<p> CHECS – An Inter-Hospital Communications Exercise San Luis Valley / Southwest Regions</p><p>March 22, 2011</p><p>AFTER ACTION REPORT / IMPROVEMENT PLAN</p><p>Colorado Hospital Association After Action Report / Improvement Plan CHECS – An Inter-Hospital Communications Exercise</p><p>ADMINISTRATIVE HANDLING INSTRUCTIONS</p><p>1. The title of this document is The "CHECS - An Inter-Hospital Communication Exercise - San Luis Valley / Southwest Regions" 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:</p><p>Hospital Representative:</p><p>[CLIENT ORGANIZATION REPRESENTATIVE NAME] Colorado Hospital Association (Office) [CLIENT ORGANIZATION REPRESENTATIVE PHONE] (E-Mail) [CLIENT ORGANIZATION REPRESENTATIVE EMAIL]</p><p>Exercise Director:</p><p>Ginny Schwartzer All Clear Emergency Management Group (Office) 919-323-9995 (E-Mail) [email protected]</p><p>Disaster Resistant Communities Group LLC – www.drc-group.com 2 | Page After Action Report / Improvement Plan CHECS – An Inter-Hospital Communications Exercise</p><p>CONTENTS</p><p>ADMINISTRATIVE HANDLING INSTRUCTIONS...... 2 CONTENTS...... 3 EXECUTIVE SUMMARY...... 4 SECTION 1: EXERCISE OVERVIEW...... 5 Exercise Details...... 5 Participant Information...... 5 SECTION 2: EXERCISE DESIGN SUMMARY...... 6 Exercise Purpose and Design...... 6 Exercise Objectives, Capabilities and Activities...... 6 Scenario Summary...... 6 SECTION 3: ANALYSIS OF CAPABILITIES...... 7 SECTION 4: CONCLUSION...... 11 APPENDIX A: IMPROVEMENT PLAN...... 12 APPENDIX B: PARTICIPANT FEEDBACK (3 THUMBS UP – 3 THUMBS DOWN)...... 13 APPENDIX C: ACRONYMS...... 16</p><p>Disaster Resistant Communities Group LLC – www.drc-group.com 3 | Page After Action Report / Improvement Plan CHECS – An Inter-Hospital Communications Exercise</p><p>EXECUTIVE SUMMARY</p><p>CHECS - An Inter-Hospital Communication Exercise - San Luis Valley / Southwest Regions was designed and facilitated to [REASON FOR EXERCISE]</p><p>During the exercise participants:</p><p> [GENERAL ACTIVITY 1]  [GENERAL ACTIVITY 2]</p><p>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.</p><p>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</p><p>Disaster Resistant Communities Group LLC – www.drc-group.com 4 | Page After Action Report / Improvement Plan CHECS – An Inter-Hospital Communications Exercise</p><p>SECTION 1: EXERCISE OVERVIEW</p><p>Exercise Details</p><p>CHECS - An Inter-Hospital Communication Exercise - San Luis Exercise Name: Valley / Southwest Regions</p><p>Type of Tabletop Exercise:</p><p>Exercise Start March 22, 2011 Date:</p><p>Duration: Three Hours</p><p>Location: San Luis Valley / Southwest Regions </p><p>Sponsor: Colorado Hospital Association </p><p>Program: [EXERCISE PROGRAM]</p><p>Purpose: [EXERCISE PURPOSE]</p><p>Mission: [EXERCISE MISSION]</p><p>Scenario Type: [SCENARIO TYPE]</p><p>Participant Information</p><p>Participant Organization</p><p>Conejos County Hospital</p><p>Mercy Regional Medical Center</p><p>Rio Grande Hospital</p><p>San Luis Valley Regional Medical Center</p><p>Southwest Memorial Hospital</p><p>Number of Participants 28</p><p>Disaster Resistant Communities Group LLC – www.drc-group.com 5 | Page After Action Report / Improvement Plan CHECS – An Inter-Hospital Communications Exercise</p><p>SECTION 2: EXERCISE DESIGN SUMMARY</p><p>Exercise Purpose and Design</p><p>[EXERCISE PURPOSE]</p><p>Exercise Objectives, Capabilities and Activities</p><p>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.</p><p>Based upon the identified exercise objectives below, the exercise planning team decided to demonstrate the following capabilities during this exercise:</p><p>CHECS Evaluation</p><p>Activity Target Capability</p><p># 1 CHECS Emergency Notification Process</p><p># 2 Resource Request Process</p><p>Scenario Summary</p><p>It is 4:00PM MDT on a cool March afternoon. Road maintenance crews working along US Highway 160 accidentally knocked down a power line which causes a transformer in a nearby sub-station to short out and catch on fire shutting down the entire sub-station.</p><p>Disaster Resistant Communities Group LLC – www.drc-group.com 6 | Page After Action Report / Improvement Plan CHECS – An Inter-Hospital Communications Exercise</p><p>SECTION 3: ANALYSIS OF CAPABILITIES</p><p>CHECS Evaluation</p><p>Performance Target Capability</p><p>[OVERALL] Activity # 1: CHECS Emergency Notification Process</p><p>Associated Critical Tasks</p><p>Task # 1.1: Implement initial notification plans and protocols.</p><p>Adequate Evaluator # 1</p><p> Both regions had some variation in initial preparatory response. Southwest Region: 2 out of 4 hospitals in SW region responded to #002. 