Creating Emergency Training Systems

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Creating Emergency Training Systems

• William H. Dice MD
• Director,
• Office of Public Health Emergency Preparedness
• Erie County Department of Health
• Buffalo, New York

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Abraham Lincoln
LET US HAVE FAITH THAT RIGHT MAKES MIGHT, AND IN
THAT FAITH, LET US, TO THE END, DARE TO DO OUR
DUTY AS WE UNDERSTAND IT."--From the February
27, 1860 Cooper Union Address
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Training Wisdom

• Training should focus on the mission
• Training should be realistic
• Train essential tasks first
• Standards must be enforced
• The more you sweat in training the less you
  bleed in war. Chinese Proverb

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Training Wisdom
Far better it is to dare mighty things, to win
glorious triumphs even though checkered by
failure, than to rank with those poor spirits who
neither enjoy nor suffer much because they live
in the gray twilight that knows neither victory
nor defeat. Theodore Roosevelt26th president of
US (1858 - 1919)
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Reasons to Train

• Assess readiness
• Improve coordination and interoperability
• Enhance public awareness
• Educate government officials
• Test plans

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Objectives

• Forming a NIMS-based Training Routine
• Training as a Continuum
• Build a Mass Casualty Exercise
• Prepare to Conduct a Multidisciplinary Exercise

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Training Development

• Sequence training from individual skills through
  collective events.
• Teach principles to individuals
• Conduct hands-on training with equipment
• Situational drill(s) bring people together
• Integrate groups into field exercise

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Training Perspective

• Individual
• Knowledge
• Skill
• Specific to position/experience
• Collective
• Task requires a crew
• Multiple units or organizations

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Training Cycle
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Standards
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Training Cycle

• Define Mission(s)
• Identify Mission Essential Tasks
• Assess Task Performance
• Prepare Training Plan
• Execute Training
• Evaluate Training

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NIMS and Training

• Include ICS and NIMS in training plan
• Require ICS 200 ICS 700
• Use Principles of Incident Command in Exercises
• Incident Action Plan
• Public Information

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Training Ramp-Up

• Instruction
• Increase knowledge
• Improve skills
• Table-top
• Identify players
• Share plans
• Improve coordination
• Identify resource requirements

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Training Ramp-Up

• Situational Drill
• Task specific collective scenario
• Test resource requirements
• Refine operating procedures/plan
• Field Exercise
• Multiple tasks
• Multiple agencies
• Multiple jurisdictions

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Training Principles

• What are the essential organizational tasks?
• Do the tasks have measurable standards?
• Is the organization ready to perform the tasks to
  standard?
• Design short-term training to correct weaknesses.
• Design long-term training to maintain standards
  and enhance interoperability.

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Practical 1
Write one emergency response task for your
organization that applies to the mission
Action Verb Emergency Function
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Task Development

• Task
• Deploy Secondary Assessment Center
• Conditions
• Any time any weather on hospital property

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Practical 2
Write the standard(s) for the task
Who What When Where How
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Task Development

• Standard
• Six personnel
• Test radio, internet, and phone communications
• Within 1 hour
• At Site Y
• Using pre-positioned equipment

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Task Fundamentals

• Organizational tasks are derived from the mission
  and related tasks in external directives
• Essential tasks apply to the entire organization
• Resources do not affect task identification
• Leader, collective and individual tasks support
  the organizations essential tasks.

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Practical 3

• Review Task
• Action?
• Relate to everyones mission?
• Review Standards
• Observable and measurable?
• Adequate?
• Feasible?
• Is the task organizational, leader, collective,
  or individual?

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Exercise Options

• Orientation
• Tabletop
• Drill
• Full-scale

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Orientation Exercise

• Informal
• No simulation
• Introduce concepts
• Identify roles
• Discuss plan

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Drill

• Limited to single task
• Usually single organization
• Typically includes simulation
• May be classroom or field

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Tabletop
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Tabletop

• Informal discussion
• Scenario based
• No time pressure
• Evaluates plans and procedures
• Resolves coordination and responsibility issues

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Full Scale Exercise

• Realistic use of training aids
• Involves real people and equipment
• Multiple jurisdictions/agencies
• Multiple tasks
• EOC is involved
• High stress

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Progressive Training Plan

• May take years
• Each event builds on the previous
• Orient
• Drill
• Tabletop
• Exercise
• Culminates in full scale exercise

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Exercise Planning

• Assess readiness to perform tasks
• Determine scope of exercise
• Develop timeline
• Build planning team
• Prepare exercise objectives
• Write supporting documents
• Develop evaluation tool

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Exercise Pitfalls

• Timeline compression
• Lack of realism
• Too many objectives
• Poor evaluation tool
• Inadequate organizational preparation
• Not enough facilitators/controllers
• Testing versus training

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Assess Needs

• What is the hazard or event?
• What is the geographic area?
• What tasks/operating systems need training?
• Which exercise format is most appropriate?

