Gabrielle Ramirez, EMT; David Gordon, EMT; Abhishek Rao, EMT; Brett Bell, EMT University of Pennsylvania Medical Emergency Response Team

MCI Training Program: Evaluation and Future Directions Gabrielle Ramirez, EMT; David Gordon, EMT; Abhishek Rao, EMT; Brett Bell, EMT University of Pennsylvania Medical Emergency Response Team Abstract 22nDevelopment/Implementation Evaluation In 2010, the University of Pennsylvania Medical Emergency Response Team (MERT) The Tabletop Exercise Two-Time Evaluation Process initiated a Mass Casualty Incident (MCI) training program anchored by a MCI Field In the past, MERT has placed a strong emphasis on the Evaluation MCI Field Evaluation Training Exercise (FTX), which allows MERT to rehearse MCI protocol execution with Tabletop Using Debrief Training Using MCI Debrief triage aspect of mass casualty incident response. Little Exercise Tabletop interagency partners and approximately 40 simulated patients. To further improve MCI Drill Rubric to no training has been done on the decision-making Rubric response, MERT developed a tabletop exercise that ensures MERT members are fluent Uncoordi aspect. This lack of practice is reflected in the Poor nated in the Incident Command System (ICS) and familiar with MERT MCI operating guidelines. repeated flaws of judgment seen during MERT’s prioritizat delivery The Tabletop Exercise Evaluates ion of Other Aspects Evaluated by the Unlike the fast-paced MCI drill, the tabletop exercise is an environment for annual MCI Field Training Exercise. patients MERT’s Capabilities and Tabletop Exercise: Knowledge in: members to ask clarifying questions, learn the ICS thought process, and make Slow • Time action completed response to mistakes at their own pace. Purpose of the exercise: response • Incident Command² time slow response time The tabletop scenario introduces a MCI scenario to a small group overseen by a Provide a space to clarify misconceptions, highlight • MERT operating guidelines missed procedures, and rehearse proper MCI • Knowledge of ICS and relevant MERT facilitator and evaluator. The facilitator presents information to the group and questions • Sizeup response. operating guidelines response to uncoordinated delivery members’ decision-making while the evaluator tracks progress using a FEMA-adapted Examples of Expected Actions Per ¹ • Assignment of level of priority to rubric that parallels the rubric used to evaluate the MCI drill’s success. Both highlight Delivery: Tabletop Rubric: sections of floor plan response to often-forgotten MERT operating guidelines and parts of ICS. Afterwards, all of those • Held in an informal and “no-fault” setting. Our Goal: To fix these • Remembers to bring Mass Casualty poor prioritization of patients involved debrief and complete feedback forms. Our hope is that members will apply • Presented by Facilitator. mistakes. Response Bag. • No field work. what they have learned during the tabletop to an MCI drill and, thus, show • Incident Command established. Note: MCI Field Training Exercise rubric • improvement in the fluidity of the simulated response. Executed in three phases. • Gives an initial report to PennComm. assesses different, yet similar criteria as found in • Establishes a staging area. the Tabletop rubric. Exercise Materials and Personnel: Exercise Personnel Roles : • Ensures MERT members sign-in/out. • Facilitator (1 for each group) • Facilitator Introduction • Evaluator (1 for each group) o Leads and guides the exercise by • Worksheets: presenting information and asking o Floor plan participants’ thought process and In response to suggestions from UPenn’s Division of Public Safety and Philadelphia Fire Discussion/Conclusion o Damage Assessment Forms the factors they considered in Department after our past MCI Field Training Exercises, MERT sought to redesign its Mass o Facilitator Guidelines making choices. MERT’s Disaster Response Officer has already prepared MERT’s - Stronger Casualty Incident training program. o Rubric o Debriefs with participants. first tabletop exercise, which is scheduled to run in early March familiarity with ICS 2018. Later that month, MERT is holding a smaller-scaled MCI and relevant MERT o Feedback Forms • Evaluator operating o Assesses members based on the Field Training Exercise to test the effects of the Tabletop Exercise. guidelines Our MCI Training Program Transition Team is presented with: events and expected actions listed -Better The Tabletop Exercise was made to address common decision- • A hazard on the rubric. prioritization of making mistakes performed by MERT members during MCI Field patients Debrief the • Location o Passive role and does not interfere Training Exercises. We expect to see improvements in overall Tabletop Day of MCI • Time limit (40-60 minutes) with the exercise. performance, particularly in the factors that were originally Scenario Drill • Scenario impeding the fluidity of MERT’s MCI field training exercise response. -Decrease in response time Phase I Little to no considerable improvement in performance will require Old MCI New MCI a revision of the Tabletop Exercise and, possibly, the MCI training a. The team discusses the c. Once the initial plan is Training Training b. The group develops an program. process for setting up the developed, the Facilitator initial plan to respond to the Program Program Command Post and medical pauses the exercise to MCI FTX 1 Hour Smaller situation. MCI FTX in treatment area. discuss the plan. Drill in the PowerPoint Scaled MCI the Spring References Fall Lecture in the Fall 1. Community Emergency Response Team Tabletop Exercise. https://www.fema.gov/media library- data Phase II /20130726-1917-250457806/cert_tabletops_combined.pdf. Accessed February 15, 2018. 2. IS-100.B Course Materials. Federal Emergency Management Agency | Emergency Management Institute. Key Element: Tabletop Exercise https://training.fema.gov/is/coursematerials.aspx?code=IS-100.b. Accessed February 15, 2018. a. After the discussion, the Facilitator passes b. Using this new information, the team then out Damage Assessment Forms with develops a plan for responding to the information on the victims. scenario. Our New MCI Training Philosophy Acknowledgments The Penn Division of Public Safety, University administration, and MERT advisory board are instrumental in supporting MERT and MERT’s MCI Training Program. ● Maureen Rush, Vice President for Public Safety & Chief of Police Phase III ● Gene Janda, Chief, Fire and Emergency Services Standardized Practice in ● Mike Fink, Deputy Chief of Tactical & Emergency Readiness Safe space for More fluid ● Alvin Wang, Penn MERT Medical Director evaluation MCI decision- questions MCI response ● Karu Kozuma, Associate Vice Provost of Student Affairs with rubric making skills ● Erika Gross, Director for Finance, Administration & Risk Management a. The exercise ends either when all actions b. At the conclusion of the exercise, ● Ben Evans, Executive Director of Risk Management & Insurance have been discussed or the time limit is participants review what they have learned ● Wendy White, Senior Vice President and General Counsel of the University of Pennsylvania and Penn Medicine ● Joe Tierney, Executive Director, Robert A. Fox Leadership Program reached. and provide feedback on the exercise. ● Noelle Melartin, Director for the Office of Alcohol and Other Drug Program Please direct correspondence to [email protected] www.postersession.com.

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