3 out 4 hospitals would activate HCC for an electrical utility outage with one hospital stating they would if loss was ongoing. Hospitals in SW region would notify other hospitals within the region, although one hospital would do so only if on divert. That same hospital would change status to divert if running off generators but sample notice to other hospitals was missing Observations some information, such as whether anticipates the need for resources, etc., When conducting roll-call, affected hospital was not able to establish communications with all hospitals. San Luis Valley Region: 2 out of 3 hospitals would activate HCC for an electrical outage. One hospital would activate once they determine the expected length of outage and impact on hospital. Not all appropriate staff at hospitals received EMResource notifications.</p><p> Update all contact lists routinely for all modes of communication  Consider routine testing by doing regular roll-calls using Recommendation communication modalities available and making improvements as s needed  Consider reviewing initial assessment procedures for different risk scenarios</p><p>Task # 1.2: Communicate important event information to non-affected hospitals.</p><p>Strong Evaluator # 1</p><p>Disaster Resistant Communities Group LLC – www.drc-group.com 7 | Page After Action Report / Improvement Plan CHECS – An Inter-Hospital Communications Exercise</p><p> Hospitals that responded in both regions indicated that the message contained an appropriate amount of information when notified by the affected hospital via EMResource, however, not all hospitals responded to this question. There wasn’t consistency in Observations response to how the hospital would request supplies in both regions. For example, in the SW region, one hospital deferred answering to someone else. In the SLV region, one hospital noted that their policy for requesting supplies and receiving the request did not account for when the individual was not available.</p><p>Recommendation  Review protocols for requesting supplies and make modifications s as needed</p><p>Task # 1.3: Non-affected hospitals receive notification of event and follow internal procedures to respond to the event notification.</p><p>Adequate Evaluator # 1</p><p> Not all hospitals received event notification in EMResource, possibly due to contact list not being up-to-date. Not enough Observations information to assess whether hospitals followed internal procedures to respond to event notification.</p><p>Recommendation  Update contact lists for all methods of communication on a s regular basis</p><p>Task # 1.4: Event information is updated throughout the event.</p><p>Adequate Evaluator # 1</p><p> Unable to assess whether affected hospitals updated non- Observations affected hospitals when event changed. Communication methods for SLV did not always work smoothly.</p><p> Integrate use of EMS/Radios Recommendation  Consider having redundant methods of communicating in case s one method fails • Important to update event information when event changes, including when situation stabilizes and need for resources no longer required.</p><p>Disaster Resistant Communities Group LLC – www.drc-group.com 8 | Page After Action Report / Improvement Plan CHECS – An Inter-Hospital Communications Exercise</p><p>Performance Target Capability</p><p>[OVERALL] Activity # 2: Resource Request Process</p><p>Associated Critical Tasks</p><p>Task # 2.1: Affected hospital communicates need for resources, assets or equipment to non-affected hospitals within the region.</p><p>Adequate Evaluator # 1</p><p> Requests for blankets by both affected hospitals were incomplete per CHECS Plan. For example, they did not include location of where to bring the supplies. Not all hospitals in both regions received the request for supplies. Messages had to be left in one Observations instance (SW) and in the second instance the receptionist was unable to locate the number (SLV). Both regions noted issues with emailing the Resource Request form with SW noting that the form should be faxed versus emailed.</p><p> Review plan for information to be included when making resource requests Recommendation  Review contact lists and update as needed s  Review methods of communicating resource needs via resource form and make modifications as needed</p><p>Task # 2.2: Affected and non-affected hospitals have internal procedures which outline processes to request resources and obtain appropriate internal approvals.