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Assess Needs

• Who should participate?
• Law Enforcement
• Laboratories
• Local Government
• State Government
• Federal Government

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Scope

• Apply realistic limits to the exercise.
• Single hazard
• Where will event occur?
• Identify 3-5 operations to train
• What agencies benefit the most?

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Purpose Statement

• The purpose of EXE is to test and evaluate the
  following essential tasks
• by involving the following agencies
• in a full scale exercise simulating an at .

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Practical 4
Write a purpose statement to exercise your
organization.
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Practical 4
The purpose of this regional public health and
emergency services exercise is to test and
evaluate regional capability for conducting
cross-jurisdictional emergency operations
following an explosive release of radiological
material and to evaluate the following tactical
objectives.  
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Objectives

• Objectives are task specific
• Objectives can be organizational or individual
• Objectives drive the scenario
• Training aids enhance play of objectives

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Practical 5
Write four objectives you want to evaluate in
your exercise 1. 2. 3. 4.
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Practical 5

• Health Department Exercise Objectives
• Deployment of public health resources across
  county lines
• Multiagency/jurisdictional Communications
• Conduct medical radiological triage
• Conduct radiological decontamination

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Communication
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Narrative

• Sets the stage
• Provides background
• Establishes the situation at the start of the
  exercise

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Practical 6
Write a narrative for your exercise

• What happened?
• When did it happen?
• Where did it happen?
• What response has occurred?
• How much damage?
• Relevant weather.
• Any preceding events?
• Response constraints.

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Practical 6
The Office of Homeland Security has issued a
threat warning to the State Emergency Management
Office (SEMO). The SEMO has notified the local
Emergency Managers of the specific threat and
recommended that the state increase monitoring of
public events. In response to the threat, local
departments of health have been instructed to
develop and conduct specific radiological
training for medical personnel and hospitals.
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Practical 6
The FBI has informed WNY law enforcement of the
theft of an industrial radiological source.
Local law enforcement is aware of a series of
forced entry events at propane distributors with
the loss of 23 20 tanks. The Counterterrorism
Task Force is aware of increased surveillance
activities at public gathering sites by unknown
groups.
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Practical 6
An invitational track meet is being held at
Silver Creek HS with 150 participants and 400
spectators. During the event a trash container
near spectators and concessions explodes. About
50 persons are injured with at least one death.
An additional 50-100 persons are disoriented and
confused by the blast. A 50 foot high smoke
plume drifts downwind.
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Practical 6
A cell phone call to 911 initiates the
response.   Weather conditions are partly cloudy
skies, light westerly winds, temperature high of
75 and low of 60s.
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Identify Major Events

• Events support objectives
• Events are controlled by facilitators
• Events may require role-players
• Events may require training aids
• Events may be notional

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Realism
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Practical 7
Write four major events that will happen after
the start of the exercise 1 2 3 4
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Practical 7

• First Responders encounter radiological
  contaminated casualties with life threatening
  injuries.
• Radiological contaminated casualties are
  evacuated to local hospitals.
• The RDD creates a plume extending into a
  neighboring county.
• A Secondary Device is discovered near the
  Incident Site. 

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Expected Actions

• Each major event triggers an action according to
  the plan being evaluated.
• Events will drive the pace of the exercise.
• Events are designed to require players to react.
• Evaluators are keyed to watch player reactions to
  events.

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Messages

• Messages keep all players involved.
• Messages cause a player or agency to carry out an
  action.
• Message components
• Sender
• Receiver
• Method of transmission
• Contents

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Practical 8
Write a notional message that controllers will
insert into the exercise play
From To Via Content
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Practical 8
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(No Transcript)
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Evaluation
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Evaluation
Players need to know the standard for each
task Evaluators need to know what tasks are
being evaluated what the standards are for each
task who is performing the task where the task
is to be performed when the task will be
performed
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After Action
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After Action
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After Action

• Executive Summary
• Exercise Overview
• Exercise Goals and Objectives
• Analysis of Outcomes
• Analysis of Capacity to Perform Critical Tasks
• Conclusion
• Improvement Plan

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Exercise Pearls

• Include agencies in planning
• Always include a Tabletop before a Full-scale
  drill
• Think of a field exercise as the last event in a
  continuum
• Make NIMS/ICS routine

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Discussion
Abraham Lincoln
"With malice toward none with charity for all
with firmness in the right, as God gives us to
see the right, let us strive on to finish the
work we are in to bind up the nation's wounds
to care for him who shall have borne the battle,
and for his widow, and his orphan..."--From the
March 4, 1865 Inaugural Address