newport Community Hospital
Observations / Good dialog with participants
Recommendations / None
Adequate / Coalition of Responsible Disabled (CORD)
Observations / None
Recommendations / None
Strong / Providence Sacred Heart Medical Center
Observations / Internal & external activation / communications completed timely and effectively
Recommendations / Develop incident command roles to ensure urban campus hospitals are adequately covered
Strong / Lakeland Village
Observations / A system is in place for notifications. This system worked well.
Recommendations / None
Strong / Holy Family Hospital
Observations / 3 people in the ER participated, the ER manager - controller, charge nurse - scribe, and one other who was an internal controller. No others in the ER participated. The senerio was revised at the last minute so there was some confusion. Those that should have been involved in the new senerio were not available and those that were involved were not ICS trained, so there was a lot of improvising in this exercise. The exercise was held in the ER manager's office and not in the ER. The exercise that was affected was on the 5th floor construction site. The environmental services manager, security and maintenance managers were notified immediately along with the ER manager and charge nurses. There were no patients on this floor however charge nurses were asked to check on patients on the 4th & 6th floors to ensure they were not being compromised.
Recommendations / It would have helped if security and maintenance could have participated. Also as stated above, the charge nurse and internal evaluator were not ICS trained, so there was a lot of improvising. They did very well and the controller provided a lot of excellent direction. In everyday life, you never know what might happen so something to think about is providing ICS training to charge nurses.
Strong / Camas Center Clinic
Observations / This was easily accomplished with one phone call to the maintenance supervisor.
Recommendations / None
Task # 1.2: Understanding of incident command system activation triggers.
Strong / Tri-State Memorial Hospital
Observations / Incident Commander was well versed in ICS.
Recommendations / None
Strong / Lincoln Hospital
Observations / Once problem was identified, incident command was established and with pertinent information being shared to appropriate facility staff.
Recommendations / None
Adequate / Coalition of Responsible Disabled (CORD)
Observations / No written plan to identify triggers, but most staff knew if it was an event of any significance, they are to contact directors. They don't use Incident Command System to manage an event as they are a very small agency.
Recommendations / Would be helpful for both directors to be involved in exercises and plan development.
Weak / Columbia Basin Health Association
Observations / Participants were unsure, had to be directed by the Safety Officer.
Recommendations / Further training about system activation triggers needed.
Adequate / Garfield County Hospital
Observations / Initially there was confusion as to why a Charge Nurse may be the initial incident commander. Clarifications were made with the players that if this incident occurred at 2am and that he/she was the only nurse on the floor, then he/she may be incident commander until appropriate facility leadership arrived, a face-to-face was completed, and authority then turned over.
Recommendations / Some staff has not had training in ICS or HICS. This is because of staff turnover. As part of a new employee hire the ICS/HICS courses need to be offered and/or taught. Annual review of ICS/HICS should be done to keep everyone up to speed on specific ICS/HICS command positions, job descriptions, trigger points, functionality, etc.