</p><p>Weak Evaluator # 1</p><p>Observations  Southwest Region: One hospital’s EOP did not outline financial or other criteria thresholds for approval. In general, there was not enough information to assess process for lending resources for SW region. San Luis Valley Region: 2 of 3 hospitals did not outline financial or other criteria thresholds for approval. One hospital noted plan for requesting resources not adequate since it depends on availability of materials management personnel for telephone contact. For SLV Region, some hospitals would request supplies via the request for emergency assistance form and another would use phones and radios. Plan calls for use of phones/form; however, this was good opportunity to test redundant methods of making the request and testing the radios. Need to update plan to accommodate redundant methods if they</p><p>Disaster Resistant Communities Group LLC – www.drc-group.com 9 | Page After Action Report / Improvement Plan CHECS – An Inter-Hospital Communications Exercise</p><p> are available. Equipment loan forms will need to be added to stack of EOC forms for at least one hospital (SLV Regional). For another hospital it was noted that the request for assistance form needed to be incorporated into EOP process. At least one SLV hospital did not receive resource request form via email. One SW hospital had detail about their process for lending resources, although did not include information about reimbursement.</p><p> Consider developing model MOU language. If MOU language exists, review and adapt for hospital use Recommendation  Review procedures with appropriate staff and incorporate s operating procedures into written plans</p><p> Review methods for communicating resource request forms</p><p>Task # 2.3: Non-affected hospitals receive Resource Request form and offer requested support.</p><p>Adequate Evaluator # 1</p><p> Not all hospitals completed forms with appropriate information Observations (SW) and one hospital did not return a resource request form.</p><p> Consider redundancies in both sending resource request form Recommendation and receiving (e.g., fax) s  Include all information for appropriate contacts.</p><p>Disaster Resistant Communities Group LLC – www.drc-group.com 10 | Page After Action Report / Improvement Plan CHECS – An Inter-Hospital Communications Exercise</p><p>SECTION 4: CONCLUSION</p><p>Exercises such as this one allow personnel to validate training and practice strategic and tactical prevention, protection, response and recovery capabilities in a risk-reduced environment. Exercises are the primary tool for assessing preparedness and identifying areas for improvement, while demonstrating community resolve to prepare for major incidents.</p><p>Exercises aim to help entities within the community gain objective assessments of their capabilities so that gaps, deficiencies, and vulnerabilities are addressed prior to a real incident.</p><p>Exercises are the most effective (and safer) means to:</p><p> Assess and validate policies, plans, procedures, training, equipment, assumptions, and interagency agreements;  Clarify roles and responsibilities;  Improve interagency coordination and communications;  Identify gaps in resources;  Measure performance; and  Identify opportunities for improvement.</p><p>This exercise succeeded in addressing all of the above as it provided examples of good to excellent participant knowledge, teamwork, communication and use of plans and procedures while pointing out areas in need of improvement and clarification.</p><p>Listed below is a summary of the level of performance the Target Capabilities and Tasks evaluated during the exercise. This summary outlines the areas in which the San Luis Valley and Southwest Regions are strong as well as identifying areas that the departments should invest future planning, training and exercise funds on. </p><p>CHECS Evaluation</p><p>Activity Target Capability Performance</p><p># 1 CHECS Emergency Notification Process [OVERALL]</p><p># 2 Resource Request Process [OVERALL]</p><p>Disaster Resistant Communities Group LLC – www.drc-group.com 11 | Page After Action Report / Improvement Plan CHECS – An Inter-Hospital Communications Exercise</p><p>APPENDIX A: IMPROVEMENT PLAN</p><p>This Improvement Plan has been developed specifically for the San Luis Valley and Southwest Regions based on the results of CHECS - An Inter-Hospital Communication Exercise - San Luis Valley / Southwest Regions conducted on March 22, 2011. These recommendations draw on both the After Action Report and the After Action Conference.</p><p>Capability Observation Recommendation Responsible Agency Completion Date</p><p>CHECS Emergency  Notification Process </p><p>Resource Request  Process </p><p>Disaster Resistant Communities Group LLC – www.drc-group.com 12 | Page After Action Report / Improvement Plan CHECS – An Inter-Hospital Communications Exercise</p><p>APPENDIX B: PARTICIPANT FEEDBACK (3 THUMBS UP – 3 THUMBS DOWN)</p><p>Thumbs Up</p><p>EMsystem worked well and we were notified appropriately</p><p>Radio communication</p><p>Clearly stated needs from Rio Grande Hospital</p><p>800 MHZ roll call went well use on ONX use of the conference line to clarify aspects of the exercise</p><p>Staff participation, radio and Onx system all worked well.</p><p>Request for assistance form is clear and user friendly.</p><p>Our estabilished MOU's facilitate the ease of assistance</p><p>Use of EMSystem and 800 mHz radios for communications </p><p>Use of facility EOP</p><p>Cooperation from area facilities and other external partners</p><p>Over all great communication</p><p>Good participation from all hospitals</p><p>Most of or internal plans were able to work</p><p>The communication worked well with CCH and Rio Grande Hospital communication with e-mail</p><p>Planning of the drill itself good staff participation.</p><p>Good communication with radio, onx and ER system</p><p>Request form easy tool</p><p>Participation of staff We have different department managers participating. Which made it easy to answer the different questions.</p><p>Disaster Resistant Communities Group LLC – www.drc-group.com 13 | Page After Action Report / Improvement Plan CHECS – An Inter-Hospital Communications Exercise</p><p>Communication between facilities We were able to communicate with the host facility and the exercise facility by phone and radio</p><p>Program coordination in general We were able to complete the exercise as requested. Internet connection and phone connection went well.</p><p>800 MHz radio worked well stimulated good discussions</p><p>Great organization of the table top by ONX </p><p>All three SLV hospitals participated</p><p>We were able to practice using EMsystem and 800 radios</p><p>Thumbs Down</p><p>Big delay between Rio Grande and SLVRMC vie e-mail</p><p>We need access to area hospital contact (telephone and e-email)</p><p>Delay in radio communication with Rio Grande Hospital</p><p>EOP details regarding resources from suppliers</p><p>EOP details for requesting resources from other facilities</p><p>CHEC plan collaboration and details</p><p>Up date our emergency Incident Command and EOP</p><p>Orginization of our recources.</p><p>Internal communication re drill and radio useage. </p><p>Updating of contacts for external partners / to include email address and phone numbers</p><p>If we had an actual power failure, we could not utilize phones/e-mails/pagers - so need to update policy for backup </p><p>Phone contact with external partners (Conejos) </p><p>We should look at changing to either 800 MG or Email as first line of communication.</p><p>Equipment loan form not in Diaster plan book. We had one it was just not in hard copy </p><p>Dril again </p><p>Need to have comunication through my cell phone </p><p>Disaster Resistant Communities Group LLC – www.drc-group.com 14 | Page After Action Report / Improvement Plan CHECS – An Inter-Hospital Communications Exercise</p><p> timing of e-mail between rio Grande and SLVRMC</p><p>Update to EOP</p><p>More internal communication re drill and radio usage. encorporation of request from into EOP</p><p>We need to update our emergency manual. We found information that is missing and we need to includue in the manual for future references.</p><p>We need to have more radios availables in case we need it, and educate the staff about the use of the equipment available in case of an emergency</p><p>We need to have an updated inventory of our resources in case of emergencies. This will help us to know what we have available and what we need to have on hand in case of an emergency. The staff needs to be awere of the inventory available. details of suppliers added to EOP communications among local hospitals-- e-mail, fax, phone, 800 radio.</p><p>We have phone as the first mode of communication, that didn't work</p><p>We were too slow for listing ICS positions</p><p>Need to update the plan for requesting supplies</p><p>Disaster Resistant Communities Group LLC – www.drc-group.com 15 | Page After Action Report / Improvement Plan CHECS – An Inter-Hospital Communications Exercise</p><p>APPENDIX C: ACRONYMS</p><p>Acronym Meaning</p><p>CHECS Colorado Hospital Emergency Coordination System</p><p>COMM Communications</p><p>CONOPS Concept of Operations</p><p>EOC Emergency Operations Center</p><p>EOP Emergency Operations Plan</p><p>ESF Emergency Support Function</p><p>HCC Hospital Command Center</p><p>HICS Hospital Incident Command System</p><p>IAP Incident Action Plan</p><p>IC Incident Command </p><p>ICS Incident Command System</p><p>IMT Incident Management Team</p><p>JIC Joint Information Center </p><p>LOFR Liaison Officer</p><p>MOA Memorandum of Agreement</p><p>MOU Memorandum of Understanding</p><p>NIMS National Incident Management System</p><p>OPS Operations</p><p>PIO Public Information Officer </p><p>SitRep Situation Report</p><p>SOG Standard Operating Guideline</p><p>SOP Standard Operating Procedure</p><p>Disaster Resistant Communities Group LLC – www.drc-group.com 16 | Page</p>